Scheme of effective treatment of arthrosis of the knee
Arthrosis is a disease of the body, expressed in inflammation of the joints. The appearance of arthrosis is associated with excess weight and insufficient nutrition of cartilage tissue, as well as with low mobility. With arthrosis of the knee joint, there is a crunch, pain, knees stop bending. This is an extreme, catastrophic stage of the disease. Before its occurrence for a long time, the initial stage of the disease is observed, when the knees partially lose mobility, ache and begin to crackle. The earlier the treatment is started, the greater the result can be achieved. In the early stages of the disease, complete recovery can be achieved, at later stages - only support the body and joints, postpone the time of their destruction.
Effective treatment of arthrosis is achieved by two directed actions:
- blocking the further spread of inflammation;
- treatment of existing degradation changes.
Let us consider in more detail which therapeutic measures contribute to joint treatment.
Methods for the treatment of arthrosis
The knee joint has the property of accumulating deposits inside itself, forming salt outgrowths in the presence of stagnation of internal fluids. The more active a person leads, the less he has the risk of arthrosis of knee joints. Preventative measures consist of daily walking, not fast running( jogging), feasible sports, active outdoor games. To treat the disease after its manifestation is more difficult than to prevent its development by preventive measures.
If pain and immobility have already appeared, the disease requires immediate treatment and normalization of lifestyle. Consultations of specialists confirm the fact of necessity of actions in two directions: changing the way of life and medicinal effect.
Treatment of arthrosis is a long process, delaying indefinitely and not always guaranteeing the result. Osteoarthritis of the knee joints is often accompanied by destructive changes in the joint. Often, treatment can relieve pain and partially restore knee mobility, but when exposed to adverse factors, exacerbation of arthrosis occurs. This not completely cured disease is called chronic. Virtually all types of arthrosis of various joints( knee, hip) represent chronic diseases.
Treating knee arthrosis with medicines is better than cleaning up the disease with a surgical procedure.
Osteoarthritis of the knee joint: what is better to treat?
The method of treatment by surgical intervention is used for the complete destruction of the joint, its dysfunctionality. In such cases, the patient's joint is replaced with a metal prosthesis.
Official and traditional medicine offers its own treatment methods. Pharmaceutical preparations used for inflammation of the knee joints have a purposeful action:
- to remove inflammation;
- is saturated with chondroitin( to restore cartilage);
- to remove the spasm of the vessels of the legs( for the normalization of blood circulation).
Knee joint diseases: treatment by a natural pharmacy
Treatment of arthrosis of the knee joint folk remedies often gives a more noticeable effect than the use of finished medicines.
Arthrosis of the knee joint articulations in folk medicine is treated by various means of plant natural origin: herbs, seeds, leaves, fruits, beekeeping products, natural minerals. The three whales on which the success of the treatment of arthrosis are based are: excretion( slags), nutrition( necessary substances) and motor activity( for normalization of blood circulation).
Activities to increase motor activity are introduced into the regime when the patient is able to perform them( after relieving the pain and returning the available mobility).It is better not to delay with the introduction of available physical exercises and walks, they enhance the effectiveness of treatment. Saturation of knee joints with vitamins, trace elements and other necessary substances ensures their ability to function( bend, unbend, withstand weight load).To restore cartilaginous tissue prescribed drugs containing chondroitin. Cleaning from existing deposits allows you to remove pain and restore mobility.
Method 1: treatment of knee arthrosis from the inside
Treatment from the inside involves the use and assimilation through the digestive tract of drugs that contribute to recovery. Such natural medicines and stimulants are mummies, raw vegetable and fruit juices and herbal teas.
The ingestion of freshly squeezed juices and mummies supplies the body with the necessary nutrients. In this case, the substances come in an assimilated form. Juices supply a lot of vitamins to the human body. The correct selection of the composition of fruits and vegetables in juice forms a set of elements that contribute to the prevention, treatment and recovery of knee joints. Effective treatment of arthrosis is achieved by drinking juice obtained from cranberries, beets and black radish.
Mumiye is a natural supplier to the body of a whole complex of useful substances:
- macro- and microelements( about sixty, leading - potassium, calcium, magnesium and manganese);
- amino acids( glycine, lysine, methionine);
- fatty acids( oleic, linoleic);
- organic acids( citric, tartaric, oxalic);
Such a rich complex of substances provides anti-inflammatory and restoring effect, removes toxins and saturates with vital elements. Mumiye is a natural stimulant for the production of collagen, which forms the basis of connective tissue( bones, cartilage and tendons).Mummies eat 0.2 g in the morning on an empty stomach, 30 minutes before eating. It is better not to mix natural balsam with food, give it a full digestion in the gastrointestinal tract and effectively maintain the diseased organ or joint. Purified from sand and clay, the mummy can be purchased in a pharmacy in the form of tablets or packaged in sachets.
Among the herbs that contribute to the treatment of arthrosis, we distinguish eucalyptus, lobster and dandelions. Eucalyptus tea is used three times a day in the presence of significant inflammation and an ESR index of more than 14 units( in a blood test).Mokritsa is used to brew tea three times a day. Of dandelions, more often make alcohol tincture and use drops, diluting in a glass of water, once a day, in the morning.
Method 2: Knee joint treatment with compresses
Compresses allow the joint to absorb the necessary nutrients through the skin. As a rule, compresses have a resolving effect. Among the herbal preparations that improve the condition of arthrosis joint, there are burdock and birch buds.
The burdock wraps the patient joint. For compress compress several( 5-10 pieces) of large leaves, knead them to isolate the juice, lightly heat( put a pot of hot water on top).After that, a stack of cooked mugs is applied to the diseased knee with a velvety( bottom) side. Cover with polyethylene and fix with a scarf, elastic bandage( not tight).
A similar treatment for the knee joint can be done with a compress made from snowdrop flowers, birch leaves and raw potatoes. To compress the potato tinder on a fine grater with the formation of gruel. It is better to take the smallest available grater, so that the size of the potato particles in the gruel is minimal. Requires a consistency of manga, from which raw potato juice is easily isolated. Before applying, grated potatoes are slightly heated in a water bath, the duration of heating should not be large, so that the potato particles are not blackened. Next, a warm gruel is laid on the diseased knee, covered with polyethylene and wrapped in a scarf.
Osteoarthritis in the initial stage can be treated with compresses from medical bile. To enhance the absorbency of the bile, ammonia, iodine and glycerin are added. The listed components are infused with bile within ten days and only after that they are used for compresses. Before wetting the tissue, the infusion liquid is poured into a glass container and heated in a water bath.
In the initial stage of arthrosis of the knee joints, a compress of crushed and steamed horseradish roots also helps.
Vinegar, alcohol, turpentine and camphor oil( 1 tablespoon) are placed in a glass and poured with melted internal fat( pork, beef).The mixture is mixed, preheated and impregnated with tissue for compression before use.
Method 3: Treatment of arthrosis with
By massaging the skin over the diseased organ or in the area of its response, the blood flow increases. Normal blood flow is the basis for the successful cure of inflammation. With the flow of blood, food comes and slag ballast leaves. Strengthen the effectiveness of massage can be using additives in massage oil. Cleanser exhibits an effective effect on articular inflammation. The technology of making massage oil with celandine is as follows: freshly cut leaves and stems of celandine are placed in a dark glass container( a bottle or jar), poured with vegetable oil and insisted for two weeks. Then filter and use as an oil for massage and kneading.
Relieve the joint condition and achieve recovery by alcohol rubbing. Tincture for rubbing contains not only alcohol, its action is enhanced by the addition of medicinal plants: dandelion flowers, stems and roots of the saber( the second name is the joint).To prepare the tincture used dark glassware with a tight lid. Time of insisting from two weeks to a month. Dandelions fill the entire bottle, after which it is filled with vodka. Sabelnik enough 50 g per 0.5 liter capacity.
Method 4: treatment with
rubbers. The knee joint can be treated with rubbers. They are made from various raw materials, which supply the necessary cartilage and nutrients to the cartilage tissue. Various creams of turpentine, internal fat, mummy, camphor are used in addition to yolk and vinegar, supplying collagen and microcells inside the cartilage cartilage.
Here are the recipes for the preparation of ointments, the most effective in the treatment of arthrosis.
- One yolk, one teaspoon turpentine and one teaspoon of vinegar are mixed until homogeneous.
- Honey( 100 g) and mummy( 100 g) are mixed in an enamel vessel with a wooden or stainless spoon( preferably wooden).Do not use an aluminum spoon to mix medicated preparations. Such a remedy is used if a person does not have an obvious allergy to beekeeping products. To rub the knee with honey ointment, spread hands with vegetable oil to prevent the sticking of honey on your hands.
Rubbing ointment is applied to the affected knee, slightly rubbed and wrapped with warm cloth. For wrapping it is better to use natural fabrics( a cotton bottom layer, for warming wrapped with a woolen scarf, a downy shawl).Heat promotes better penetration of active substances into internal tissues, increased blood circulation, which, in turn, accelerates the supply of nutrients and the removal of waste and salts. Such procedures, accompanied by a warm wrapping, are performed at night, leaving an ointment to soak up and affect the entire time of night sleep( about 8 hours).In the morning, the remnants of the ointment are washed off or wiped with a damp towel. The lower cotton fabric after night wrapping contains toxins that have come out of the diseased knee. Therefore, for the next wrapping it must be rinsed and dried.
pull-out massages Performed using honey. Natural honey is applied to the knee joint. After that, the knee is slightly pressed with fingers and palms, and lift them. During pressing, honey sticks to the hands, while raising hands, the knee skin slightly stretches behind the fingers and palms. The sticking and tearing of the hands to the skin is a kind of massage, during which a part of the unhealthy deposits accumulated inside the joint is stretched to the surface of the skin. It is these toxic deposits that form the inactivity and growth of salt deposits, cause pain. The duration of such a massage is 10-15 minutes, after which the remnants of honey are thoroughly washed off. Available on the skin of honey residues contain a large amount of slag substances, so they must be carefully rinsed or wiped to prevent re-absorption. After the stretching massage, the knee wraps in a natural woolen fabric, this enhances the efficiency of excretion, since the processes of releasing the joint from the slags continue in the warmth.
Method 6: clay compresses, baths with essential oils
Clay possesses a natural ability to purify the environment in which it is located. To clean joints, it is applied as a mask and left to dry. It is important to know that after drying, the clay must be removed( stripped, washed off).Do not leave a dry clay on the body, because the ballast harmful substances stretched into it can diffuse back through the skin to the internal tissues. In severe cases, several clay masks can be applied sequentially. After the first layer of clay dries, it is washed off and the second layer is applied, then the next third.
Baths with essential oils in the treatment of knee joints are rather an anesthetic method than a remedy. The addition of oils slightly strengthens the anti-inflammatory effect. The traditional scheme of treatment of arthrosis uses for anesthesia eucalyptus, mammoth, calendic ether.
To treat the joint successfully, it is necessary to understand the nature of the disease and the effect of various substances on the cartilaginous articular tissue. The scheme of treatment of the knee joint includes a complex effect on the diseased joint with various drugs that supply anti-inflammatory and reducing substances to the cartilaginous tissue.
Compresses for knee arthrosis
Traditional medicine has long used compresses on medicinal herbs.
Compress from cabbage
Leaves, oiled with honey, are tied to the diseased knee. The compress is changed twice a day. Treatment lasts for a month.
Compressor from burdock
Compresses for arthrosis made from burdock are made in two ways:
- The washed and dried leaves of the plant( 6-7 pieces) are stacked and put on them utensils containing hot water. Then the joint is lubricated with sunflower oil and the leaves are applied to it with the underside. Heat the cellophane and woolen shawl. They keep it till morning.
- The mashed burdock leaf is impregnated with various substances and is tied to a sore spot for the night. The compress is done for 4 nights: the first night is moistened with cologne, the second with honey and cologne, the third with garlic clove, and the fourth with Vishnevsky ointment.
Compression of celandine
Linen fabric impregnated with celandine juice and applied to the affected joint for 40-50 minutes.
Compresses of the knee joint of celandine do for a week. After a 10-day break, the course is repeated twice.
Horseradish roots, ground with a grater, are placed on a water bath before steaming, but do not bring to a boil. The resulting gruel is applied to the injured knee.
Compression of fat
The most effective means are compresses for arthrosis of the knee joint, prepared from porcine interior fat. A layer of fat is applied to the knee. Then it is wrapped with polyethylene and a woolen shawl. It is advisable not to remove the bandage for a week. But if this is not possible, then you can do compresses at night.
Osteoarthritis: preparations for external use
- Osteoarthrosis: preparations for compresses
Deforming arthrosis is a joint disease that occurs as a result of destruction of articular cartilage at their inborn inferiority, inadequate nutrition under excessive load on mobile bone joints. Pain with joint arthrosis appears at the very start of the development of the disease, at first under increased stress, then simply during movement and even at rest. Pain sensations, although not strong, but their regularity and constancy are exhausting, they force us to search for effective drugs for the treatment of arthrosis, and not only for parenteral and internal use. Ointment for arthrosis, gel, Dimexide or Bischofite in a compress can improve the condition and reduce pain in the joints.
Arthrosis: gel and ointment with deforming arthrosis in the stage of inflammation
Inflammation in the joint with arthrosis occurs as a result of irritation of the synovial membrane of the joint by products of destruction of the cartilaginous tissue and osteophytes. The inflamed joint swells, the skin over it blushes, the movements become painful and limited by the appearance of effusion in the joint cavity.
The use of non-steroidal anti-inflammatory drugs for osteoarthritis can quickly stop inflammation, however, when ingested, they can cause undesirable side effects, affect the digestive system, liver and kidneys. Ointments, creams and gels for arthrosis - drugs are safe, not providing systemic action.
It should be noted that topical preparations for osteoarthritis are not capable of curing joints, but they help reduce swelling and relieve pain. In the manufacture of these drugs for the treatment of arthrosis, non-steroidal anti-inflammatory drugs are used, they are not absorbed into the total blood flow and affect only the affected joint. Indomethacin and Butadion Ointments, Diclofenac Ointment are indispensable for those who have arthrosis. The preparation Voltaren gel or Fastum gel with their ability to penetrate into the tissues quickly suppress the phenomenon of synovitis.
Osteoarthritis: drugs for the desired use in the remission phase of
The absence of inflammation in the joint opens up opportunities for the use of other drugs. For the treatment of arthrosis in the remission phase, funds are used that improve blood circulation in the affected tissues, which activate metabolic processes and contribute to the restoration of the destroyed cartilage.
Ointment and gel forms of preparations for osteoarthritis are valuable for their warming effect. Heat causes a rush of blood to the joint, improves the nutrition of tissues, removes toxic metabolic products, relaxes muscles, ligaments, improves the mobility of the ossicles. And although only 5-7% of active substances penetrate the joint, arthrosis "fades", especially if the treatment is supplemented with physiotherapy and physiotherapy procedures. Menovazine, Espol, Gevkamen, Nikoflex-cream are recommended for use in degenerative diseases of the joints.
Osteoarthritis: preparations for compresses
Compresses for deforming arthrosis of joints are applicable both during the exacerbation of synovitis and in the remission of the disease. They are more effective than simply applying ointments and creams to the joint area, since the active substance is in a dissolved state and is in long contact with the skin.
For compresses for arthrosis, Dimexide, Bischofite and medical bile are most often recommended.
Preparation Dimexid is a liquid with colorless crystals dissolved in it. The active substance of the preparation has a high penetrating ability and pronounced antimicrobial, anti-inflammatory, resorptive, analgesic effect and moderately pronounced fibrinolytic activity. Dimexid quickly stops inflammation, relieves joint edema, improves the flow of metabolic processes, removes toxic metabolic products, damaging the membranes of cartilage cells. Compresses with Dimexide are especially indicated for arthrosis, which occurs with synovitis.
Bischofite, a product obtained in the process of oil production, occupies a special place among the preparations for the treatment of arthrosis. Bischofite has moderate anti-inflammatory and analgesic properties. It warms, improves circulation in the joint, ligaments and muscles, improves the course of metabolic processes, promotes cartilage regeneration.
Medical bile is a natural product obtained when slaughtering cattle. By its irritating properties, bile causes a rush of blood to the joint, relaxes the musculoskeletal apparatus, activates metabolic processes, helps to cleanse the joint of salts and toxic products of inflammation.
Before you begin your hard struggle, be sure to find a good doctor, check with him and together with him make a treatment plan. Do not try to diagnose yourself! The fact is that joint damage resembling arthrosis occurs in many other diseases, and low-scoring people very often make mistakes in determining the disease. Assess the possibility of treatment with the use of KSL Koltsov plates.
It's better not to save time and money on medical advice, because a mistake can cost you much more in all respects. But this does not mean that you must blindly believe any doctor and should not delve into the essence of his recommendations, comprehending the mechanism of action of those drugs that are assigned to you. The patient should understand the meaning of the medical appointments and represent what the various treatment procedures are for.
So, in the therapeutic treatment of gonarthrosis, it is important to combine a number of medical measures in such a way as to solve several problems at once:
- - to remove pain;
- - to improve the nutrition of articular cartilage and accelerate its recovery;
- - to activate blood circulation in the area of the affected joint;
- - reduce the pressure on the damaged articular areas of bones and increase the distance between them;
- - strengthen the surrounding aching joint of the muscle;
- -increase the mobility of the joint.
Below we will look at how a particular treatment method helps achieve the stated goals:
1. Non-steroidal anti-inflammatory drugs( NSAIDs): diclofenac, piroxicam, ketoprofen, indomethacin, butadione, meloxicam, tselerbex, nimulide and their derivatives.
For non-steroidal arthrosis, that is non-hormonal, anti-inflammatory drugs are traditionally used to eliminate pain and inflammation of the joint, because against a background of severe pain it is impossible to begin normal treatment. Only by eliminating acute pain with an anti-inflammatory drug, you can later go, for example, to massage, gymnastics and those physiotherapeutic procedures, which because of the pain would be intolerable.
However, it is undesirable to use drugs of this group for a long time, since they are able to "mask" manifestations of the disease. After all, when the pain decreases, a deceptive impression is created that a cure has begun. Arthrosis, meanwhile, continues to progress: NSAIDs only eliminate individual symptoms of the disease, but do not treat it.
Moreover, in recent years, data have been obtained, indicating the harmful effect of prolonged use of nonsteroidal anti-inflammatory drugs on the synthesis of proteoglycans. Molecules of proteoglycans are responsible for the entry into the cartilage of water, and a violation of their function leads to dehydration of the cartilaginous tissue. As a result, the cartilage already affected by arthrosis begins to break even faster. Thus, the tablets that the patient takes to reduce pain in the joint can accelerate the destruction of this joint.
In addition, using non-steroidal anti-inflammatory drugs, it must be remembered that they all have serious contraindications and, if prolonged, they can cause significant side effects( described in detail in the book "Pain in the legs").
Therefore, if long-term use of anti-inflammatory substances is necessary in the therapy of arthrosis, it is better to use selective anti-inflammatory drugs( Movalis drug).Selective agents are much less likely to give unpleasant side effects, almost do not cause complications and do not adversely affect the structure of the articular cartilage. They can be drunk for a long time, even by courses from several weeks to several years( naturally, only under the supervision of a doctor).
2. Chondroprotectors - glucosamine and chondroitin sulfate.
Glucosamine and chondroitin sulfate belong to the group of chondroprotectors - substances that feed cartilage tissue and restore the structure of damaged cartilage of joints.
Chondroprotectors( glucosamine and chondroitin sulfate) - the most useful group of drugs for the treatment of arthrosis.
Unlike non-steroidal anti-inflammatory drugs( NSAIDs), chondroprotectors not only eliminate the symptoms of arthrosis, but affect the "basis" of the disease: the use of glucosamine and chondroitin sulfate promotes the restoration of the cartilaginous surfaces of the hip joint, the improvement of articular fluid production and the normalization of its "lubricating" properties.
This complex effect of chondroprotectors on the joint makes them indispensable in the treatment of the initial stage of arthrosis. However, there is no need to exaggerate the possibilities of these drugs.
Chondroprotectors are not effective at the third stage of arthrosis, when the cartilage is almost completely destroyed. After all, it is impossible to grow a new cartilaginous tissue or restore the old form to the deformed bones of the knee with the help of glucosamine and chondroitin sulfate. And in the first and second stages of gonarthrosis, chondroprotectors act very slowly and improve the patient's condition far from immediately. To get a real result, you need to undergo at least 2-3 courses of treatment with these drugs, which usually goes from six months to one and a half years, although advertising glucosamine and chondroitin sulfate usually promises recovery in a shorter time.
I regret to note that there is some cunning in these promises. With all the usefulness of chondroprotectors of miraculous medicinal healing, arthrosis can not be expected. Recovery usually requires much more effort than taking two or three dozen tablets.
Probably, the fact that the chondroprotektor's capabilities are often overestimated in advertising caused the attacks on these drugs in one of the "popular" TV shows. TV host of the program "Health" from someone's filing said that chondroprotectors are useless for the treatment of arthrosis.
Thus, she cast a huge shadow on these very useful medicines, questioned the work of a number of serious medical institutions and clinics that tested these drugs and proved that chondroprotectors uniquely contribute to the restoration of articular cartilage and inhibit the development of arthrosis. After the clinical approbation of chondroprotectors, the Ministry of Health of Russia has allowed their sale in pharmacies as medications( of course, this does not refer to those medicines that have not been registered as a medicine and are sold as bioadditives).Another thing is that, as I said, chondroprotectors are not "all-powerful".Treatment with these medicines requires proper and long-term administration in combination with other treatments.
Nevertheless, of all the drugs used in the treatment of arthrosis, it is the chondroprotectors that bring the greatest benefit. In addition, they have virtually no contraindications and rarely give unpleasant side effects.
It's important to know! To achieve maximum therapeutic effect, chondroprotectors should be used by courses, regularly, for a long time. It is practically meaningless to take glucosamine and chondroitin sulfate once or occasionally.
In addition, in order to obtain the maximum effect from the use of chondroprotectors, it is necessary to ensure the daily intake in the body of adequate, that is, sufficient doses of drugs throughout the course of treatment. A sufficient dose of glucosamine is 1000-1500 mg( milligram), and chondroitin sulfate - 1000 mg per day.
Note by Dr. Evdokimenko. Scientists are now arguing about how to better take glucosamine and chondroitin sulfate - simultaneously or separately. Opinions were divided. Some scientists argue reasonably that glucosamine and chondroitin sulfate must be taken together, simultaneously.
Others argue in the same way that glucosamine and chondroitin sulfate, when taken concurrently, interfere with each other, and they must be taken separately.
Perhaps there is a clash of interests of those manufacturers that manufacture monopreparations containing only glucosamine or only chondroitin sulfate, with those manufacturers that produce "two in one" products containing a combination of glucosamine and chondroitin sulfate. Therefore, the issue of joint or separate use of glucosamine and chondroitin sulfate remains open, and I will leave it at your discretion.
Currently, in our pharmacological market, chondroprotectors are most widely represented by the following preparations:
Arthra, manufactured in the USA.Form release: tablets containing 500 mg of chondroitin sulfate and 500 mg of glucosamine. To achieve a full-fledged therapeutic effect, you must take at least 2 tablets a day.
Arthroflex, produced in Romania. Form release: tablets containing 265 mg of chondroitin sulfate and 375 mg of glucosamine. To achieve a full-fledged therapeutic effect, you need to take at least 3-4 tablets a day.
DONA, produced in Italy. Monopreparation containing only glucosamine. Form release: powder, packaging of 1500 mg of glucosamine in 1 sachet;a day it is necessary to take 1 packet of the drug;or capsules containing 250 mg of glucosamine;a day, take 4-6 capsules of the drug;
Condro( Condro Nova), manufactured in India. Form release: capsules containing 200 mg of chondroitin sulfate and 250 mg of glucosamine. To achieve a full-fledged therapeutic effect, you must take at least 4 tablets a day.
Structum produced in France. Monopreparation containing only chondroitin sulfate. Form release: capsules containing 250 or 500 mg of chondroitin sulfate. On the day, you must take 4 tablets containing 250 mg of chondroitin sulfate, or 2 tablets containing 500 mg of chondroitin sulfate.
Teraflex, produced in Great Britain. Form release: capsules containing 400 mg of chondroitin sulfate and 500 mg of glucosamine. To achieve a full-fledged therapeutic effect, you must take at least 2 tablets a day.
Chondro, manufactured in India. Form release: capsules containing 200 mg of chondroitin sulfate and 250 mg of glucosamine. To achieve a full-fledged therapeutic effect, it is necessary to take at least 4 tablets a day.
Chondroitin AKOS, produced in Russia. Monopreparation containing only chondroitin sulfate. Form release: capsules containing 250 mg of chondroitin sulfate. To achieve a full-fledged therapeutic effect, you must take at least 4 capsules a day.
Chondrolon, produced in Russia. Monopreparation containing only chondroitin sulfate. Form release: ampoules containing 100 mg of chondroitin sulfate. To achieve a full therapeutic effect, it is necessary to conduct a course of 20-25 intramuscular injections.
Preparations containing glucosamine and chondroitin sulfate have almost no contraindications. They can not be used only by those who suffer from phenylketonuria, or have hypersensitivity directly to glucosamine or chondroitin sulfate.
They also have very few side effects. Chondroitin sulfate sometimes causes allergies. A glucosamine can occasionally provoke pain in the abdomen, its swelling, diarrhea, or constipation;and very rarely - dizziness, headache, pain in the legs or swelling of the legs, tachycardia, drowsiness or insomnia. But in general, I repeat, these drugs very rarely cause any unpleasant sensations.
The duration of treatment with glucosamine and chondroitin sulfate may be different, but more often than not, I suggest that patients take chondroproteins daily for 5-6 months. At least six months of treatment should be repeated. That is, one way or another, glucosamine and chondroitin sulfate is recommended to take approximately 150 days a year for 3-5 years.
3. Medicinal ointments and creams.
Therapeutic ointments and creams can in no way heal arthrosis of the knee joints( even if their advertising claims the opposite).But nevertheless, they can alleviate the condition of the patient and reduce pain in the diseased knee. And in this sense, ointments are sometimes very useful.
So, with arthrosis of the knee joint, which proceeds without the symptoms of synovitis, I recommend warming ointments to my patients in order to improve blood circulation in the joint.
For this use Menovazine, Gevkamen, Espol, Nikoflex-cream, etc. These ointments usually cause the patient a feeling of pleasant warmth and comfort. They rarely give any side effects.
Ointments based on non-steroidal anti-inflammatory substances( Indomethacin, Butadion, Dolgit, Voltaren-gel, Fastum) are used when the course of gonarthrosis is aggravated by synovitis. Unfortunately, they do not work as effectively as we would like - after all, the skin misses no more than 5-7% of the active substance, and this is clearly not enough to develop a full-fledged anti-inflammatory effect.
4. Means for compresses
Compressors have a somewhat greater healing effect compared to ointments.
Of the locally used topical agents, in my opinion, three drugs deserve: dimexide, bischofite and medical bile.
Dimexide is a chemical substance, a liquid with colorless crystals, has a good anti-inflammatory and analgesic effect. In this case, unlike many other substances of external application, dimexide is really capable of penetrating through skin barriers. That is, the dimexide applied to the skin is really absorbed by the body and works inside it, reducing inflammation in the source of the disease. In addition, dimexide has a resolving power and improves metabolism in the field of application, which makes it most useful in the treatment of arthrosis occurring with the presence of synovitis.
Bischofite is an oil derivative, a brine produced during the drilling of oil wells. Got his fame thanks to the drillers, who first drew attention to its therapeutic effect for arthrosis. While working on oil wells from permanent contact with the brine of oil, the drillers underwent resorption of arthritic nodules in their hands. Later it turned out that Bischofite has a moderate anti-inflammatory and analgesic effect, and also acts warming, causing a feeling of pleasant warmth.
Bile is a natural bile extracted from the gall bladder of cows or pigs. Bile has a resolving and warming effect and is used in the same cases as bischofite, but has some contraindications: it can not be used for pustular skin diseases, inflammatory diseases of lymph nodes and ducts, febrile conditions with an increase in body temperature.
5. Intra-articular injections( injections into the joint)
Intra-articular injections are often used to provide emergency relief for arthrosis of the knee joint. In many cases, intra-articular injection can really alleviate the condition of the patient. But at the same time, injections in the joint with arthrosis are done much more often than is necessary in reality. It is about this wrong, in my opinion, the trend I want to talk more.
Most often, the joints are injected with corticosteroid hormones: kenalog, diprospan, hydrocortisone, flosteron, celeston.
Corticosteroids are good because they quickly and effectively suppress pain and inflammation in synovitis( swelling and swelling of the joint).It is the speed with which the therapeutic effect is achieved - the reason that corticosteroid injections have gained special popularity among doctors. But this led to the fact that intra-articular hormone injections began to be carried out even without real necessity. For example, I repeatedly encountered the fact that hormones were injected into the joint of the patient with a preventive purpose in order to prevent the further development of arthrosis.
However, the problem is that just the arthrosis itself, corticosteroids are not treated and can not be treated. So, they can not prevent the development of arthrosis! Corticosteroids do not improve the condition of the articular cartilage, do not strengthen the bone tissue and does not restore normal blood circulation. All they can do is to reduce the reciprocal inflammatory response of the body to this or that damage in the joint cavity. Therefore, intra-articular injection of hormonal drugs as an independent treatment method is useless: they should be used only in complex therapy of arthrosis.
For example, the patient identified gonarthrosis stage II with swelling of the joint due to the accumulation of fluid in it. The accumulation of fluid( synovitis) makes it difficult to conduct treatment procedures: manual therapy, gymnastics, physiotherapy. In this situation, the doctor carries out intra-articular injection of the hormonal drug to eliminate the synovitis, and in a week starts the rest of the active medical measures - this is the right approach.
Now let's imagine a different situation. The patient also has stage II gonarthrosis, but without accumulation of fluid and joint edema. Is it necessary to inject corticosteroids into the joint in this case? Of course, no. There is no inflammation - there is no "point of impact" for corticosteroid hormones.
But even if the intra-articular injection of corticosteroids is really necessary, several rules must be followed. First, it is undesirable to make such injections in the same joint more often than once every 2 weeks. The fact is that the medication administered will "work" in full force not immediately and the doctor will be able to finally evaluate the effect of the procedure just after 10 to 14 days.
One should also know that usually the first injection of corticosteroids brings more relief than the subsequent ones. And if the first intra-articular injection of the drug has not produced a result, it is unlikely that it will give the second or third injection of the same drug in the same place. If the first intraarticular injection is ineffective, you either need to change the drug, or, if the drug change does not help, or rather choose the site of the injection.
If, after this, the introduction of a corticosteroid into the joint did not produce the desired result, it is better to abandon the very idea of treating this joint with hormonal drugs. Moreover, to inject hormones into the same joint more than four to five times in general is highly undesirable otherwise the likelihood of side effects will significantly increase.
Unfortunately, in practice one has to deal with the excessive "purposefulness" of doctors who repeatedly inject corticosteroids into the same joint without achieving at least a minimal effect with the first three injections. More than the others, I was struck by two such cases.
One patient was given "only" ten injections of the Kenalog, and the procedure was performed daily, even without the necessary 10-day break necessary to evaluate the results of the injection. And the second patient was injected with hormones into the knee joints, observing the interval( true, only 3 to 5 days), but at the same time for the treatment of the poor fellow received twenty to twenty-five injections of corticosteroids in one joint!
It would seem that the doctor "overdid" a little - nothing terrible. Can there be any harm from such treatment? It turns out, can! First, with each nyxis of the joint, although slightly, but injured by a needle. Secondly, with intraarticular injection, there is always some risk of infection in the joint. Thirdly, frequent hormonal administration provokes a disruption in the structure of the ligaments of the joint and the surrounding muscles, causing a relative "looseness" of the joint.
And most importantly, frequent injections of corticosteroids worsen the condition of those patients whose joint damage is combined with diabetes mellitus, high blood pressure, obesity, kidney failure, gastric or intestinal ulcer, tuberculosis, purulent infections and mental illness. Even introduced exclusively into the joint cavity, corticosteroids have an effect on the entire body and can exacerbate the course of these diseases.
It is much more useful to administer hyaluronic acid preparations( called hyaluronic acid - sodium hyaluronate) to the knee joint affected by arthrosis. They appeared on sale about 10 years ago.
Hyaluronic acid( sodium hyaluronate) preparations are also called "liquid prostheses" or "liquid implants", because they act on the joint as a healthy synovial fluid - that is, as a natural "joint lubricant".
Hyaluronic acid preparations are very useful and effective drugs: sodium hyaluronate forms a protective film on the damaged cartilage, which protects the cartilage tissue from further destruction and improves the sliding of the contacting cartilaginous surfaces.
In addition, hyaluronic acid preparations penetrate into the depth of the cartilage, improving its elasticity and elasticity. Thanks to hyaluronidase, the "dried up" and thinned cartilage with arthrosis restores its damping properties. As a result of the weakening of mechanical overload, pain in the diseased knee joint decreases and its mobility increases.
In doing so, injected correctly into the joint cavity, hyaluronic acid preparations practically do not give side effects.
Treatment with hyaluronic acid is carried out by courses: in total for the course of treatment it is required to conduct 3-4 injections in each diseased knee, the interval between injections is usually from 7 to 14 days. If necessary, repeat the course in six months or a year.
From my point of view, the main and only serious drawback of hyaluronic acid preparations is their high price. So, in 2010 hyaluronic acid is represented in our market mainly by import preparations Synivsk, Fermatron, Ostenil, Duralan. And each injection with these drugs costs the patient at least 3000 rubles.
An alternative to imported preparations of hyaluronic acid can serve as a new domestic preparation of Hyastat, produced by Tula pharmacologists. Not inferior to imported analogs, and for a number of indicators and superior to imported drugs, hyastat costs about 30% cheaper. And to date, hiastat may well be considered the drug of choice for intra-articular treatment of arthrosis of the knee joint.
. Returning to the issue of saving, I want to note that despite the relatively high cost of hyaluronic acid preparations, their use allowed literally "put on foot" many patients from those who, before the advent of these medicines, would have had to operate on.
And given the cost of the operation on the joints, it turns out that the timely use of hyaluronic acid( even for several years) in any case and in all senses costs the patient much cheaper surgery for knee replacement. Of course, provided that the doctor who carries out such injections owns the technique of administration.
Note by Dr. Evdokimenko. It is important to know: hyaluronic acid preparations are instantly destroyed in that joint in which there are pronounced inflammatory processes. Therefore, it is practically useless to administer them to patients who have gonarthrosis on the background of the active stage of arthritis. But it is useful to use them for persistent remission of arthritis for treatment of the phenomena of secondary gonarthrosis.
When primary gonarthrosis, too, you need to pay attention to such moments. For example, if the patient's joint "bursts" from the accumulation of excess, pathological fluid, it makes sense first to "extinguish" the phenomenon of synovitis( inflammation) and remove excess pathological fluid by pre-intraarticular injection of hormones or the use of non-steroidal anti-inflammatory drugs. And only then to introduce hyaluronic acid into the joint, freed from inflammatory elements.
In addition to corticosteroid hormones and hyaluronic acid preparations, attempts are being made to insert into the joint various chondroprotectors, such as alflutope, chondrolon or homeopathic Target T.
. However, these drugs are inferior in effectiveness to hyaluronic acid preparations. They help from the strength of 50% of patients, and guess whether there will be an effect from their use or not, is impossible in advance. In addition, the course of treatment requires 5 to 20 injections per joint, which, as we have said, is fraught with possible injury to the joint and various complications.
6. Manual therapy and physiotherapy
Manual therapy for gonarthrosis of the first and second stages often gives an excellent result. Sometimes, several procedures are enough to make the patient feel a great deal of relief. Especially good manual therapy of knee joints helps, if you combine it with the extension of the joint, the use of chondroprotectors and intra-articular injections of ostenil.
This combination of treatment procedures, from my point of view, is much more effective than the numerous physiotherapeutic measures offered in any clinic. I will give one example from practice.
Case from the practice of Dr. Evdokimenko. At the reception came a woman of 47 years with arthrosis of the right knee joint of the II stage. By the time of our meeting, she had been sick for 5 years. Over the years, the woman has had time to experience all possible methods of physiotherapy, which can only be offered in our district clinics: laser, magnetotherapy, ultrasound, phonophoresis, etc. Despite all the efforts of physiotherapists, the patient's joint condition continued to deteriorate - and this is natural, since, say, chondroprotectors for all five years were assigned to a woman only once, in a short course.
Completely desperate, the woman decided to take extreme measures - she underwent a course of treatment with cauterization of sagebrush cigarettes in the eastern method. As a result, the knee was covered with scars from burns, but did not move better. Yes, and I could hardly - in spite of all my respect for eastern medicine, I understand that wormwood cauterizations can not eliminate bone deformities and increase the distance between the bones knuckled in the knee.
After the woman was not helped by numerous physiotherapeutic procedures and even cauterization with wormwood cigarettes, she practically agreed to surgical treatment. But then all the same I changed my mind and decided to try the complex method I proposed.
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