- Non-steroidal anti-inflammatory drugs( NSAIDs)
- Basic tools
In recent decades, the incidence of musculoskeletal system in the population of many countries increased. Arthroses and arthritis affect people of young age and have a tendency to a chronic progressive course. Stop the development of the disease can be with a timely call to the doctor. Otherwise, the risk of irreversible changes, loss of ability to work and a decrease in the quality of life is great.
The main role in the treatment of joint diseases is medication, the dosage and duration of reception of which is established by a specialist after a diagnostic examination and determining the severity of the course of the pathology.
The main goal of conservative therapy is to eliminate pain, reduce inflammation, restore normal volume and amplitude of movements. Some medications affect the symptoms of the disease, others can eliminate its cause. A comprehensive approach increases the effectiveness of treatment and helps achieve lasting positive results.
Non-steroidal anti-inflammatory drugs( NSAIDs)
NSAIDs are drugs that have antipyretic, analgesic, anti-inflammatory effects on the body. They are prescribed as a symptomatic remedy for arthrosis of joints and arthritis. The medicines of this group relieve the signs of inflammation in the pathology of the musculoskeletal system of any nature and are prescribed in the acute period of the disease. Non-steroidal drugs have a non-hormonal origin, but have a pronounced analgesic effect. They are divided into two main groups, which differ selectively influence on mediators of inflammation.
Non-selective NSAIDs inhibit the production of enzymes COX-1 and COX-2, which causes side effects from the digestive tract. The enzyme cyclooxygenase is involved in the synthesis of inflammatory mediators called prostaglandins. In this case, COX-1 has protective functions for the gastric mucosa, and COX-2 is released when the joints become inflamed. The inhibition of the production of two fractions of the enzyme leads to a good anti-inflammatory effect and a persistent elimination of pain. However, it often causes side effects associated with the formation of ulcers of the mucosa of the digestive tract and bleeding. Therefore, the drugs are prescribed short courses for 10-14 days against the background of taking funds to protect the gastric mucosa, for example, omeprozole.
Ibuprofen-based preparations refer to nonselective NSAIDs
- diclofenac( voltaren, diclovite, orthophene, naproxen);
- ibuprofen( bolinet, advill, dolgite, mothrin);
- indomethacin( indowene, indocid, moovide, methindole);
- ketoprofen( arthrosilene, ketonal);
- lornoxicam( xsefokam);
- piroxicam( pyrox, tonsillin, erazon, pyrox).
Selective NSAIDs refer to the new generation of drugs. They block the synthesis of only COX-2, thereby selectively acting on the inflammation focus in the affected joint. In this case they have a somewhat less analgesic effect, but do not cause irritation of the mucous membrane of the stomach and intestines.
- nimesulide( aponyl, nise, kokstral, nymphast);
- meloxicam( melox, arthrosan, movalis, lem);
- celecoxib( ranseleks, phlogoxib).
Movalis is an effective anti-inflammatory drug with a selective effect of
Selective drugs can be administered for several months under the supervision of a physician. It should be borne in mind that repeated courses of treatment of NSAIDs worsen metabolic processes in the cartilage and should be used with caution in joint arthrosis. Pharmacological industry NSAIDs are available in tablets, injections, rectal suppositories and ointments.
For the therapy of arthritis, which are accompanied by an inflammatory reaction and a painful syndrome of high intensity, steroid hormones are used. They are prescribed in tablets( prednisolone, hydrocortisone), intraarticular injections and are substances synthesized by the adrenal cortex. Hormone therapy is usually used in cases where NSAIDs do not have the necessary clinical effect. In addition, the drugs are recommended for the appearance of synovitis - inflammation of the periarticular soft tissues( ligaments, tendons, muscles).For the treatment of diseases of the musculoskeletal system, intraarticular injections are recommended:
Kenalog is used for insertion into the joint cavity
The therapeutic course is 1-3 injections, which are carried out at intervals of 5-10 days. Hormonal therapy is prescribed in the acute period of the disease under the strict supervision of the attending physician. The introduction of steroid drugs into the joint is associated with the risk of complications( infection, blockage of the joint, trauma of the soft tissue structures) and requires a highly qualified approach. Therapy is recommended for inflammation of the elbow, hip, knee joint in the event of persistent pain that does not lend itself to cupping by other methods.
Chondroprotekotry is prescribed for degenerative-dystrophic joint diseases - arthrosis, which is accompanied by destruction of intraarticular cartilage. Preparations of this group contain two main components, presented chondroitin sulfate and glycazamine. They contribute to the restoration of the normal structure of the cartilaginous tissue, block the work of enzymes involved in inflammation, reduce the intensity of pain.
Chondroitin sulfate is an important component of cartilage, it normalizes the water content in it and provides elasticity. Glycazamine is the precursor of honroitin. It promotes the normal synthesis of synovial fluid - lubricant for the smooth and painless movement of intraarticular sections of bones. As the tissues age and when exposed to adverse factors at a young age, the body does not sufficiently synthesize these substances, which requires their additional introduction in the composition of medications. Otherwise there is destruction of cartilage, pain during movement and complete cessation of functioning of affected joints, which leads to disability. Medicines also strengthen the ligaments, tendons, muscles that support the anatomically correct structure of the joint.
The pharmacological industry produces chondroprotectors containing only glycazamine or chondroitin sulfate, as well as combined agents that are considered more effective in the therapy of arthrosis. The following medicines are most popular in medical practice:
- preparations with chondroitin sulfate( mucosate, structum, chondrolone, chondroxide);
- preparations with glycazamine( elbon, altron-flex, don, yunium);
- combined agents containing glycosamine and chondroitin sulfate( honda, arthroflex, arthron complex, teraflex, chondro, arthra).
In addition, chondroprotectors can be taken as a part of biologically active additives( BAA).They include not only the main components for the restoration of cartilage, but also additional ingredients that improve the regenerative and protective properties of articular tissues. The most effective for the health of the musculoskeletal system Methylsulfanylmethane( contains sulfur) and Celadrin( includes a complex of fatty acids).They are part of Glucasamine Chondroitin Super Formula, Chondroitin Glucasamine MSM, Millenium Neo, Celadrin 525, New Celadrin & MSM, Agel FLX, which are considered to be the best homeopathic remedies for cartilage repair. It should be remembered that chondroprotectors in the composition of drugs and dietary supplements are slowly accumulating in the body, therefore they are prescribed repeated courses for 4-6 months for several years.
Structum is a monopreparation with the chondroprotective effect of
. The achievements of modern medicine have allowed the introduction of "arthroplasty prostheses" inside the joint, which are hyaluronic acid preparations:
- is ostanil,
- is a pharmatron.
They prevent the friction of the articular surfaces of bones, forming a protective film on the cartilage. This contributes to the elimination of pain, the activation of metabolism in the pathology site, and the normalization of the motor activity of the joints. The course of treatment is prescribed 5-10 injections, depending on the severity of the disease. In addition, chondroprotectors such as chondrolon, aflutop, T. T are introduced into the joint. The price of therapy with this group of drugs is quite high, but they affect not only the symptoms, but also the cause of arthrosis, which helps to eliminate the pathological process.
Remicade effectively removes inflammation of the joints of the autoimmune nature
For autoimmune diseases of the musculoskeletal system, basic medicines are used. They are aimed at eliminating the inflammatory response of connective tissue, which is caused by the damaging effect of antibodies in violation of the normal functioning of the immune system. These drugs affect the cause of the pathological process and are prescribed in conjunction with NSAIDs and steroid hormones in the acute phase of the disease. Basis therapy is represented by the following means:
- gold preparations,
Drugs are prescribed for rheumatoid, psoriatic, reactive arthritis and other autoimmune pathology of the musculoskeletal system with long courses from 6 months to several years.
For the treatment and strengthening of joints, in addition to the main groups of drugs, medicines are used that increase the effectiveness of the therapy. Vasodilators( trental) improve the blood flow in articulations, the supply of nutrients and medicinal substances inside the joint.
Muscle relaxants( midogalm) remove muscle spasm in the area of inflammation, thus providing analgesic effect. Local application of ointments, gels, solutions with irritating components( finalgon, apizatron, dimexide) reflexively improves trophism and metabolism, affecting the nerve receptors of the skin. The main condition for recovery is complex therapy under the supervision of a doctor. In neglected cases it is necessary to resort to an operation that often requires joint prosthetics, leads to loss of ability to work, and limits the freedom of movement.