Treatment of osteoarthritis of the knee joints, treatment of gonarthrosis- To put it slightly, not the simplest task.Therefore, before you start your hard fight with this disease, be sure to find a good doctor, examine it and develop a treatment plan with it.
In no case do not try to establish a diagnosis for yourself!
The fact is that the lesions of the joint, resembling arthosis, occur with many other diseases and that weak people are very often wrong to determine the diagnosis.It is best not to save time and money for medical consultation, because the error can cost you much more in all respects.
But that does not mean that you must blindly believe any doctor and do not immerse yourself in the essence of his recommendations, including the mechanism of action of the drugs prescribed to you.The patient must understand the meaning of medical prescriptions and represent why certain therapeutic procedures are carried out.
Thus, with the therapeutic treatment of gonartrose, it is important to combine a certain number of therapeutic measures so as to solve several problems at the same time:
- eliminate pain;
- Improve nutrition of articular cartilage and speed up its restoration;
- activate blood circulation in the affected joint;
- Reduce pressure on damaged bone seals and increase the distance between them;
- strengthen the muscles surrounding the sick joint;
- Increase joint mobility.
Below, we will examine how this or that treatment method helps achieve your objectives:
1. Non-steroidal anti-inflammatory drugs:
Non -steroidal anti -inflammatory drugs - NSAIDs: diclofenac, pyroxycs, ketoprofen, indomethacin, butadion, melooxicam, healing, nimulid and their derivatives.
With osteoarthritis, non-hormonal anti-inflammatory drugs are traditionally used to eliminate the pain and inflammation of the joint, because in the context of intense pain, it is impossible to start a normal treatment.It is only by eliminating acute pain with anti-inflammatory drugs, you can then go, for example, to massage, gymnastics and physiotherapeutic procedures that would be intolerable because of pain.
However, it is not desirable to use drugs in this group for a long time, as they are able to "hide" the manifestations of the disease.
After all, when the pain decreases, a misleading impression is created that a remedy has started.Meanwhile, osteoarthritis continues to progress: NSAIDs only eliminate the individual symptoms of the disease, but do not treat it.
In addition, in recent years, data has been obtained indicating the harmful effects of prolonged use of non-steroidal anti-inflammatory drugs on the synthesis of proteoglycans.Proteoglycan molecules are responsible for flowing water into cartilage, and a violation of their function leads to dehydration of the cartilage fabric.Consequently, the cartilage already affected by osteoarthritis begins to collapse even more quickly.Thus, the pills that the patient takes to reduce pain in the joint can speed up the destruction of this joint.
In addition, using non-steroidal anti-inflammatory drugs, it should be remembered that everyone has serious contraindications and with prolonged use can give significant side effects.
2. Chondroprotectors - Glucosamine and Chondroitine Sulfate:
Chondroprotectors - Glucosamine and chondroitin sulfate - These are substances that feed the fabric of cartilage and restore the damaged cartilage structure of the joints.
Chondroprotectors are the most useful group of drugs for treatment of osteoarthritis.
Unlike non-steroidal anti-inflammatory drugs (NSAIDs), chondroprotectors do not eliminate both the symptoms of osteoarthritis as the "basis" of the disease: the use of glucosamine and chondroitin sulfate contributes to restoring the surfaces of the hip cartilage, to improve the production of joint fluid and"Lubrications" of hip spurs.
A similar complex effect of chondroprotectors on the joint makes them essential in the treatment of the initial stage of osteoarthritis.However, there is no need to exaggerate these drugs.
Chondroprotectors are ineffective in the third stage of osteoarthritis, when cartilage is almost completely destroyed.After all, it is impossible to cultivate a new cartilaginous tissue or to return the first shape to deformed knee bones with glucosamine and chondroitine sulfate.
And at the first or second stages of gonartrose, chondroprotectors act very slowly and improve the patient's condition at a time.To obtain a real result, you must follow at least 2 to 3 treatment courses with these drugs, which generally take six months to a year and a half.
3. UNGUENTS AND THERAPEUTIC CRUES:
Appros and therapeutic creams can in no case cure osteoarthritis of the knee joints (even if their advertisement approves the opposite).However, they can alleviate the patient's condition and reduce pain in a painful knee.And in this sense, ointments are sometimes very useful.
Thus, with the osteoarthritis of the knee joint which occurs without synovitis without phenomena, I recommend reheating ointments to my patients in order to improve blood circulation in the joint.
To do this, use extracted pepper fruits, etc.The listed ointments generally cause a feeling of warmth and pleasant comfort in the patient.They rarely give side effects.
Onguants based on non-steroidal anti-inflammatory substances are used in cases where the price of gonarthrosis is aggravated by synovitis.Unfortunately, they do not act as effectively as we would like - because the skin does not pass more than 5 to 7% of the active substance, and this is clearly not enough to develop a complete anti -inflammatory effect.
4. Fund for compresses:
Compresses have a slightly large therapeutic effect compared to the ointments.
Among the local funds used in our time, in my opinion, three drugs deserve the greatest attention: Dimxide, Bishophyte and medical bile.
Dimxyide- The chemical substance, liquid with colorless crystals, has a good anti-inflammatory and analgesic effect.At the same time, unlike many other external substances, Dimoxide is really capable of penetrating skin barriers.In other words, the dimxide applied to the skin is really absorbed by the body and works inside, reducing inflammation in the center of the disease.In addition, dimxid has an absorbable property and improves metabolism in the field of application, which makes it the most useful in the treatment of osteoarthritis, which occur with the presence of synovitis.
Bishop- Oil derivative, brine extracted during the drilling of oil wells.He acquired his fame thanks to the Foreurs, who were the first to pay attention to his therapeutic effect with osteoarthritis.While working on petroleum wells of constant contact with an oil brine from the drill, arthosis nodules on their hands occurred.In the future, it turned out that Bishophyte has a moderate anti-inflammatory and analgesic effect, and also acts warmly, causing a pleasant feeling of warmth.
Medical bile- The natural bile extracted from the biles of the bile of cows or pigs.Bile has an absorbable and warming effect and is used in the same cases as bischophyte, but has some contraindications: it cannot be used for skin pustules, inflammatory diseases of lymphatic nodes and conduits, feverish states with an increase in body temperature.
5. Intra-articular injections (injections in the joint):
Intra-articular injections are often used to provide emergency care for osteoarthritis of the knee joint.In many cases, intra-articular injection can really alleviate the patient's condition.But at the same time, injections of articulation with osteoarthritis are made much more often than necessary.These are these incorrect trends, I mean in more detail.
Most often, corticosteroid hormone drugs are introduced into the joint: Triamcinone, betamethasone, hydrocortisone.
Corticosteroids are good in that they quickly and effectively remove pain and inflammation with synovitis (edema and swelling of the joint).It is the speed at which the therapeutic effect is reached which is the reason why the injections of corticosteroids have gained popularity among doctors.
But that led to the fact that intra-articular hormone injections began to be carried out even without real need.For example, I have faced several times that hormones were introduced into the patient's joint for preventive purposes in order to avoid the development of osteoarthritis.
However, the problem is that the simple osteoarthritis itself, corticosteroids are not treated and cannot be treated.Thus, they cannot prevent the development of osteoarthritis!Corticosteroids do not improve the condition of articular cartilage, do not strengthen bone tissue and do not restore normal blood circulation.
Everything they can reduce the reaction of the body's inflammatory reaction to one or the other of damage in the joint cavity.Therefore, it is useless to use intra-articular injections of hormonal drugs as a method of independent treatment: they should only be used in complex osteoarthritis therapy.
For example, the patient detected stage II gonartrose with swelling of the joint due to the accumulation of liquid.The accumulation of liquid (synovitis) makes it difficult to carry out medical procedures: manual therapy, gymnastics, physiotherapy.In such a situation, the doctor performs an intra -articular injection of the hormonal medication to eliminate synovitis, and in a week begins with other active therapeutic measures - this is the right approach.
Now imagine another situation.The patient also has stage II gonartrose, but without accumulation of liquid and joint edema.Is it necessary to enter corticosteroids in the joint in this case?Of course, no.There is no inflammation - there is no "exhibition point" for cortecedness hormones.
But even if the intra-articular introduction of corticosteroids is really necessary, a number of rules should be observed.First, it is not desirable to make such injections in the same articulation more often of once in 2 weeks.The fact is that the drug introduces "will work" immediately in force and that the doctor can finally assess the effect of the procedure just after 10 to 14 days.
You should also know that the first injection of corticosteroids generally brings more relief than the following ones.And if the first intra-articular administration of the drug has not given any results, it is unlikely that it will give the second or third introduction of the same drug in the same place.In the event of ineffectiveness of the first intra-articular injection, you must either modify the drug, or if the change of medicine has not helped, more specifically, to choose the injection site.
If even after that, the introduction of a corticosteroid in the joint did not give the desired result, it is preferable to abandon the very idea of treating this joint with hormonal drugs.In addition, the injection of hormones in the same articulation is more than four to five times in general, it is extremely undesirable differently differently, the probability of side effects.
Unfortunately, in practice, you have to face an excessive "determination" of doctors who, again and again, introduce corticosteroids in the same articulation, without reaching at least the minimum effect with the first three injections.Two of these cases hit me more than the others.
One of the patients made "only" only ten injections of a Kenalog, while the procedure was carried out daily, even without a ten -day break to assess the results of the injection.And the second patient was introduced into hormones inside the knee joints, observing the interval (but only 3 to 5 days), but at the same time, the poor comrade received twenty to twenty-five corticosteroid injections in a joint for treatment!
It seems that the doctor "went too far" a little - it's okay.Can there be damage to such treatment?It turns out that maybe!
First, with each injection, the joint, although slightly, is injured by a needle.Second, with intra-articular injection, there is still a certain risk of infection in the joint.Third, the introduction of frequent hormones causes violation of the structure of the joints of the joint and surrounding muscles, causing relative "decomposition" joints.
And above all, frequent corticosteroid injections aggravate the state of patients in whom joint lesions are combined with diabetes mellitus, high blood pressure, obesity, renal failure, stomach or intestines, tuberculosis, purulent infections and mental illnesses.Even introduced exclusively in the joint cavity, corticosteroids affect the whole body and can worsen the course of these diseases.
It is much more useful to administer hyaluronic acid drugs in the knee joint affected by osteoarthritis (another name for hyaluronic acid - sodium hyaluronate).They appeared on sale about 15 years ago.
Hyaluronic acid preparations (sodium hyaluronate) are also called "liquid prostheses" or "liquid implants", because they act on the joint as a healthy synovial liquid-that is to say as a natural "joint lubrication".
Hyaluronic acid preparations are very useful and effective drugs: sodium hyaluronate forms a protective film on damaged cartilage, protecting the cartilage fabric against additional destruction and improving the sliding of cartilage surfaces in contact.
In addition, hyaluronic acid preparations enter the depths of cartilage, improving its elasticity and elasticity.Thanks to hyaluronidase, "dried" and slimming with osteoarthritis, cartilage restores its properties absorbing shocks.Due to the weakening of mechanical overload, pain in the sick knee joint decreases and its mobility increases.
At the same time, the joints administered properly in the joint cavity, hyaluronic acid preparations do not give side effects.
Treatment with hyaluronic acid preparations is carried out in the courses: in total, 3 to 4 injections are necessary for treatment in each painful knee, the interval between injections is generally 7 to 14 days.If necessary, the course is repeated in six months or a year.
From my point of view, the main drawback and the only drawback of drugs with hyaluronic acid is their high price.Thus, in 2020, hyaluronic acid was represented on our market in the main imported drugs.
But returning to the question of savings, I want to note that despite the relatively high cost of hyaluronic acid preparations, their use has literally allowed many patients of those who previously, before these drugs, it should certainly be operated.
And given the cost of the operation on the joints, it turns out that the appropriate use of hyaluronic acid (even for several years) in all cases and that in all directions costs the patient much cheaper than surgery for the endoprothetics of the knee joint.Of course, provided that the doctor who leads such injections has the introductory technique.
It is important to know: hyaluronic acid preparations are instantly destroyed in this joint in which inflammatory processes pronounced are in progress.Therefore, it is practically useless to present them to patients in whom gonarthrosis takes place in the context of the active stage of arthritis.But it is useful to use them with a remission of persistent arthritis to treat the phenomena of secondary gonarthrosis.
With primary gonarthrosis, you should also pay attention to these moments.For example, if the patient's articulation "bursts" from the accumulation of excess pathological fluid, it is logical to "extinguish" first the phenomena of synovitis (inflammation) and to eliminate excessive pathological fluid using a previous intra-inflammatory injection.And then only to introduce hyaluronic acid into the joint, released from inflammatory elements.
In addition to corticosteroid hormones and hyaluronic acid preparations, tries to introduce various chondroprotectors into the joint.
But these drugs are several times lower in hyaluronic acidic drugs.They help patients with patients and guess whether the effect of their use or not is impossible in advance.In addition, the course of treatment requires 5 to 20 injections in the joint which, as we have said, is heavy with possible injuries to joint and various complications.
6. Manual therapy and physiotherapy:
Manual therapy for Gonartrose of Stage I and II often gives an excellent result.Sometimes several procedures are sufficient for the patient to feel significantly relief.Manual therapy particularly many random joints helps, if you combine it with joint extension, the supply of chondroprotectors and intra-articular injections of the point.
Such a combination of therapeutic procedures, from my point of view, is much more effective than the many physiotherapeutic measures offered in any clinic.I will give an example of the practice.
The case of the doctor's practice.
A 47 -year -old woman with an osteoarthritis of the right knee of stadium II came upon reception.At the time of our meeting, she had been sick for 5 years.Over the years, women have managed to feel all possible physiotherapy methods that can be offered in our district clinics: laser, magnetotherapy, ultrasound, phonophoresis, etc.A woman was named.Short lessons.
Completely desperate, the woman decided extreme measures - she underwent a treatment lesson with cauterising wood cigarettes according to the eastern methodology.As a result, the knee was covered with burns scars, but it did not move better.Yes, and it was unlikely that I could, despite all my respect for oriental medicine, I understand that the cauterization of the green wood cannot eliminate bone deformations and increase the distance between the articulated bones in the knee.
After the woman did not help the many physiotherapeutic procedures and even cauterization in Ermage wooden cigarettes, she practically accepted almost surgical treatment.But then she still changed her mind and decided to try the complex method I proposed.
The first processing session has passed, as they say, "with a cry" - we managed to "stir" the articulation using manual mobilization a little.Consequently, we programmed the next session after preliminary preparation: in 3 weeks, the woman took chondroprotectors, made self-massage and compresses with dimxyide.After 3 weeks, I started again by the mobilization of the joint, then I made a repositioning ("reduction") of the joint using manual manipulation.There was a click and suddenly, the joint started to move much easier and freer.The woman felt clear relief.
During the following two sessions using mobilization, we set the improvement obtained, after which we set the success of two intra-articular injections of the point.And after a month and a half from the beginning of our not very intense treatment (after all, we only needed six meetings), the woman was finally able to throw the wand that had been bored with her and started to move quite freely.
Two years have passed since then.Twice a year, the patient takes chondroprotectors in a short lesson, and sometimes comes to my control technique, where I am happy to note that the knee state is only better from year to year.And now, even the first stage of osteoarthritis would be very difficult to suppose - the patient's knee joint has been almost completely restored.
Thus, only six treatment sessions (manual therapy plus intra-surestalstals in Orenil) in combination with the course of chondroprotectors were more effective than five years of physiotherapy.
From this story (and in no case the only one like that), it becomes clear why I consider physiotherapy as an important part, but only an additional part of the medical program for gonarthrosis.In this sense, I like laser therapy, thermal treatment (Ozokerte, paraffin therapy, therapeutic mud) and especially cryotherapy (treatment with local cooling).
7. Diet:
The diet with osteoarthritis is also very important.
8. Using cane:
Based on the stick during walking, patients with osteoarthritis of the knee joints seriously help their treatment, because the stick takes 30 to 40% of the load intended for the joint.
It is important to choose a stick according to your size.To do this, stand up straight, lower your hands and measure the distance between the wrist (but not with your fingertips!) And the ground.It is such a length that there should be a cane.When buying a baguette, pay attention to its end - it must be equipped with a rubber nozzle.Such a stick is amortized and does not slip when they rest on it.
Remember that if your left leg hurts, the stick should be held in your right hand, and vice versa.Pass a step with the patient with one foot, transfer part of the body weight to a stick.
9. Therapeutic gymnastics:
The most important treatment for osteoarthritis of the knee joints is special therapeutic gymnastics.Almost no one who has a gonartrose cannot achieve real improvement in the state without therapeutic gymnastics.
After all, it is impossible to strengthen the muscles, to "pump" blood vessels and activate blood circulation as much as it can be done using special exercises.
At the same time, doctor's gymnastics is almost the only treatment method that does not require financial costs for the purchase of equipment or medicines.Everything the patient needs is two square meters of free space in the room and a carpet or a blanket thrown on the ground.
There is nothing left to consult a specialist in gymnastics and the patient's desire himself to make this gymnastics.Admittedly, just with such a desire, most of the victims do not burn.Almost all patients, in whom I reveal osteoarthritis, I literally have to persuade physiotherapy exercises.And it is as often as possible to convince a person only with regard to the inevitability of surgery.
The second "gymnastics" problem is that even patients configured for physiotherapy exercises cannot often find the necessary exercise sets.Of course, there are brochures for patients with osteoarthritis on sale, but the competence of a certain number of authors is doubtful - after all, some of them have no medical training.
Thus, these "teachers" do not always understand the meaning of individual exercises and the mechanism of their action on painful joints.Often, gymnastics complexes simply correspond to one brochure to another.At the same time, there are such recommendations that it is just to grasp your head!
For example, many brochures prescribe the patient with osteoarthritis of the knee joints "to perform at least 100 squats per day and walk as much as possible".
Often, patients follow such advice, without consulting before with a doctor, then sincerely perplexed why they worsened.Well, I will try to explain why the state of the sick joints of these exercises, as a rule, is only worsening.
Imagine the joint as a bearing.Damaged by osteoarthritis, the endolori joint has already lost its ideal shape.The surface of the "rolling" (or cartilage) has ceased to be smooth.In addition, the cracks, the nests and the "blunders" appeared on it.In addition, lubrication inside the sphere was thickened and dried, it was clearly not sufficient.