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Today our story is about arthrosis. Perhaps you can not find either one elderly person, or even a middle-aged person, which there would be no periodic joint pain. With pain not accompanied by signs of inflammation. What does it mean? Signs inflammation is considered: redness of the skin over the joint, its edema or swelling, intense or mild pain, hot to the touch skin and a violation of its function, which is expressed in limiting movement.
With arthrosis, pain also occurs, but it no longer has these inflammatory signs, but accompanied by a crunch, occurs in the beginning of movement, and then, as the motor activity, the joint gradually “engages”, and the pain disappears. Therefore, in the event that you can hardly get out of bed in the morning because of knee pain, gasping, and then, after half an hour, you realize that the pain disappeared, and the comfort of movement returned, then you, no doubt arthrosis of the knee joints. How many people in our country suffers from this disease?
Statistics, even the roughest, are disappointing. Patients diagnosed with arthrosis (i.e. those patients who have really gone through all the necessary types examination), and are observed by a doctor, in our country there are more than 10 million people, and this is only sick. That is, these are the people who are diagnosed with this and who periodically refer to a doctor with certain complaints, medical documentation is kept. It is quite possible to double or triple this number, if we add here those patients who have periodic pain in one or another joints, but which were never examined, and did not seek medical help.
However, at present the number of patients with first time identified arthrosis only increases, and, according to official figures, with 2001 to 2005, the incidence of arthrosis increased by almost 50%.
The reason for this is sedentary, office work among the urban population, and high physical exertion in rural, if the condition is more wide rural health coverage, with normal diagnostic level. Moreover, it is disappointing that it is growing the incidence of arthrosis is already relatively young starting from 45 years. If we take international statistics, then, by WHO estimates that one of the main causes of disability is arthrosis of the knee joints, and it is in fourth place among of all causes in women, and in men – in eighth place in general age categories. Before you start a drug review drugs for the treatment of various forms of arthrosis, recall what kind of pathological condition, and what arthrosis happens.
- Symptoms and signs of arthrosis
- What is the difference between arthritis and arthrosis?
- A bit about degrees, or stages
- The basic principles of the treatment of arthrosis
- Medicines for arthrosis
- Etoricoxib (Arkoksia, Kostaroks, Etoriaks)
- Advantages and disadvantages
- Diclofenac (Voltaren, Ortofen, Diclac, Diclogen, Diclogen, Diklonak, Naklofen)
- Advantages and disadvantages
- Ketoprofen (Ketonal, Arthrosilen, Arthrum, Flamax, Flexen)
- Advantages and disadvantages
- Meloxicam (Movalis, Amelotex, Arthrosan, Genitron, Mirlox, Movasin, Revmart),
- Advantages and disadvantages
- Local hormones for intraarticular administration
- Betamethasone (Diprospan, Betaspan, Phlosterone)
- Advantages and disadvantages
- Artificial grease and chondroprotectors
- Advantages and disadvantages
As we recall, the ending “-oz” means not inflammatory process, and the proliferation, an abundance of any tissue. This is a deformation and proliferation (compensatory) of the bone tissue on which lies articular cartilage due to malnutrition, or dystrophy, and subsequent destruction, or degeneration.
Now it becomes clear the official term, which called “degenerative-degenerative articular pathology cartilage. “In a disease such as arthrosis, regardless of in which joints these changes are observed, there are many synonyms. If you hear the names of diseases such as osteoarthrosis, deforming arthrosis, deforming osteoarthrosis, – this is all one and also.
Of course, arthrosis is often combined with secondary inflammation, then there are symptoms of arthritis. In this case, they talk about arthroso-arthritis, or osteoarthritis. In any case, all this is one and the same condition associated with the destruction and malnutrition cartilage, a change in the structure of bones at the base of the joints. In only one case, the process proceeds with the presence of inflammatory component, and in another case, without the presence of inflammation. Usually arthrosis without inflammation covers the entire joint completely, since ultimately not only cartilage itself suffers, but also synovial membrane, a bone located under the cartilage, or subchondral bone.
Next, the articular bag is involved in the process, and in neglected cases – we are already talking about damage to the periarticular muscles, or periarticular muscles. It goes without saying that in inflammatory the process involves the ligaments located in the joint cavity, for example, cruciate ligaments of the knee joint. How so arthrosis is manifested?
Symptoms and signs of arthrosis
As mentioned above, most often arthrosis occurs in the knee joints, and there are special reasons for this. It would seem, by logic of things, those joints on which the largest weight, and in this case it’s cartilage ankle joints that carry almost full the weight of the human body. But these joints are so arranged that the manifestation arthrosis is just rare in them, but the knee joints (gonarthrosis) suffer much more often. In second place is arthrosis. hip joints (coxarthrosis), and then you can call arthrosis big toe, ankle joint, and small arthrosis joints of the fingers. How can one be suspected of oneself symptoms of classic arthrosis? Here they are:
The first and main symptom is pain in the limbs, more precisely, in the corresponding joints. In this case, pain does not occur in at rest, and during movement, often the pain has a starting character, and then, with continued movement, the pain disappears.
What is the reason for this disappearance of pain? Starting pain appears then, when initially, before the start of movement, the articular surfaces are uneven, bumpy, they are covered with the so-called fabric detritus, which is a kind of “talker” of destroyed cartilage with a very small size. Detritus at night in at rest, gradually settles from the synovial fluid to the surface cartilage like sand to the bottom, agitated by the passage of a large the ship.
After the movement begins, this detritus and annoying articular surfaces and surrounding tissues, causing starting pains. After 15-20 minutes it is pushed from the surfaces to the periphery joint and pain disappear.
The more arthrosis progresses, the pain becomes more intensively, and the second stage of arthrosis leads to pain occurs already under light load, and the third stage is characterized constant pain when the joint is not even loaded. Besides, night pains are also characteristic in some cases, due to outflow difficulties from the affected joint.
The second characteristic symptom is a crunch in the affected a joint that is dry and “rough” in nature.
This crunch is heard from a distance, and it is clear that he indicates the destruction of articular cartilage, and the more arthrosis progresses, the greater the intensity and this crunch;
The third symptom is a gradual decrease in amplitude. movement, or freedom in the corresponding joint.
Naturally, this is a later symptom than the previous ones. is he arises due to secondary muscle spasm, which is already chronic in nature. The second reason for immobility is reduction in the lumen of the joint space due to impaired synthesis cartilage, as well as due to changes in bone tissue, i.e. development growths – bone spines, or osteophytes. Many in this picture saw a description of the radiograph for osteochondrosis, when, for example, there is a decrease in height in the thoracic and cervical spine intervertebral discs, the development of hook-shaped osteophytes at the edges vertebrae, and so on. This is not unusual since osteochondrosis of the intervertebral discs, or osteochondrosis of the spine – this is the same arthrosis, only localized in small joints between the vertebrae.
finally, in advanced stages due to accession inflammatory component (due to constant friction destroyed cartilage of surrounding tissues) and the volume of synovial liquids.
The joint changes its external form, configuration, it arises as follows called reactive synovitis. Synovial fluid pressure from the inside leads to deformation of the joints, their swelling and constant, aching and bursting pain. This stage includes for example, the so-called patellar ballooning phenomenon. If the patient has a pronounced accumulation of synovial fluid in knee joint, then it contributes to the swelling of the patella out. Outwardly, it is imperceptible against the background of a swollen joint, but if press the patella and push it inward, then it will plunge into depth and then again will be pushed out by pressure synovial fluid. This floating movement feels good under fingers of an orthopedic traumatologist.
What is the difference between arthritis and arthrosis?
How to distinguish arthritis from arthrosis? We have already described the classic signs of arthritis that are not observed with “pure” arthrosis. It should be added that all the symptoms of arthritis are associated with one or another severity of inflammation. Here are the main differences:
- arthritis can occur at any age, for example in autoimmune juvenile may occur in children or adolescents arthritis, and arthrosis begins somewhere from 40 years;
- arthritis can affect almost any joint, and quite often rheumatologists are faced with a pathology such as polyarthritis. Arthrosis is not capable of such a combination and defeat from the very beginning. small joints. We can say that arthrosis “stupidly” affects large joints with a heavy load;
- the classic sign of difference is the difference in pain. At we know arthrosis, pains occur when moving, are most severe when the beginning of the movement, when getting out of bed, and wear the starting character. But with arthritis, pain does not depend on movement, and more often total associated with the appearance of severe inflammatory edema. AND this edema is just the most and occurs at night when the joint is still. Arthrosis at night in the initial stages will never;
- in terms of various research methods, such as MRI, arthrosis is, first of all, the destruction of cartilage, which clearly visible on tomograms. Arthritis does not lead to destruction cartilage, and above all, is manifested by the reaction of other tissues.
Finally, age must be considered. Arthrosis almost always occurs at the age of over 40, and manifested by gonarthrosis, or knee arthrosis, or coxarthrosis-arthrosis of the hip joint. It is coxarthrosis most often and leads to disability and the need to arthroplasty.
A bit about degrees, or stages
Joint pathology is “good” in that, to determine the stages, or degrees do not require large quantities research. So:
- the initial stage has practically no symptoms, sometimes slight pain occurs during movement and during exercise;
- in the second stage, the pain is already changing, its intensification occurs. Yes, the patient can tolerate her, but she is no longer fleeting, but quite tangible. It is at this stage that the first osteophytes appear, which are clearly visible on x-ray, dystrophy and degeneration are noticeable cartilaginous tissue, the same crunch appears;
- the third stage is an already developed clinical picture. Themselves the supporting platforms of the joints are roughly deformed, this leads to changes in the axes of rotation and even to the deformation of the limbs themselves.
Articular ligaments are reflexively shortened, pains become constant, the amplitude of motion in the joints decreases, the size joint space is sharply reduced. At the end of this stage, the joint is practically completely destroyed, and ankylosis occurs, that is, a condition complete stillness. It is at this stage that it is no longer possible conservative treatment and conduct endoprosthetics.
However, do not think that you can start the process, and do not be treated as long as you like, because “as a result, anyway can put a new artificial joint. “This is serious misconception. Yes, of course, the affected joint can be thrown away and put a new one. But you need to remember that severe and advanced arthrosis changes the condition of the surrounding ligaments, muscles, and replace and remove them no longer possible. Therefore, the more the process is launched, the more serious the subsequent rehabilitation process is more difficult and longer, even with installation of the most modern and expensive imported endoprostheses.
The basic principles of the treatment of arthrosis
It is clear that in advanced stages the only kind treatments that preserve the quality of life, eliminate pain, and returns freedom of movement, is a modern operational intervention, i.e. endoprosthetics. But the treatment of osteoarthritis starts from the first stages, when it matters a lot non-drug therapy. So, you must:
- reduce the load on damaged joints, for example, by weight loss;
- instead of taking long walks, use a bicycle, or scooter;
- sometimes it is necessary to change working conditions. So if the patient stands behind the conveyor for hours and osteoarthrosis progresses knee joints, then you need to transfer it to other conditions labor;
- the patient is assigned the correct orthopedic regimen;
- he is engaged in swimming, conducts therapeutic sessions physical education;
- various physiotherapeutic procedures are prescribed;
- nutrition plays an important role improving trophism of articular cartilage and improving quality connective tissue in general.
But between the second and third degree of arthrosis is a pain syndrome, as well as the frequent occurrence of joined inflammation, perhaps the most severely impairing quality of life in patients, and drug therapy is already needed here, including – and carrying out intraarticular blockades. Finally, we move smoothly to a review of drugs that are used to treat arthrosis.
Medicines for arthrosis
Before listing the various drugs should be added, that the list given in the article is not intended to make someone of manufacturers advertising or anti-advertising, their choice is justified indications for use, clinical efficacy, publication data in scientific journals. First of all, presented and described original drugs, not generics. In drug names first, if any, the INN, or international generic name common to all “medicinal cluster “, then the first, original representative (for the first time created drug). Then come the generics examples, or commercial copies of the original drug.
The following is a range of retail prices for pharmacies of all forms property in the Russian Federation, prices are indicated from the original drug to the cheapest generic. And start We review funds from the most popular group, or from non-steroidal anti-inflammatory drugs.
|Nomination||a place||Name of product||price|
|NSAIDs||1||Etoricoxib (Arkoksia, Kostaroks, Etoriaks)||521 rub|
|2||Diclofenac (Voltaren, Ortofen, Diclac, Diclogen, Diclogen, Diklonak, Naklofen)||189 rub|
|3||Ketoprofen (Ketonal, Arthrosilen, Arthrum, Flamax, Flexen)||116 rub|
|4||Meloxicam (Movalis, Amelotex, Arthrosan, Genitron, Mirlox, Movasin, Revmart),||61 rub|
|Local hormones for intraarticular administration||1||Betamethasone (Diprospan, Betaspan, Phlosterone)||175 rub|
|Artificial grease and chondroprotectors||1||Sinwisk||19 600 rub.|
We will say right away that the drugs from this group in no way affect articular cartilage. That’s why they are called – “anti-inflammatory” that reduce the manifestation of inflammation. And this means that they are primarily indicated for patients in whom there is an inflammatory component, that is, there is arthroso-arthritis. But do not think that even if the signs there is no inflammation, then these drugs will be ineffective. Cause pain which occurs with a variety of diseases, is not formed only as a nervous response, but like a reaction to a destructive effect tissue detritus, which accumulates in the joints, on the secondary damage to muscles and ligaments.
And non-steroidal anti-inflammatory drugs fight not only with inflammation, but can also relieve fever during fever, and have pronounced analgesic effect. There is a general law: the drug should be prescribed in short courses, and in the presence of pathology stomach and duodenum, with gastritis, peptic ulcer stomach diseases, heartburn hide behind drugs, inhibitors proton pump, which had an entire article, most often it simple drug omeprazole.
We list the most famous, effective, modern, and often used drugs for degenerative-degenerative pathology joints from this group. Unfortunately, all of the above praises these are not synonyms for any one group. It’s impossible. So very effective is an “ancient” and rather crude means – diclofenac (Voltaren, Ortofen), but it can be used very short courses with exacerbation, not longer than 3 days. Arcoxia may be considered a modern and safer drug. or etoricoxib. Frequently used means can be considered ketoprofen, meloxicam. Get to know these representatives closer.
Etoricoxib (Arkoksia, Kostaroks, Etoriaks)
Arcoxia copes with pain and inflammation, but rupture of the mechanism inflammation and amelioration of symptoms does not mean elimination causes of inflammation. Therefore, this drug should be prescribed better only in short courses, in the first days after acute joint pain.
Arcoxia is not only a selective cyclooxygenase 2 inhibitor type, but it also shows a high degree of selectivity. Almost 95% is a connection with the desired isoform of the enzyme – COX 2. That is why this drug is safe and can even be used. in patients with compromised gastric mucosa and duodenum, i.e. in patients with various forms gastritis and even peptic ulcer, although in remission and under cover with certain drugs (omeprazole). Etoricoxib or Arkoxia, is able to inhibit cyclooxygenase depending from the dose. However, it has no effect on the first type an enzyme that is affected by very “ancient” medicines, such as Diclofenac. The product is produced by the German company Merck, and the cost of 7 tablets of 0.09 g in January 2020 is from 345 rubles. Kostaroks (India) will cost from 267 rubles, and Etoriaks from Slovenia (Krka) will cost about the same.
Advantages and disadvantages
Contraindication to use is a universal combination bronchial asthma, sinus polyposis and aspirin intolerance. It is also the presence of ulcerative bleeding, ever, or active a condition of erosive gastritis or a stomach ulcer and duodenal ulcer guts. In general, these are all exacerbations of inflammatory diseases intestines such as Crohn’s disease or ulcerative colitis. It is impossible apply Arcoxia with low blood coagulability, as well as with severe renal and liver failure. Contraindicated Arkoksia during pregnancy and during breastfeeding feeding, as well as children and adolescents, boys and girls in under 16 years old. The drug can be used, but carefully with the presence of ulcerative history, Helicobacter pylori infection, in individuals suffering from diabetes and chronic alcoholism, as well as individuals taking anticoagulants, such as warfarin, or disaggregants, e.g. Curantyl, clopidogrel or acetylsalicylic acid.
Of the advantages, a high range of security, and low risk of complications.
Diclofenac (Voltaren, Ortofen, Diclac, Diclogen, Diclogen, Diklonak, Naklofen)
Diclofenac, which is in Serbian form in ampoule form Hemofarm company, it costs very cheaply: 47 rubles for 5 ampoules. Why ampoules? Because they are faster and more effective than pills. By the way, the Russian company Biochemist produces exactly the same ampoules, 3 ml each, but the package is 10 ampoules each, and at the same time same price. What kind of packaging to buy as prescribed by a doctor – small Serbian, or large domestic – you decide, but better a little one. Very high quality is Voltaren, production Lek from Slovenia, but then a package of 5 ampoules will cost from 226 rubles. This drug is almost 5 times more expensive than Serbian, but But this is an original tool.
Diclofenac is an honorary “grandfather” in the non-steroidal family anti-inflammatory drugs, and despite its enough low security range, it is still loved and used. Prescribe Diclofenac is necessary for a variety of diseases musculoskeletal system, with arthritis, with ankylosing spondylitis, in dentistry and orthopedics, he also finds his application. Gynecologists prescribe it with algodismenorrhea, that is, with painful periods. But most of all it is used by neurologists, traumatologists and orthopedists. Many options for arthrosis, acute pain in back, neuralgia and radiculitis, exacerbation of protrusion of the intervertebral hernias – here is a far from complete list of indications for use Diclofenac.
It is very important to remember that a single dose is 1 ampoule. The drug must be administered deeply intramuscularly, repeat the introduction the drug can be no earlier than 12 hours. To be treated with injections diclofenac can be no longer than 2 days. In other words, acquire packaging in 5 ampoules – the best solution when it comes to sudden and short pain syndrome.
Advantages and disadvantages
If Diclofenac had no shortcomings, then he would be worth significantly more expensive since it removes very efficiently inflammation, and fights pain, but it’s not for nothing that taking the drug is limited two days. It can cause gastritis, inflammatory changes. intestines, pancreatitis and liver necrosis, fulminant, that is fulminant form of toxic drug hepatitis. Very it is dangerous to apply diclofenac to ulcers, patients with various forms of gastritis, and especially erosive and ulcerative. Therefore, in the case If necessary, they are “covered” by omeprazole tablets.
Often there is a headache, dizziness, skin appears rash, and other side effects. Also in the official instructions there is an impressive list of contraindications, which it is necessary to take into account the doctor, and especially when it comes to elderly patients. But with all this, short courses Diclofenac is able to put a person on his feet, even with acute pain syndrome, and its cheapness and good quality of imported the drug makes it a competitor to even more powerful drugs.
Ketoprofen (Ketonal, Arthrosilen, Arthrum, Flamax, Flexen)
Ketonal is a more modern drug compared to Diclofenac, the next generation. His acting the substance is ketoprofen, and each ampoule with a volume of 2 ml contains its 100 mg. It is indicated for use in severe pain of various origin, and of course, in the first place, this is damage to the musculoskeletal system. These are various arthrosis, gonarthrosis and coxarthrosis in the third stage, bursitis and tendonitis, osteochondrosis and gout, rheumatoid arthritis and ankylosing spondylitis, psoriatic arthritis. Also, this tool is used for pain a syndrome due to malignant neoplasms, with migraine, headache and radiculitis.
Ketoprofen in ampoules should be used no more than two ampoules in day. It is advisable that the course of treatment with ketonal not exceed 3-5 days, and it is advisable to use the medicine in the smallest dosages that bring effect, for example, 1 ampoule daily in the evening for 3 days. Launches Ketonal Company Lek from Slovenia, and a package of 10 ampoules on average costs 227 rubles.
Advantages and disadvantages
The big plus of Ketonal is the permission of the official instructions to apply it during pregnancy, of course, with special caution, and as short a course as possible. It is impossible use only in the third trimester when it may occur violation of labor. Contraindications the drug is about exactly the same as in other cases. Besides hypersensitivity is an allergy to NSAIDs, i.e. combination of aspirin asthma, nasal polyposis and intolerance aspirin. This is an exacerbation of peptic ulcer, low coagulability blood, children’s age, pronounced hepatic and renal failure. It is contraindicated at high risk of various bleeding. But in the event that he is in the case of various arthrosis assigned a short course in the absence of contraindications, then he similarly able to bring substantial relief to patients with pain syndrome of various genesis.
Meloxicam (Movalis, Amelotex, Arthrosan, Genitron, Mirlox, Movasin, Revmart),
Movalis, or Meloxicam is the last drug considered us for deep intramuscular injections to pain relief and fight against inflammation, as well as relieve painful pain with a neglected form of arthrosis and the presence of arthrosoarthritis. the first discovered from the group of oxycams – COX inhibitors 2. Movalis is original meloxicam produced by a German company Beringer Ingelheim, and a package of 3 ampoules will cost 850 rubles. Movalis belongs to the group of non-steroidal anti-inflammatory drugs that can reduce all the classic signs inflammation: redness, fever, soreness and swelling. Act the drug is based on a blockade of prostaglandin synthesis.
Indicated for diseases of the musculoskeletal system apparatus, various forms of arthritis, arthrosis and osteoarthrosis. The classic indication for Movalis is acute pain in the lower part backs, lumbago, other forms of dorsopathy, brachial periarthritis and other diseases. In case of uncomplicated pain, for example, with osteoarthritis, an ampoule is administered intramuscularly 1.5 ml, containing 7.5 mg Movalis. In severe cases two ampoules are administered per day, for example with rheumatoid arthritis. Inject more than two ampoules daily, i.e. more than 15 mg, not allowed.
Advantages and disadvantages
The drug is packaged in 3 ampoules: this is enough for three days primary relief of acute pain. Contraindications and side effects in Movalis are characteristic of all NSAIDs, they were repeatedly mentioned above, and we will not dwell on them will be. Of course, the high cost of the drug is striking: one an ampoule for administration costs 283 rubles, and one ampoule of diclofenac, even if you take expensive imported packaging, it will cost 8 rubles. we we get that the cost of one day of treatment with diclofenac is cheaper in 32 times than one injection of Movalis. This is exactly the situation about which was described above. If diclofenac wouldn’t have of so many side effects, it would be much expensive. This is not Movalis dear, this Diclofenac is too cheap. AND in general, the most affordable meloxicam for injection, or one of the most available – it’s 50 rubles for 3 ampoules of domestic production.
Local hormones for intraarticular administration
Local hormonal drugs that are long-acting corticosteroids – this is real panacea for patients with prolonged, persistent pain, on the third stages of advanced arthrosis with the addition of symptoms of arthritis, with the presence of synovial effusion and an increase in synovial volume liquids. And you can not take hormones inside, with arthrosis, and arthrosis-arthritis requires intra-articular administration, using syringe with a needle in a medical facility.
If the drug is injected into the joint cavity, then it acts quickly, without side effects, or with their minimal manifestation, since it does not enter the bloodstream, and the drug can have very long action. The most famous drugs used in arthrology for the treatment of chronic pain and stopping inflammation in arthrosis is diprospan and Kenalog.
As a result, steroid hormones, for a long time, (up to six months after one injection!) allow the patient to improve range of motion, increase mobility in the joint, reduce pain, and relieve inflammation.
But at the same time, despite the elimination of unpleasant symptoms, they do not lead to restoration of articular cartilage. Consider an example of local hormonal therapy using betamethasone, for example a drug like diprospan. This will be quite enough, since only 2 corticosteroid hormones are used in medicine for intraarticular injection. The first of these is betamethasone, which will be described below, and the second is triamcinolone, which is available under the guise of Kenalog. Since they are from the same group, they have much in common.
Betamethasone (Diprospan, Betaspan, Phlosterone)
Diprospan is a high-quality suspension consisting of two betamethasone compounds. It has a clear, yellowish or colorless color, slightly viscous texture in which there are whitish particles. The ampoule also contains additional substances. In each ampoule of one milliliter of this suspension. The tool has high anti-inflammatory as well as anti-allergic and immunosuppressive effect. We are interested in just the first effect, therefore, first of all, Diprospan is used for diseases musculoskeletal system, and of course, with various types arthrosis, and especially with an inflammatory component.
A very important and valuable property of diprospan is considered very its slow release from the depot, in this case from the joints. With various types of arthrosis, Diprospan is used not only intraarticular, but also periarticular, and we must remember that it cannot be apply intravenously and subcutaneously. If topical administration is needed, then you can usually not use a local anesthetic, and usually enough for introduction into large joints from one to 2 ml per each joint.
The duration of the clinical effect after one injection may last up to a month or longer, with a very good answer – up to six months. You can buy one ampoule of Diprospan in pharmacies at a price of 260 rub, respectively, the same amount and one injection will cost, and for large, for example, for the knee joint it can be 2 milliliter. If we consider that there may be severe gonarthrosis with pain both left and right, then the maximum dosage for all two the knee joint will be 4 ml, that is, about 1000 rubles. drug consumption.
Advantages and disadvantages
The main advantage of intraarticular hormones is low the likelihood of a systemic effect, for example, increasing blood pressure, lowering potassium in the blood plasma, or “classic” – erosive and ulcerative lesion of the gastrointestinal a path, a decrease in the rate of wound healing and so on. Such side effects usually occur with systemic administration of corticosteroids preparations. The second advantage is quite long action, but still you need to remember the main contraindications to the appointment of corticosteroid hormones, even for intraarticular injection. First of all, these are systemic mycoses, then there is a fungal infection, with damage to the internal organs and penetration into the blood, the presence of acute joint infection, for example brucellosis, or tuberculous arthritis, the presence of increased sensitivity to betamethasone. Better to refrain from use. hormones, even intraarticularly, to pregnant women.
Artificial grease and chondroprotectors
Artificial lubricant, or synovial fluid, is always needed high quality. It performs many functions: nourishes cartilage, reduces friction in the joint, absorbs shock and acts as a shock absorber. Natural lubricant is continuously renewable, viscoelastic polymer. It is always on the surface of the cartilage, lubricates them as well as nourishes. Patients should remember that since 2003 World Health Organization recommends applying artificial lubrication preparations, in the complex therapy of arthrosis, when conservative treatment becomes ineffective.
If there are joint prostheses, i.e. endoprostheses, then artificial lubrication can also be called a synovial prosthesis, or joint fluid. The main indication for its use is pain, discomfort during movement, as well as stiffness in the joints. When little natural lubrication, then artificial the drug, and it, like hormones, is administered intraarticularly, moreover strictly into the synovial fissure.
There are many proven effects of using artificial synovial fluid. If you take a course of injections, then the patient on for several months, and even up to a year, returns to easy and painless movements. Usually during each course 5 injections are made at regular intervals, and the duration of the effect depends on the quality and on the choice of the drug.
Of course, the highest possible effect brings timely the introduction of a joint fluid substitute, and these are the initial stages arthrosis. If there are already serious changes, then any means will bring less efficiency, because the cartilage will already be destroyed. After all, even high-quality lubrication of seriously damaged gears in any engine will not fix the problems: it will buzz and collapse farther.
What are the general contraindications against the introduction of artificial synovial fluid? It:
any local inflammation in the joint, because on the background the inflammatory focus is the destruction of any artificial joint fluid, which consists of hyaluronic acid, and natural too;
synovial fluid prosthesis is not used for autoimmune pathology, for example with rheumatoid arthritis, but this is not the purpose of our article;
an allergic reaction to natural synovial fluid that the animal has origin, and this reaction can be up to anaphylactic shock, therefore it is best to prescribe synovial fluid prostheses synthetic, although they are more expensive.
The better the drug, the less often the patient will have to undergo repeated treatment, and the longer the medicine will act. From What determines the effect of the drug? From the size of drug molecules facilities. It is preferable to use high molecular weight means, since they are more slowly excreted from the body and slowly collapse, providing the so-called prolonged action. If the molecular weight of the product is small, then the molecule hyaluronic acid is rapidly destroyed into fragments, separated, and is removed from the joint.
Recall that natural, natural joint fluid, which is the standard, has a mass of about 3 million daltons. Low molecular weight drugs are up to 800,000, and high molecular weight artificial joint fluid – more than 2.5 million units. As one of the reference drugs, constituting artificial joint lubrication, here we present American drug Sinvisk.
As for chondroprotectors, they were repeatedly written about in other articles. These are simple dietary supplements that do not have evidence base, since both glucosamine and chondroitin sulfate from blood does not penetrate the joints, but distributed as you like organism, splitting into smaller fragments. Therefore much it’s cheaper to just eat jelly than to buy expensive and useless means.
It is available in the form of a package of 3 ampoules, 2 ml each, worth 24,500 rubles. Accordingly, the price of 1 ml will be a little over 4000 rubles. Such a high price is justified, the news Synvisc is a highly viscous, elastic fluid, with an average molecular weight of about 6 million daltons, that is, 2 times thicker and heavier than natural lubrication. It consists of gilans, not hyaluronic acid, gilans are derivatives of hyaluronic acid acids that consist of repeating units of disaccharides. it acetylglucosamine and sodium hyaluronate. Naturally introduce it need strictly in the joint cavity, if there is not a large amount effusion.
In case of osteoarthrosis of the knee, 3 injections are necessary after one week each, as a course of treatment. In this mode dosing the usual effect of the application lasted for 26 weeks, and in the case of osteoarthrosis of the knee, the best cases the response was 52 weeks, after 1 course of three injections. Therefore, the quality and explains the high cost of this tool, but it should be remembered that it is considered expensive in our country, since for it you need to pay about the average monthly salary. IN THE USA a skilled worker receives about $ 25 per hour of work, and in Russia, this figure is just over $ 3, so in the country – the manufacturer of this tool is eight times cheaper.
Advantages and disadvantages
Sinvisk contains a little chicken protein. Therefore, if the patient has intolerance, or hypersensitivity, it is necessary be careful. The administration procedure is generally well tolerated, and occasionally there may be short-term pain or swelling, but it happens seldom. Some disadvantage is the method of application. at first intraarticular injection required, removal of a certain amount synovial fluid, in an amount equal to the input, warming the drug to room temperature, compliance with strict rules asepsis, selection of the size and length of the needle depending on the joint. Therefore, health workers need to learn the rules of conduct of this drug. However, such rules are necessary for the introduction of absolutely all synovial fluid prostheses, and the difference only in packaging, volumes, prices and quality. In many cases, the drug is administered under x-ray control.
Popularity rating based on analysis of demand data service wordstat.yandex.ru.
Attention! This rating is subjective, not advertising and does not serve as a guide to the purchase. Before the purchase consultation with a specialist is necessary.