Treatment of arthrosis of knee joints, treatment of gonarthrosis- To put it mildly, not the simplest task.Therefore, before starting the hard fight with this disease, be sure to find a good doctor, examine and prepare a treatment plan.
In no case do not try to diagnose yourself!
The fact is that joint injuries that resemble artrose occur with many other diseases and low, and people are very often mistaken for diagnosis.It is much better not to save time and money for medical consultation, as the error can be much more expensive in every respect.
But this does not mean that all doctors need to be blinded and should not be immersed in the essence of your recommendations, understanding the mechanism of action of the drugs you prescribed for you.The patient should understand the meaning of medical prescriptions and depict certain therapeutic procedures.
So, with therapeutic treatment of gonarthrosis, it is important to combine a number of therapeutic measures in such a way as to solve multiple problems at the same time:
- eliminate pain;
- Improve the nutrition of joint cartilage and accelerate its recovery;
- activate blood circulation in the affected joint;
- Reduce pressure on the bone injured joints and increase the distance between them;
- Confirm the muscles surrounding the sick joint;
- Increase joint mobility.
Below we examine how this or this treatment method will help you achieve your goals:
1. No -steroid anti -inflammatory drugs:
Nonsteroid anti -inflammatory drugs -NSAIDS: diclofenac, pyroxy, ketoprofen, indomethacin, butadion, meloxicam, healing, nimulide and their derivatives.
Arthrosis, non -hormonal, anti -inflammatory drugs are traditionally used to eliminate the joint and inflammation of the joint, as it is impossible to start normal treatment in the cause of severe pain.Only with the elimination of acute pain can go later with anti -inflammatory drugs, such as massage, gym and physiotherapy procedures that would be indispensable due to pain.
However, it is not desirable for a long time to use the drugs of this group because they are able to "obscure" the manifestations of the disease.
After all, when the pain decreases, they give a misleading impression to start the cure.Meanwhile, arthrosis goes on: NSAIDs only remove certain symptoms of the disease, but do not treat it.
In addition, data have been obtained in recent years, which indicated the harmful effects of prolonged use of non -steroid anti -inflammatory drugs on proteoglycans synthesis.Proteoglycan molecules are responsible for the flow of water in the cartilage and their function violation leads to dehydration of cartilage tissue.As a result, the cartilage already affected by arthrosis collapses even faster.Thus, the tablets that the patient require to reduce joint pain can accelerate the destruction of this joint.
In addition, using non -steroid anti -inflammatory drugs, it should be remembered that each has a serious contraindication and can cause significant side effects with prolonged use.
2
Chondroprotectors - glucosamine and chondroitin sulfate - these are substances that nourish the cartilage and restore damaged cartilage structure.
Chondroprotectors are a group of the most useful drugs to treat joint treatment.
Unlike non -steroid anti -inflammatory drugs (NSAIDs), chondroprotectors do not eliminate the symptoms of arthrosis as much as the "base" of the disease: the use of glucosamine and chondroitin sulfate promotes the piping of the hip, improvesproperties.
A similar complex effect of chondroprotectors makes them essential on the treatment of the initial stage of arthrosis.However, these drugs do not need to be exaggerated.
Chondroprotectors in the third stage of the joint is low in efficiency when the cartilage is almost completely destroyed.After all, it is impossible to grow a new cartilage or return the previous form with glucosamine and chondroitin sulfate to deform the knee bones.
And in the first or second stages of gonarthrosis, chondroprotectors behaves very slowly and improves the patient's condition at the same time.To achieve the real result, you must perform at least 2-3 treatment courses with these drugs, which usually last from six months to one and a half years.
3. Therapeutic ointment and creams:
Therapeutic ointments and creams can by no means cure the arthrosis of the knee joints (even if their advertisements are approved by the opposite).Nevertheless, they can alleviate the patient's condition and reduce pain in the painful knee.And in this sense, the ointment is sometimes very useful.
So, with the arthrosis of the knee joint, which appears without synovitis without phenomena, I recommend that you heat the ointments to my patients to improve blood circulation in the joint.
To do this, use pepper fruit extract, etc.The ointments listed are usually causing pleasant heat and comfort in the patient.Side effects are rarely given.
Ointments based on non -steroid anti -inflammatory substances are used in cases where the process of gonarthrosis exacerbates synovitis.Unfortunately, they do not behave as efficiently as we want - because the skin passes up to 5-7% of the active substance, which is clearly not enough to develop a complete anti -inflammatory effect.
4. The funds required for compression:
Compressions have a slightly large therapeutic effect relative to the ointment.
Of the local funds used in our age, three drugs deserve the most attention: Dimexide, Bishophytus and medical bile.
Dampen- The chemical, the fluid with colorless crystals, has a good anti -inflammatory and analgesic effect.At the same time, unlike many other external materials, Dimexide is really able to penetrate the skin obstacles.That is, the dimexide applied to the skin is really absorbed by the body and works in it, reducing inflammation in the focus of the disease.In addition, Dimexide has an absorbable properties and improves metabolism in the application area, which is the most useful in treating arthrosis, which occurs in the presence of synovitis.
Bishop- Oil derivative, saline extracts during drilling the oil well.Thanks to the drills, he reached his reputation, who was the first to watch the therapeutic effect of arthrosis.While working on the oil well from the constant contact from the drill, artrose lumps occurred on their hands.In the future, it turned out that Bishophyte has a moderate anti -inflammatory and analgesic effect and acts warm, causing pleasant heat.
Medical bile- Natural bile, mined from bile bubbles of cows or pigs.The bile has an absorbing and warming effect and is used in the same case as biskophit, but there are some contraindications: it cannot be used for pustular diseases of the skin, inflammatory diseases of the lymph nodes and wires, feverish conditions with increased body temperature.
5. Intra -articular injections (injections in the joint):
Intraarticular injections are often used to provide an emergency supply of arthrosis of the knee joint.In many cases, intraarticular injection can indeed alleviate the patient's condition.At the same time, joint injections are performed much more often than necessary.I think about the wrong, in my opinion, in more detail.
Most often the drugs of corticosteroid hormones are introduced into the joint: triamcinone, betamethasone, hydrocortisone.
Corticosteroids are good in the sense of quickly and effectively suppress pain and inflammation with synovitis (edema and joint swelling).The rate of achieving the therapeutic effect is the reason why corticosteroid injections have become particularly popular with doctors.
But this led to the intraarticular injections of hormones even without real need.For example, I have been confronted several times with the fact that hormones were introduced into the patient's joint for preventive purposes to prevent further development of arthrosis.
However, the problem is that only the corticosteroids of arthrosis itself are not treated and cannot be treated.So they can't prevent arthrosis!Corticosteroids do not improve the condition of the articular cartilage, do not strengthen bone tissue and restore normal blood circulation.
Everything that can reduce the inflammatory reaction of the body to one or another damage to the joint cavity.Therefore, it is pointless to use intraarticular injections of hormonal drugs as an independent treatment method: it should only be used in the complex therapy of arthrosis.
For example, the patient showed the II.Stage gonarthrosis with swelling of the joint as the fluid accumulated in it.The accumulation of liquid (synovitis) makes it difficult to perform medical procedures: manual therapy, gymnastics, physiotherapy.In such a situation, the physician performs intra -articular injection of the hormonal drug to eliminate synovitis and start other active therapeutic measures in one week - this is the appropriate approach.
Imagine another situation now.The patient II.There is also a stage gonarthrosis, but without the accumulation of fluid and joint edema.Do you need to enter the joints in this case?Of course, no.No inflammation - no "exposure point" for corticosteroid hormones.
But even if the intraarticular introduction of corticosteroids is indeed necessary, many rules must be followed.First of all, it is undesirable to perform these injections in the same joint once in 2 weeks.The fact is that the drug introduced will operate with full force immediately and the doctor will only be able to evaluate the effect of the procedure after 10 to 14 days.
You should also know that the first injection of corticosteroids usually results in more relief than later.And if the first intra -articular administration of the drug has resulted in no result, it is unlikely that the second or third introduction of the same medicine will be introduced to the same place.If the first intra -articular injection is ineffective, you need to change the medicine, or if the change of medicine is not helped, more precisely, select the injection site.
If the introduction of corticosteroids still did not add the desired result to the joint, it is better to leave this joint with hormonal drugs.In fact, hormones in the same joint are usually four to five times, which is extremely undesirable differently increasing the likelihood of side effects.
Unfortunately, in practice, doctors who re -introduce corticosteroids into the same joint should be confronted with the excessive "determination" of doctors without having to achieve at least the minimum effect with the first three injections.Two of these cases were better than others.
One patient only performed ten kenalog injections, while the procedure was taken daily, even if a ten -day break needed to assess the results of the injection.And the second patient was introduced into hormones inside the knee joints, observing the interval (though only 3-5 days), but at the same time the poor guy received twenty -twenty -five corticosteroid injections in the treatment!
The doctor seems to have gone a little "too far" - okay.Can you hurt such treatment?It turns out maybe!
First, with every injection, the joint, although slightly injured, is a needle.Second, with intra-articular injection, there is always a certain risk of infection in the joint.Third, the introduction of frequent hormones causes a violation of the structure of the joint and the surrounding muscles, which causes relative "deteriorating" joints.
And most importantly, a frequent injection of corticosteroids exacerbates the condition of patients in which joint damage is combined with diabetes mellitus, high blood pressure, obesity, kidney failure, stomach or intestinal ulcers, tuberculosis, purulent infections.Corticosteroids still introduce the whole body into the joint cavity and can exacerbate the process of these diseases.
The administration of hyaluronic acid drugs is much more useful in the knee joint affected by arthrosis (another name of hyaluronic acid - sodium -hyaluronate).They appeared for sale about 15 years ago.
Hyaluronic acid preparations (sodium -hyaluronate) are also called "liquid prostheses" or "liquid implants" because they act as a healthy synovial fluid on the joint -that is, natural "joint lubrication".
Hyaluronic acid preparations are very useful and effective drugs: Sodium hyaluronate protective film from the damaged cartilage, protecting from further destruction of cartilage and repairing contact cartilage.
In addition, hyaluronic acid preparations penetrate the depth of the cartilage, improving its elasticity and elasticity.Due to hyaluronidase, "dried" and joint thin, the cartilage restores its shock -abstract properties.As a result of the weakening of mechanical overload, the patient's knee pain is reduced and mobility increases.
At the same time, jointly administered joints, hyaluronic acid preparations, virtually no side effects.
Treatment with hyaluronic acid preparations is performed in courses: a total of 3-4 injections are required to treat treatment in all sore knees, the interval between injections is usually 7-14 days.If necessary, the course is repeated in six months or one year.
In my opinion, the main price of hyaluronic acid drugs is the high price.So, in 2020, hyaluronic acid is represented in the main import drug market.
But returning to the issue of savings, I would like to note that despite the relatively high costs of hyaluronic acid preparations, their use literally made many patients who, before these, before these medicines, must be firmly operated.
And considering the costs of joint operation, it turns out that timely use of hyaluronic acid (even for years), and in every sense, the patient is much cheaper than the endoprotics of the knee joint.Of course, provided that a doctor who performs such injections owns the introduction technique.
It is important to know that hyaluronic acid preparations are immediately destroyed in the joint in which the pronounced inflammatory processes are in progress.Therefore, it is practically useless for patients in whom gonarthosis is behind the active stage of arthritis.But it is useful to use them to treat secondary gonarthosis with persistent arthritis remission.
In the case of primary gonarthrosis, you should also pay attention to such moments.For example, if the patient's joint is "exploded" from the accumulation of excessive, abnormal fluid, it is worth first "extinguishing" the phenomenon of synovitis (inflammation) and removing excessive pathological fluid using a previous intra -articular injection, or taking non -steroid anti -infllammatoric drugs.And only then introduce hyaluronic acid into the joint, getting rid of the inflammatory elements.
In addition to corticosteroid hormones and hyaluronic acid preparations, they try to introduce various chondroprotectors into the joint.
But these drugs are often lower in the efficiency of hyaluronic acid drugs.They help patients from 50% strength and figure out whether or not their use is impossible.In addition, the treatment requires 5-20 injections in the joint, which, as we have said, involves potential injuries and various complications.
6. Manual therapy and physiotherapy:
Manual therapy for gonarthrosis of stages I and II often gives great results.Occasionally, many procedures are sufficient for the patient to feel significant relief.In particular, manual treatment of random joints helps to combine it with the joint extension, the intake of chondroprotectors, and the intraarticular injections of the point.
Such a combination of therapeutic procedures, in my opinion, is much more effective than the clinic recommended many physiotherapy measures.I'll give you an example of practice.
The case from the doctor's practice.
At the reception, a 47 -year -old woman, II.Stage with the right knee joint arthrosis.By the time of our meeting, he was sick for 5 years.Over the years, the woman has been able to experience all possible physiotherapeutic methods to recommend in our district clinics: laser, magnetic button, ultrasound, phonophoresis, etc.appointed.Short course.
Desperately, the woman decided on extreme measures - according to the Eastern methodology, the worm was treated with cigarettes cauterizing cigarettes.As a result, his knees were covered with burns but did not move better.Yes, and despite my respect for Eastern medicine, I understand that wormwood cauterization cannot eliminate bone deformations and increase the distance between the bones formulated in the knee.
After the woman did not help with many physiotherapy procedures, and even the worm cigarette cigarettes, she almost agreed to surgery.But then he still changed his mind and decided to try the complex method I suggested.
The first treatment seat, as they say, is "squeaking" - we only succeeded in "mixing" the joint with the help of common mobilization.Therefore, after pre -preparation, we scheduled the following meeting: Within 3 weeks, the woman made chondroprotectors, made self -massage and compresses with dimexide.After 3 weeks, I started again by mobilizing the joint and then relocating it with hand manipulation ("reduction").There was a click and suddenly the joint started to move much easier and freely.She felt a clear relief.
The next two sessions recorded the improvement achieved by mobilization and the success of the two intra -articular injection of the point.And from the beginning of our not too intense treatment, after a month and a half (after all, we only needed six meetings), the woman was finally able to reject the wand that was bored with her and began to move freely.
Two years have passed since then.Twice a year, the patient buys short conditional conditioner conditioners and occasionally comes to my control technique, where I am happy to notice that the condition of the knee is only better year after year.And now, even the first stage of arthrosis is very difficult to assume - the patient's knee joint has been restored almost completely.
Thus, only six treatment sessions (manual therapy and orenil intra cultivation) combined during chondropotectors were more effective than physiotherapy for five years.
From this story (and by no means the only one) it becomes clear why I consider physiotherapy important, but I only consider it the rest of the Medical Program for Gonarthrosis.In this sense, I love laser therapy, thermal treatment (ozokerite, paraffin therapy, therapeutic mud) and especially cryotherapy (treatment of local cooling).
7. Diet:
The joint diet is also very important.
8. Using the reed:
According to the bot walk, patients with arthrosis of the knee joints are seriously helping treatment, as the stick takes 30-40% of the load for the joint.
It is important to choose a stick according to your height.To do this, stand straight, lower your hands and measure from your wrist (but not from your fingertips!) To the floor.It's so long to have reed.When buying a stick, pay attention to the end - it must be fitted with a rubber nozzle.Such a stick is amortized and does not slip when they rest on it.
Remember that if your left foot hurts, the stick should be held in your right hand and vice versa.If you take a foot step with a leg, move part of your body weight to a stick.
9. Therapeutic gymnastics:
The most important treatment for joint treatment of knee joints is special therapeutic gymnastics.Almost anyone with gonarthrosis cannot achieve real improvement in the state without therapeutic gymnastics.
After all, it is impossible to strengthen the muscles, the "pump" blood vessels and activate the bloodstream as far as possible through special exercises.
However, doctor's gymnastics is almost the only method of treatment that does not require financial costs to buy equipment or medicines.The patient only needs two square meters of free space in the room, as well as a carpet or blanket thrown on the floor.
There is nothing to consult with a high school specialist and the patient's desire to do this tournament.True, with only such a desire, most sufferers do not burn.Almost all patients with whom I explore arthrosis must literally convince physiotherapy.And most often, a person can only be convinced of the inevitability of surgical intervention.
The second "gymnastic" problem is that even patients who are configured for physiotherapy are often not found.Of course, there are brochures for patients with selling arthrosis, but many authors have a doubt - after all, some have no medical education.
Thus, such "teachers" do not always understand the meaning of individual practices and the mechanism of their actions on sore joints.Often, gym complexes simply correspond to a thoughtful way from one brochure to another.At the same time, there are recommendations that are right to grab your head!
For example, many brochures require a patient with arthrosis of the knee joints to "perform at least 100 squats and as much as possible".
Often patients follow these advice without having previously been consulted with a doctor and then honestly confused why they became worse.Well, I will try to explain why the condition of patient joints from such exercises is just deteriorating.
Imagine the joint as a bearing.Due to the injury of arthrosis, the sore joint has already lost its ideal shape.The surface of the "bearing" (or cartilage) is no longer smooth.In addition, cracks, holes and "burrows" appeared on it.In addition, the lubrication inside the sphere was thickened and dry, obviously not enough.