Treatment of knee joint arthrosis, gonartrosis treatment- To say the least, not the easiest task.So before you start your hard fight with this disease, be sure to find a good doctor, examine it and do a treatment plan with it.
In no case do not try to establish a diagnosis for yourself!
The fact is that articulation injuries, similar to artransea, occur with many other diseases and low people -present are often confused in determining the diagnosis.It is better not to save time and money for medical consultation, because the error can cost much more expensive in all aspects.
But that does not mean that you should blindly believe in any doctor and should not delve into the essence of your recommendations, understanding the mechanism of action of those medicines that are prescribed for you.The patient must understand the meaning of medical prescriptions and represent why certain therapeutic procedures are performed.
Therefore, with the therapeutic treatment of gonarthrosis, it is important to combine several therapeutic measures to solve several problems at the same time:
- eliminate pain;
- improve joint cartilage nutrition and accelerate its restoration;
- Activate blood circulation in the affected joint;
- Reduce pressure on the damaged bone joints and increase the distance between them;
- Strengthen the muscles around the sick joint;
- Increase joint mobility.
Below, we will consider how this or this method of treatment helps achieve your goals:
1.
Anti -inflammatory drugs non -esteroids -aines: diclofenac, piroxycs, ketoprofen, indomethacin, butadion, meloxicam, healing, nimulide and their derivatives.
With arthrosis, non -inflammatory drugs are traditionally used to eliminate pain and inflammation of the joint, since, against the background of intense pain, it is impossible to initiate normal treatment.Only by eliminating acute pain with anti-inflammatory drugs, you can subsequently go, for example, massage, gymnastics and those physiotherapeutic procedures that would be intolerable due to pain.
However, it is undesirable to use medicines of this group for a long time, as they are able to "mask" the manifestations of the disease.
After all, when the pain decreases, a misleading impression is created that a cure began.Meanwhile, arthrosis continues to progress: NSAIDS eliminate only 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 -esteroid anti -inflammatory drugs on proteoglycan synthesis.Proteoglycan molecules are responsible for the flow of water in the cartilage, and a violation of its function leads to dehydration of the cartilage tissue.As a result, the cartilage already affected by arthrosis begins to collapse even faster.Thus, the pills the patient takes to reduce joint pain can accelerate the destruction of this joint.
In addition, using non -non -esteroidal anti -inflammatory drugs, it should be remembered that they all have serious and prolonged -use -indication can give significant side effects.
2. CondoProtectors - Glucosamine Sulfate and Condroitin:
Condropoprotectors - Glucosamine and chondroitin sulfate - are substances that feed the cartilage tissue and restore the structure of the damaged cartilage of the joints.
Condroprotectors are the most useful group of medicines for the treatment of arthrosis.
Unlike anti -non -esteroids (NSAIDs), chondroprotectors do not eliminate both arthrosis symptoms and the "base" of the disease: the use of glucosamine and chondroitin sulfate helps restore hip joint cartilage surfaces, improve production.
A similar complex effect of the CondoProtectors on the joint makes them indispensable in the treatment of the early stage of arthrosis.However, there is no need to exaggerate these drugs.
CondoProtectors are poorly effective in the third stage of arthrosis, when the cartilage is almost completely destroyed.After all, it is impossible to cultivate a new cartilaginous tissue or return the previous shape to the deformed knee bones with glucosamine and chondroitin sulfate.
And in the first or second stages of gonarthrosis, chondroprotectors act very slowly and improve the patient's condition at once.For a real result, you need to go through at least 2-3 treatment courses with these medications, which usually takes six months to a year and a half.
3. Ointments and therapeutic creams:
Therapeutic ointments and creams can by no means cure the arthrosis of knee joints (even if their advertising takes the opposite).However, they can alleviate the patient's condition and reduce painful knee pain.And in this sense, ointments are sometimes very useful.
Therefore, with knee joint arthrosis that occurs without synovitis without phenomena, I recommend warming ointments to my patients to improve blood circulation in the joint.
To do this, use pepper fruits extract, etc.Listed ointments usually cause a pleasant feeling of heat and patient comfort.They rarely give side effects.
Ointments based on non -steroidal anti -inflammatory substances are used in cases where the course of gonarthrosis is aggravated by synovitis.Unfortunately, they act not as effectively as we would like - because the skin passes no more than 5 to 7% of the active substance, and this is clearly not enough to develop a complete anti -inflammatory effect.
4. Funds for compresses:
Compresses have a slightly large therapeutic effect compared to the ointments.
Of the local funds used in our time, in my opinion, three medications deserve the greatest attention: Diexide, Bishófito and Medical Bile.
Dimexide- Chemical, liquid with colorless crystals, has a good anti -inflammatory and analgesic effect.At the same time, unlike many other external substances, diexide is really capable of penetrating skin barriers.That is, diexide applied to the skin is actually absorbed by the body and works within it, reducing inflammation in the focus of the disease.In addition, diexide has an absorbable property and improves metabolism in the application area, which makes it the most useful in the treatment of arthrosis, which occurs with the presence of synovitis.
Biss- Oil derivative, brine extracted during drilling oil wells.He gained his fame thanks to perforators, who were the first to pay attention to their therapeutic effect with arthrosis.While working in oil wells from constant contact with a broca oil brine, artroas' nodules occurred in their hands.In the future, it has been found that the Boseophyte has an anti -inflammatory and moderate analgesic effect, and also acts warmly, causing a pleasant feeling of warmth.
Medical billion- Natural bile extracted from bile bubbles of cows or pigs.Bile has an absorbable and heating effect and is used in the same cases as biskophy, but has some against -indications: it cannot be used for pustular skin diseases, inflammatory diseases of lymph nodes and ducts, feverish states with an increase in body temperature.
5. Intra -articular injections (joint injections):
Intra -articular injections are often used to provide emergency care for knee joint arthrosis.In many cases, intraarticular injection can actually relieve the patient's condition.But at the same time, articulation injections with arthrosis are made much more often than necessary.It's about this incorrect, in my opinion, trends, I want to talk in more detail.
Most of the time, corticosteroid hormones are introduced into the joint: Triacinone, betamethasone, hydrocortisone.
Corticosteroids are good, as they suppress pain and inflammation with synovitis (edema and swelling of the joint).It is the speed with which the therapeutic effect is achieved and that is why corticosteroid injections have gained particular popularity among doctors.
But this led to the fact that intra -articular hormone injections began to be performed even without real need.For example, I repeatedly faced the fact that hormones were introduced into the patient's joint for preventive purposes in order to prevent additional arthrosis development.
However, the problem is that only arthrosis itself is not treated and cannot be treated.Therefore, they cannot prevent the development of arthrosis!Corticosteroids do not improve the condition of joint cartilage, do not strengthen bone tissue and do not restore normal blood circulation.
Everything they can reduce the inflammatory reaction of body response to one or another damage to the joint cavity.Therefore, it makes no sense to use intra -articular hormonal drugs as an independent treatment method: they should be used only in complex arthrosis therapy.
For example, the patient detected stage II gonarthrosis with a swelling of the joint due to fluid accumulation.Liquid accumulation (synovitis) makes it difficult to conduct medical procedures: manual therapy, gymnastics, physiotherapy.In this situation, the doctor performs an intra -articular hormonal injection to eliminate synovitis and, in a week, begins with other active therapeutic measures - this is the correct approach.
Now imagine another situation.The patient also has stage II gonarthrosis, but without accumulation of fluid and joint edema.Is it necessary to enter the corticosteroids in the joint in this case?Of course, no.There is no inflammation - there is no "exposure point" for corticosteroid hormones.
But even if the intra -articular introduction of corticosteroids is really necessary, several rules must be observed.Firstly, it is undesirable to make these injections in the same joint more often than once in 2 weeks.The fact is that the drug introduced "will work" in full force immediately and the doctor may finally evaluate the effect of the procedure right after 10 to 14 days.
You also need to know that usually the first injection of corticosteroids brings more relief than subsequent ones.And if the first intra -articular administration of the drug does not give a result, it is unlikely to give the second or third introduction of the same medicine to the same place.In case of ineffectiveness of the first intra -articular injection, you need to change the medicine or if the change in medicine has not helped, more precisely, to choose the place of injection.
If, even after that, the introduction of a corticosteroid in the joint did not give the desired result, it is better to abandon the very idea of treating this articulation with hormonal medications.In addition, hormone injection in the same joint is greater than five to five times in general, it is extremely undesirable, differently, the likelihood of side effects has increased differently.
Unfortunately, in practice, you must face excessive "determination" of doctors who repeatedly introduce corticosteroids into the same joint without reaching at least the minimum effect with the first three injections.Two of these cases impressed me more than others.
One of the patients made "only" ten injections of a kenalog, while the procedure was performed daily, even without a ten -day interval required to evaluate the results of the injection.And the second patient was introduced into hormones within the knee joints, observing the interval (although only 3 to 5 days), but at the same time, the poor subject received twenty -five corticosteroid injections in a joint for the course of treatment!
It seems that the doctor "went too far" a little - okay.Can there be any damage to this treatment?It turns out that, maybe!
First, with each injection, the joint, though slightly, is injured by a needle.Secondly, with intra-articular injection, there is always a certain risk of joint infection.Third, the frequent introduction of hormones cause a violation of the joint joint structure and the surrounding muscles, causing "decadent" relative joints.
And most importantly, frequent corticosteroid injections worsen the condition of those patients in which joint damage is combined with diabetes mellitus, high blood pressure, obesity, renal failure, stomach or intestine ulcer, tuberculosis, purulent infections and mental diseases.Even introduced exclusively into the joint cavity, corticosteroids affect the whole body and can aggravate the course of these diseases.
It is much more useful to manage hyaluronic acid drugs in the knee joint affected by arthrosis (another name for hyaluronic acid hyaluronate - sodium hyaluronate).They appeared for sale about 15 years ago.
Hyaluronic acid preparations (sodium hyaluronate) are also called "liquid prostheses" or "liquid implants" as they act in the joint as a healthy synovial liquid - that is, as a natural "joint lubrication".
Hyaluronic acid preparations are very useful and effective drugs: sodium hyaluronate forms a damaged cartilage protective film, protecting the cartilage tissue from additional destruction and improving the sliding of contact cartilage surfaces.
In addition, hyaluronic acid preparations penetrate the depths of the cartilage, improving its elasticity and elasticity.Thanks to hyaluronidase, "dry" and thinning with arthrosis, the cartilage restores its absorbent properties of shock.As a result of the weakening of mechanical overload, sick knee joint pain decreases and its mobility increases.
At the same time, the joints administered correctly in the joint cavity, hyaluronic acid preparations are hardly effectively effects.
Treatment with hyaluronic acid preparations is performed in the courses: in total, 3-4 injections are required for the course of treatment in each painful knee, the interval between injections is usually 7 to 14 days.If necessary, the course is repeated in six months or one year.
From my point of view, the main and only serious disadvantage of hyaluronic acid drugs is its high price.Thus, in 2020, hyaluronic acid is represented in our market in the main import medicines.
But, returning to the issue of the economy, I want to note that, despite the relatively high cost of hyaluronic acid preparations, their use literally allowed many patients from those who before these medications would definitely have to be operated on.
And given the cost of the operation in the joints, it is found that the timely use of hyaluronic acid (even for several years) in any case and, in every way, costs the patient much cheaper than surgery for knee joint endoprotic.Obviously, provided that the doctor who conducts such injections has the introduction technique.
It is important to know: Hyaluronic acid preparations are instantly destroyed in the joint in which the pronounced inflammatory processes are underway.Therefore, it is virtually useless to present them to patients in which gonarthrosis continues against the antecedents of the active internship of arthritis.But it is useful to use them with persistent remission of arthritis to treat secondary gonarthrosis phenomena.
With primary gonarthrosis, you also need to pay attention to these moments.For example, if the patient's joint "explosions" from the accumulation of excess pathological fluid makes sense to "extinguish" the phenomena of synovitis (inflammation) and remove excessive pathological fluid with the help of an anterior intra -inflammatory injection.And only then to introduce hyaluronic acid into the joint, released from inflammatory elements.
In addition to corticosteroid hormones and hyaluronic acid preparations, attempts to introduce various chondoprotectors into the joint.
But these medications are often inferior in efficacy of hyaluronic acid medications.They help with the force of 50% to patients and guess if the effect of their use is not impossible in advance.In addition, the course of treatment requires 5 to 20 injections in the joint, which, as we said, is full of possible joint injuries and various complications.
6. Manual therapy and physiotherapy:
Manual therapy for stage gonarthrosis I and II usually gives a great result.Sometimes several procedures are sufficient for the patient to feel significant relief.Particularly the manual random joint therapy, if you combine it with the joint extension, the intake of condoprotectors and intraarticular injections of the point.
This combination of therapeutic procedures, from my point of view, is much more effective than the numerous physiotherapeutic measures proposed in any clinic.I will give an example of the practice.
The case of the practice of the doctor.
A 47 -year -old woman with arthrosis of the right knee articulation of stage II arrived at the reception.At the time of our meeting, she had been sick for 5 years.Over the years, women have been able to experience all possible methods of physiotherapy that can be proposed in our district clinics: laser, magnetotherapy, ultra -som, phonophoresis etc.Despite all the efforts of physical therapists, only once, the condition of the patient continued to deteriorate, and this is only that the woman, who was only named, which is only that the patient, what was named, what is what is what is what is what is what is what is what is what is what is what is what is what is what is what is what is what is what is what is what is what is what is what is what is what is what is what is whatwhich is what is what is what is what is what is what is what is what is what is what is what is what is what is what is what is what is what is what is what is reaping.Once a woman was named.Short short.
Completely desperate, the woman decided extreme measures - she underwent a course of treatment with worm wood cagarers, according to the oriental methodology.As a result, the knee was covered with Burns scars, but it didn't move better.Yes, and it was unlikely that I could, despite all my respect for oriental medicine, I understand that the cauterization of worm wood cannot eliminate bone deformations and increase the distance between knee articulated bones.
After the woman did not help numerous physiotherapeutic procedures and even cauterization in wood cigarettes, she practically almost agreed to surgical treatment.But then she still changed her mind and decided to try the complex method she proposed.
The first treatment session was approved, as is said to be, "with a corral" - we only managed to "awaken" the joining with the help of manual mobilization a little.Therefore, we scheduled the next session after preliminary preparation: Within three weeks, the woman took a chondoprotector, did self -mass and compress with diexide.After three weeks, I started again with the mobilization of the joint and then made a repositioned ("reduction") of the joint using manual manipulation.There was a click and suddenly the board began to move much easier and freer.The woman felt a clear relief.
In the next two sessions using mobilization, we set the improvement achieved, after which we set the success of two intra -articular injections of the point.And after a month and a half of the beginning of our not very intense treatment (after all, we needed only six meetings), the woman finally managed to discard the wand she had bored with her and began to move freely.
Two years have passed since then.Twice a year, the patient takes chondroprotectors in a short course and occasionally comes to my control technique, where I am happy to observe that the knee condition is only better from year to year.And now, even the first stage of arthrosis would be very difficult to assume - the patient's knee articulation was almost completely restored.
Thus, only six treatment sessions (manual therapy plus Orenil intra -surveillance injections) in combination with the course of chondroprotectors were more effective than five years of physiotherapy.
From this story (and by no means the only way), it is clear because I consider physiotherapy as important, but only an additional part of the gonarthrosis medical program.In this sense, I like laser therapy, heat treatment (ozockeita, paraffin therapy, therapeutic mud) and especially cryotherapy (local cooling treatment).
7. Diet:
Diet with arthrosis is also very important.
8. Using sugarcane:
Based on the rod when walking, patients with knee joint arthrosis seriously help their treatment, as the stick takes 30 to 40% of the load for joint.
It is important to choose a stick according to your height.To do this, get straight, lower your hands and measure the distance from the wrist (but not the fingertips!) On the floor.It is a length that there must be a cane.When buying a wand, pay attention to the end - it must be equipped with a rubber nozzle.Such a stick is amortized and does not slip when they rest in it.
Remember that if your left leg hurts, the stick should be kept in the right hand and vice -versa.Step to the patient with one foot, transfer part of the body weight to a twig.
9. Therapeutic Gymnastics:
The most important treatment for knee joint arthrosis is special therapeutic gymnastics.Almost no person with gonarthrosis can achieve real improvement in the state without therapeutic gymnastics.
After all, it is impossible to strengthen the muscles, “pump” blood vessels and activate blood flow as much as this can be achieved using special exercises.
At the same time, the doctor's gymnastics is almost the only method of treatment that does not require financial costs for the purchase of equipment or medicines.All the patient needs is two square meters of free space in the living room and a carpet or blanket thrown on the floor.
There is nothing more to consult a gym specialist and the patient's own desire to do this gymnastics.It is true that, only with this desire, most patients do not burn.Almost every patient, in whom I reveal arthrosis, I have to literally persuade physical therapy exercises.And it is more often possible to convince a person only when it comes to the inevitability of surgical intervention.
The second "gymnastic" problem is that even patients configured for physical therapy exercises cannot usually find the necessary exercise sets.Obviously, there are brochures for patients with arthrosis for sale, but the competence of several authors is doubtful - after all, some of them have no medical education.
Therefore, these "teachers" do not always understand the meaning of individual exercises and the mechanism of their action in the painful joints.Often the gymnastics complexes simply correspond without thinking from one brochure to another.At the same time, there are recommendations in them that it is fair to grab your head!
For example, many brochures prescribe the patient with knee joint arthrosis "to perform at least 100 squats a day and walk as much as possible."
Often patients follow this advice, without previously consulted a doctor and then sincerely perplexed because they got worse.Well, I will try to explain why the condition of the sick joints of such exercises, as a rule, only worsens.
Let's imagine the articulation as a bearing.Damaged by arthrosis, the painful joint has already lost its ideal form.The surface of the "bearing" (or cartilage) is no longer smooth.In addition, cracks, holes and "burrs" appeared in it.In addition, lubrication within the sphere thickened and dry, clearly not enough.