Treatment of knee joint osteoarthritis, gonarrosis treatment- To put it gently, not the easiest task.Therefore, before starting your hard fight with this disease, be sure to find a good doctor, examine it and do a treatment plan with it.
In any case, do not try to establish a diagnosis for you!
The fact is that the injuries of the articulation, which resemble the arthare, occur with many other diseases, and the people present present are often wrong in determining the diagnosis.It is better not to save time and money for medical consultation, because the error can cost you much more expensive in all aspects.
But this does not mean that he should blindly believe any doctor and that he should not deepen the essence of his recommendations, understanding the mechanism of action of drugs that are prescribed.The patient must understand the meaning of medical recipes and represent why certain therapeutic procedures are carried out.
Then, with the therapeutic treatment of gonarrosis, it is important to combine a series of therapeutic measures in such a way that it solves several problems at the same time:
- eliminate pain;
- improve the nutrition of articular cartilage and accelerate its restoration;
- activate blood circulation in the affected joint;
- reduce the pressure on the damaged joints of the bones and increase the distance between them;
- Strengthen the muscles surrounding the sick joint;
- Increase joint mobility.
Next we will consider how this or that method of treatment helps to achieve its objectives:
1. Non -steroid anti -inflammatory drugs:
Non -steroidal anti -inflammatory drugs -Aine: Diclofenaco, Piroxycs, Cetoprofen, Indomethacin, Buadio, Meloxicam, Healing, Nimulida and its derivatives.
With osteoarthritis, non -hormonal anti -inflammatory medications are traditionally used to eliminate pain and inflammation of the joint, since in the context of severe pain it is impossible to begin normal treatment.Just eliminating acute pain with anti -inflammatory drugs, then it can go, for example, to massage, gymnastics and those physiotherapeutic procedures that would be intolerable due to pain.
However, it is not desirable to use drugs from this group for a long time, since they can "mask" the manifestations of the disease.
After all, when the pain decreases, a misleading impression is created that a cure began.Meanwhile, osteoarthritis continues to progress: NSAIDs only eliminate individual symptoms of the disease, but do not treat it.
In addition, in recent years, data that indicate the harmful effects of prolonged use of non -steroidal anti -inflammatory drugs in the synthesis of proteoglycans have been obtained.Proteoglycan molecules are responsible for the flow of water in the cartilage, and a violation of its function leads to the dehydration of cartilage tissue.As a result, cartilage already affected by osteoarthritis begins to collapse even faster.Therefore, the pills that the patient takes to reduce the pain in the joint can accelerate the destruction of this joint.
In addition, the use of non -steroidal anti -inflammatory drugs should be remembered that everyone has serious contraindications and with prolonged use can give significant side effects.
2. Condroprotectors - glucosamine and chondroitin sulfate:
Condroprotectors: glucosamine and chondroitin sulfate - These 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 osteoarthritis.
Unlike non -steroid anti -inflammatory drugs (NSAIDs), condoprotectors do not eliminate the symptoms of osteoarthritis as well as the "base" of the disease: the use of glucosamine and chondroitin sulfate helps restore cartilage surfaces from the hip joint, improve the production of the joint liquid and normalize its "lubricant" properties.
A similar complex effect of condoprotectors in the joint makes them indispensable in the treatment of the initial stage of osteoarthritis.However, there is no need to exaggerate these drugs.
Condroprotectors are not very effective in the third stage of osteoarthritis, when the cartilage is almost completely destroyed.After all, it is impossible to cultivate a new cartilaginous fabric or return the previous shape to the deformed bones of the knee with glucosamine and chondroitin sulfate.
And in the first or second stages of gonarrosis, the condoprotectors act very slowly and improve the patient's condition at the same time.To obtain a real result, you must submit to at least 2-3 courses of treatment with these drugs, which usually has been six months and a half.
3. Ointments and therapeutic creams:
Therapeutic ointments and creams can in no way cure the osteoarthritis of the knee joints (even if their advertising approves otherwise).However, they can relieve the patient's condition and reduce pain in a painful knee.And in this sense, ointments are sometimes very useful.
Then, with the osteoarthritis of the knee joint that occurs without synovitis without phenomena, I recommend heating ointments to my patients to improve blood circulation in the joint.
To do this, use pepper fruit extract, etc.Listing ointments generally cause a feeling of pleasant heat and comfort in the patient.They rarely give side effects.
Ointments based on non -steroidal anti -inflammatory substances are used in cases where the course of gonarrosis is aggravated by synovitis.Unfortunately, they act not as effectively as we would like, because the skin does not pass more than 5 to 7% of the active substance, and this is not enough to develop a complete anti -inflammatory effect.
4. Funds for compresses:
Compresses have a slightly large therapeutic effect compared to ointments.
Of the local funds used in our time, in my opinion, three drugs deserve the greatest attention: tellxide, bishophytus and medical bony.
Tellxide- The chemical, liquid with colorless crystals, has a good anti -inflammatory and analgesic effect.At the same time, unlike many other external substances, the tellxide is really able to penetrate the barriers of the skin.That is, the body of the skin applied to the diméjido applied to the skin is really absorbed by the body and works inside, reducing inflammation in the disease approach.In addition, the diméxide has an absorbable property and improves metabolism in the area of application, which makes it more useful in the treatment of osteoarthritis, which occurs with the presence of synovitis.
Bishophyte- Oil derivative, brine extracted during oil well drilling.He obtained his fame thanks to the perforators, who were the first to pay attention to their therapeutic effect with osteoarthritis.While working in oil wells from constant contact with a drill oil brine, arthose nodules were produced in their hands.In the future, it turned out that Bishophyte has a moderate anti -inflammatory and analgesic effect, and also acts hot, causing a pleasant heat feeling.
Medical Bile- Natural bile extracted from bile biles of cows or pigs.Bile has an absorbable and heating effect and is used in the same cases as Biscophia, but has some contraindications: it cannot be used for pustular skin diseases, inflammatory diseases of lymph nodes and ducts, febrile states with an increase in body temperature.
5. Intra -articular injections (joint injections):
Intra -articular injections are often used to provide emergency care to the osteoarthritis of the knee joint.In many cases, intra -articular injection can really relieve the patient's condition.But at the same time, articulation injections with osteoarthritis are performed much more frequently than necessary.This is incorrect, in my opinion, trends, I want to speak in more detail.
Most of the time, the drugs of corticosteroid hormones are introduced into the joint: triamcinone, betamethasone, hydrocortisone.
Corticosteroids are good because they quickly and effectively suppress pain and inflammation with synovitis (edema and swelling of the joint).It is the speed with which the therapeutic effect is achieved that is the reason why corticosteroid injections have gained particular popularity among doctors.
But this led to the fact that intra -articular hormones injections began to be carried out even without real need.For example, I have repeatedly faced the fact that hormones were introduced into the patient's articulation with a preventive purpose to prevent additional development of osteoarthritis.
However, the problem is that only osteoarthritis itself are not treated and cannot be treated.So, they cannot prevent the development of osteoarthritis!Corticosteroids do not improve the condition of the joint cartilage, do not strengthen bone tissue and does not restore normal blood circulation.
Everything that can reduce the inflammatory reaction of the body's response to one or another damage to the joint cavity.Therefore, it makes no sense to use intra -articular injections of hormonal drugs as an independent treatment method: they should be used only in complex osteoarthritis therapy.
For example, the patient detected gonarrosis of stage II with a swelling of the joint due to the accumulation of fluid.The accumulation of liquid (synovitis) makes it difficult to perform medical procedures: manual therapy, gymnastics, physiotherapy.In this situation, the doctor performs an intra -articular injection of the hormonal drug to eliminate synovitis, and in a week it begins other active therapeutic measures: this is the correct approach.
Now imagine another situation.The patient also has stadium II gonarrosis, but without accumulation of liquid edema and articulation.Is it necessary to enter 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, a series of rules must be observed.In the first place, it is not desirable to make such injections in the same articulation more frequently 1 time in 2 weeks.The fact is that the medicine introduced "will work" in full validity and the doctor may finally evaluate the effect of the procedure just after 10 to 14 days.
You should also know that generally the first injection of corticosteroids brings more relief than later.And if the first intra -articular administration of the medicine did not give a result, it is unlikely to give it the second or third introduction of the same medication to the same place.In case of ineffectiveness of the first intra -articular injection, you must change the medication, or if the change of medicine has not helped, more accurately, to choose the injection site.
If even after that, the introduction of a corticosteroid in the articulation did not give the desired result, it is better to abandon the very idea of treating this joint with hormonal drugs.In addition, the injection of hormones in the same joint is more than four or five times in general, it is extremely undesirable differently, the probability of side effects increases differently.
Unfortunately, in practice, it must face the excessive "determination" of doctors who, again and again, introduce corticosteroids into the same articulation, without at least achieve the minimum effect with the first three injections.Two of these cases surprised me more than others.
One of the patients made "only" ten injections of a Kenalog, while the procedure was carried out daily, even without a ten -day break needed to evaluate the injection results.And the second patient was introduced into hormones into the knee joints, observing the interval (although only 3 to 5 days), but at the same time, the poor partner received twenty -seven to twenty -five corticosteroid injections in a joint for the course of treatment.
It seems that the doctor "went too far" a little, that's fine.Can there be any damage for such treatment?It turns out, maybe!
First, with each injection, the joint, although slightly, is injured by a needle.Secondly, with intra -articular injection, there is always a certain risk of articulation infection.Third, the introduction of frequent hormones causes a violation of the structure of the joints of the joint and the surrounding muscles, which causes relative articulations of "decomposition".
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.It was even introduced exclusively into joint cavity, corticosteroids affect the entire body and can aggravate 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.
Hyaluronic acid preparations (sodium hyaluronate) are also called "liquid prosthesis" or "liquid implants", since they act on the joint as a healthy synovial fluid, that is, as a natural "joint lubrication."
Hyaluronic acid preparations are very useful and effective medications: sodium hyaluronate forms a protective film on damaged cartilage, protecting the cartilage tissue from greater destruction and improves the sliding of the contact cartilage surfaces.
In addition, hyaluronic acid preparations penetrate the depths of the cartilage, improving their elasticity and elasticity.Thanks to the hyaluronidase, "drying" and thinned with osteoarthritis, the cartilage restores its shock absorption properties.As a result of the weakening of mechanical overload, pain in the sick knee joint decreases and its mobility increases.
At the same time, joints administered correctly in joint cavity, hyaluronic acid preparations practically do not give side effects.
The treatment with hyaluronic acid preparations is carried out in the courses: in total, 3-4 injections are required for the course of treatment in each sore knee, the interval between the 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 inconvenience of hyaluronic acid medications is its high price.Then, in 2020, hyaluronic acid is represented in our market in the main import medications.
But returning to the issue of savings, I want to keep in mind that, despite the relatively high cost of hyaluronic acid preparations, their use literally allowed many patients to before, before these medications, it would definitely have to operate.
And given the cost of the joint operation, it turns out that the timely use of hyaluronic acid (even for several years) in any case and, in every way, the patient is much cheaper than the endoprothetic surgery of the knee joint.Of course, provided that the doctor who performs such injections possesses the introduction technique.
It is important to know: hyaluronic acid preparations are instantly destroyed in that joint in which pronounced inflammatory processes are underway.Therefore, it is practically useless to present to those patients in which gonarrosis proceeds in the context of the active stage of arthritis.But it is useful to use them with persistent remission of arthritis to treat secondary gonarrosis phenomena.
With primary gonarrosis, you should also pay attention to such moments.For example, if the patient's articulation is "exploited" by the accumulation of excess pathological fluid, it makes sense to "extinguish" first the phenomena of synovitis (inflammation) and eliminate excessive pathological liquid with the help of an intra -articular intra -articular injection preceding or take anti -non -steroidal inflammatory drugs.And only then to introduce hyaluronic acid in the joint, released from inflammatory elements.
In addition to corticosteroid hormones and hyaluronic acid preparations, try to introduce several condroprotectors in the joint.
But these medications are often in effectiveness of the effectiveness of hyaluronic acid medications.They help 50% force to patients, and guess whether the effect of their use or is not impossible in advance.In addition, the treatment course requires 5 to 20 injections in the joint, which, as we said, is full of possible articulation injuries and several complications.
6. Manual therapy and physiotherapy:
Manual therapy for gonarrosis of stage I and II often gives a great result.Sometimes several procedures are enough for the patient to feel significant relief.Particularly well, manual therapy of random joints helps, if it combines it with joint extension, the intra -articular conjunction of the point.
Such a 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 doctor's practice.
A 47 -year -old woman with osteoarthritis of the right knee joint of stage II reached the reception.At the time of our meeting, she had been sick for 5 years.Over The Years, The Woman Managed to Experience All Possible Methods of Physiotherapy that can be proposed in Our District Clinics: Laser, Magnetotherapy, Ultrasound, Phonophoresis, etc.Even there the efforts of Physiotherapists, The Patient's Condition of the Patient Continued to deteriorate - and This is natural, since, Let's Say, Chondroprotectors wereappointed.Short course.
Completely desperate, the woman decided on extreme measures: she underwent a treatment with caulstering adjustment cigarettes according to the eastern methodology.As a result, the knee was covered with scars of Burns, but did not move better.Yes, and it was unlikely that, despite all my respect for oriental medicine, I understand that the cauterization of the alien cannot eliminate bone deformations and increase the distance between the bones articulated in the knee.
After the woman did not help the numerous physiotherapeutic procedures and even cauterization in adjustment cigarettes, she almost almost accepted surgical treatment.But then she still changed her mind and decided to try the complex method I proposed.
The first treatment session passed, as they say, "with a crunch": we "awaken" the articulation with the help of manual mobilization a bit.Therefore, we scheduled the next session after the preliminary preparation: within 3 weeks, the woman took condoprotectors, performed the self -awareness and will be compressed with diméxide.After 3 weeks, I started again with the mobilization of the joint, and then made a replacement ("reduction") of the joint using manual manipulation.There was a click and suddenly the joint began to move much easier and faster.The woman felt a clear relief.
In the following two sessions using the mobilization, we solve the improvement achieved, after which we solve the success of two intra -articular injections of the point.And after a month and a half since the beginning of our not very intense treatment (after all, we only needed six meetings), the woman could finally rule out the wand that had been bored and began to move with enough library.
Two years have passed since then.Twice a year, the patient takes condroprotectors in a short course, and occasionally reaches my control technique, where I am pleased to note that the knee condition 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 was almost completely restored.
Therefore, only six treatment sessions (Manual therapy plus Orenilo Intra -Surveillance) in combination with the course of condoprotectors were more effective than five years of physiotherapy.
From this story (and in no way the only one like that) is clear why I consider that physiotherapy is important, but only an additional part of the medical program for gonarrosis.In this sense, I like laser therapy, thermal treatment (ozokerita, paraffin therapy, therapeutic mud) and especially cryotherapy (treatment with local cooling).
7. Diet:
The diet with osteoarthritis is also very important.
8. Using the cane:
Based on the stick when walking, patients with osteoarthritis of the knee joints seriously help their treatment, since the stick acquires 30 - 40% of the load destined for the joint.
It is important to choose a stick according to its height.To do this, stop straight, lower your hands and measure the distance from the wrist (but not from the fingertips!) To the floor.It is so length that there must be a cane.When buying a wand, pay attention to its purpose: it must be equipped with a rubber mouthpiece.Such a stick is amortized and does not slide when they rest on it.
Remember that if your left leg hurts, then the stick must be sustained in your right hand, and vice versa.Taking a step through the patient with one foot, transfer part of the body weight to a stick.
9. Therapeutic gymnastics:
The most important treatment for the osteoarthritis of the knee joints is special therapeutic gymnastics.Almost no person who has gonarrosis can achieve a 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 it can be achieved using special exercises.
At the same time, 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 room and a carpet or blanket thrown to the floor.
There is nothing to consult a specialist in gymnastics and the patient's desire to do this gymnastics.It is true, just with such desire, most patients do not burn.Almost all patients, in which they reveal osteoarthritis, have to literally persuade physiotherapy exercises.And it is often possible to convince a person only when it comes to the inevitability of surgical intervention.
The second "gymnastic" problem is that even those patients configured for physiotherapy exercises often cannot find the necessary exercise sets.Of course, there are brochures for patients with osteoarthritis for sale, but the competition of several authors is doubtful;After all, some of them have no medical education.
So, such "teachers" do not always understand the meaning of individual exercises and the mechanism of their action in the painful joints.Often, the gymnastic complexes simply correspond synonic from one brochure to another.At the same time, there are such recommendations in them that it is correct to grab their head.
For example, many brochures recipe the patient with osteoarthritis of the knee joints "to carry out at least 100 squats per day and walk as much as possible."
Often, patients continue this advice, without being previously consulted with a doctor, and then sincerely perplexed why they worsened.Well, I will try to explain why the condition of the sick joints of such exercises, as a rule, only worsens.
Imagine the joint as a bearing.Damaged by osteoarthritis, the sore joint has already lost its ideal shape.The surface of the "bearing" (or cartilage) ceased to be smooth.In addition, cracks, potholes and "burrs" appeared.In addition, lubrication within the thickened and dry sphere has not been enough.