Treatment of the osteoarthritis of the knee joints, treatment of gonarthrosis- To express it easily, not the easiest task.Before you start your hard struggle with this disease, you should definitely find a good doctor, examine it and create a treatment plan with it.
In no way do not try to make a diagnosis for yourself!
The fact is that the lesions of the joint that resemble osteoarthritis occur in many other diseases and people with low importance are very often confused when determining the diagnosis.It is better not to save time and money for medical advice, since the error can cost you much more expensive in any respect.
However, this does not mean that you have to blindly believe in a doctor and that you should not immerse yourself in the essence of his recommendations in order to understand the mechanism of action of these medication that are prescribed.The patient should understand and represent the importance of medical regulations why certain therapeutic methods are carried out.
With the therapeutic treatment of gonar rose, it is important to combine a number of therapeutic measures in such a way that several problems are solved at the same time:
- Eliminate pain;
- Improvement of the nutrition of the articular cartilage and accelerate the restoration;
- Activate circuit in the affected joint;
- Reduce the pressure on damaged bone compounds and increase the distance between you;
- Strengthen the muscles that surround the hospital;
- Increase mutual mobility.
In the following we will consider how this or this treatment method helps to achieve your goals:
1. Non -steroidal anti -inflammatory medication:
Non -steroid anti -inflammatory drugs: diclofenac, pyroxycs, ketoprofen, indomethacin, butdadion, meloxicam, healing, nimulid and their derivatives.
Osteoarthritis traditionally uses hormonal, anti -inflammatory drugs to eliminate the pain and inflammation of the joint, as it is impossible to start normal treatment against the background.Only by eliminating acute pain with anti -inflammatory drugs can you, for example, be unbearable for massage, gymnastics and those physiotherapeutic methods that are unbearable due to pain.
However, it is undesirable to use medication in this group for a long time because they are able to "mask" the manifestations of the disease.
When the pain decreases, a deceptive impression is finally created that healing began.In the meantime, arthrosis continues: NSAIDS eliminate individual symptoms of the disease, but do not treat them.
In addition, data has been obtained in recent years that indicate the harmful effects of a longer use of non -steroidal anti -inflammatory medication to the synthesis of prototoglycans.Proteoglycan molecules are responsible for the water flow in the cartilage, and a violation of your function leads to dehydration of cartilage tissue.As a result, the cartilage, which is already affected by osteoarthritis, begins 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, it must be remembered that all of non -steroidal anti -inflammatory drugs with serious contraindications can have serious side effects.
2. Chondroprotectors - glucosamine and chondroitin sulfate:
Chondroprotectors - glucosamine and chondroitin sulfate - these are substances that feed cartilage tissue and restore the structure of the damaged cartilage of the joints.
Chondroprotectors are the most useful group of medication for the treatment of osteoarthritis.
In contrast to non -steroidal anti -inflammatory drugs (NSAIDS), chondroprotectors do not eliminate the arthrosis symptoms as much as the "basis" of the disease: the use of glucosamine and chondroitine sulfate helps to restore the cereal surfaces of the hip joint, to produce the production of articular fluid and normalize.
A similar complex effect of chondroprotectors on the joint makes it indispensable in the treatment of the initial stage of osteoarthritis.However, there is no need to overdo these medication.
Chondroprotectors are not very effective in the third stage of osteoarthritis if the cartilage is almost completely destroyed.After all, it is impossible to breed a new cartilage or to return the former form with glucosamine and chondroitin sulfate to the knees of the knee.
And in the first or second stage of gonar rose, chondroprotectors look very slow and immediately improve the patient's condition.To achieve a real result, you have to undergo at least 2-3 treatment courses with these medication, which normally last from six months to one and a half years.
3 .. Therapeutic ointments and creams:
Therapeutic ointments and creams cannot in any way cure the osteoarthritis of the knee joints (even if their advertising agrees the opposite).Nevertheless, you can relieve the patient's condition and reduce the pain in a painful knee.And in this sense, ointments are sometimes very useful.
With the osteoarthritis of the knee joint, which occurs without synovitis without a phenomenon, I recommend my patients to heat ointments to improve blood circulation in the joint.
To do this, use pepper fruits, etc. The listed ointments usually cause a feeling of pleasant heat and comfort in the patient.They rarely give side effects.
Ointments are based on non -steroidal inflammatory substances in which the course of gonarthrosis is worsened by synovitis.Unfortunately, they do not look as effective as we want - because the skin does not pass more than 5 to 7% of the active substance, and this is clearly not enough to develop a complete anti -inflammatory effect.
4. Fund for compresses:
Compresses have a slightly large therapeutic effect compared to ointments.
In my opinion, three medication deserves the greatest attention of the local funds used in our time: dimexid, bishophytus and medical bile.
Dimexid- Chemical substance, liquid with colorless crystals, has a good anti -inflammatory and analgesic effect.At the same time, Dimexid can penetrate the skin barriers in contrast to many other external substances.This means that the dimexide used on the skin is really absorbed by the body and works in it, which reduces the inflammation in the focus of the disease.In addition, Dimexid has an absorbable property and improves the metabolism in the area of application, which makes it most useful when treating osteoarthritis that occur with synovitis.
Bishophytes- Oil derivative, salt solution extracted when drilling oil drilling.Thanks to the drills, he achieved his fame, which was the first to pay attention to his therapeutic effect with osteoarthritis.While they worked on oil drilling from constant contact with a salsal salt solution from the drill, arthrosis cubes occurred on their hands.In the future it turned out that bishophytes have a moderate anti -inflammatory and analgesic effect and also has a warm effect, which leads to a feeling of pleasant heat.
Medical bile- Natural bile broken down from the gallbladder of cows or pigs.The bile has an absorbable and warming effect and is used in the same cases as bishophyt, but has some contraindications: it cannot be used for pustular diseases of the skin, inflammatory diseases of the lymph nodes and channels, feverish conditions with an increase in body temperature.
5. Injections (injections in the joint):
Injections are often used to supply the knee joint emergency.In many cases, the intra -karticular injection can really relieve the patient's condition.At the same time, osteoarthritis injections are made much more often than necessary.It's about this wrong opinion, in my opinion I would like to speak in more detail.
In most cases, medication of corticosteroid hormones are inserted into the joint: triamcinone, betamethasone, hydrocortisone.
Corticosteroids are good in that they suppress pain and inflammation with synovitis (edema and swelling of the joint) quickly and effectively.It is the speed at which the therapeutic effect is achieved, which is the reason why corticosteroid injections have achieved a special popularity among doctors.
However, this meant that intra -karticular injections of hormones were carried out without real need.For example, I repeatedly confronted the fact that hormones were introduced to the patient's joint for a preventive purpose in order to prevent the further development of osteoarthritis.
The problem, however, is that only the arthrosis even corticosteroids are not treated and cannot be treated.So you cannot prevent the development of osteoarthritis!Corticosteroids do not improve the condition of the articular cartilage, do not strengthen the bone tissue and do not restore the normal bloodstream.
Everything you can reduce the inflammatory reaction of the body to one or the other damage to the joint cavity.Therefore, it is pointless to use intra -karticular injections of hormonal drugs as an independent treatment method: they should only be used in the complex therapy of osteoarthritis.
For example, the patient recognized the gonart rose of the II stage with a swelling of the joint due to the accumulation of fluid in it.The accumulation of liquid (synovitis) makes it difficult to carry out medical interventions: manual therapy, gymnastics, physiotherapy.In such a situation, the doctor carries out an intra -karticular injection of the hormonal drug to eliminate synovitis and begins in a week to other active therapeutic measures - this is the correct approach.
Now imagine another situation.The patient also has gonar rose in stage II, but without the accumulation of fluid and jointed edema.In this case, is it necessary to enter corticosteroids into the joint?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 number of rules must be observed.First, it is undesirable to make such injections in the same joint more than once in 2 weeks.The fact is that the introduced medicine immediately “works” in full power and the doctor will be able to finally evaluate the effects of the procedure shortly after 10 to 14 days.
You also need to know that the first injection of corticosteroids usually brings more relief than the following.And if the first Intra -Karticular administration of the drug has not achieved any result, it is unlikely that it will give the second or third introduction of the same medicine to the same place.In the event of an ineffectiveness of the first INTRA carticular injection, you either have to change the drug or if the change of drug has not helped, select the injection site in more detail.
Even if the introduction of a corticosteroid into the joint did not achieve the desired result, it is better to give up the idea of treating this joint with hormonal medication.In addition, the injection of hormones in the same joint is more than four to five times in general, and it is extremely undesirable differently different, the likelihood of side effects.
Unfortunately, in practice you have to be exposed to an excessive “determination” of doctors who repeatedly insert corticosteroids into the same joint without achieving the minimum effect with the first three injections.Two such cases hit me more than others.
One of the patients only "made" ten injections of a kenalog "only", while the procedure was carried out daily, even without a ten -day break that was necessary to evaluate the results of the injection.And the second patient was introduced into the hormones within the knee joints and observed the interval (although only 3 to 5 days), but at the same time the poor guy received twenty to twenty five injections of corticosteroids in one joint in one joint!
It seems that the doctor "went a little too far" - it's okay.Can it harm such treatment?It may turn out!
First, the joint is injured by a needle at every injection, albeit slightly.Second, there is always a certain risk of infection in the joint in the event of intra -articular injection.Thirdly, frequent hormones provoke a violation of the structure of the joints of the joint and the surrounding muscles, which leads to relative "falling" joints.
Above all, frequent injections of corticosteroids deteriorate the condition of the patients in which joint damage with diabetes mellitus, high blood pressure, obesity, kidney failure, stomach ulcers or intestines, tuberculosis, atryry infections and mental illnesses are combined.Even inserted exclusively into the articular cavity, corticosteroids influence the entire body and can worsen the course of these diseases.
It is much useful to give hyaluronic acid medicines in the knee joint affected by osteoarthritis (another name for hyaluronic acid - sodium hyaluronate).They appeared for sale about 15 years ago.
Hyaluronic acid preparations (sodium hyaluronate) are also referred to as "liquid prostheses" or "liquid implants" because they act as a healthy synovial fluid on the joint - ie as natural "joint lubrication".
Hyaluronic acid preparations are very useful and effective medication: sodium hyaluronate forms a protective film on the damaged cartilage, which protects the cartilage tissue from further destruction and improving the gliding of the contact cartilage surfaces.
In addition, hyaluronic acid preparations penetrate the depths of the cartilage and improve their elasticity and elasticity.Thanks to hyaluronidase, "dried" and with arthrosis, which is thinned out with arthrosis, the cartilage restores its shock -absorbing properties.As a result of the weakening of the mechanical overload, the pain in the sick knee joint decreases and its mobility increases.
At the same time, the joints that are correctly administered in the articular cavity and hyaluronic acid preparations have practically no side effects.
Treatment with hyaluronic acid preparations takes place in courses: a total of 3-4 injections are required for the treatment of treatment in any painful knee, the interval between injections is usually between 7 and 14 days.If necessary, the course will be repeated in six months or one year.
In my view, the main and only serious disadvantage of hyaluronic acid medication is your high price.In 2020, hyaluronic acid will be represented in our market in our market.
However, when I returned to the topic of savings, I would like to find that, despite the relatively high costs for hyaluronic acid preparations, their use literally many patients from those who have to be operated before these medication.
In view of the costs of the company at the joints, it turns out that the timely use of hyaluronic acid (even several years) costs the patient much cheaper in any case and in every respect than the operation for endoprosthetics of the knee joint.Provided that the doctor who carries out such injections has the introduction technology.
It is important to know: hyaluronic acid preparations are immediately destroyed in the joint, in which pronounced inflammatory processes are underway.It is therefore practically useless to present them to the patient in whom the gonarthrosis acts against the background of the active stage of arthritis.However, it is useful to use them with persistent arthritis remission to treat phenomena of secondary gonarthrosis.
With primary gonarthrosis, you also have to pay attention to such moments.If, for example, the patient's joint "falls" from the accumulation of excess, pathological fluids, it makes sense to "delete" the phenomena of synovitis first and to remove the excessive pathological liquid with the help of a previous intra -cartigular injection of hormones or not to enter into -styles.And only then freed from inflammatory elements to insert hyaluronic acid into the joint.
In addition to corticosteroid hormones and hyaluronic acid preparations, an attempt is made to introduce various chondroprotectors into the joint.
However, these drugs are many times in relation to the effectiveness of hyaluronic acid medicines.They help from 50% to patients and advise you whether the effect of your use is impossible in advance.In addition, the course of treatment requires 5 to 20 injections in the joint, which, as we said, are affected with possible injuries to the joint and various complications.
6. Manual therapy and physiotherapy:
Manual therapy for the gonart rose of the I and II stage often provides a big result.Sometimes several procedures are sufficient so that the patient feels considerable relief.Particularly good manual manual therapy of random joints helps if you combine them with the joint extension, the absorption of chondroprotectors and intra -articular injections of the point.
Such a combination of therapeutic interventions from my point of view is much more effective than the numerous physiotherapeutic measures proposed in every clinic.I will give an example from practice.
The case from the doctor's practice.
A 47 -year -old woman with osteoarthritis of the right knee joint of the II level came to the reception.At the time of our meeting, she has been sick for 5 years.Over the years, the woman has managed to experience all possible methods of physiotherapy that can be proposed in our district clinics: laser, magnetic therapy, ultrasound, phonophoresis, etc. Despite all the efforts of physiotherapists, the patient's patient's patient continued - only once, only once, only once.Once, just a woman.was appointed.short course.
The woman chose extreme measures completely -she was treated with chewy wormwood cigarettes in accordance with the Oriental methodology.As a result, the knee was covered with scars from burns, but it didn't move better.Yes, and it was unlikely that despite all my respect for Eastern Medicine, I would understand that Wörholzkauterization could not eliminate any bone deformations and increase the distance between the bones articulated in the knee.
After the woman had not helped the numerous physiotherapeutic processes and even cauterization in wormwood cigarettes, she practically almost agreed to treat surgical treatment.But then she still changed my opinion and decided to try the complex method that I had suggested.
The first treatment meeting, as you say, passed "with a creak" - we managed to "stir up" the joint only with the help of manual mobilization.Therefore, we planned the next meeting after the preliminary preparation: Within 3 weeks, the wife took chondroprotectors, made self -massage and compressed with dimexid.After 3 weeks I started mobilizing the joint again and then made a reputation ("reduction") of the joint using manual manipulation.There was a click and suddenly the joint moved much easier and more freely.The woman felt clearer relief.
In the next two sessions using the mobilization, we have determined the improvement achieved, according to which we have determined the success of two intra -cardboard injections of the point.And after a month and a half from the beginning of our not very intensive treatment (after all, we only needed six meetings), the woman was finally able to reject the wand that had bored with her and began to move quite 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 like to find that the condition of the knee is only better from year to year.And now even the first stage of osteoarthritis would be very difficult to assume - the patient's knee joint was almost completely restored.
So only six treatment meetings (manual therapy plus intra -monitoring injections from Orenil) in combination with chondroprotectors were more effective than five years of physiotherapy.
From this story (and by no means the only one like this) it becomes clear why I consider physiotherapy to be important, but only an additional part of the medical program for gonarthrosis.In this sense, I like laser therapy, thermal treatment (ozokerites, paraffin therapy, therapeutic mud) and in particular cryotherapy (treatment with local cooling).
7. Diet:
The diet with osteoarthritis is also very important.
8. With a cane:
Based on the stick when walking, patients with osteoarthritis of the knee joints seriously help their treatment, since the floor takes 30 to 40% of the load intended for the joint.
It is important to choose a stick according to your size.To do this, you are standing, lower your hands and measure the distance from the wrist (but not from your fingertips!) To the floor.It is such a length that there should be a stick.When buying a wand, pay attention to its end - it should be equipped with a rubber nozzle.Such a stick is amortized and does not slip when you rest.
Remember when your left leg hurts, the stick should be kept in your right hand and vice versa.Transfer a step of the patient with one foot and transfer the body weight to a stick.
9. Therapeutic gymnastics:
The most important treatment of osteoarthritis of the knee joints is the special therapeutic gymnastics.Almost no person who has gonar rose 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 can be achieved with special exercises.
At the same time, the doctor's gymnastics is almost the only treatment method that does not require any financial costs for buying devices or drugs.All the patient needs is two square meters of free space in the room and a carpet or a blanket that is thrown onto the floor.
There is no longer a gymnastics specialist and the patient's wish to do this gymnastics.It is true that most of those affected do not burn with such a wish.Almost every patient in whom I spiced up osteoarthritis I have to literally convince the physiotherapy exercises.And it is most often possible to convince a person only when it comes to the inevitability of a surgical intervention.
The second "gymnastic" problem is that even those patients configured for physiotherapy exercises cannot often find the necessary practice rates.Of course there are brochures for patients with osteoarthritis for sale, but the competence of a number of authors is doubtful - after all, some of them have no medical training.
Such “teachers” do not always understand the importance of individual exercises and the mechanism of their effect on painful joints.Often, gymnastics complexes simply correspond without thought from one brochure to the other.At the same time, there are such recommendations that it is exactly right to grab your head!
For example, many brochures prescribe the patient with osteoarthritis of the knee joints "" to carry out at least 100 squats per day and to run as far as possible ".
Patients often follow such advice without first consulted with a doctor and then sincerely confused why they worsen.Well, I will try to explain why the condition of the health connections usually only deteriorates from such exercises.
Let's imagine the joint as a warehouse.The agony damaged by arthrosis has already lost its ideal shape.The surface of the "camp" (or cartilage) stopped being smooth.In addition, cracks, potholes and "Burrs" appeared.In addition, the lubrication in the ball is thickened and dried out, it was clearly not enough.