Along with drug therapy in the form of tablets and injections, the treatment of arthrosis and osteoarthritis includes local effects. People with this diagnosis are often frightened when faced with the variety of ointments and gels presented in the pharmacy. All external agents are divided into several groups based on the composition of the active substance. Which ones are most effective and why?
It is impossible to cure arthrosis with ointments
Why are ointments prescribed for arthrosis?
Local agents relieve pain and relieve inflammation. In addition they:
- stimulate blood circulation in the periarticular tissues;
- warm, which also promotes more active blood movement;
- saturate tissues and cartilage with useful substances;
- enhance the effect of chondroprotectors, intra-articular injections of Noltrex and other drugs.
You should not use ointments without a doctor’s prescription: this can aggravate the disease
Is it possible to replace cream-type medications with ointment-type ones and vice versa?
What is better, ointment or cream, is decided by the doctor in each specific case. When it is not possible to obtain the required dosage form, the ointment can be replaced with cream. Replacement is possible in cases where the dosage of the active substance in the creamy medicine is the same or less than in the ointment. If the dosage is less, the cream will need to be applied more often (the number of additional procedures must be calculated in advance).
You cannot use ointment instead of cream. It is absorbed much deeper, so it can affect the “wrong” areas (for example, with a strong inflammatory process).
When replacing ointment with cream, pay attention to the concentration of the active substance.
Do not use different dosage forms at the same time. When mixed, their components may not provide the same effect as desired. If your treatment plan includes different medications and you are deciding whether to apply an ointment or a gel first, start with the gel-like substance. When it is completely absorbed and its expiration date has passed (usually 2-4 hours), clean the treated surface from the film as much as possible, then lubricate it with ointment. This is also true for creams that should be used before ointments.
What warming and vasodilating ointments should I use?
This group includes local drugs that stimulate blood circulation in the area around the joint, helping to relieve pain and spasm. The cells are better saturated with oxygen and nutrients, which means that other processes (for example, the restoration of cartilage tissue) occur more intensively in them.
Snake or bee venom, as well as red pepper, are used as a warming component. The products should not be applied to damaged skin (with wounds) or during joint inflammation. It is forbidden to use drugs containing poison for a long time, as there is a risk of “stretching” the ligaments. Warming ointments are applied before bedtime.
The most popular drugs in this group are:
- Voltaren - with the addition of snake venom;
- Apizartron – with bee venom;
- Espol - with red pepper;
- Gevkamen - contains several components, including menthol, camphor, cloves and eucalyptus essential oil.
Warming ointments contain bee or snake venom
Gel or ointment – which is better in emergency situations?
The gel is absorbed much faster than ointment. Therefore, in a situation where you urgently need to relieve pain, for example, a joint, it acts faster. If you need to provide a longer analgesic effect, relieve inflammation, ointment is preferable.
In addition to the duration of action, the list of ways in which an ointment differs from a gel includes the ability to adhere to the surfaces being treated. Gel-like medications adhere better to wet, wet surfaces, from which ointment-like medications simply slide off.
In general, ointment can penetrate deeper than gel. However, some gel preparations (for example, Traumeel) contain additives that ensure deep penetration of the main active ingredient. Then the difference between gel, cream and ointment is insignificant.
Gels and creams act faster, ointments last longer.
Painkillers and anti-inflammatory ointments
These remedies are based on diclofenac, ibuprofen and other active ingredients that can relieve inflammation. Their use is advisable at the initial stage of treatment of arthrosis or osteoarthritis, as well as during exacerbation. Most often used:
- Diclofenac;
- Fastum gel – based on ketoprofen with an analgesic effect;
- Nise – contains nimesulide with the effect of analgesia and inflammation;
- Dolgit – it contains ibuprofen and a warming component.
How does a cream differ from an ointment, and an ointment from a gel?
The difference between cream, gel, balm and ointment is as follows:
- Cream is a dosage form based on oil and water. Creamy substances are easily absorbed, but are not able to penetrate deep into the tissue. They can be applied to surfaces that are constantly wet. In most cases, they are completely absorbed and do not stain clothes. You can rub the cream in and go about your business.
- The gel does not contain fats and oils, its acid-base indicators are close to those of the skin. It spreads easily over the skin, is quickly absorbed, and does not clog pores. Sometimes, after it dries, an airtight film remains (for example, Diclofenac). The structure of gel-like preparations can be liquid (for example, Troxevasin) or viscous. When stored in the refrigerator, they partially thicken, but when heated to room temperature, they restore their properties. Like creams, gels are convenient to use during the day.
- Ointment is a dosage form based on fats. It is absorbed more slowly than gel-like and creamy preparations, but it lasts longer. Penetrates deeply. It is applied to dry surfaces, scars, seals. Lubricated areas can be covered with bandages. The remaining fatty base usually has to be removed manually, so you need to apply ointment-like substances under clothing carefully. Some of them have a specific smell (for example, Vishnevsky ointment). The thickest ointments are called pastes. They contain up to 20% powdery substances. Most often they have drying properties.
- Balm is a medicinal or cosmetic product that contains no water at all. When you need to clarify what the difference is between a balm and a cream, this difference is given first. The absence of water allows balms to retain their properties for a long time. This is due to the fact that harmful bacteria multiply in water, and there is no natural habitat for them here.
Which is better, gel or cream, depends on the patient’s age and the condition of his skin.
The main difference between cream and ointment is the percentage of fat content. Something in between these substances in texture is called liniment. This dosage form contains fats and oils. If there is more fat, then the liniment resembles an ointment, if there is oil, it resembles a cream (for example, Synthomycin liniment). At body temperature, liniments begin to melt, so they are applied a little at a time so that excess medicine does not drip onto clothes and the floor.
TOP 5 ointments for the treatment of arthrosis
Only a doctor can prescribe this or that remedy for deforming arthrosis of the ankle, knee or elbow, looking at the clinical picture and severity of the disease. Some drugs are indicated for the knee joint, others are more effective for lesions of the feet. But there are also universal ointments:
- Diclofenac – suitable for all diseases of the musculoskeletal system. It has a strong anti-inflammatory and analgesic effect.
- Ibuprofen is most effective for knee and shoulder injuries, but is also used in other cases.
- Nimesulide – due to the minimal number of contraindications, it is used very often.
- Indomethacin - indicated for swelling and inflammation.
- Ketoprofen is an ointment with a strong analgesic effect.
Arthrosis of the joints of the hands and feet is treated with various ointments
Gel and ointment - difference in shelf life
Expiration dates are usually given for sealed medications. As a rule, manufacturers write how long a substance can be stored unopened. In general, ointment-based preparations last longer than gel-based preparations because the fats they contain prevent drying out.
Store medications as recommended by the manufacturer.
When storing ointment, pay attention to the manufacturer's recommendations. In the refrigerator, the medicine can harden, and at a crucial moment you simply cannot get it out of the tube.
Gel-like preparations are more convenient to use than ointment-like preparations with a similar effect, and therefore cost a little more.
Features of the use of ointments for arthrosis
- Any product can be used for no longer than two weeks, and applied no more than 2-3 times a day.
- To achieve the desired effect, it is enough to squeeze out a strip 2-5 cm long, depending on the size of the affected joint.
- If after the first use the ointment does not produce results (the pain syndrome has not decreased), it must be replaced - in agreement with the doctor - with another one.
- The active ingredient in the ointment will have a stronger effect if you combine local treatment of arthrosis with electrophoresis.
- There are analogues of imported drugs on the market with the same active ingredient, but at a lower cost. They can also be used for the same purpose.
Aching and acute pain require different ointments: consult your doctor!
External treatments for osteoarthritis have a number of contraindications. If the patient has already had gastrointestinal ulcers, or has kidney or liver pathologies, one should be very careful with this therapeutic method.
It makes sense to resort to safe and effective intra-articular injections of Noltrex synovial fluid substitute. The drug has a long-lasting effect and has virtually no contraindications, with the exception of inflammation in the joint. After the course, you can forget about pain for a long time, while ointments are only an aid.
Diclofenac gel
Dosage form
Gel for external use
Composition per 100 g:
Active substance
: diclofenac sodium – 1.00 g.
Excipients
: 2-propanol – 45.00 g, macrogol 7 glyceryl cocoate – 6.00 g, hypromellose 4000 – 3.00 g, Scots pine oil – 0.15 g, lavender oil – 0.05 g, purified water – up to 100 .00 g.
Description
Colorless or with a slight yellowish tint, transparent gel with a characteristic odor.
Pharmacotherapeutic group
Non-steroidal anti-inflammatory drug (NSAID).
ATX code: M02AA15.
Pharmacological properties
Pharmacodynamics
The active component diclofenac is a non-steroidal anti-inflammatory drug with pronounced analgesic, anti-inflammatory and antipyretic properties. Indiscriminately inhibiting cyclooxygenase types 1 and 2, it disrupts the metabolism of arachidonic acid.
Diclofenac is used to eliminate pain and inflammation in joints, muscles and ligaments of traumatic or rheumatic origin, helping to reduce pain and swelling associated with the inflammatory process, increasing joint mobility.
Thanks to its hydroalcoholic base, Diclofenac has a calming and cooling effect.
Pharmacokinetics
The amount of diclofenac absorbed through the skin is proportional to the area of the treated surface and depends on both the total dose of the drug applied and the degree of skin hydration. After applying Diclofenac, gel for external use 1% (4 applications per day) to a skin surface area of 400 cm2, the concentration of the active substance in the plasma corresponds to its concentration when using 2% diclofenac gel (2 applications per day). On day 7, the relative bioavailability of the drug (AUC ratio) is 4.5% (for an equivalent dose of diclofenac sodium salt). When wearing a moisture-permeable dressing, suction did not change. The concentration of diclofenac in plasma, synovial membrane and synovial fluid was measured when the drug was applied to the area of the affected joint. Maximum plasma concentrations were approximately 100 times lower than after oral administration of the same amount of diclofenac. 99.7% of diclofenac is bound to plasma proteins, mainly to albumin (99.4%).
Diclofenac is preferentially distributed and retained deep in tissues prone to inflammation, such as joints, where its concentration is 20 times higher than in plasma.
The metabolism of diclofenac is carried out partly by glucuronidation of the unchanged molecule, but mainly through single and multiple hydroxylation, which leads to the formation of several phenolic metabolites, most of which are converted to glucuronide conjugates. Two phenolic metabolites are biologically active, but to a much lesser extent than diclofenac.
The total systemic plasma clearance of diclofenac is 263±56 ml/min. The terminal half-life is 1-2 hours. The half-life of metabolites, including two pharmacologically active ones, is also short and amounts to 1-3 hours. One of the metabolites (3′-hydroxy-4′-methoxydiclofenac) has a longer half-life, however, this the metabolite is completely inactive. Most of diclofenac and its metabolites are excreted in the urine.
Indications for use
• Back pain due to inflammatory and degenerative diseases of the spine (sciatica, osteoarthritis, lumbago, sciatica),
• Pain in the joints (joints of the fingers, knees, etc.) with osteoarthritis,
• Muscle pain (due to sprains, strains, bruises, injuries),
• Inflammation and swelling of soft tissues and joints due to injuries and rheumatic diseases (tenosynovitis, bursitis, lesions of periarticular tissues, wrist syndrome).
Contraindications
Hypersensitivity to diclofenac or other components of the drug; tendency to develop attacks of bronchial asthma, skin rashes or acute rhinitis when using acetylsalicylic acid or other NSAIDs; pregnancy (III trimester), breastfeeding; children's age (up to 12 years); violation of the integrity of the skin at the intended site of application.
Carefully
Hepatic porphyria (exacerbation), erosive and ulcerative lesions of the gastrointestinal tract, severe dysfunction of the liver and kidneys, blood clotting disorders (including hemophilia, prolonged bleeding time, bleeding tendency), chronic heart failure, bronchial asthma, old age, pregnancy (I and II trimester).
Use during pregnancy and breastfeeding
Due to the lack of data on the use of Diclofenac in pregnant women, the use of the drug during the first and second trimesters of pregnancy is recommended only as prescribed by a doctor, weighing the benefits for the mother and the risk for the fetus.
The drug is contraindicated in the third trimester of pregnancy due to the possibility of decreased uterine tone, impaired fetal renal function with subsequent development of oligohydramnios and/or premature closure of the fetal ductus arteriosus.
Due to the lack of data on the penetration of Diclofenac into breast milk, the drug is not recommended for use during breastfeeding. If it is still necessary to use the drug, it should not be applied to the mammary glands or large surface areas of the skin and should not be used for a long time.
There are no data on the use of Diclofenac and its effect on fertility in humans.
Directions for use and doses
Externally.
For adults and children over 12 years of age, the drug is applied to the skin 2 times a day (every 12 hours: preferably morning and evening), lightly rubbing into the skin.
The required amount of the drug depends on the size of the painful area. A single dose of the drug - 4-8 g (which is comparable in volume to twice the size of a cherry or walnut) is enough to treat an area of 400-800 cm2. If your hands are not the area where pain is localized, then after applying the drug they should be washed. The duration of treatment depends on the indications and the observed effect. The gel should not be used for more than 14 days for post-traumatic inflammation and rheumatic diseases of soft tissues without a doctor’s recommendation. If after 7 days of use the therapeutic effect is not observed or the condition worsens, you should consult a doctor.
To remove the protective membrane, use the screw cap as a key (the recess with protrusions on the outside of the cap). Align the indentation on the outside of the cap with the shaped protective membrane of the tube and turn. The membrane should separate from the tube.
The tubes can have either a regular cap (round shape) or an innovative cap (triangular shape), which is especially convenient for use when the mobility of the hand joints is limited due to osteoarthritis or other joint diseases or injuries.
Side effect
Classification of the frequency of occurrence of adverse reactions:
very often (> 1/10); often (> 1/100, < 1/10); uncommon (> 1/1000, < 1/100); rare (> 1/10000, < 1/1000); very rare (< 1/10000), including isolated reports.
Infectious and parasitic diseases:
Very rare: pustular rash.
Immune system disorders:
Very rare: hypersensitivity reactions (including urticaria), angioedema. Respiratory, thoracic and mediastinal disorders: Very rare: asthma.
Disorders of the skin and subcutaneous tissues:
Common: dermatitis (including contact dermatitis), rash, erythema, eczema, itching.
Rarely: bullous dermatitis.
Very rare: photosensitivity reactions.
If any side effects occur, including those not indicated in the instructions, you must stop using the drug and consult a doctor.
Overdose
Due to the low systemic absorption when applying the gel, overdose is unlikely.
In case of accidental ingestion, systemic adverse reactions may develop. Treatment of overdose due to accidental ingestion: gastric lavage, induction of vomiting, activated charcoal, symptomatic therapy. Dialysis and forced diuresis are not effective due to the high degree of binding of diclofenac to plasma proteins (about 99%).
Interaction with other drugs
The drug may enhance the effect of drugs that cause photosensitivity. Clinically significant interactions with other drugs have not been described.
special instructions
Diclofenac should be applied only to intact skin, avoiding contact with open wounds. The drug should not come into contact with the mouth, eyes or mucous membranes. After applying the drug, a bandage may be applied, but airtight occlusive dressings should not be applied. If a skin rash develops after application of the drug, its use should be discontinued.
The effect of the drug on the ability to drive vehicles and machinery
Does not affect.
Release form
Gel for external use 1%.
5, 10, 15, 20, 25, 30, 35, 40, 50, 60, 70, 80, 90, 100 g in orange glass jars with a triangular rim and a lid that is tensioned with a sealing element.
5, 10, 15, 20, 25, 30, 35, 40, 50, 60, 70, 80, 90, 100 g in polymer jars complete with lids or in polyethylene terephthalate jars with closures.
20, 25, 30, 35, 40, 50, 60, 70, 80, 100 g in aluminum tubes, coated with BF-2 varnish, with caps made of high-density polyethylene or in polymer tubes with polyethylene screw caps.
Each jar and tube, along with instructions for use, is placed in a cardboard pack.
Storage conditions
At a temperature not higher than 25 °C.
Keep out of the reach of children.
Best before date
3 years.
Do not use after the expiration date stated on the packaging.
Vacation conditions
Available without a prescription.
Gel or cream – which is better to use for cosmetic purposes?
Cosmetics for hands, face and body are also made in the form of gels and creams.
- Cosmetic gel consists of 75−85% water. The remaining 15−25% are microparticles with the ability to retain moisture and other special properties. The high water content allows gel-like products to be easily absorbed into the skin, perfectly moisturize it, and avoid the formation of an unpleasant greasy film. They are recommended for young, combination, oily and problematic skin.
- Creams contain much less water than gel products. But they contain a lot of oils that provide different effects: nutrition, whitening, smoothing out fine wrinkles, etc. Creamy products are suitable for mature, dry and combination skin. They often leave an oily sheen and may not be completely absorbed. It is dangerous to apply them to problem skin - fats can clog pores and provoke even greater inflammation.
Problem skin loves gel, while normal skin loves cream.
The main difference between gel and ointment and cream is the time of use: gel-like substances are best used in the morning and afternoon, and cream-like substances are best used before bed. There are day creams, which are similar in structure to a gel, and night creams, which are more like an ointment.