Chondroprotectors for arthrosis: extra expenses or salvation from disability

Joint problems can begin at any age. This is the case when it is better to prevent a problem than to treat it later. If:

• Are you experiencing constant pain in your joints?
• It's hard to get out of bed in the morning;
• Feel stiff in your movements;
• The doctor diagnosed: Arthrosis (ARTHRITIS, Osteoarthrosis, Osteoarthritis)

Pharmacological drugs are used in the treatment of arthritis and arthrosis. NSAIDs and glucocorticoids only help alleviate the symptoms of the pathology - pain, swelling, limited mobility, inflammatory reaction.

For severe problems, complex therapy is required.

Chondroprotectors help cope with the problem, promote the restoration of joints and cartilage, strengthen the ligamentous apparatus, improve metabolism in cartilage tissue, and slow down destruction.

This is a “building material” that helps the body renew cartilage structures.

In addition to taking medications, it is important to pay attention to a rational physical regimen. It is recommended to perform a complex of exercise therapy every day.

Anatomy and physiology of the joint

The joint consists of several parts: articular surfaces, capsule, cavity. The fluid inside the joint is a lubricant. There is a soft sliding of surfaces.

Types of joint structures are divided according to the principle:

• When 2 bones connect, it is a “simple” joint.
• Complex articulation of two or three surfaces, for example, the knee joint.

Joints vary in shape and function.

The surfaces of the bone entering the joint are covered with hyaline cartilage. Healthy cartilage is smooth, quite elastic, and strong. Capable of absorbing fluid (synovium) and releasing it back. Synovia prevents surface wear.

The capsule is represented by connective tissue and performs the function of protection, secretion of synovial fluid, the inner side is formed by a membrane.

Inside the joints are located:

• Cartilage;
• Discs or menisci;
• Ligaments.

Cartilage: the basis of mobility. Thanks to them, smooth movements are possible. The basis of cartilage tissue is chondrocytes. Located in connective tissue fibers. Consist of glycosaminoglycans, collagen and hyaluronic acid. Chondrocytes are capable of synthesizing these substances.

In case of injuries, connective tissue pathology, rheumatoid processes, injuries, inflammation is activated. Mediators are released into the blood - substances that act destructively on cartilage elements; by the way, NSAIDs can also act destructively.

As a result, the joint ceases to perform functions, and the motor amplitude is impaired. An inflammatory reaction occurs inside, swelling and hyperemia visually appear. The person feels pain.

To preserve cartilage and restore, it is recommended to take special products, Chondroprotectors (translated as “joint protectors”).

What is synovial fluid?

It is a filtrate of blood plasma, which contains hyaluronic acid, outdated joint cells, electrolytes, and proteolytic enzymes that destroy old proteins.

Hyaluronic acid binds and retains water in the joint cavity, due to which the synovial fluid moisturizes the articular surfaces of the bones, and they move relative to each other like clockwork.

And one more important point. The fluid in the joint cavity does not stand like in a swamp.

It circulates. Old cells die, new ones are born, the blood plasma filtrate is renewed, and for this process, like air, movement is necessary.

What are chondroprotectors

Unique products in this group protect articular cartilage. Regular, course intake is a good prevention of pathology. The use of chondroprotectors can prevent cartilage damage and restore it in case of disease.

The effect of the chondroprotector group is due to glucosamine and chondroitin sulfate. Each component has properties that have a beneficial effect on the joint.

Glucosamine is a natural component of healthy cartilage, under the influence of which substances of cartilage tissue are synthesized. It will protect against peroxidation, free radicals and other destructive effects on cartilage. In case of pathology - anti-edematous effect, reduces the inflammatory process of joints.

Chondroitin sulfate is a stimulator of the formation of cartilage substances: glycosaminoglycans, proteoglycans, collagen, hylauronic acid. Protects cartilage from destruction. Under the influence of chondroitin sulfate, the production of synovial fluid inside the joints is stimulated. In case of arthritis, it reduces the inflammatory process.

A good chondroprotector protects a complex or simple joint from destruction in case of pathology, and helps the structures recover.

Chondroprotectors are different: monocomponent or combined. With simultaneous exposure to chondroitin sulfate and glycosaminoglycan, complete restoration of cartilage tissue occurs.

Receiving treatment with these drugs is often necessary.

Why does arthrosis develop?

It most often develops as a result of one of four problems:

1. Or they overloaded the joint (excess weight or sports loads that exceed the ability of the cartilage to absorb them).
2. Or they UNDERLOADED it (hypodynamia, as a result of which the blood supply to the joint is disrupted, the cartilage does not receive adequate nutrition and begins to deteriorate).
3. Or all together (overweight + physical inactivity).
4. Or a serious injury that disrupts the metabolism in the joint and its nutrition.

What happens in the joint under the influence of these factors?

1. Chondrocytes do not have time (with OVERLOAD) or cannot (with UNDERLOAD) to form a sufficient amount of glucosamine.
2. If there is no glucosamine, chondroitin is not formed.
3. If chondroitin is not formed, hyaluronic acid is not formed.
4. If hyaluronic acid is not formed, fluid is not retained in the joint.
5. If there is little fluid in the joint, the articular heads of the bones are not moisturized.

And then this happens:

How do chondroprotectors work?

The advantage of the drugs: they stop the degenerative processes of the joints. The best chondroprotectors for joints act on the cause. And, not only for clinical manifestations.

The cartilage of the articular surfaces is restored, and the secretion of synovial fluid is stimulated. Chondroprotective agents are necessary for the prevention and treatment of joint diseases. At the initial stages of degenerative lesions, a chondroprotector is able to stop the progression of the pathological process.

Therapy should take a long time, at least 2-3 courses in a row, at the discretion of the doctor.

Medicines stimulate the production of collagen, hyaluronic acid and other substances of healthy cartilage. Cartilage under the influence of the drug becomes smooth, elastic and strong.

If the cartilage is completely destroyed, it will not be possible to restore it with the help of chondroprotectors. This is an indication for surgery. Don't let it get to this point! As a rule, chondroitins are still prescribed. They should be taken as part of a comprehensive treatment. After all, a person has a huge number of joints (more than three hundred) and they all need support.

Advantages of new generation chondroprotectors

Extensive research into pharmacological agents is currently underway. The results indicate that the combination of chondroitin sulfate and glucosamine sulfate/hydrochloride demonstrates synergism. This means that the results are much higher than when taking both substances separately.

One of the evidence is the indicator of glycosaminoglycan production by chondrocytes:

• with monotherapy with second-generation drugs it increased by 32%; • complex treatment with third-generation chondroprotectors gave an increase of 96%.

After a six-month course of taking them, pain decreases by 79%. However, today in rheumatology there is no clear opinion on what allows this to be achieved. This may be the presence of NSAIDs in the composition, a consequence of restoration of cartilage structure, or a placebo effect.

Mechanism of action of chondroprotectors

When joint diseases occur, cartilage tissue is destroyed and the amount of synovial fluid decreases. The content of hyaluronic acid, chondroitin sulfate, and glycosaminoglycan decreases in cartilage.

The products will restore cartilage tissue and return its composition to normal. The treatment process is long. At the same time, the manifestation of the inflammatory reaction is reduced, and pain, swelling and impaired movement are correspondingly reduced. They do not act as quickly as non-steroidal anti-inflammatory drugs, but it is more important to act on the cause of the disease, and not to mask the symptoms by simply temporarily relieving pain.

The chondroprotector normalizes the composition of the synovial fluid.

Medicines are prescribed for 2 to 6 courses in a row. Tablet forms are used for treatment.

Risk factors for cartilage tissue

The main threat is a sedentary lifestyle. There are no movements - no muscle contractions, no compression of joints. The result is a disruption of blood supply and metabolic processes.

The nutrition of cartilage is also limited by:

• excess weight (this is most difficult for diabetics and pregnant women); • extreme physical activity (occurs among athletes and teenagers who want to test their strength); • staying on your feet for a long time (standing or walking); • ingrowth of capillaries with subsequent ossification (occurs with untreated damage).

As a result, chondrocytes cease to receive substances to maintain vital functions, which leads to their depletion and subsequent death. They also do not receive building material for restoration. Therefore, there is a need for outside help - chondroitin, glucosamine, hyaluronic acid.

What are chondroprotectors?

Chondroprotectors are divided by composition and generations.

The composition of each drug is different. Medicines are produced on the basis of chondroitis sulfate, mucopolysaccharides, glucosamine, and their combinations.

If the active substance is chondroitin sulfate, destructive processes in cartilage are prevented. Activates the secretion of intra-articular fluid, reduces the inflammatory reaction and pain.

Sometimes the products consist of bone marrow or animal cartilage.

Medicines whose active ingredient is glucosamine are often used. It improves the elasticity and strength of cartilage, slows down destructive processes in cartilage tissue;

A drug containing several active components is quite effective. Products containing, in addition to a chondroprotector, an anti-inflammatory component, have a complex effect.

According to the time of appearance of chondroprotective drugs in medicine, there is a division:

• First;
• Second;
• Third generation.

Conventionally, the latest generation is the most advanced and modern. This includes, for example, Artra® - this is a combination drug containing high concentrations of chondroitin and glucosamine.

When they talk about chondroprotectors, they are divided according to the method of administration. Available in the form of tablets and injections. There are dosage forms that replace synovial fluid when it is deficient. The doctor determines how to use the product.

For the acute form of the disease, injections are suitable, possibly into the affected joint, since the active substance is delivered faster, but there are risks due to the high comorbidity of patients and unnecessary trauma is unnecessary. When the inflammatory process subsides and during remission, tablets and capsules are used for oral administration. At any time, you can use ointments and gels locally on the affected area, which can be classified as distracting procedures, since there is no systemic effect (local remedies are essentially an effect on the receptors of the skin, but the problem is much deeper)

Kinds

In addition to classification according to the main active ingredients, chondroprotectors are divided by generation:

• First generation drugs are of natural origin. These are extracts from plant tissues and animal cartilage. • Second generation drugs contain individual purified substances - chondroitin sulfate, glucosamine or hyaluronic acid. • Third generation drugs are combination drugs. It may contain substances necessary to nourish the joints. Sometimes other elements are included in the composition - vitamins, minerals, fatty acids.

In pharmacies they are presented in different forms. For oral administration there are tablets, capsules, and soluble powders. Ointments are provided for topical use. There are also formulations for intramuscular and intra-articular injections.

Causes of diseases

The factors causing joint pathology are diverse. These include:

• traumatization, including sports
• age-related changes (the problem is getting younger)
• genetic predisposition;
• metabolic disorders;
• ecology;
• stressful situations;
• a sedentary lifestyle or excessive stress on the joints;
• malnutrition – lack of important vitamins and microelements;
• obesity;
• infection;

During active sports, when there is an increased load on the menisci and cartilage, it is recommended to use products that strengthen the cartilage tissue. Excess weight is a signal for the use of chondroprotectors.

To prevent the disease from developing, it is necessary to engage in prevention and treatment in the early stages. Honda protectors are useful in preventing the development of pathology.

A little more about chondrocytes

Chondrocytes are responsible for the restoration and production of substances necessary for cartilage. But the whole problem is that there are very few of them: only 5%, and the rest (95%) is cartilage matrix (collagen fibers).

In addition, among chondrocytes there are young, mature and aged cells. The parade is commanded, of course, by the mature ones. Others either STILL do not have enough strength to synthesize the substances necessary for cartilage, or ALREADY do not have enough.

But with adequate loads and normal nutrition of the joint, this is enough.

conclusions

Thus, for normal joint function you need:

1. Mature chondrocytes receiving adequate nutrition.
2. Normal blood supply to the joint.
3. Adequate functioning of the muscles surrounding the joint.

For what diseases are chondroprotectors used?

Drugs are prescribed for all diseases of the joints. For arthritis (arthrosis) of any etiology and rheumatoid lesions, a preventive drug, for example, a chondroprotector, is useful. Inflammation in these diseases subsequently leads to the destruction of cartilage. Treatment agents are prescribed in a course once every six months, this prevents the destruction of cartilage tissue or restores damage.

If arthritis (arthrosis) is caused by an infectious agent, not only antibacterial agents are needed, but also a drug to protect hyaline, since bacteria, viruses and fungi often cause cartilage destruction.

Treatment takes place in different forms of medications: tablets, injections, ointments. The doctor prescribes the drug and method of delivery.

Intervertebral hernia is treated with chondroprotectors. But what complicates the therapy is that the blood flow in the area of ​​the cartilage of the intervertebral joints is insufficient.

They help with osteochondrosis, especially in the initial stages, when there are no degenerative changes. Medicines are prescribed topically, in the form of ointments or tablets.

For gouty arthritis, you should take a course until the cartilage is destroyed. Since the destruction of cartilage tissue gradually occurs.

In the complex treatment of gonarthrosis (arthrosis of the knee joint), drugs from this group are used.

When is it used?

Chondroprotectors for joints act as vitamins or medicines. In general, they are prescribed not only for osteoarthritis, but also for other pathologies of the musculoskeletal system:

• osteochondrosis (degenerative changes in the cartilage of intervertebral discs); • arthritis (inflammation of the joints); • bursitis (inflammation of the synovial bursa).

The main task of chondroprotectors is to provide cartilage tissue with sufficient nutrition. There are no blood vessels in it, so it receives the necessary substances indirectly, that is, through diffusion.

Normally, when the cartilage is compressed, synovial fluid is released, which nourishes and moisturizes it. With increased loads, injuries, and degenerative processes, its consistency changes, which prevents its absorption. The use of chondroprotective drugs is required to restore the composition and structure of synovial fluid.

How to take the drug

It is advisable to start taking medications early. It is necessary to take a course of medications at the first signs of pathology. At this stage they help as much as possible, prevent the development of cartilage destruction, and at the initial stages of the degenerative process they are able to restore cartilage tissue.

With complete destruction of hyaline tissue, the use of chondroitins as the main treatment is ineffective. It will not be possible to restore cartilage this way. Medicines do not give immediate effect; they have a cumulative effect and courses of treatment must be repeated periodically as a preventive measure. Treatment of pathology should not be limited to chondroprotectors; an integrated approach is important. Changing your lifestyle, eating foods rich in natural glucosamines and chondroitin.

There are different forms of chondroprotector medication: tablets, solutions, ointments, capsules, gels. To determine which one is suitable for the patient, the state of the body, the degree and type of pathology, and contraindications are taken into account. Only a doctor can prescribe the correct treatment.

Honda protectors are prescribed for a course of treatment. The drug has a cumulative effect.

As a preventive measure, they are useful for people with obesity, excessive physical activity, and the elderly.

What to replace it with?

We found out that it is undesirable for pregnant women to take chondroprotective drugs. Parents of teenagers may be skeptical about their use. But the problem must be solved to avoid worsening the degenerative process.

Chondroitin and glucosamine can be obtained from:

• ingredients for jellied meat (hooves, ears, tails); • chicken or beef broth, cooked over low heat (fast cooking destroys the substances); • fish (especially river fish); • mussels; • shrimp; • avocado; • soy.

You can often hear that gelatin replaces chondroprotectors. This is not entirely true. It is really rich in collagen, a protein that strengthens connective tissue. The substance used to thicken it is extracted from animal cartilage. However, gelatin does not contain chondroitin or glucosamine.

Contraindications for use

There are restrictions on prescribing medications for recovery. It is not recommended to take chondroprotectors:

• during pregnancy and lactation;
• if you have an allergic reaction to any components of the drug;
• in case of kidney dysfunction;
• with genetic pathology - a disorder of phenylalanine metabolism.

Carrying a child and breastfeeding are temporary reasons to stop using medications. If a woman had problems before conception and took chondroprotectors, the doctor excludes them for the period of pregnancy and childbirth. The drug should be treated with caution.

If the pathology manifests itself while you are expecting a baby, contact your doctor.

You can take tablet forms with caution if the gastrointestinal tract is disrupted. Long-term use of tablets or capsules can cause flatulence, bloating and abdominal pain.

People with diabetes mellitus and bronchial asthma should be careful about taking therapy.

Stages of arthrosis

Stage 1 arthrosis:

1. Cartilage loses water, i.e. dries out.
2. Collagen fibers are torn or destroyed completely.
3. The cartilage becomes dry, rough and cracks.
4. Instead of sliding unhindered, the cartilage of the articulating bones “clings” to each other.

Stage 2 arthrosis:

1. The pressure on the bone increases.
2. The heads of the bones begin to gradually flatten.
3. The cartilage becomes thinner.
4. The joint gap decreases.
5. The joint capsule and synovial membrane “shrink.”
6. Bone outgrowths – osteophytes – appear along the edges of the bones.

Stage 3 arthrosis:

1. The cartilage disappears completely in some places.
2. The bones begin to rub against each other.
3. The joint deformity increases.

Stage 4 arthrosis:

1. The cartilage is completely destroyed.
2. The joint space is practically absent.
3. The articular surfaces are exposed.
4. The deformation of the joint reaches its maximum.
5. Movement is impossible.

As a result of these changes, inflammation develops in the joint. It becomes swollen and the pain intensifies.

Now let's move directly to the drugs.

But first, a few basic points.

Is it possible to combine it with alcohol?

Since medications are taken for a long time, patients wonder whether the drug can be combined with alcoholic beverages. Depending on the form of drug delivery, compatibility with alcohol is determined.

If you drink alcohol and take pills at the same time, you may develop side effects from the digestive system. These are nausea, vomiting, increased liver enzymes, and loose stools.

But in general there are no contraindications in this context. To be sure, carefully read the instructions for use. Usually, if there are restrictions, they write about them.

Features of the action of drugs

What are chondroprotectors? Chondroprotectors are medications that act on the area where the problem is located. The active components help reduce the amount of effusion in the joint capsule.

It is worth noting that chondroprotectors are names that combine a diverse group of medications and biological additives. These medications promote the dynamic restoration and preservation of cartilage integrity. Of course, treatment takes a lot of time; a course of at least 2 months will be required. The constituent substances of chondroprotectors are chondroitin sulfate and glucosamine. The tablets also have auxiliary components: antioxidants, vitamins, minerals.

Are chondroprotectors effective? Taking the drugs helps reduce inflammation and normalizes the overall structure of porous cartilage tissue. As a result, the pain begins to subside. The peculiarity of these products is that they do not promote the development of new tissues, but the regeneration of old cartilage. But, the effective result will be if there is at least a small layer of cartilage in the damaged joint.

Medicines can be used together with analgesics. In case of changing pathologies of the musculoskeletal system, these tablets will provide an effective result only when the disease is in the initial stage of development.

Chondroprotectors: reviews

Elena:

...My mother's knees hurt. The doctor diagnosed arthritis and prescribed the drug “Arthra” in courses, 2 times a year. I can unequivocally state the fact that the product helps to cope with the problem. Mom went to the doctor immediately when pain appeared, so the drug helped cope with the symptoms and restored full range of motion in her legs. Now she takes Arthra once every six months.

Sergey:

...A year ago I started experiencing problems with my knees. I turned to a therapist, the doctor advised me to take the drug “Arthra”. The price, of course, is not three kopecks, but health is more important. I really wanted to get rid of the pain. The course was prescribed to me for a long period of 6 months. Additionally, vitamins and calcium were prescribed. I can say after a month of regular use of Arthra, I felt much better, the pain and swelling in my knees went away. Now I feel great, I will repeat the course of the drug as a preventative measure.

Most reviews of chondroprotectors are positive, since these products really help relieve symptoms and restore cartilage tissue. A negative review is most often written if the cartilage is completely destroyed and an impossible miracle is expected from the drug.

Sometimes you don’t like the fact that you need to take the medicine in courses and the effect does not come immediately, unlike NSAIDs. It is easier for a person to take one tablet and the pain goes away immediately. But anti-inflammatory drugs have only a symptomatic, short-term effect, essentially masking the symptoms. Constant use of these drugs harms the gastric mucosa and does not solve the problem.

Chondroprotectors act on the disease itself, help restore cartilage tissue and have a “cumulative” effect. Substances as building materials for cartilage. Continuous or course use will improve mobility and pain will subside.

Treatment of arthrosis of the knee joints - treatment of gonarthrosis

Treatment of arthrosis of the knee joints, treatment of gonarthrosis is, to put it mildly, not the easiest task. Therefore, before you begin your difficult fight against this disease, be sure to find a good doctor, get examined by him and draw up a treatment plan with him.

Never try to diagnose yourself!

The fact is that joint lesions resembling arthrosis occur in many other diseases, and uninformed people very often make mistakes in determining the diagnosis. It is better not to save time and money on a medical consultation, because a mistake can cost you much more in all respects.

But this does not mean that you are obliged to blindly trust any doctor and should not delve into the essence of his recommendations, comprehending the mechanism of action of the medications that are prescribed to you. The patient must understand the meaning of medical prescriptions and imagine why certain medical procedures are carried out.

Thus, during the therapeutic treatment of gonarthrosis, it is important to combine a number of therapeutic measures in such a way as to solve several problems at once:

• eliminate pain;
• improve nutrition of articular cartilage and accelerate its recovery;
• activate blood circulation in the area of ​​the affected joint;
• reduce pressure on damaged joint areas of bones and increase the distance between them;
• strengthen the muscles surrounding the sore joint;
• increase joint mobility.

Below we will look at how this or that treatment method helps achieve your goals:

Video: Treatment of arthrosis of the knee joint, part 2:

Non-steroidal anti-inflammatory drugs:

Non-steroidal anti-inflammatory drugs - NSAIDs: diclofenac, piroxicam, ketoprofen, indomethacin, butadione, meloxicam, Celebrex, nimulide and their derivatives.

For arthrosis, non-steroidal, that is, non-hormonal, anti-inflammatory drugs are traditionally used to eliminate pain and inflammation of the joint, since against the background of severe pain it is impossible to begin normal treatment. Only by eliminating acute pain with anti-inflammatory drugs can you subsequently move on, for example, to massage, gymnastics and those physiotherapeutic procedures that would be intolerable due to pain.

However, it is undesirable to use drugs from this group for a long time, as they can “mask” the manifestations of the disease.

After all, when the pain decreases, a deceptive impression is created that healing has begun. Arthrosis, meanwhile, continues to progress: NSAIDs only eliminate individual symptoms of the disease, but do not cure it.

Moreover, in recent years, data have been obtained indicating the harmful effects of long-term use of non-steroidal anti-inflammatory drugs on the synthesis of proteoglycans. Proteoglycan molecules are responsible for the entry of water into cartilage, and disruption of their function leads to dehydration of cartilage tissue. As a result, cartilage already affected by arthrosis begins to deteriorate even faster. Thus, pills that a patient takes to relieve joint pain may accelerate the destruction of that joint.

In addition, when using non-steroidal anti-inflammatory drugs, it is necessary to remember that they all have serious contraindications and can cause significant side effects with long-term use.

Read more about anti-inflammatory drugs here*

***

Chondroprotectors - glucosamine and chondroitin sulfate:

Chondroprotectors - glucosamine and chondroitin sulfate - are substances that nourish cartilage tissue and restore the structure of damaged joint cartilage.

Chondroprotectors are the most useful group of drugs for the treatment of arthrosis.

Unlike non-steroidal anti-inflammatory drugs (NSAIDs), chondroprotectors do not so much eliminate the symptoms of arthrosis as act on the “base” of the disease: the use of glucosamine and chondroitin sulfate helps restore the cartilaginous surfaces of the hip joint, improve the production of joint fluid and normalize its “lubricating” properties.

Such a complex effect of chondroprotectors on the joint makes them indispensable in the treatment of the initial stage of arthrosis. However, there is no need to exaggerate the capabilities of these drugs.

Chondroprotectors are not very effective in the third stage of arthrosis, when the cartilage is almost completely destroyed. After all, it is impossible to grow new cartilage tissue or return the deformed bones of the knee to their previous shape with the help of glucosamine and chondroitin sulfate.

And even in the first and second stages of gonarthrosis, chondroprotectors act very slowly and do not immediately improve the patient’s condition. To get a real result, you need to undergo at least 2-3 courses of treatment with these drugs, which usually takes from six months to one and a half years.

Read more about chondroprotectors here*

***

Therapeutic ointments and creams:

Medicinal ointments and creams cannot in any way heal arthrosis of the knee joints (even if their advertising claims otherwise). But nevertheless, they can alleviate the patient’s condition and reduce pain in the sore knee. And in this sense, ointments are sometimes very useful.

Thus, for arthrosis of the knee joint that occurs without symptoms of synovitis, I recommend warming ointments to my patients in order to improve blood circulation in the joint.

For this purpose, Menovazin, Gevkamen, Espol, Nicoflex-cream, etc. are used. The listed ointments usually cause the patient a feeling of pleasant warmth and comfort. They rarely give any side effects.

Ointments based on non-steroidal anti-inflammatory substances (Indomethacin, Butadionic, Dolgit, Voltaren-gel, Fastum) are used in cases where the course of gonarthrosis is aggravated by symptoms of synovitis. Unfortunately, they do not act as effectively as we would like - after all, the skin allows no more than 5-7% of the active substance to pass through, and this is clearly not enough to develop a full anti-inflammatory effect.

***

Products for compresses:

Compress products have a slightly greater therapeutic effect compared to ointments.

Of the topical agents used in our time, in my opinion, three drugs deserve the greatest attention: dimexide, bischofite and medical bile.

Dimexide is a chemical substance, a liquid with colorless crystals, which has a good anti-inflammatory and analgesic effect. Moreover, unlike many other substances for external use, dimexide is actually able to penetrate skin barriers. That is, dimexide applied to the skin is actually absorbed by the body and works within it, reducing inflammation at the site of the disease. In addition, dimexide has a resolving property and improves metabolism in the area of ​​application, which makes it most useful in the treatment of arthrosis that occurs with the presence of synovitis.

Bishofite is an oil derivative, a brine obtained during oil drilling. It gained its fame thanks to drillers who were the first to pay attention to its therapeutic effect on arthrosis. While working in oil wells, drillers experienced resorption of arthrosis nodules on their hands due to constant contact with oil brine. Later it turned out that Bishofite has a moderate anti-inflammatory and analgesic effect, and also has a warming effect, causing a feeling of pleasant warmth.

Medical bile is natural bile extracted from the gall bladders of cows or pigs. Bile has a resolving and warming effect and is used in the same cases as bischofite, but has some contraindications: it cannot be used for pustular skin diseases, inflammatory diseases of the lymph nodes and ducts, febrile conditions with increased body temperature.

***

Intra-articular injections (injections into the joint):

Intra-articular injections are often used to provide emergency treatment for arthrosis of the knee joint. In many cases, intra-articular injection can actually alleviate the patient's condition. But at the same time, injections into the joint for arthrosis are done much more often than is actually necessary. It is about this incorrect, in my opinion, trend that I would like to talk in more detail.

Most often, corticosteroid hormone preparations are injected into the joint: Kenalog, Diprospan, hydrocortisone, flosterone, celeston .

Corticosteroids are good because they quickly and effectively suppress pain and inflammation due to 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 injections of hormones began to be carried out even without a real need. For example, I have more than once encountered the fact that hormones were injected into a patient’s joint for prophylactic purposes in order to prevent the further development of arthrosis.

However, the problem is that it is arthrosis itself that corticosteroids do not and cannot treat. This means they cannot prevent the development of arthrosis! Corticosteroids do not improve the condition of articular cartilage, strengthen bone tissue, or restore normal blood circulation.

All they can do is reduce the body’s inflammatory response to this or that damage in the joint cavity. Therefore, it is pointless to use intra-articular injections of hormonal drugs as an independent method of treatment: they should be used only in the complex therapy of arthrosis.

For example, a patient has stage II gonarthrosis with swelling of the joint due to the accumulation of fluid in it. The accumulation of fluid (synovitis) makes it difficult to carry out medical procedures: manual therapy, gymnastics, physiotherapy. In such a situation, the doctor performs an intra-articular injection of a hormonal drug to eliminate synovitis, and a week later begins other active treatment measures - this is the right approach.

Now let's imagine a different situation. The patient also has stage II gonarthrosis, but without fluid accumulation and joint swelling. Is it necessary to inject corticosteroids into the joint in this case? Certainly not. No inflammation - no “point of impact” for corticosteroid hormones.

But even if intra-articular injection of corticosteroids is really necessary, a number of rules must be followed. Firstly, it is undesirable to do such injections into the same joint more often than once every 2 weeks. The fact is that the administered medicine will not “work” in full force immediately and the doctor will be able to finally assess the effect of the procedure just after 10 - 14 days.

You should also know that usually the first injection of corticosteroids brings more relief than subsequent ones. And if the first intra-articular injection of a drug does not produce results, it is unlikely that the second or third injection of the same drug in the same place will. If the first intra-articular injection is ineffective, you need to either change the drug, or, if changing the drug does not help, choose the injection site more accurately.

If after this the injection of a corticosteroid into the joint does not give the desired result, it is better to abandon the very idea of ​​treating this joint with hormonal drugs. Moreover, it is generally extremely undesirable to inject hormones into the same joint more than four or five times, otherwise the likelihood of side effects increases significantly.

Unfortunately, in practice we have to deal with excessive “singleness” of doctors who inject corticosteroids into the same joint over and over again, without achieving at least a minimal effect with the first three injections. Two similar cases struck me more than others.

One of the patients received “only” ten injections of Kenalog, and the procedure was carried out daily, even without the required ten-day break necessary to evaluate the results of the injection. And the second patient was injected with hormones inside the knee joints, observing an interval (though only 3 to 5 days), but during the course of treatment the poor fellow received twenty to twenty-five injections of corticosteroids into one joint!

It would seem that the doctor “went too far” a little - no big deal. Could there be any harm from such treatment? It turns out it can!

Firstly, with each injection, the joint, albeit slightly, is injured by the needle. Secondly, with intra-articular injection there is always some risk of infection in the joint. Thirdly, frequent injections of hormones provoke disruption of the structure of the joint ligaments and surrounding muscles, causing relative “looseness” of the joint.

And most importantly, frequent injections of corticosteroids worsen the condition of those patients whose joint damage is combined with diabetes mellitus, high blood pressure, obesity, renal failure, gastric or intestinal ulcers, tuberculosis, purulent infections and mental illness. Even when administered exclusively into the joint cavity, corticosteroids have an effect on the entire body and can aggravate the course of these diseases.

hyaluronic acid preparations into the knee joint affected by arthrosis (another name for hyaluronic acid is sodium hyaluronate). They went on sale about 15 years ago.

Hyaluronic acid (sodium hyaluronate) preparations are also called “liquid prostheses” or “liquid implants” because they act on the joint like healthy synovial fluid - that is, as a natural “joint lubricant”.

Hyaluronic acid preparations are very useful and effective medicines: sodium hyaluronate forms a protective film on damaged cartilage, protecting cartilage tissue from further destruction and improving the sliding of contacting cartilage surfaces.

In addition, hyaluronic acid preparations penetrate deep into the cartilage, improving its firmness and elasticity. Thanks to hyaluronidase, cartilage that has dried out and become thinner due to arthrosis restores its shock-absorbing properties. As a result of weakening the mechanical overload, pain in the sore knee joint decreases and its mobility increases.

At the same time, when administered correctly into the joint cavity, hyaluronic acid preparations have virtually no side effects.

Treatment with hyaluronic acid preparations is carried out in courses: in total, a course of treatment requires 3-4 injections into each sore knee, the interval between injections is usually from 7 to 14 days. If necessary, the course is repeated after six months or a year.

From my point of view, the main and only serious drawback of hyaluronic acid preparations is their high price. Thus, in 2021, hyaluronic acid is represented on our market mainly by imported drugs Synvisc , Fermatron , Ostenil , Duralan , etc.

On average, each injection with these drugs costs the patient no less than 3,000 - 5,000 rubles.

But returning to the issue of savings, I would like to note that despite the relatively high cost of hyaluronic acid preparations, their use made it possible to literally “put back on their feet” many patients who previously, before the advent of these drugs, would have definitely had to undergo surgery.

And taking into account the cost of joint surgery, it turns out that timely use of hyaluronic acid (even over several years) in any case and in every sense costs the patient much less than knee replacement surgery. Of course, provided that the doctor performing such injections knows the injection technique.

Note from Dr. Evdokimenko. This is important to know: hyaluronic acid preparations are instantly destroyed in the joint in which pronounced inflammatory processes occur. Therefore, they are practically useless to administer to those patients whose gonarthrosis occurs against the background of the active stage of arthritis. But they are useful to use in stable remission of arthritis for the treatment of secondary gonarthrosis.

With primary gonarthrosis, you also need to pay attention to similar points. For example, if a patient’s joint is “bursting” from the accumulation of excess, pathological fluid, it makes sense to first “extinguish” the symptoms of synovitis (inflammation) and remove excess pathological fluid by means of a preliminary intra-articular injection of hormones or taking non-steroidal anti-inflammatory drugs. And only then inject hyaluronic acid into the joint, freed from inflammatory elements.

In addition to corticosteroid hormones and hyaluronic acid preparations, attempts are being made to introduce various chondroprotectors into the joint, such as alflutop, chondrolone or the homeopathic drug Cel T.

But these drugs are several times less effective than hyaluronic acid drugs. They help at most 50% of patients, and it is impossible to predict in advance whether their use will have an effect or not. In addition, a course of treatment requires 5 to 20 injections into the joint, which, as we said, is fraught with possible injury to the joint and various complications.

***

Manual therapy and physiotherapy:

Manual therapy for gonarthrosis of stages I and II often gives excellent results. Sometimes several procedures are enough for the patient to feel significant relief. Manual therapy of the knee joints helps especially well if it is combined with joint traction, taking chondroprotectors and intra-articular injections of Ostenil.

This combination of treatment procedures, from my point of view, is much more effective than the numerous physiotherapeutic measures offered in any clinic. Let me give you one example from practice.

A case from the practice of Dr. Evdokimenko.

A 47-year-old woman came to the appointment with stage II arthrosis of the right knee joint. By the time we met, she had been ill for 5 years. Over the years, the woman managed to experience all the possible methods of physiotherapy that can only be offered in our regional clinics: laser, magnetic therapy, ultrasound, phonophoresis, etc. Despite all the efforts of the physiotherapists, the condition of the patient’s joints continued to deteriorate - and this is natural. , since, say, chondroprotectors were prescribed to a woman only once in a short course over the entire five years.

In complete despair, the woman decided to take extreme measures - she underwent a course of treatment using burning wormwood cigarettes according to the Eastern method. As a result, the knee was covered with scars from burns, but it did not move better. And it was unlikely that she could - despite all my respect for Eastern medicine, I understand that wormwood moxibustion cannot eliminate bone deformities and increase the distance between the bones articulated in the knee.

After numerous physiotherapeutic procedures and even burning with wormwood cigarettes did not help the woman, she practically agreed to surgical treatment. But then I changed my mind and decided to try the complex method I proposed.

The first treatment session was, as they say, “creaky” - we only managed to “stir” the joint a little with the help of manual mobilization. Therefore, we scheduled the next session after preliminary preparation: for 3 weeks the woman took chondroprotectors, did self-massage and compresses with dimexide. After 3 weeks, I started again with mobilization of the joint and then repositioned (“set”) the joint using manual manipulation. There was a click and suddenly the joint began to move much easier and more freely. The woman felt obvious relief.

In the next two sessions, we consolidated the achieved improvement using mobilization, after which we consolidated the success with two intra-articular injections of Ostenil. And after a month and a half from the start of our not very intensive treatment (after all, we only needed six meetings), the woman was finally able to throw away the stick that was boring her and began to move quite freely.

Two years have passed since then. Twice a year the patient takes a short course of chondroprotectors, and occasionally comes to me for a follow-up appointment, where I am pleased to note that the condition of the knee is only getting better from year to year. And now even the first stage of arthrosis would be very difficult to predict - the patient’s knee joint has been restored almost completely.

Thus, only six treatment sessions (manual therapy plus intra-articular injections of Ostenil) in combination with a course of chondroprotectors turned out to be more effective than five years of physical therapy.

From this story (and by no means the only one of its kind) it becomes clear why I consider physiotherapy important, but only an additional part of the treatment program for gonarthrosis. In this sense, more than other procedures, I like laser therapy, thermal treatment (ozokerite, paraffin therapy, therapeutic mud) and especially cryotherapy (treatment with local cooling).

More details about each individual method of physiotherapy are described in the book “Pain in the Legs”.

***

Diet:

Diet for arthrosis is also very important.

You can read more about the anti-arthrosis diet here*

***

Using a cane:

Leaning on a stick when walking, patients with arthrosis of the knee joints seriously help their treatment, since the stick takes on 30 - 40% of the load intended for the joint.

It is important to choose a stick according to your height. To do this, stand up straight, lower your arms and measure the distance from your wrist (not your fingertips!) to the floor. This is exactly the length the cane should be. When buying a stick, pay attention to its end - it should be equipped with a rubber nozzle. Such a stick cushions and does not slip when people lean on it.

Remember that if your left leg hurts, then you should hold the stick in your right hand, and vice versa. When taking a step with your affected leg, transfer part of your body weight to the stick.

***

Physiotherapy:

The most important method of treating arthrosis of the knee joints is special therapeutic exercises. Almost no person suffering from gonarthrosis will be able to achieve real improvement in their condition without therapeutic exercises.

After all, in no other way is it possible to strengthen muscles, “pump” blood vessels and activate blood flow as much as this can be achieved with the help of special exercises.

At the same time, Dr. Evdokimenko’s gymnastics is almost the only treatment method that does not require financial costs for the purchase of equipment or medications. All the patient needs is two square meters of free space in the room and a rug or blanket thrown on the floor.

Nothing more is needed except consultation with a gymnastics specialist and the desire of the patient himself to do this gymnastics. True, most sufferers do not have this desire. Almost every patient in whom I detect arthrosis during examination has to be literally persuaded to engage in physical therapy. And it is most 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 who are committed to physical therapy often cannot find the necessary sets of exercises. Of course, there are brochures for sale for patients with arthrosis, but the competence of a number of authors is questionable - after all, some of them do not have a medical education.

This means that such “teachers” themselves do not always understand the meaning of individual exercises and the mechanism of their action on sore joints. Often, gymnastic complexes are simply thoughtlessly copied from one brochure to another. At the same time, they contain such recommendations that you can just grab your head!

For example, many brochures instruct a patient with knee arthrosis to “do at least 100 squats a day and walk as much as possible.”

Often patients follow such advice without first consulting a doctor, and then sincerely wonder why they feel worse. Well, I’ll try to explain why the condition of sore joints from such exercises, as a rule, only worsens.

Let's think of a joint as a bearing. Damaged by arthrosis, the diseased joint has already lost its ideal shape. The surface of the “bearing” (or cartilage) is no longer smooth. Moreover, cracks, potholes and “burrs” appeared on it. Plus, the lubricant inside the sphere had thickened and dried out, and it was clearly not enough.

Try to put such a structure into operation and, in addition, give it a load beyond the norm. Do you think that due to excessive rotation, such a deformed “bearing” can become smoother and more even, and the lubricant more liquid and “sliding”? Or, on the contrary, will the entire structure quickly wear out, become loose and collapse? In my opinion, the answer is obvious: such a “bearing” will collapse prematurely due to excessive load. In the same way, any bearings are destroyed and worn out during movement if, for example, sand gets into the lubricant and excessive friction occurs.

It is not difficult to understand that already damaged, cracked and “dried out” joints are destroyed by stress in the same way. This means that from exercises that create excessive stress on sore joints, these same joints will only get worse.

So maybe if you have arthrosis you can’t do gymnastics at all? Nothing like that is possible and even necessary. As already mentioned, gymnastics is an important method of treating arthrosis. However, of all the exercises, it is necessary to choose only those that strengthen the muscles of the affected limb and the ligaments of the diseased joint, but do not force it to bend and unbend excessively.

Probably, after such a recommendation, many of the readers will be surprised: how can you load the muscles and ligaments of a limb without forcing its joints to bend and straighten?

In fact, everything is very simple. Instead of the fast dynamic exercises we are accustomed to, that is, active flexion and extension of the legs, we need to do static exercises. For example, if, while lying on your back, you slightly lift your straightened leg up and keep it suspended, then after a minute or two you will feel fatigue in the muscles of your leg and abdomen, although the joints in this case did not work (did not move). This is an example of a static exercise.

Another variant. You can very slowly raise your straightened leg to a height of 15 - from the floor and slowly lower it. After 8 to 10 such slow exercises, you will also feel tired. This is an example of a gentle dynamic exercise.

It’s a completely different matter if the exercise is performed quickly and energetically, with maximum amplitude. By swinging your legs or actively squatting, you put increased stress on your joints, and their destruction accelerates. But the muscles, oddly enough, are strengthened much worse with such movements. We conclude: to strengthen muscles and ligaments with arthrosis, exercises should be done either statically, fixing the position for a certain time, or slowly dynamically.

By the way, it is slow dynamic and static exercises that most of my patients do not like to do, since they are especially difficult to perform. But this is how it should be: correctly selected, these exercises strengthen those muscles and ligaments that have atrophied in a person due to illness. Therefore, at first, be patient.

When doing gymnastics, do not rush. If you want to recover, you will somehow have to train yourself to do the exercises slowly and smoothly, without jerking. A jerking effort can only “tear” the muscles and will bring absolutely no benefit. And remember: if some exercise causes sharp pain, it means that it is contraindicated for you or you are doing it incorrectly. In this case, be sure to consult with your doctor about the correct execution of this exercise.

A video with gymnastics for the treatment of arthrosis of the knee joints can be viewed here *

At the end of the section on the treatment of arthrosis of the knee joint, I would like to address one question that patients often ask me: is it necessary to exercise the leg by walking for a long time and is walking useful for gonarthrosis?

I answer: of course, for a healthy person, long walking is useful in every sense - for the heart, for the respiratory system, for blood vessels, for the legs, etc. But with arthrosis, especially advanced, the knee joints cannot cope with even the minimum daily load, and here We invite you to download even more of them! Such actions will most likely only lead to aggravation and further destruction of the joints.

Before loading, or rather overloading, your knees, you must first relieve the aggravation, strengthen the leg muscles and properly treat the sore joints. Only then can you move on to active everyday activities, gradually increasing the load and in no case allowing pain.

***

Article by Dr. Evdokimenko© for the book “Pain in the Legs”, published in 2004. Edited in 2011. All rights reserved.

READ MORE:

• Arthrosis of the knee joint (gonarthrosis). Symptoms, stages.
• What is arthrosis of the knee joint (gonarthrosis) often confused with?
• Examination for arthrosis of the knee joint (gonarthrosis)
• Causes of arthrosis of the knee joint (gonarthrosis)
• Changes in the knee joint with gonarthrosis
• The best exercises for the treatment of gonarthrosis

Chapters from other books by Dr. Evdokimenko

Which chondroprotector is the best?

Only your attending physician can choose the best chondroprotector for your specific case. Our website provides information about the drug Artra®, which is manufactured in the USA under strict quality control. The drug contains high concentrations of glucosamine and chondroitin, which provides a complex effect. The product is available in tablet form for oral administration. The appointment is convenient, only once a day, and this is so important.

1. Ilyin, D.P. Diseases of the joints and back in old age / D.P. Ilyin. - M.: Vector, 2011. - p. 100-105
2. Maznev, N. Arthritis, arthrosis, gout. Joint diseases. Author's treatment methods / N. Maznev. - M.: Ripol Classic, House. XXI century, 2010. – p. 488-500
3. Pokrovsky, Boris Diseases of the joints / Boris Pokrovsky. - M.: Lada, ACC-Center, 2011. - p. 645-648
4. Rodionova, O. N. Diseases of the joints / O. N. Rodionova. - M.: Vector, 2012. - p. 245-252
5. Worrall, Jennifer Arthritis and other joint diseases. Everything you need to know / Jennifer Worrall. - M.: AST, Astrel, 2015. - p. 124-128
6. Badokin V.V., Effective pharmacotherapy, 38/2013. –p.68–75
7. Karateev E.A. et al., Use of NSAIDs. Clinical recommendations, IMA-Press, M., 2009. – p. 58-59
8. Joint diseases. Guide for doctors / ed. V. I. Mazurova. - 2008. - from 300-305.

Features of the use of chondroprotectors in dogs

1. Chondroprotectors are long-acting drugs. They are effective only after long-term use, so it is necessary to complete the full course prescribed by a veterinarian.
2. If the dog is diagnosed with dysplasia, chondroprotectors will have to be taken, possibly without interruption, but even the most expensive medications will not cure the animal completely.
3. If a veterinarian prescribes “human” drugs to treat a dog for arthrosis, which is also not uncommon, it is necessary to clarify the dosage, since this information is not included in the instructions.
4. In old age, it is recommended to give chondroprotectors to the four-legged animal without interruption - on an ongoing basis.
5. Prophylactic use of medications from this group by a young large breed puppy reduces the risk of incorrect paw placement and the development of joint diseases.

Chondroprotectors are not contraindicated for pregnant and lactating dogs, but they should be given with caution

Since chondroprotectors do not have an immediate effect and require long-term therapy, many are interested in what else can be used to treat arthrosis in dogs. If one joint is damaged, it can be affected locally by intra-articular injections of Noltrex Vet. The drug is a synthetic substitute for synovial fluid; it is injected into the joint capsule and mechanically moves apart the rubbing surfaces of the cartilage.

The course of treatment is 2-4 injections at weekly intervals. At the end of therapy, the pain goes away, mobility returns, and lameness disappears. The dog regains interest in food and walks. Noltrex Vet injections for arthrosis or osteoarthritis are perfectly combined with chondroprotectors, which veterinarians recommend that animals take for preventive purposes.

Piascledine 300

This chondroprotector made in France has a natural herbal composition. The active ingredients of “Piascledina 300” are unsaponifiable compounds of soybean oil and avocado oil. The chondroprotector helps improve metabolic processes in cartilage, reduces pain and inflammation, stops cell destruction, and improves joint mobility. You need to take Piaskledin 300 for at least six months. The product is a little expensive, but its effectiveness is high. The chondroprotector has virtually no side effects, so it has excellent ratings among both doctors and patients.

Piascledine

Laboratoires Expanscience, France

The contents of Piaskledin capsules are components from plant materials.
Oil extracts (unsaponifiable components) from avocados and soybeans have a regulating effect on metabolism in cartilage tissues. The drug has an anti-inflammatory effect. The substances of the drug have an analgesic effect. from 952

1014

• Like
• Write a review

Where does the mistrust of chondroprotectors come from?

There have always been two opposing opinions regarding chondroprotectors (both among patients and among doctors and representatives of the pharmaceutical market): some are confident that such drugs are indispensable for the symptomatic treatment of arthrosis, others say that the positive effect of chondroprotectors is a myth. Moreover, in many countries, chondroprotectors are not included in the treatment protocols for osteoarthritis. Why is that? Because we all hope that a “magic pill” will immediately get rid of health problems, but we don’t want to make special efforts to solve the issue comprehensively. Treatment of joints is not only drugs, but also lifestyle changes, weight loss, dosed exercise, etc. Often we hope to start drinking chondroprotectors and quickly heal our joints. If there is no improvement, we give up this idea.

You should not expect a positive result from taking chondroprotectors if you have the third stage of arthrosis - here conservative treatment is useless, only surgical treatment.

But most rheumatologists are still confident that taking chondroprotectors will greatly improve the situation with arthrosis of the first or second degree, when the cartilage has not yet been destroyed and chondrocytes are alive.

In addition to facilitating gliding, synovial fluid nourishes cartilage

Photos from open sources

Don

This German chondroprotector can be called one of the first on the Russian market; the drug contains 750 mg of glucosamine. “Dona” has shown its effectiveness in treating joints: the chondroprotector perfectly relieves pain, restores mobility to the joint and prevents it from collapsing. "Dona" is prescribed both as the only tablets for the treatment of joints and in complex therapy. By the way, you can buy Dona not only in tablets, but also in injections and powder for solution. In general, patients respond very well to this product, but at the same price it is now possible to buy a third-generation chondroprotector, which contains not one, but several active components.

Don

Rottafarm, Italy

Primary and secondary osteoarthritis, glenohumeral periarthritis, osteochondrosis, spondylosis, chondromalacia of the patella.
from 1092

2338

• Like
• Write a review

Recommendations for patients

Any medicine should be used only as prescribed by a doctor. In order for chondroprotectors to have a beneficial effect on joints, they must be used at an early stage of the development of the disease. The patient must comply with the following recommendations:

• there is no need to put too much stress on the damaged joint;
• a person should not be too fat; with a decrease in body weight, joint pain also decreases;
• do not make movements that place stress on the damaged joint;
• do not overcool the lower extremities;
• carry out physical therapy;
• do not forget about rest;
• good for hiking.

By following these recommendations and using chondroprotector drugs, you can achieve the expected result. What drugs are classified as chondroprotectors and what diseases do they cure?

Diaflex

This Romanian-made chondroprotector is prescribed for the treatment of osteoarthritis. The active substance of Diaflex is diacerein. The chondroprotector slows down the destruction of cartilage, relieves inflammation and pain in the joint. The first positive effect after taking the drug is noticeable after 2-4 weeks. Diaflex can be purchased at a pharmacy with a prescription and is available in capsule form.

Diaflex

Rompharm Company SRL, Romania

The drug Diaflex is a non-steroidal anti-inflammatory drug (NSAID).
Diacerein is an anthraquinoline derivative, a diacetylated derivative of rhein. Metabolized to an active metabolite, rhein, it inhibits the activity of interleukin-1, which plays an important role in the development of inflammation and cartilage degradation in osteoarthritis. Inhibits the action of other cytokines (including interleukin-6, tumor necrosis factor-alpha). The action develops after 2-4 weeks. Diacerein has analgesic anti-inflammatory activity when taken orally. from 858

4.0 1 review

829

• Like
• Write a review