The widespread use of injections based on hyaluronic acid into the joint began in 2014. Over the course of several years, experts were able to collect statistical data that confirm some and refute other known truths about these drugs. So, what is their effectiveness actually, based on the results of treatment of arthrosis and osteoarthritis of individual patients?
Hyaluronic acid injections are not a panacea
Criteria for assessing the effectiveness of drugs
Experts collected data regarding the effects of intra-articular injections on joints and analyzed it according to the following criteria:
- pain reduction;
- improving joint functioning;
- reduction of stiffness, including in the morning;
- reducing the intake of non-steroidal anti-inflammatory drugs.
Efficacy was assessed in three stages: after 2, 4 and 8 weeks.
Intra-articular injections of sodium hyaluronate, as it turned out, do not begin to act immediately
Types of joint injections
Three types are used:
- paraarticular;
- periarticular;
- intra-articular.
Paraarticular
The method involves injecting medication into the tissue of the damaged joint. At the moment, this is one of the most effective ways to help the patient relieve pain and relieve inflammation. In this case, intradermal and subcutaneous administration is performed using thin and short needles. The injections are practically painless, and the procedure itself is completed quickly.
Periarticular
blockades are indispensable for osteoarthritis affecting a large area, arthritis and periarthrosis. The drug is injected into the tendon and muscle tissue.
Intra-articular
The method involves introducing a substance into the joint tissue.
What they say a month after the start of the course of injections
Many patients note that during the first to third weeks after the start of injections, stiffness in the joint gradually decreased. If at the end of the first week 31% of respondents say this, then by the end of the third their number increases to 37%. After completing the treatment of arthrosis and osteoarthritis with this method, the effect persisted for 7-9 months.
As for the pain syndrome, a decrease in pain a month after the first injection was noted by 39% of patients, which is twice as much as in the previous case.
Treatment
The doctor will help clarify the diagnosis and find out the cause of the pain:
- Rule out inflammatory rheumatological disease (RD).
- Determine the degree of cartilage destruction and the stage of osteoarthritis.
- Select an adequate individual treatment regimen.
The doctor will prescribe an examination, which includes:
- Clinical blood and urine tests
- Laboratory blood test - CRP (C-reactive protein), RF (rheumatoid factor), uric acid - exclude rheumatoid diseases; ALT, AST, creatinine, cholesterol, sugar, total protein - exclude concomitant diseases that affect the selection of treatment and prognosis of the disease.
- X-ray of painful joints (both limbs symmetrically, even if complaints are on one side).
- In case of severe swelling of a particular joint (for example, the knee), ultrasound of the joint or MRI of the joint is performed to exclude traumatic damage to the ligamentous apparatus, menisci, and to clarify the distribution of fluid in the joint.
Treatment of this disease consists of a comprehensive approach to the disease, which includes the use of non-drug and drug methods, and, if necessary, surgical intervention. Although OA is an incurable disease, treatment measures tailored to each patient can reduce pain and inflammation, improve joint movement and slow the progression of the disease.
The basis is proper nutrition
As already mentioned, excess weight (body mass index BMI more than 25 kg/m2) is an indisputable risk factor for the development of osteoarthritis, so these patients need to change their diet. First of all, you need to reduce the amount of fats and carbohydrates in food, increase the consumption of fish, fresh vegetables and fruits. The menu should include foods containing fiber and foods containing sulfur, such as asparagus, garlic, and onions. Sulfur is necessary for building bones, cartilage and connective tissue. It is advisable to avoid eating black pepper, egg yolk, tomatoes, white potatoes, as these foods contain a substance called solanine. Solanine interferes with the function of enzymes in muscles and can cause pain and discomfort. In addition, meals should be fractional (3-4 times a day), regular (at the same time) and even, the last meal should be no later than 2-3 hours before bedtime. Compliance with these rules should lead to gradual but constant weight loss.
Physical activity
If you have arthrosis of the leg joints, running, jumping and squats, fast walking, especially climbing uphill, carrying heavy objects and participating in competitions are not recommended, since with this type of physical activity a force acting on the joints exceeds the weight of the body, which aggravates the load on the already changed cartilage .
Walking at a calm pace, swimming, cycling and skiing, gymnastics and physical therapy are useful. For patients with osteoarthritis, swimming is the optimal form of physical activity and the best form of sports. In water, the range of motion in the joints is maximum, and the weight load is minimal. If you don’t know how to swim, do it in a water aerobics group: with music, fun, in a group!
Cycling not only improves blood circulation in the joints, maintains muscle tone, but also gives a positive emotional mood. You should avoid riding on uneven terrain if you are not confident on the bike, as falling and bruising will not bring anything useful. A safe way is to exercise on an exercise bike. To get started, 15–20 minutes is enough. training, then the duration of classes can be increased to 40 minutes.
In winter, go skiing more often. Skiing at a calm rhythm is beneficial: due to sliding, the weight load is reduced, blood oxygen saturation improves, and muscles and joints are strengthened.
Physiotherapy
It must be remembered that weight loss measures and physical activity must be combined with physical therapy (physical therapy), carried out taking into account certain rules. Physical therapies play an important role in relieving the symptoms of osteoporosis by improving joint function and increasing endurance and muscle strength. Regular exercise therapy classes lead to a reduction in pain and improvement in joint movements, but it is best to start classes under the guidance of a specialist in physical therapy, for example, in health groups. Physical exercises should be carried out without static loads (sitting, lying down, in the pool). You need to exercise for at least 30–40 minutes a day, 10–15 minutes several times during the day. For osteoarthritis of the knee joints, the main ones are exercises that help strengthen the thigh muscles (for example, raise a straightened leg by 25 cm while lying on your back and hold it for several seconds); exercises aimed at increasing range of motion (“bicycle”); exercises that help improve the general aerobic condition of the muscles (walking on level ground at a moderate pace). You need to start walking from a distance that does not cause pain, and gradually increase the duration of walking to 30-60 minutes five to seven days a week). Patients should also be aware of the peculiarities of the motor regime for osteoarthritis, the main principle of which is to unload the affected joint. Long walking, standing, and frequent climbing of stairs are not recommended.
What happens after 8 weeks
About 35% of patients said they were almost completely free of pain during this period. Approximately 11% stopped taking anti-inflammatory drugs, and 40% reduced their dose by 20 times! Even those who continued to take this group of medications still reported noticeable relief in their joints.
In practice, Noltrex works longer and more effectively than sodium hyaluronate injections
Intra-articular injections of sodium hyaluronate into the knee are performed according to the following scheme:
During the procedure
When you receive hyaluronic acid injections for the first time, you will need to sign an informed consent form (a form stating that you agree to the procedure and understand the risks involved).
Your doctor may do an ultrasound (an imaging technique that uses sound waves to produce images) to determine where to inject. The doctor will examine your joint and clean the area. In some cases, a local anesthetic (medicine that numbs an area of the body) may be given before the hyaluronic acid injection.
When injecting hyaluronic acid, you will only feel a slight tingling sensation as the needle pierces the skin and the medication is injected. After administering the medication, your doctor will remove the needle and clean the injection site. You will be given a small bandage (Band-aid®) over this.
to come back to the beginning
What does this mean: conclusions
Research results indicate that injections of liquid prostheses based on hyaluronic acid have a delayed effect in relation to the treatment of osteoarthritis. Replenishment of the deficiency of synovial fluid occurs immediately, but the effect occurs only after a few weeks, and lasts relatively short time - 6-9 months. The maximum peak effect of sodium hyaluronate was recorded in the fourth week after the start of the course.
The synthetic drug "Noltrex" acts, according to doctors and patients, a little longer - from nine months to one and a half to two years. It contains no components that can be broken down by enzymes, so the medicine remains in the body much longer and has a powerful analgesic effect in a short time.
Of course, the effect of Noltrex on each patient is individual and depends on the stage of arthrosis, the characteristics of the disease and even the qualifications of the physician. However, in general, a synthetic-based drug, both in theory and in practice, is superior to sodium hyaluronate in terms of effectiveness.
Possible side effects
With strict adherence to the rules of manipulation, side effects can be completely avoided. Specialists at the Yuzhny clinic recommend carefully ensuring that the doctor thoroughly cleans his hands before the injection, puts on gloves and disinfects the injection site. The syringe must also be in individual sterile packaging, and the ampoule with the drug must be hermetically sealed. After the injection, the doctor places a sterile napkin on the joint; in this case, unwanted infectious complications can be avoided.
One of the common mistakes is an incorrectly selected needle, which, when inserted, can damage the periosteum or enter a nerve or vessel. With careful adherence to technique and good knowledge of anatomy, such errors should not occur.
Common adverse reactions to injections of drugs containing hyaluronan are slight swelling at the injection site and slight pain. The patient’s condition can be adequately assessed within two days, when the primary symptom disappears.
Some forms of injection can cause significant swelling, inflammation and increased pain - the so-called pseudoseptic reaction.
reactions
reactions
If signs of negative reactions appear, the possibility of further use of the drug is determined only by the attending physician.
Contraindications
Hyaluronate is a naturally occurring organic compound and is therefore quite well tolerated after parenteral administration or application to the skin. There are several pathological and physiological conditions of the patient’s body that are considered medical contraindications:
- The presence of allergic reactions to any of the components of the drug.
- Childhood.
- Pregnancy and lactation (breastfeeding).
- An autoimmune pathology in which cells of the immune system “erroneously” produce antibodies to tissues, which leads to the development of a specific inflammatory reaction in them. Such diseases include rheumatoid arthritis, ankylosing spondylitis, and rheumatism.
- Inflammatory processes that have an acute course, regardless of nature and location.
- Changes in the skin, which are primarily a contraindication for the use of dosage forms of drugs for external use.
Before prescribing a drug, the doctor must make sure that the patient has no contraindications.