Injections for joints: what to expect from the procedure and how much will the treatment cost?

Form of release of drugs for osteoarthritis Pharmacological groups of drugs for arthrosis

Arthrosis is a multifactorial disease, which is also called a “lifestyle disease.”

Therefore, complex treatment is also required, with the help of medications, physiotherapy, massage, orthopedic regimen and diet. And yet, in the treatment of exacerbations and maintenance of remission, drugs for osteoarthritis play a leading role. They have both a symptomatic effect (eliminate pain and inflammation, swelling) and help restore the structural and qualitative characteristics of cartilage tissue (for example, chondroprotectors).

Don’t know what medications to take for arthrosis? Let's talk about what you need to have in your first aid kit.

Some drugs can be taken to prevent arthrosis, even before the first symptoms appear, and some are effective only at a certain stage of the disease. How to navigate the treatment of joint osteoarthritis with drugs?

Disease groups

Drug treatment of joints is prescribed taking into account the cause of the disease, the nature and predominant localization of the inflammatory process. Depending on the main mechanism of pathology development (pathogenesis), all diseases affecting various joints are divided into several groups:

• Inflammatory processes called arthritis. They can be infectious, autoimmune in origin, or represent a reaction of joint tissue to various unfavorable factors (reactive arthritis).
• Degenerative-dystrophic processes or arthrosis are a group of pathological processes that are united by the gradual destruction of joint tissue (degeneration) against the background of a violation of their nutrition (dystrophy). In this case, cartilage tissue is predominantly affected.
• Previous injuries - excessive mechanical impact leads to disruption of tissue integrity, as well as the subsequent development of inflammation and degenerative-dystrophic processes.

The pathogenesis and origin of the disease is determined by an orthopedic traumatologist using modern techniques for visualizing internal structures.

The importance of synovial fluid for cartilage tissue

By origin, it is a blood transudate - a non-inflammatory effusion that differs from plasma in a lower concentration of proteins. From a functional point of view, it is an intra-articular lubricant that fills their cavity and ensures the sliding of cartilage.

A sufficient amount of synovial fluid ensures: • metabolism between cartilage and the vascular bed; • activation of humoral immunity during inflammation; • biomechanical mobility of joints.

Variable load on articular surfaces subject to friction is the main condition for the viability of cartilage tissue. During compression, interstitial fluid is released from it, which is mixed with synovial fluid and purified. With relaxation, reverse diffusion occurs. If it is not there, the cartilage will have nothing to feed on, and then its degeneration will begin.

Drug treatment of joints

Drug treatment of joints
The list of drugs presented on the modern pharmacological market is quite wide. For ease of use, according to the mechanism of the therapeutic effect of the active substance, medications are divided into clinical and pharmacological groups. In the treatment of joint pathology, several main groups are mainly used, which include:

• Non-steroidal anti-inflammatory drugs.
• Hormonal anti-inflammatory drugs based on adrenal hormones and glucocorticosteroids.
• Narcotic analgesics.
• Chondroprotectors and vitamin preparations.
• Muscle relaxants.
• Immunosuppressants.

For each pathological process, which is predominantly localized in large or small joints, a combination of medications is selected.

Sources

1. Folomeeva O.M. Prevalence of rheumatic diseases in the population of Russia and the USA / O.M. Folomeeva [et al.] // Scientific and practical. rheumatol. – 2008. – No. 4. – P. 4–13.
2. S.A. Turdialieva, E.A. Mozharovskaya, O.M. Kudrina, D.V. Cherkashin. The most common joint diseases: current issues of diagnosis and treatment. UDC 616(091):378.661(07.07):615.89
3. Joint diseases. Author: Mazurov V.I. Publisher: SpetsLit, 2008, ISBN 978-5-299-00352-9.
4. Karateev A.E. The use of paracetamol in the treatment of acute and chronic pain: comparative effectiveness and safety. Rus. honey. magazine 2010; 18 (25): 1477–88.
5. Imametdinova G.R., Chichasova N.V. Non-steroidal anti-inflammatory drugs in the treatment of joint diseases // Breast Cancer. 2015. No. 25. pp. 1491–1495.
6. The effectiveness of diclofenac in the treatment of osteoarthritis / A. N. Belovol, I. I. Knyazkova, L. V. Shapovalova // Problems of osteology. – 2012. – T.15, No. 1. – P. 54–57.
7. Il'ina AE, Barskova V.G., Kudaeva F.M., Ilyina AE, Barskova V.G., Kudayeva F.M. Application of nimesulide in rheumatology. Modern rheumatology. 2008;2(3):63-66.
8. Meloxicam - a broad view of the problem of use. O.V. Kotova. Research Center GBOU VPO "First Moscow State Medical University named after. THEM. Sechenov." "Medical Forum" No. 1 (2).

Nonsteroidal anti-inflammatory drugs

The main group of drugs that are used for inflammatory pathology of the structures of the musculoskeletal system, including arthritis. The mechanism of action is to suppress the activity of enzymes responsible for the synthesis of inflammatory mediators, prostaglandins, by cells of the immune system. Prostaglandins have a direct irritating effect on the nerve endings in the tissues, leading to pain, increasing the blood supply to the tissues, as well as their swelling.

For pathology of the joints or other structures of the musculoskeletal system, the use of such representatives as diclofenac, ketanov, rheumoxicam is recommended. They accumulate in connective tissue, causing a good anti-inflammatory and analgesic therapeutic effect. The drugs are not intended for long-term use, as they can have a negative effect on the stomach and liver. They are manufactured in several dosage forms - a solution for parenteral intramuscular or intravenous administration (injections), tablets for oral administration, as well as ointment or cream for external use.

Effect of chondroprotectors of different generations

As these drugs evolved, the direction of their action changed and their effectiveness in the treatment of arthrosis increased. Representatives of the first generation were focused on the subchondroid bone, the confirmed results were quite low.

With second-generation chondroprotectors the situation was ambiguous:

• Regarding mucopolysaccharides (medicinal forms of hyaluronic acid), which modify the structure of joints, there is no sufficient evidence base for effectiveness. • Dosage forms of chondroitin sulfate, whose action is aimed directly at cartilage, have confirmed the success of their task. However, they did not solve the problem with the lack of proteoglycans. • Glucosamine preparations, which are stimulators of proteoglycan synthesis, have also proven effective. However, they are not enough for the regeneration of chondrocytes.

Therefore, there was a need to create a good product that has a comprehensive effect on joints. The goal was achieved with the advent of new generation chondroprotectors. The combination of chondroitin with glucosamine ensures the achievement of the desired therapeutic effect. And their combination with NSAIDs allows for complex treatment (relieving pain, suppressing inflammation) without increasing the amount of medications used.

Hormonal agents

The mechanism of action of hormonal anti-inflammatory drugs is also primarily associated with suppression of the activity of enzymatic systems responsible for the synthesis of inflammatory mediators. The drugs are made on the basis of natural glucocorticosteroid hormones, which are synthesized by the adrenal glands. The drugs are manufactured in dosage forms for external and internal use. Injections with a solution of glucocorticosteroids can be prescribed for injection directly into the joint cavity (intra-articular injection). This allows you to quickly and effectively reduce the severity of the inflammatory process in large joints - knee, hip, shoulder, elbow joints. Hormonal anti-inflammatory drugs in the form of oral tablets (Prednisolone) can be prescribed over a long course for autoimmune joint pathology.

Pharmacological groups of drugs for arthrosis

In the treatment of osteoarthritis with drugs, there are several therapeutic directions - relieving pain and inflammation, restoring blood supply and nutrition to joints, eliminating spasms.

Nonsteroidal anti-inflammatory drugs for the treatment of arthrosis

Non-hormonal anti-inflammatory drugs for arthrosis have a mild therapeutic effect and are prescribed at all stages of the disease. The dosage and duration of the course of NSAIDs is determined by the doctor, since the drugs can have side effects on internal organs (contraindicated in acute and chronic diseases of the gastrointestinal tract, liver and kidneys).. To prevent them. , together with non-steroidal anti-inflammatory drugs for the treatment of arthrosis, omeprazole (capsules) is prescribed. You can only take these medications with water.

What drugs help with arthrosis?

1. Nimesil (powder for suspension). Gives a quick effect within 3-4 hours after administration, effectively relieves pain and relieves inflammation. One of the best drugs for the treatment of arthrosis.
2. Ibuprofen (tablets, ointment, injections). Has minimal impact on internal organs and blood vessels.
3. Meloxicam, movalis, amelotex (tablets, injections, gel). The most gentle remedy for the digestive system among non-steroidal anti-inflammatory drugs for the treatment of arthrosis. Not recommended for heart patients.
4. Piroxicam (tablets, capsules, ointment, gel). Quickly relieves pain and inflammation. Aggressive to gastrointestinal mucous membranes.
5. Indomethacin (tablets, ointment, suppositories). Effectively relieves pain, but before use you need to read the list of contraindications. Aggressive to gastrointestinal mucous membranes.
6. Ketoprofen (tablets, injections, gel, ointment, spray). Relieves pain and inflammation, eliminates swelling and morning stiffness of joints. It has high bioavailability (about 90%). The anti-inflammatory effect of the treatment of joint arthrosis with the drug reaches its peak on the 7th day of administration.
7. Diclofenac (tablets, ointment, gel). One of the most accessible and popular NSAIDs. However, it has a number of contraindications. Treatment of arthrosis with drugs containing diclofenac is effective for arthrosis-arthritis.

Glucocorticoid drugs for arthrosis

Corticosteroid drugs for joint arthrosis are potent drugs with serious side effects (they affect the condition of the skin and endocrine system, and the functioning of internal organs). Therefore, for the treatment of arthrosis, the doctor always chooses the minimum therapeutic dose. Uncontrolled and prolonged use of glucocorticoid anti-inflammatory drugs for arthrosis will only worsen the condition of the joints and the body as a whole.

The course of treatment with corticosteroids is up to 10 days, no more than 2-3 times a year (IV, IM or IM). Significant relief of pain and inflammation occurs within 1-2 days after the first dose of the drugs, and the effect lasts from 1 week to a month.

Doctors prescribe the following injectable drugs for the treatment of arthrosis:

1. Hydrocortisone.
2. Prednisolone.
3. Methylprednisolone.
4. Triamcinolone.
5. Diprospan.
6. Betamethasone.

Chondroprotectors and reparants

This group of drugs for the treatment of arthrosis supplies the body with nutrients to restore the joint. Chondroprotectors require long-term use, but provide stable remission. They help fight pain and inflammation not symptomatically, but directly affect the condition of the joint.

Among the most effective drugs for arthrosis, doctors and patients call:

1. Artracam (powder). A preparation based on glucosamine sulfate from shrimp and shellfish. Well tolerated and absorbed by the body, compatible with NSAIDs. Normalizes the production of enzymes in articular cartilage, increases the strength of the cartilage lining and the production of synovial fluid. Course: 1 sachet daily for 6 weeks. If necessary, the course can be repeated after 2 months.
2. Alflutop (injections). Extract of four species of marine fish for intramuscular and intramuscular administration. Improves the quality of cartilage and joint fluid, stimulates the production of hyaluronic acid. Reduces pain and discomfort, inhibits the progression of the disease. Course: 20 intramuscular injections daily or 5-6 intramuscular injections every 3-4 days.
3. Artra (tablets). Glucosamine and chondroitin sulfate. Course: 1 tablet twice a day in the first 3 weeks, after which 1 tablet daily. Course duration: 6 months. The effect after taking lasts up to 2 years.
4. Structum (capsules). Chondroitin sulfate. The course lasts from 3 to 6 months. (1-2 capsules 2 times a day). The effect after treating joint arthrosis with the drug lasts 3-5 months. The drug accumulates in the synovial fluid. It has average bioavailability (about 13% compared to 26% of the drug artracam).
5. Chondroitin Complex (capsules). Chondroitin and glucosamine sulfate. Stimulates the regeneration of articular cartilage and slows down degenerative processes. Reduces the need to take NSAIDs. Bioavailability is about 13%. Course: 3 capsules per day in the first 3 weeks, then 2 capsules per day for 2-3 months.
6. Chondroitin ointment. Helps relieve inflammation and normalize calcium phosphate metabolism in joints, inhibiting the development of the disease. Course: 2-3 weeks (can be repeated). The ointment should be applied to the skin over the affected joint in a thin layer 2-3 times a day and rubbed in.

Chondroprotectors and stimulators of cartilage tissue regeneration also include drugs for arthrosis with hyaluronic acid:

1. Synocrom.
2. Ostenil.
3. Synvisc.

These agents are injected directly into the joint cavity to protect the cartilage from abrasion and drying out. Hyaluronic acid is also a building material for connective cartilage tissue (cell membranes are made of it). The introduction of hyaluronic acid is recommended for patients whose synovial fluid analysis has revealed its insufficient viscosity or poor composition. The continuous effect after one injection lasts from 3 months to 1 year.

Injectable chondroprotectors trigger rapid restoration of the cartilage surface, increase the range of motion in the joint and relieve pain after the first injection.

The mentioned drugs for arthrosis are also used in cases where NSAIDs are contraindicated for patients. That is, there are severe disturbances in the functioning of the cardiovascular system: coronary disease, angina pectoris, hypertension, risk of heart attack/stroke, or a history of such. Or problems with the gastrointestinal tract: ulcers, colitis, gastritis, gastroduodenitis, intestinal erosion and others. The doctor can completely replace NSAIDs with hyaluronic acid during a course of glucocorticoid drugs for the treatment of arthrosis.

Warming and locally irritating drugs for arthrosis

Warming preparations for the treatment of arthrosis include ointments, gels, balms and aerosols. These forms of release do not have any fundamental differences in application and effectiveness.

This group of drugs for arthrosis stimulates blood circulation in the periarticular area and improves nutrition of the joints, helps eliminate swelling and discomfort, and has a beneficial effect on joint mobility (especially in the presence of morning stiffness). In the absence of allergic reactions, these drugs can be used up to 6 times a day.

1. Capsicam and espol (ointments), capsicum (spray). Warming ointments based on hot pepper extract are a completely natural remedy with instant action.
2. Nicoflex (ointment). Also contains capsaicin, an irritating component of red peppers.
3. Nayatox (ointment). A drug for the treatment of arthrosis based on cobra venom.
4. Viprosal (ointment). A drug based on viper venom.
5. Apizartron (ointment). A preparation based on bee venom.

Locally irritating drugs for arthrosis cannot be used for lesions and damage to the skin.

Antispasmodic drugs for arthrosis

Drugs to eliminate musculoskeletal spasms in the treatment of osteoarthritis are used to alleviate the patient’s condition and restore normal tissue trophism. Taking antispasmodics significantly reduces pain and prevents muscle destruction (characteristic of arthrosis dystrophy).

1. Mydocalm (tablets, injections).
2. Baclofen (tablets).
3. Sirdalud (tablets).
4. Tolperisone (tablets, injections).
5. Drotaverine, no-spa (tablets, injections).

As a rule, these drugs for arthrosis are taken as needed. If spasticity is present, the course of treatment is 10-15 days. It is better to stop taking antispasmodics for diseases of the central nervous system and eyes.

Drug treatment of joints

Drug treatment of joints
Analgesics are medications designed to reduce the severity of pain of various origins, which often accompanies a pathological process or injury to the joints. Narcotic painkillers have a blocking effect on central pain receptors and are effective against intense pain, particularly after injury. Medicines are prescribed only by a doctor, usually only to relieve severe pain, as they can lead to the formation of dependence in the patient. Narcotic analgesics include morphine.

Hyaluronic acid

It is also called a “synovial fluid prosthesis”, since hyaluronic acid acts as a lubricant that protects the joint from injury. It normalizes the composition of the synovium, which becomes denser and more viscous. Hyaluronic acid perfectly relieves pain and inflammation, activates the processes of self-regeneration of cartilage. Its most common use is in patients with arthrosis. With this remedy, injections are often made into the hip joint and knees. The standard course of treatment consists of 3-5 procedures with a week interval between them. The effect lasts for a long time, up to 1 year. The most frequently prescribed drugs with “natural lubrication” are Gialgan, Hi-Flex, Gialsin.

Chondroprotectors and vitamins

Chondroprotectors are drugs that are primarily used to treat degenerative-dystrophic diseases of the structures of the musculoskeletal system, affecting cartilage tissue. The drugs can improve the nutrition of cartilage and reduce the intensity of degeneration processes. They are available in tablet dosage form and are intended for oral administration in long courses. Vitamins are indicated for use regardless of the origin and nature of the pathological process, as they can improve metabolic processes in tissues.

PRP therapy

PRP stands for platelet-rich plasma. Platrlet rich plasma. Platelets are responsible for the formation of blood clots - blood clots that can clog damaged blood vessels. Platelets also actively participate in the processes of cleansing wounds of unnecessary proteins and stimulate the activity of fibroblasts. The latter are responsible for the production of collagen and elastin, which are the basis of connective tissue.

PRP therapy is injections for joint pain that have a number of advantages:

• do not cause allergies or side effects;
• rarely lead to the development of complications; (hormones);
• vitamins;
• do not transmit infection..

These advantages are due to the use of the patient’s own blood, which is completely compatible with body tissues. To improve the effect, plasma administration can be combined with hyaluronic acid preparations.

Subtleties of performing joint injections

For intra-articular injections, a syringe with a long needle is used. The specialist must hit it exactly into the joint space. To avoid mistakes, such manipulations are often performed under ultrasound guidance. If necessary, before administering the drug, fluid is pumped out of the joint, since complications may occur if it is present.

Contrary to popular belief, joint injections are a painless procedure. According to most patients, they cause the same sensations as regular intramuscular ones.

To ensure that the medicine is evenly distributed inside the joint, simple movements must be performed after the injection. Sometimes the doctor will apply a tight bandage. There is no other complex rehabilitation and recovery period after intra-articular injection. The doctor will only recommend not to put any strain on the affected joint for a while, not to lift heavy objects, and to give up alcohol for a few days.

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Intra-articular injections feel comparable to intramuscular injections

Indications

• osteoarthritis;
• arthritis;
• bursitis;
• synovitis;
• tendinitis.

Joint diseases are very common, especially among older people. If you are one of them, or the time has come to repeat the course of treatment, call us. Our center employs high-level specialists with extensive experience, making patients feel comfortable and confident. If necessary, you will be prescribed one or more intra-articular injection procedures and a drug will be selected based on the indications.

Morning stiffness of the knee joints

The knee joint has a complex structure - it consists of three bones, synovial lining (cartilage 5-6 mm thick), ligaments, and two menisci. Therefore, diagnosis of his diseases that cause stiffness is available only to a doctor.

Most often, the knees are affected by arthrosis (especially in overweight people, professional athletes, injured patients or people over 40 years old). These joints are also vulnerable to arthritis, a similar-looking disease that often affects patients under 40 years of age. At night, arthritic knee pain can interfere with healthy sleep, and in the morning, swelling makes it difficult to begin daily activities.

Stiffness in the knees can cause damage to the meniscus (even a small partial tear), which is accompanied by pain. In the absence of severe pain, it is worth considering the option of obesity.

A lesser known disease is also characteristic of the knee joint - Baker's cyst, which is associated with the accumulation of excess synovial fluid. It is common among athletes, elderly and sedentary people, and can occur with severe physical stress. May be accompanied by fever, tingling in the knee area, cramps, stiffness, and may manifest as a swelling noticeable upon palpation behind the knee.

Advantages

• The drugs dissolve very slowly, up to 12 months.
• They have a local effect on all joint tissues.
• Almost do not enter the systemic circulation and do not affect the functioning of internal organs.
• Thanks to the previous point, they can be used in patients with severe concomitant pathologies, when treatment with other methods is unacceptable.
• Intra-articular injections help avoid surgery.
• After the procedure, no rehabilitation is required; the doctor can only apply a tight bandage and warn against excessive physical exertion.

Shoulder stiffness

The shoulder joint is also considered loaded and designed for multi-axis rotation. Therefore, stiffness in it is often caused by rheumatoid, gouty and other arthritis, bursitis, rupture of the rotator cuff, osteochondrosis, arthrosis, spinal cord injuries, tendinitis, so-called. “frozen shoulder syndrome” and other diseases. Sometimes stiffness occurs due to problems with the heart or lungs - in this case, the patient may mistake the manifestations of pain for a real restriction in the shoulder joint. How to get rid of joint stiffness in this case? First, consult a doctor for pain medication.