Nonsteroidal anti-inflammatory drugs in the treatment of joint diseases

Types of joint diseases

The most common joint diseases are:

• inflammatory – arthritis (rheumatoid, gouty, psoriatic, infectious, reactive);
• non-inflammatory – arthrosis;
• secondary – against the background of diseases of other organs: systemic lupus erythematosus, scleroderma, polymyositis, Sjögren’s disease, oncology.

Inflammation can affect both individual parts of the joint and its entire structure. Symptoms differ depending on the cause of the lesion, but are united under the general name “articular syndrome.” Patients complain of pain, limitation of movements, and deformation of the damaged area.

The main non-inflammatory disease of the musculoskeletal system is osteoarthritis. By the age of 50-60, almost 85% of the population suffers from its manifestations².

Osteoarthritis damage begins with inflammation in the synovium and ligamentous apparatus. As a result, the process involves all components of the joint. When cartilage is destroyed, the bones become irreversibly deformed at the articular surfaces and lose functionality, which is accompanied by the appearance of chronic pain.

Pain from joint diseases significantly reduces the quality of life. Photo: HayDmitriy / Depositphotos

Why do my joints hurt?

Arthralgia can have a number of causes, such as:

• toxic syndrome in acute infectious processes;
• acute or recurrent arthritis of various etiologies;
• progressive degenerative-dystrophic changes in cartilage, damage to the synovial membranes;
• residual effects after an inflammatory process or injury;
• pseudoarthralgia (psychosomatic simulation of joint pain - Ed.).

If one joint hurts, first of all we can assume an injury, an infectious process or the deposition of salt crystals in the joint (microcrystalline arthritis). For young people, arthralgia is most likely to be associated with injury, infection, or a primary inflammatory disease (eg, rheumatoid arthritis). At the same time, in older people, the most likely causes are osteoarthritis or microcrystalline arthritis.

When it comes to arthropathy involving multiple joints, the most common causes are systemic inflammatory diseases, as well as microcrystalline arthritis, osteoarthritis and infections.

Rare causes of arthralgia include synovitis of various etiologies, hemorrhages into the joint cavity due to blood clotting disorders, tumor processes, and side effects after taking medications (for example, angiotensin-converting enzyme inhibitors or proton pump inhibitors).

It is important to remember that the appearance of pain can be associated with damage to the periarticular tissues - bursitis, tendinitis, fasciitis, epicondylitis and tenosynovitis. Sometimes joint pain is a consequence of disorders of the musculoskeletal system (for example, flat feet) or neuralgia and myalgia of other origins.

Causes of joint diseases

The following factors have an adverse effect on the joint³:

• age over 45 years;
• excess weight;
• female;
• hereditary predisposition;
• congenital developmental anomalies - hypermobility, dislocations, tissue underdevelopment;
• long-term mechanical impact;
• intense sports activities;
• injuries;
• physical inactivity – an insufficiently active and varied lifestyle;
• concomitant diseases with metabolic disorders: diabetes mellitus, gout, dysfunction of the thyroid gland, adrenal glands, hypothalamic-pituitary system in the brain;
• osteoporosis – a decrease in the quality of bone tissue and its mass for various reasons;
• viruses: rubella, hepatitis, HIV, adenoviruses, infectious mumps (“mumps”);
• autoimmune inflammation - the body perceives joint components as foreign, producing antibodies against them;
• bacterial infections: tick-borne borreliosis (Lyme disease), gonorrhea, staphylococcal sepsis.

The cause of the disease may be specific. In rheumatoid arthritis, this is an autoimmune inflammation, the origin of which is still unknown. Young, able-bodied people often suffer. Ankylosing spondylitis (ankylosing spondylitis) is associated with genetic and immune disorders, and, to a lesser extent, with intestinal and sexually transmitted infections³.

Do not endure pain and do not self-medicate! See your doctor. Photo: monkeybusiness/Depositphotos

Application

Glucocorticosteroids are used by doctors only if necessary.

These drugs are used in anesthesiology and resuscitation practice. Intravenous administration of corticosteroids during anesthesia maintains hemodynamic parameters. In severe circulatory disorders, drugs help increase tissue perfusion and venous outflow, normalize peripheral resistance and cardiac output, and stabilize cellular and lysosomal membranes.

In severe allergic reactions, intravenous administration of adequate doses of GCS has a therapeutic effect, but the onset of action of GCS is delayed. Thus, the main effects of hydrocortisone develop only 2-8 hours after its administration.

Glucocorticosteroids have a pronounced effect in adrenal insufficiency that develops before and during surgery. Hydrocortisone, cortisone and prednisolone are used for replacement therapy.

The administration of long-acting corticosteroids is practiced to prevent respiratory distress syndrome in premature infants, which reduces the risk of complications and death by 40-50%.

Forms of drugs

Various forms of hormonal drugs are available. This is done not only for ease of use, but also allows you to get the desired effect. Tablet forms are used to treat systemic diseases and allergies.

Inhalation forms are used in the treatment of diseases of the respiratory system (Symbicort, Pulmicort, Seretide). Because their use is usually long-term, they are formulated to have minimal systemic effects.

For the treatment of autoimmune inflammatory diseases of the joints, drugs are produced for intra-articular administration (Diprospan, Kenolog). They are released slowly and the effect of 1 injection on a joint can be quite long.

Ointments (Sinaflan), gels are used in dermatology to treat skin diseases and allergies.

Undesirable effects

Undesirable effects are related to the duration of treatment and dose. More often with prolonged use of more than 2 weeks and high doses. However, high doses of hormones for 1-5 days usually do not cause the development of adverse events. Replacement therapy is considered safe, since very low doses of GCS are used.

Undesirable effects:

1. At the initial stages of admission:

• poor sleep;
• emotional excitability;
• excess appetite, weight gain.

2. When taking GCS and other drugs or diseases in combination:

• hypertonic disease;
• increased sugar levels and risk of diabetes;
• ulcers of the digestive system;
• acne.

3. Possible when used for a long time with large doses:

• Cushingoid;
• suppression of the adrenal glands;
• weakening of protection against infectious diseases;
• osteonecrosis;
• myopathy;
• poor healing from injuries.

4. Late and gradually developing (associated with accumulation):

• osteoporosis;
• cataract;
• atherosclerosis;
• growth retardation in children;
• fatty liver degeneration.

Abrupt cessation of short-term (within 7-10 days) GCS therapy is not accompanied by the development of acute adrenal insufficiency, although some suppression of cortisol synthesis still occurs. Longer therapy with GCS (longer than 10-14 days) requires gradual withdrawal of drugs.

Taking synthetic drugs with a long duration of action causes undesirable effects. Abruptly stopping hormones can lead to acute adrenal insufficiency. Restoring adrenal function can take from several months to a year and a half.

Contraindications

Glucocorticosteroids should not be used without a doctor's recommendation.

There are no absolute contraindications if the benefit is greater than the risk. Especially in emergency situations and short-term use. For long-term treatment, relative contraindications may be:

• decompensated diabetes mellitus;
• symptoms of mental illness;
• exacerbation of peptic ulcer of the stomach and duodenum;
• severe osteoporosis;
• severe hypertension;
• severe heart failure;
• active form of tuberculosis;
• systemic mycoses and fungal skin infections;
• acute viral infections;
• severe bacterial diseases;
• primary glaucoma;
• pregnancy.

Today we cannot do without glucocorticosteroids in medicine. Since their effects are very diverse, the doctor must choose the drug that is suitable specifically for your case.

Classification of drugs for joints

The following groups of drugs are used to treat joints:

• analgesics – effective, quick-acting painkillers;
• non-steroidal anti-inflammatory drugs (NSAIDs, NSAIDs) - inhibit the activity of mediators of pain and inflammation - cyclooxygenases (COX-1, COX-2);
• intra-articular glucocorticosteroids - hormones, effective agents that suppress immunoinflammatory reactions for a long time;
• muscle relaxants – eliminate muscle spasms;
• chondroprotectors - chondroitin sulfate and glucosamine (relatively effective slow-acting agents that slow down the progression of osteoarthritis).

Important!

It is important to start combined treatment of osteoarthritis in the first 2-3 months after the onset of symptoms. In this case, the probability of maintaining operability over the next 10 years increases to 75%³.

Most often, drugs of different groups are prescribed. First, signs of acute inflammation are removed, then medications are prescribed to help restore the components of the joint.

Types of drugs

This group of hormones can be divided into groups according to the rate of excretion from the body:

• from 8 to 12 hours, short-acting: hydrocortisone, cortisone;
• from 18 to 36 hours, average duration: prednisolone, methylprednisolone, triamcinolone;
• from 36 to 54 hours, long-acting: dexamethasone, betamethasone.

Hormones also differ in the severity of glucocorticoid and mineralcorticoid properties and in the strength of their effect on the hypothalamic-pituitary-adrenal regulatory system.

TOP drugs for joints

The choice of medications remains up to the doctor. Below we will look at 15 drugs that are most often prescribed for joint pathology.

1. Strontium ranelate. Preparations based on strontium ranelate are effective against osteoporosis. They slow down the destruction of bone tissue and restore the supply of nutrients to cartilage. Their effectiveness and safety in the treatment of osteoarthritis of the knee joints has been proven. Used for a long time (years).

2. Diclofenac sodium is the best medicine for joints in the treatment of traumatic injuries, especially in athletes. Local (in the form of patches, ointments) and general (injections, tablets) forms are often combined to achieve maximum effectiveness. Included in the group of non-steroidal anti-inflammatory drugs (NSAIDs). Diclofenac suppresses the activity of inflammatory isoenzymes – cyclooxygenase-1 and 2. It has a moderate risk of damage to the gastrointestinal tract and cardiovascular system⁶. Not recommended for long-term use.

3. Nimesulide. This drug is also a NSAID and has a dose-dependent effect. It quickly penetrates into the area of ​​inflammation, where it accumulates in greater quantities than in the blood⁷. In addition to suppressing COX-2, it has the following effects⁷:

• slows down the destruction of chondrocytes that make up cartilage;
• reduces the activity of inflammatory cells - macrophages, neutrophils;
• indirectly has an antihistamine effect similar to antiallergic drugs - relieves swelling and redness.

Important!

With long-term use, nimesulide negatively affects the gastrointestinal tract.

Side effects from the liver and cardiovascular system are less pronounced⁷. Nimesulide is well tolerated by patients and is suitable for both rapid pain relief and course of symptomatic treatment.

Several groups of drugs are used to treat joints. Photo: aivolie / freepik.com

4. Meloxicam. A drug from the NSAID group that selectively blocks COX-2 in therapeutic doses. Has less damaging effects on the gastrointestinal tract, heart and kidneys⁸. The drug not only relieves pain symptomatically, but also slows down the progression of osteoarthritis of the knee joints. The strength of the effects is equal to diclofenac, but is better tolerated⁸.

5. Ibuprofen. An early representative of NSAIDs that indiscriminately inhibits the activity of both forms of COX. Slowly penetrates into the joint cavity, eliminating inflammation and pain. It has a relatively low incidence of side effects from the gastrointestinal tract (peptic ulcers, NSAID gastropathy, bleeding). Contraindicated in severe liver disease and renal failure. With long-term use, you need to monitor the appearance of side effects in order to prevent dangerous complications in time.

6. Ketoprofen. One of the oldest NSAIDs with non-selective action. Has a good analgesic effect. Suitable for relieving acute pain. It is used in the form of tablets, capsules, injection solution and ointments. Increasing the therapeutic dose leads to complaints from the gastrointestinal tract: heartburn, abdominal pain, bleeding. Ketoprofen is used in surgical practice, including after interventions on the knee joints.

7. Etoricoxib. New generation NSAIDs with good analgesic properties and safety profile⁵. The risk of side effects from the digestive tract and heart is minimal. Suitable for long-term therapy, taken only once a day.

To eliminate sudden pain, it is enough to use NSAIDs for 1-2 weeks, preferably in combination with muscle relaxants⁵. For chronic inflammation, the course is extended to 4-8 weeks. To reduce the negative effect of NSAIDs on the mucous membrane of the digestive tract, antisecretory drugs - omeprazole, pantoprazole, esomeprazole⁵ - are added to the treatment regimen.

8. Tizanidine. A muscle relaxant that eliminates increased muscle tone in joint pathologies. Helps reduce pain, prevents the formation of contractures (limitation of passive movements in the joint), improves the functionality of the musculoskeletal system. According to its chemical structure, it belongs to imidazole derivatives. Prescribed simultaneously with NSAIDs and other drugs for the treatment of joints. Tizanidine may reduce the incidence of gastrointestinal complications caused by NAIDs. The most common side effects are lethargy, dry mouth, and a slight decrease in blood pressure.

9. Triamcinolone. A synthetic corticosteroid that is administered intra-articularly. Relieves swelling, pain and inflammation. The optimal course of treatment is up to 3 injections per year. The therapeutic effect lasts 3-4 weeks. At the injection site it can cause irreversible changes (atrophy) of the skin and nerve trunks.

Triamcinolone injection into the joint. Genrix20061.mail.ru / Depositphotos

10. Methylprednisolone acetate. A hormone with an average duration of action – up to 1.5-2 weeks. Has moderate anti-inflammatory and analgesic properties. It is used intra- and periarticularly, especially for rheumatic diseases and post-traumatic reactions.

11. Betamethasone. A long-acting glucocorticosteroid (hormone) used for intra-articular administration. The anti-inflammatory and analgesic effect after one injection lasts up to 4-6 weeks. Does not lead to excessive deposition of crystals in the joint cavity. Indicated for arthritis and arthrosis of various origins, as well as autoimmune diseases. The dose is selected by the doctor depending on the size of the joint and the severity of inflammation. The maximum single dose is administered into a large joint (knee, shoulder) - one ampoule or bottle.

12. Chondroitin sulfate. It is used internally for osteoarthritis, rarely - externally or intramuscularly. Belongs to the group of chondroprotectors. In theory, it should reduce the destruction of cartilage components, promoting joint restoration. In practice, there is insufficient evidence of the effectiveness of these drugs, although a beneficial effect on individual patients cannot be ruled out.

Chondroprotectors are digested in the digestive tract. The components of the drug can serve as a source of building material for cartilage. However, the effectiveness of expensive medications is similar to a simple balanced diet. Abroad, chondroprotectors are classified as food additives (BAA), and not pharmacological agents. Their effectiveness has not been confirmed in Cochrane reviews.

13. Glucosamine. Another chondroprotector with a dubious evidence base. Long-term use may subjectively improve the patient's condition, but remission is not confirmed by X-ray monitoring. Therefore, it is not recommended to use glucosamine as the main remedy for the treatment of joint diseases.

14. Hyaluronic acid. Intra-articular injection of hyaluronic acid also has controversial results regarding its effectiveness. The fluid inside the joint is regularly renewed, so the additional supply of hyaluronic acid only changes its properties in the short term.

15. Paracetamol. An over-the-counter analgesic that is suitable for the relief of both acute and chronic pain⁴. Suppresses unpleasant sensations in the brain - has a central effect. Less common than NSAIDs, it leads to complications from the gastrointestinal tract and blood. Paracetamol is recommended for pain relief for osteoarthritis in elderly patients⁴. It is often used in the same regimen with NSAIDs and opioids, increasing their effectiveness by almost 30%⁴. Available in the form of tablets for oral administration, solution for infusion, rectal suppositories.

During treatment, you must strictly adhere to the prescribed dose: no more than 3-4 g/day. The most dangerous side effects relate to liver damage, including death - the substance is hepatotoxic⁴.

Conservative treatment of muscles and ligaments

Reliable connection

Conservative treatment of muscles and ligaments

Everyone knows about pain in joints and muscles. You stumbled unluckily while rushing to catch the morning bus, played football yesterday, and your ankle, shoulder and knee ache, you have difficulty straightening up after sitting at the computer for a long time - this is a common thing. People are accustomed to such situations and do not notice that they go to the doctor only in critical cases.

Common doubts: “Are my complaints really that serious? Maybe it will go away on its own?” No, it won't work. Let's find out why.

What do pains mean?

It is important to see a doctor immediately after pain or discomfort in muscles and ligaments appears for three reasons:

• these symptoms may be a sign of concomitant diseases;
• you may have overexertion, which is fraught with complications, including atrophy;
• we may be talking about sprains, and inaction will lead to ruptures and chronicity of the process.

In any case, symptoms depend on the stage of damage and can progress without specialist supervision. Moreover, the sooner you see a doctor, the more effective, comfortable and painless the examination and treatment will be.

What is overvoltage?

Overvoltage is caused by excessive cyclic load over a long period of time.

When the muscle fibers of individual muscle groups become overworked, a person experiences constant pain, sometimes leading to spasms. These manifestations can bother the patient for several months and are fraught with microtrauma. In injured tissues, in turn, degenerative processes are launched.

Damage due to overexertion (overtraining) is divided into four degrees:

• I degree – pain only after physical activity;
• II degree – pain during and after physical activity, which does not affect the result of work;
• III degree – pain during and after physical activity, affecting the result of work;
• IV degree – constant pain that interferes with daily physical activity.

The most common consequences are associated with processes in the tendon-ligamentous apparatus. There are three most common types of ailments:

• Tendinitis occurs due to tendon injury and associated vascular destruction and acute, subacute or chronic inflammation.
• Tendinosis is a non-inflammatory atrophy and degeneration of fibers within a tendon, often associated with chronic tendonitis and leading to partial or complete rupture of the tendon.
• Tenosynovitis is an inflammation of the paratendon, which is the outer sheath of some tendons and is lined with a synovial membrane (for example, damage to the extensor tendon of the thumb in de Courvain's tenosynovitis).

Speaking about specific diseases, it is interesting to note that the name of many is directly related to the type of load that caused the overstrain: “tennis elbow,” “jumper’s knee,” “swimmer’s knee,” “baseball player’s elbow.” We are talking about overexertion in a movement characteristic of a given sport, but in fact, tension in the same muscles can also occur during another type of activity. There are known people with “golfer’s elbow” who have never played golf in their lives, but work as programmers.

What is important to know about stretching?

Sprains of muscles, tendons or ligaments are the most common type of injury associated with a violation of integrity, partial rupture of individual muscle or connective tissue fibers while maintaining anatomical continuity.

Muscles are the main anatomical structure that moves the entire musculoskeletal system. Tendons are extensions of muscles that connect them to bones. Ligaments serve to attach bones to each other. They hold the bones of the joints of the musculoskeletal system of the body in specified positions.

Sprains require proper and timely treatment, as well as some knowledge on the part of the patient.

Immediately after stretching, you should never:

• warm and rub the injury site;
• continue working or training through pain.

However, after a while, these same actions turn out to be useful. At the beginning, stretched ligaments or muscles need rest for a speedy recovery, and later special exercises will be needed to help quickly return to normal life.

Thermal treatments and massage are indicated only 3-4 days after stretching. They are used to improve blood circulation and accelerate the resorption of hematoma and swelling.

Immediately after stretching you need to:

• limit physical activity of the injured segment;
• apply ice (or something cold);
• raise the injured limb upward to reduce the increase in swelling;
• in case of severe pain, it is recommended to use NSAIDs (non-steroidal anti-inflammatory drugs), both in oral forms and in the forms of gels or ointments.

And, most importantly, you need to contact a specialist as soon as possible, who will conduct a thorough diagnosis and prescribe a further course of treatment.

How is the inspection carried out?

Do not worry! When diagnosing any damage to the musculoskeletal system, the doctor cares not only about the effectiveness of treatment, but also about the patient’s comfort.

Interaction with an orthopedist consists of three main positions:

• Examination is the stage at which edema (swelling), hematomas, and ecchymoses (bruises) are detected.
• Palpation - determination of the degree of pain in the axial load of tendons and ligaments or discomfort around the damaged segment. It’s worth taking a closer look at this stage. It is very important: thanks to it, clearly defined symptoms are determined for each individual area of ​​​​damage. For example, you can identify the “anterior (or posterior) drawer” symptom in the knee joint when the cruciate ligaments are damaged or torn. Or, the area of ​​damaged muscles is examined: you can feel the seals, or, on the contrary, feel a dip in the projection of the palpated muscle, which may indicate its complete rupture.
• Assessment of movement and mobility of the damaged segment. Here it is important to understand that when diagnosing injuries to the tendons and ligamentous apparatus, pain is determined with any active movement or a complete limitation of mobility in the injured segment (this is possible with complete ruptures of the capsular-ligamentous and tendon apparatus). The study of muscle strain is also assessed: firstly, by the pain of movements (are there any difficulties when trying to bend an arm, hold even a small load, bend over, etc.), secondly, by limited movements and dysfunction (this directly indicates a possible complete muscle rupture).

Everything is as fast, clear and informative as possible. Based on the information received, the doctor will prescribe a course of treatment.

Will the doctor restrict my freedom of movement?

Many patients put off seeing a doctor for fear that they will be “put in a cast and unable to move.” These fears are a relic of the past.

Using inspection, palpation and movement assessment, a good specialist will make a diagnosis, establishing the extent and type of damage. Depending on the results, the doctor will prescribe a course of treatment, which, if necessary, will include immobilization (limiting the mobility of the damaged area).

But there is nothing to be afraid of. In the modern world, there is an orthosis method - the most gentle and effective way to treat soft tissue injuries, based on wearing a special orthopedic product (orthosis) at the site of injury. Unlike plaster, the correct orthosis:

• transmits x-rays and gives doctors the opportunity to monitor the patient’s recovery over time;
• easy to take off and put on;
• can be worn under clothing;
• allows you to adjust the degree of fixation to limit the patient’s movements only to the extent necessary for the current stage of treatment;
• hygienic: does not cause skin irritation.

An appointment with an orthopedic doctor at ORTEK will help you not only make a diagnosis, but also choose the right orthopedic products that will immediately relieve pain and begin treatment.

In ORTEK you will find a wide range of specialized products and save time on going to the doctor and subsequent search for medicinal products.

Make an appointment by phone at the Unified Orthopedic Help Desk 8 (800) 33-33-112

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).

Activity of topical corticosteroids

The activity of drugs in this group depends on at least four factors [2, 4].

Release form.

The release form of a local drug is in its own way a “vehicle” that ensures the delivery of active substances deep into the skin. Therefore, the “power” of the topical agent largely depends on its properties.

• Ointments with steroids

  are considered the most effective form of topical corticosteroids. These are water-in-oil emulsions, the high activity of which is due to the ability to form a film on the surface of the skin that is impenetrable to air and moisture and thus provides a “compress effect” - occlusion. As a result, the local concentration and effectiveness of the product increases. But occlusive preparations also have disadvantages: firstly, the skin stops “breathing”, which can contribute to the development of weeping, and secondly, they are inconvenient to apply to the skin of the scalp, chest, etc.

  It is advisable to recommend topical corticosteroids in the form of ointments for the treatment of dry skin diseases.

• Creams

  , unlike ointments, being an “oil in water” emulsion, are not fatty forms. They do not form an occlusive film on the surface of the skin and therefore lack both the disadvantages of ointments and their advantages. GCS creams are less active than steroid ointments.

  Topical corticosteroids in the form of a cream are indicated for acute and subacute inflammation without significant weeping.

• Gels

  - an oil-in-water emulsion with an alcohol base. They liquefy upon contact with skin and have a medium degree of activity.

  It is advisable to recommend gels for the treatment of areas of the body heavily covered with hair.

• Lotions

  , which are aqueous solutions, are considered the least active form of GCS. They evaporate, providing a cooling effect.

  It is advisable to recommend topical GCS in the form of a lotion if it is necessary to treat large areas, as well as areas abundantly supplied with hair follicles.

The salt to which the steroid is bound.

For example, betamethasone exists as valerate, dipropionate, and benzoate, each of which has different potencies.

Active ingredient concentration

The higher the concentration of the active substance, the higher the activity of the drug.

For example, one of the most powerful topical corticosteroids, clobetasol propionate, in the form of an ointment, is approximately 1000 times “more powerful” than the weakest drug in this group, 1% hydrocortisone.

There are two classifications of topical corticosteroids according to the degree of activity - European, which distinguishes 4 classes, and American, in which drugs are divided into 7 classes of activity. In both the first and second, activity was assessed based on vasoconstrictor tests and according to clinical studies.

European classification of topical glucocorticosteroids [3]

American classification of topical corticosteroids [3]