Modern approach to the treatment of pain in osteoarthritis

Arthritis, arthrosis are diseases with an inflammatory course, in which the synovial membrane of the joint is affected and effusion accumulates in the cavity. The knee joint is a complex problem, when pain during degenerative-dystrophic processes is exhausting and sharply worsens the quality of life. Injections are the most accessible method of therapy:

• quickly eliminate pain at the bottom of the knee, side and inside;
• relieve swelling;
• normalize the condition of cartilage tissue.

The most effective are intra-articular injections (pain injections), which instantly eliminate side effects at the site of inflammation and do not affect other internal organs.

Indications for use

Pain in the knee is often caused by infection, hypothermia, sprain, and inflammatory processes. Injections help improve the structure of food material, increase the amount of synovial fluid, reduce swelling, and relieve pain.

A blockade for knee pain with the injection of drugs directly into a joint or muscle is carried out for the following diseases and conditions:

• Arthrosis of the knee joint (gonarthrosis);
• Sprain;
• Fractures and dislocations in the joint area;
• Bursitis, synovitis;
• Gouty arthritis;
• Reiter's disease;
• Inflammation of the synovial membrane;
• Arthralgia is severe pain in the joint area.

If the bone under the knee is very painful, then before prescribing restorative treatment, it is necessary to eliminate the pain and inflammatory syndrome with injections of painkillers and anti-inflammatory drugs.

Modern approach to the treatment of pain in osteoarthritis

Osteoarthritis (OA) is the most common chronic musculoskeletal disease in the population. In Russia, more than 4 million patients with OA are registered only by visiting medical institutions [1]. A significant period of time passes from the onset of the disease to the visit to the doctor, which is primarily due to the slow development of the disease and the stage of the disease [2, 3].

OA predominantly affects stress-bearing diarthritic joints - knees, hips, however, the joints of the hands, mainly distal, are involved in the pathological process. In OA, all tissues of the joint are affected, but to a greater extent the cartilaginous plate and subchondral bone.

Among the factors influencing the progression of OA are: age over 45 years, female gender, heredity, postmenopause, previous joint trauma. A number of factors that have a negative effect on cartilage can be eliminated by the patient himself: reducing body weight, increasing physical activity, reducing the load on problem joints, and carrying weights in doses. Patient education is given great attention in schools for OA patients.

As the pathogenesis of the disease was studied and new diagnostic methods were introduced, it became clear that this disease is characterized by chronic inflammation, in which all components of the joint are involved in the pathological process, including the synovium, cartilage, joint capsule, ligaments, tendons, and subchondral bone.

Cartilage tissue is not vascularized, and its nutrition and oxygenation occurs due to chondrocytes, the cells responsible for maintaining the extracellular matrix. At an early stage, clusters of chondrocytes form in the damaged area and the level of growth factors there increases, which promotes tissue regeneration. Over time, the synthesis of tissue-damaging proteinases (metalloproteinases 1, 3, 9, 13 and aggrecanases) increases, stimulating the apoptotic death of chondrocytes, which leads to the formation of a matrix that is unable to withstand normal mechanical stress. These changes are asymptomatic, since cartilage does not have nerve endings. Clinical symptoms of OA begin to appear when innervated tissues are involved in the process, which is one of the reasons for the late diagnosis of OA [4].

The key factor in the pathophysiology of OA is synovitis, for the diagnosis of which instrumental methods are used - ultrasound examination (US) of the joint, magnetic resonance imaging (MRI), as well as histological examination of synovium biopsy material. Synovitis is a predictor of cartilage damage. Synovial macrophages produce catabolic and proinflammatory mediators, resulting in an imbalance of cartilage repair and degradation, with the latter predominant. There is increasing evidence in the literature indicating that the process initially begins as a result of chronic inflammation in the synovium, subchondral bone and ligamentous apparatus [5]. Inflammation in these structures leads to the development of synovitis, osteitis, and enthesitis, which is confirmed by MRI results. The outcome of inflammation ends with the formation of osteophytes and destruction of the articular surface. The first symptom that forces the patient to see a doctor is pain that intensifies when walking, going down stairs, and the so-called “starting” pain that occurs after prolonged sitting or resting.

The European League Against Rheumatism (EULAR) and The Osteoarthritis Research Society International (OARSI) have developed recommendations for the treatment of OA, which include non-pharmacological, pharmacological and surgical treatments [6].

Considering the fact that patients with OA have a fairly large number of concomitant diseases that require the use of antihypertensive, hypoglycemic drugs and others, when choosing a treatment regimen for this disease, it is necessary to take into account the compatibility of drugs and the safety of the therapy.

Treatment of OA still remains a complex problem, based on a complex individual choice of treatment tactics, depending on the location and prevalence of OA, the severity of clinical manifestations, joint destruction, the patient’s functional activity, and the presence of concomitant diseases.

The main goal of OA treatment is to reduce or relieve pain, improve joint function, and improve the quality of life of patients. This is achieved, first of all, by prescribing fast-acting symptomatic drugs, which include paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs). However, with long-term use of paracetamol and in high daily doses, it exhibits hepato- and nephrotoxicity. NSAIDs are widely used in rheumatology due to their analgesic and especially anti-inflammatory effects. When choosing NSAIDs in elderly patients, and this is the majority of patients with OA, it is necessary to take into account the pharmacodynamics of the drug, its compatibility with drugs for the treatment of concomitant diseases, safety in terms of the occurrence of adverse events, as well as the effect on cartilage.

Pain from OA is most often chronic, but acute pain can also occur if the congruence of the articular surfaces is disturbed. Therefore, for patients with OA, it is advisable to use NSAIDs in various forms - injectable for the relief of acute pain and oral for chronic pain. One such drug is lornoxicam [7].

Pharmacokinetic studies indicate that with oral and parenteral administration of the drug, its absorption is rapid and dose-dependent. Binding to plasma proteins (mainly albumin) is 97–99%. A study of the concentration of the drug in plasma and synovial fluid showed that its maximum in synovial fluid occurs after 4 hours, accounting for 50% of the concentration in plasma, in which 2 peaks were noted - after 30 minutes and after 4 hours. The drug is short-lived, its half-life is about 4 hours, therefore, there is no danger of its accumulation in the body. An important fact is that there were no changes in pharmacokinetics in the elderly. It should be taken into account that lornoxicam, like other NSAIDs, interacts with other drugs: it reduces the concentration of Aspirin in plasma, the effect of enalapril, furosemide, and increases the antidiabetic effect of hypoglycemic drugs. No increase in liver enzymes was detected during treatment with lornoxicam [8]. The safety of the drug was also confirmed based on a meta-analysis of clinical studies [9].

The analgesic effect of lornoxicam was compared with tramadol and ketorolac during minor surgical operations. The 8 mg dose of lornoxicam was comparable to 40 mg ketorolac and 100 mg tramadol. For acute postoperative pain, the effect of 8 mg of lornoxicam was equal to the effect of 20 mg of morphine for 8 hours, with the former being better tolerated [10].

Another advantage of lornoxicam was found when administered intravenously in patients with low back pain, which showed an increase in the level of endogenous morphines (dynorphin and B-endorphin), indicating its analgesic effect through the central nervous system [11].

The effectiveness of lornoxicam in OA has been shown in a number of studies. Thus, a multicenter randomized, double-blind, placebo-controlled treatment of patients with arthrosis of the knee and hip joints with various doses (6, 8, 12 mg) showed an advantage of the 12 mg dose according to the Lequesne index. Laboratory parameters did not reveal drug toxicity; minor adverse events from the gastrointestinal tract (GIT) were noted [12]. In another study, 135 OA patients received a higher dose of the drug - 12 mg or 16 mg per day for 12 weeks compared to 150 mg diclofenac, and 85 of them continued treatment with lornoxicam for 40 weeks, which made it possible to evaluate not only the positive clinical effect , but also the safety of the drug. A good and excellent analgesic effect was obtained in 80% and 89% of patients with good tolerability of the drug [13].

Our data, based on the treatment of 25 patients with gonarthrosis and coxarthrosis for 4 weeks with lornoxicam at a dose of 16 mg/day, showed a significant improvement in the severity of pain, morning stiffness, Ritchie index, and a decrease in C-reactive protein. The effect as improvement and significant improvement was noted by 24 patients. There was no increase in liver enzymes or a negative effect on kidney function. The incidence of mild gastrointestinal adverse events was in 20% of patients [14]. A pronounced analgesic effect of 8 mg of lornoxicam was obtained in 75% of 30 OA patients with secondary synovitis and pain severity of more than 60 mm according to VAS. Already on the 7th day, 60% of patients noted an improvement in the severity of pain at rest and during movement (up to 30–40 mm according to VAS) with relief of signs of inflammation. There was no discontinuation of the drug [15].

Interesting data on the treatment of arthrosis of the facet joints of the spine in 24 patients. The drug was administered at a dose of 8 mg per 20 ml of 0.5% Novocaine solution paravertebrally, creating a high concentration around the facet joint. Patients who received the same dose intravenously or intramuscularly served as controls. Within 15–20 minutes in the main group, the pain decreased sharply, and the patients were able to walk. The acute period lasted up to 6 days, in the comparison group up to 15 days [16].

In the work of WA Herrmann [17], in which the effect of lornoxicam was compared with diclofenac or placebo for acute pain in the spine, it was found that after taking the first dose of lornoxicam, pain significantly decreased. Within 5 days, 93% of patients obtained a good/very good result.

In rheumatology and especially in rheumaorthopedics, intra-articular administration of lornoxicam is possible [18], which is especially important for elderly patients who are contraindicated for intra-articular administration of glucocorticoids.

The work [19] presents data on the positive effect of intra-articular administration of lornoxicam to OA patients with synovitis of the knee joint. 8 mg of the drug was diluted with 10 ml of water for injection, the drug was administered once a week, for a course of 4 injections. By the fourth week, only 6.9% still had pain, rated as “mild”; in the rest, pain and synovitis were relieved. Similar results were obtained in the work of N. A. Nikitin et al. [20], during which 8 mg of lornoxicam was intra-articularly administered three times with an interval of 72 hours with preliminary evacuation of synovial fluid and assessment of the effect clinically and by ultrasound of the joint. After the third injection, only 5 out of 57 patients had ultrasound signs of synovitis. A very good effect was obtained in 70% of patients, good in 20% and satisfactory in 10%. There were no adverse events.

These studies were performed on a limited number of patients and cannot be used as recommendations. It is required to conduct multicenter studies using a single protocol with objectification of the results.

An important issue for patients in the older age group is the occurrence of fractures, which (especially fractures in the femoral neck) lead to immobility and often death. This is facilitated by an increased risk of falls due to weakness of the muscles of the lower extremities, pain during movement, cerebral pathology and changes in the structure of bone tissue [21].

Previously, OA and osteoporosis (OP) were considered mutually exclusive diseases. The basis for this was the data obtained from the study of bone mineral density (BMD), which, as a rule, was increased in women with radiologically confirmed cox- and gonarthrosis, arthrosis of the hand joints. But no reduction in the risk of fractures was found in patients with OA and increased BMD. The results of prospective studies have shown that in patients with OA the risk of non-vertebral fractures is not reduced compared to patients without OA, and in patients with coxarthrosis there is a twofold increase in the risk of femoral fractures. These results are important for understanding the need to prevent osteoporetic fractures not only in patients with reduced, but also normal or “increased” BMD. Among the factors that play a role in predisposition to OA and AP, there are common ones: female gender, old age, family aggregation, estrogen deficiency, vitamin D deficiency, etc. According to research, hormone replacement therapy with estrogen leads not only to a slowdown in the development of AP, but also reducing the incidence of cox- and gonarthrosis [22].

According to modern concepts, one of the important factors in the development of AP is vitamin D deficiency, which is not only a regulator of calcium metabolism in the body, but also has extra-skeletal effects: it increases muscle strength, reduces the risk of falls, autoimmune and other diseases. With age, its absorption in the intestines and formation in the skin decrease. Vitamin D deficiency leads to secondary hyperparathyroidism and osteomalacia with a subclinical course. Vitamin D deficiency is widespread in the population and is especially pronounced in older people.

There is evidence that vitamin D is involved not only in the metabolism of bone, but also cartilage tissue, reducing the activity of metalloproteinases and stimulating the synthesis of proteoglycan by chondrocytes. Elderly women with low intake of vitamin D from food and low levels of 25(OH) in the blood serum have a threefold increase in the risk of progression of coxarthrosis, osteophyte formation, and a threefold increase in the incidence of coxarthrosis [23]. The normal level of 25(OH) in blood serum is considered to be 50–75 nmol/l. Correcting vitamin D deficiency plays an important role not only in preventing the development of AP and osteoporetic fractures, but also the progression of OA.

For people over 50 years of age, the daily requirement for vitamin D is 800 IU, calcium - 1000–1500 mg. The daily requirement for vitamin D and calcium in more than 60% of cases is not covered by the diet. The most effective combination drug for replenishing calcium and vitamin D deficiency is Calcium-D3 Nycomed Forte, 2 tablets of which contain 800 IU of vitamin D3 and 1000 mg of calcium. There is evidence that taking the required daily dose of calcium and vitamin D as a combination drug reduces the risk of fractures by 17%, and the risk of fractures of the distal forearm by 30%. This also reduces the risk of falls [24].

The main group of drugs for the treatment of OA are slow-acting symptomatic drugs, the analgesic effect of which is delayed, but is based on a pathogenetic structure-modifying effect: slowing down the formation of erosions, preserving the structure of the cartilaginous plate, normalizing the bone structure, which leads to a reduction in the need for joint replacement [25, 26] .

Reducing pain in patients suffering from OA increases their mobility, the ability to communicate, normalizes sleep, relieves depressive disorders, and leads to an improved quality of life.

Literature

1. Morbidity rate of the adult population of Russia in 2013. Website of the Ministry of Health of the Russian Federation.
2. Erdes Sh. F., Galushko E. A., Bakhtina L. A. et al. Prevalence of arthralgia and joint swelling in residents of different regions of the Russian Federation // Scientific-practical. rheumat. 2004, 42–46.
3. Kirwan JR, Elson CJ Is the progression of osteoarthritis phasic? Evidence and implications // J. Rheumat. 2000, 27, 834–836.
4. Bijlsma JWJ, Boenbaum F., Glofeber HPJ Osteoarthritis: an update with relevance for clinical practice // Lancet. 2011, 377, 2115–2126.
5. Sellam J., Berenbaum F. The role of synovitis in pathophysiology and clinical symptoms of osteoarthritis // Nat. rev. Rheumatol. 2010, 6, 625–635.
6. Hochberg MC, Altman RD, April KT et al. ACR 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee // Arthritis Care Res (Hoboken). 2012, 64, 465–474.
7. Vertkin A.L., Topolyansky A.V. Algorithm for choosing an analgesic in the treatment of certain pain syndromes at the prehospital stage // Consilium medicum. 2005, 7 (2), 122–124.
8. Pruss TP, Strossing H. et al. Overview of the pharmacological properties, pharmacokinetics and animal safety assessment of lornoxicam // Postgrad. Med. J. 1990, 66, Suppl. 4:18–21.
9. Pleiner J., Nell G., Branebjerg P. et al. Safety of lornoxicam: an interim meta-analysis of comparative clinical trials // Eur. J. Pain. 2009, 13(Suppl.1): 191.
10. Kuzucuoglu T., Yener T., Temize F. et al. Lornoxicam and Tramadol applications for postoperative pain management in lumbar disc surgery // Regional Anesth. and Pain Med. 2005, 30, Suppl 1, p. 81.
11. Kremastinou F., Papadima A., Fotiou G. et al. Combination of morphine and lornoxicam via PCA pump for postoperative IV analgesia after spinal anesthesia // Regional Anesth.and Pain Med. 2005, 30, Suppl 1, p. 81.
12. Berry H., Bird H. A., Black C. et al. A double blind, multicenter, placebo controlled trial of lornoxicam in patients with osteoarthritis of the hip and knee // Ann. Rheum. Dis. 1992, 51(2): 238–242.
13. Kidd B., Frenzel W. A multicenter, randomized, double blind study comparing lornoxicam with diclofenac in osteoarthritis // J. Rheum. 1996, 23(9): 1605–1611.
14. Balabanova R. M. Treatment of pain syndrome in rheumatology with a new NSAID - xefocam // Pain. 1999, 10, 15–18.
15. Khripunova I.G., Khripunova A.A., Mnatsakanyan S.G. Xefocam in the relief of pain in patients with osteoarthritis // Scientific-practical. rheumatol. 2006, 2.
16. Bektashev R., Khamraev H., Bektashev O. et al. Periarticular administration of xefocam in the treatment of lumbar osteochondrosis // Breast Cancer. 2010, 18 (18), 1128–1129.
17. Herrmann WA, Geertsen MS Efficacy and safety of lornoxicam compared with placebo and diclofenac in acute sciatica/lumbosciatica: an analysis from a randomized, double blind, multicenter, parallel group study // Int. J. Clin. Pract. 2009, 11, 1613–1621.
18. Koltka K., Talu GK, Cengiz M. et al. Comparison of the efficacy of intraarticular administration of lornoxicam, bupivacaine and placebo on postoperative analgesia after arthroscopic knee surgery // Regional Anesth. And Pain Med. 2004, 29, Suppl. 2, 89.
19. Khitrov N. A., Tsurko V. V., Semenov P. A. et al. The mechanism of pain in osteoarthritis in the elderly. Intra-articular injections of Xefocam in the treatment of synovitis of the knee joints // Clinical gerontology. 2009, 2.
20. Nikitin N. A., Kalmykova E. V. Intra-articular therapy for synovitis of the knee joint // Modern rheumatology. 2007, 1.
21. Arden NK, Nevitt MC, Lane NE et al. Osteoarthritis and risk of falls, rates of bone loss. and osteoporotic fractures // Arthr. Rheumat. 1999, 42: 1378–1385.
22. Zhang Y, McAlindon TE, Hannan MT et al. Estrogen replacement therapy and worsening of radiographic knee osteoarthritis // Arthr. Rheum. 1998, 41: 1867–1871.
23. Nasonov E. L. Calcium and vitamin D deficiency: new facts and hypotheses // Osteoporosis and osteopathies. 1998, 3, 42–47.
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26. Dougades M., Nguen M., Berdah L. et al. Evaluation of the structure-modifying effects of Diacerhein in hip osteoarthritis. ECHODIAN, a three-year-placebo-controlled trial // Arthr. Rheum. 2001, 44, 2539–2547.

R. M. Balabanova, Doctor of Medical Sciences, Professor

FSBI NIIR named after. V. A. Nasonova RAMS, Moscow

Contact Information

What drugs are administered?

If burning pain in the knees bothers you during the day and at night, the affected areas swell, hurt and become inflamed, then depending on the type of disease and the degree of inflammation, injections are prescribed for knee pain with the administration of drugs: antibiotics, chondroprotectors, non-steroidal anti-inflammatory drugs, vitamins, glucocorticosteroids .

Intramuscular injections for knee pain names:

• non-steroidal drugs (Ketonal, Diclofenac, Ibuprofen);
• analgesics for muscle spasms (Baclofen, Mydocalm);
• vitamins (B1, B6, B12);
• glucocorticosteroids administered into the joint along with B vitamins (Kenalog, dexamethasone, Flosteron, Diprospan).

Orthopedic doctor Andrey Sergeevich Litvinenko comments:

The best means are chondroprotectors (Alflutop, Dona, Chondrolon, Chondroguard), since their structure is identical to cartilage tissue. Strengthen cartilage tissue, inject into the joint cavity to improve mobility, improve the quality of synovial fluid, regenerate cartilage tissue, and relieve pain.

Hyaluronic acid has a long-lasting effect. Injections based on it (Fermatron, Sinokrom, Adant, Synvisk, Armoviscon) help ease the motor function of the joint, reduce friction of the component parts, restore depreciation and flexibility of the cartilage.

Sign up for treatment

Release form of drugs for osteoarthritis

A wide range of medications are used to treat arthrosis - the patient can choose the form of release that best fits his lifestyle.

Tablets and capsules

Systemic oral medications are easy to use, easy to dose, and are suitable for the treatment of polyarthrosis that affects several joints at once. Most drugs for osteoarthritis in tablets are highly accessible to the body - up to 90% of the active substances are absorbed.

Tablets, capsules and powders are prescribed for routine treatment in courses 2-3 times a year. If remission is not interspersed with acute exacerbations that require urgent relief, the patient can manage osteoarthritis treatment with oral medications for years.

The main disadvantages of oral medications are that:

• they do not give an intense effect on the affected joint, but are carried with the blood throughout the body (i.e., they reach the cartilage provided that the periarticular tissues are well trophic);
• Even from the best drugs for the treatment of arthrosis, which are taken in courses, you should not expect an immediate effect;
• some tablets (for example, non-steroidal anti-inflammatory drugs) negatively affect the mucous membranes of the digestive system;
• Excipients of some drugs may cause individual intolerance.

Powders (in sachet)

Treatment of osteoarthritis with drugs in sachets also allows the patient to do without visiting medical institutions - unlike injections, powders are suitable for autonomous use. It is enough to dilute one dose in ½ glass of water. Compared to other oral medications, powders have a number of advantages:

• fine powders are absorbed faster and better by the body (up to 90%);
• The sachet is easy to dose and take with you - only 1 sachet per day, without blisters or jars;
• contain a minimum amount of preservatives and excipients.

Unlike tablets, powder preparations for the treatment of arthrosis of the joints can be purchased in exactly the same quantity as one course. And even if there is an excess left, it’s not scary, medicines in sachets are stored 1.5-2 times longer than tablets.

Some sachets (like the chondroprotector Artracam) contain auxiliary components - for example, vitamin C for long-term storage of the medicine and protection of joints from oxidative damage.

Injections

Compared to oral drugs for osteoarthritis, injectable drugs have a number of significant advantages:

• do not damage mucous membranes and do not affect the functioning of internal organs;
• have a longer period of elimination from the body, which means they work 2-4 times longer;
• Most injections are given every few days, while tablets are taken 1-2 times every day.

When administered into a joint or periarticular area, drugs for the treatment of arthrosis in injections:

• act immediately or within several hours after administration;
• the active ingredients are completely absorbed and reach the diseased joint.

For intra-articular administration

Preparations for intra-articular administration can be divided into medicinal cocktails, or blockades (analgesic + anti-inflammatory drugs for arthrosis + vitamins and reparants) and joint fluid prostheses. The first are aimed at instantly relieving pain and delivering nutrients to strengthen cartilage tissue directly into the joint. And the latter are shown in order to improve the sliding and shock-absorbing characteristics of cartilage. Treatment of osteoarthritis with drugs containing hyaluron can reduce the destructive load on the joint, thereby relieving inflammation and swelling. Synovial fluid grafts significantly slow the progression of the disease, delaying loss of mobility, disability and surgery, even in severe cases. When administered intra-articularly, the artificial “lubricant” can remain in the joint and directly affect its entire tissue for up to 12 months!

The duration of the blockade depends on the location of the disease and the individual characteristics of the body - on average, from 10 to 21 days.

But such drugs for joint arthrosis also have disadvantages:

• with frequent intra-articular administration, blockades with glucocorticoid and other drugs can cause destruction of cartilage tissue;
• not suitable for small and deep-lying joints - optimal primarily for knee, intervertebral, and shoulder joints.
• there is a risk of injection into the joint;
• The injection must be performed by a highly qualified specialist.

For intramuscular and intravenous administration

Treatment of osteoarthritis with drugs for intramuscular and intravenous administration is carried out infrequently, as a rule, as an emergency aid during an exacerbation of the disease or if the tablets are ineffective. As with oral medications, they enter the bloodstream and can affect the functioning of individual organs, so if you have severe concomitant diseases, it is better to opt for intra-articular injections.

Administration of the drug for the treatment of arthrosis in injections into a muscle or vein:

• less traumatic than intra-articular;
• suitable for the treatment of small and deep joints that are inaccessible for direct injection (for example, interphalangeal joints);
• has a minimal risk of complications (including infectious) at the injection site;
• You can do it yourself or seek the help of any medical professional.

For severe joint pain, your doctor may prescribe opioid analgesics intramuscularly and intravenously, such as tramadol. To relieve inflammation - glucocorticoids. Some chondroprotectors (chondroitin sulfate, alflutop) are also produced in the form of such injections.

Ointments, creams and gels

Preparations for joint arthrosis for external use are ideal as prophylaxis or adjuvant therapy, especially in the early stages of the disease. Since the active components of drugs for the treatment of arthrosis - ointments, balms and gels - must overcome the epidermal barrier (protective barrier of the skin), at best, 5% of the therapeutic substance gets into the joint. Therefore, external agents are used primarily to improve blood microcirculation, relieve discomfort or mild pain. They demonstrate particular effectiveness on joints poorly protected by soft tissues - knee, shoulder, elbow, interphalangeal and intervertebral joints of the lumbosacral region.

Most drugs - ointments for the treatment of arthrosis - can be used without limitation, about 6 times a day, combining them with massage of the affected area. However, you should be careful with drugs based on snake and bee venom, which can cause allergies and have a number of contraindications.

Solutions for compresses

Compresses are another type of complementary treatment for osteoarthritis with drugs, which are carried out to relieve inflammation and swelling, improve muscle tone and supply beneficial microelements to the joint.

Solutions for compresses have greater bioavailability than ointments, but are not as convenient to use (they require 15 minutes of rest and warmth). The most effective liquid preparations for joint arthrosis are based on bischofite, dimexide, heparin (they can be mixed together for the procedure).

Diprospan

Diprospan for knee pain is a unique glucocorticoid of its kind with anti-inflammatory, antiallergic, analgesic properties:

• has a rapid, prolonged effect;
• relieves pathological symptoms;
• treats diseases of the musculoskeletal system;
• used for intra-articular injections, drug blockades into a joint or spine.

Diprospan (anesthetic injection into the knee joint) is prescribed for arthrosis, myositis, synovitis, bursitis, rheumatoid arthritis to relieve pain and inflammation, shock conditions, and trauma.

Conclusion

Degenerative processes in joints have become a scourge in modern society today. Many people are diagnosed with arthritis, osteoarthritis, and arthrosis at a young age. The knee joint wears out quickly with increased physical activity and wearing the wrong shoes. Treatment is sometimes lengthy, painful and not always effective. Some drugs are expensive and not available to citizens.

Specialists at the Stoparthrosis clinic will help you choose the right injections for pain in your knees and joints. Visit the clinic today to help your joints.