Treatment of arthrosis of the knee joints, treatment of gonarthrosis- To put it mildly, not the easiest task.Therefore, before you start your hard struggle with this disease, be sure to find a good doctor, examine him and make a treatment plan with him.
In no case do not try to establish a diagnosis for yourself!
The fact is that the lesions of the joint, resembling arthrose, occur with many other diseases, and low -present people are very often mistaken in determining the diagnosis. It is better not to save time and money for medical consultation, because the error can cost you much more expensive in all respects.
But this does not mean that you must blindly believe any doctor and should not delve into the essence of his recommendations, comprehending the mechanism of action of those drugs that are prescribed to you.The patient should understand the meaning of medical prescriptions and represent why certain therapeutic procedures are carried out.
So, with the therapeutic treatment of gonartrosis, it is important to combine a number of therapeutic measures in such a way as to solve several problems at once:
- eliminate pain;
- improve the nutrition of articular cartilage and accelerate its restoration;
- activate blood circulation in the affected joint;
- reduce pressure on damaged joints of bones and increase the distance between them;
- strengthen the muscles surrounding the sick joint;
- Increase joint mobility.
Below we will consider how this or that method of treatment helps to achieve your goals:
1. Non -steroidal anti -inflammatory drugs:
Non -steroidal anti -inflammatory drugs - NSAIDs: diclofenac, pyroxycs, ketoprofen, indomethacin, butadion, meloxicam, healing, nimulide and their derivatives.
With arthrosis, non -hormonal, anti -inflammatory drugs are traditionally used to eliminate pain and inflammation of the joint, since against the background of severe pain it is impossible to begin normal treatment.Only by eliminating acute pain with anti-inflammatory drugs, you can subsequently go, for example, to massage, gymnastics and those physiotherapeutic procedures that would be intolerable due to pain.
However, it is undesirable to use drugs of this group for a long time, as they are able to “mask” the manifestations of the disease.
After all, when the pain decreases, a deceptive impression is created that a cure began.Meanwhile, arthrosis continues to progress: NSAIDs only eliminate individual symptoms of the disease, but do not treat it.
Moreover, in recent years, data have been obtained indicating the harmful effects of prolonged use of non -steroidal anti -inflammatory drugs on the synthesis of proteoglycans.Proteoglycan molecules are responsible for the flow of water in the cartilage, and a violation of their function leads to dehydration of cartilage tissue.As a result, the cartilage already affected by arthrosis begins to collapse even faster.Thus, the pills that the patient takes to reduce the pain in the joint can accelerate the destruction of this joint.
In addition, using non -steroidal anti -inflammatory drugs, it must be remembered that all of them have serious contraindications and with prolonged use can give significant side effects.
2. Chondroprotectors - glucosamine and chondroitin sulfate:
Chondroprotectors - glucosamine and chondroitin sulfate - these are substances that feed cartilage tissue and restore the structure of damaged cartilage of the joints.
Chondroprotectors are the most useful group of drugs for the treatment of arthrosis.
Unlike non -steroidal anti -inflammatory drugs (NSAIDs), chondroprotectors not so much eliminate the symptoms of arthrosis as the “base” of the disease: the use of glucosamine and chondroitin sulfate helps to restore the cartilage surfaces of the hip joint, improve the production of joint fluid and normalize its “lubricant” properties.
A similar complex effect of chondroprotectors on the joint makes them indispensable in the treatment of the initial stage of arthrosis.However, there is no need to exaggerate these drugs.
Chondroprotectors are little effective in the third stage of arthrosis, when the cartilage is almost completely destroyed.After all, it is impossible to grow a new cartilaginous fabric or returning the former form to deformed bones of the knee with glucosamine and chondroitin sulfate.
And at the first or second stages of gonartrosis, chondroprotectors act very slowly and improve the patient's condition at once.To obtain a real result, you need to undergo at least 2-3 courses of treatment with these drugs, which usually takes from six months to a year and a half.
3. Therapeutic ointments and creams:
Therapeutic ointments and creams in no way can heal the arthrosis of the knee joints (even if their advertising approves the opposite).Nevertheless, they can alleviate the patient's condition and reduce pain in a sore knee.And in this sense, ointments are sometimes very useful.
So, with arthrosis of the knee joint that occurs without synovitis without phenomena, I recommend warming ointments to my patients in order to improve blood circulation in the joint.
To do this, use pepper fruits extract, etc. The listed ointments usually cause a feeling of pleasant heat and comfort in the patient.They rarely give any side effects.
Ointments based on non -steroidal anti -inflammatory substances are used in cases where the course of gonarthrosis is aggravated by synovitis.Unfortunately, they act not as effectively as we would like - because the skin passes no more than 5 - 7% of the active substance, and this is clearly not enough to develop a full anti -inflammatory effect.
4. Funds for compresses:
Compresses have a slightly large therapeutic effect compared to ointments.
Of the local funds used in our time, in my opinion, three drugs deserve the greatest attention: Dimexide, Bishophytus and Medical Bile.
Dimexide- Chemical substance, liquid with colorless crystals, has a good anti -inflammatory and analgesic effect.At the same time, unlike many other external substances, dimexide is really able to penetrate the skin barriers.That is, the dimexide applied to the skin is really absorbed by the body and works inside it, reducing inflammation in the focus of the disease.In addition, dimexide has a absorbable property and improves metabolism in the area of application, which makes it the most useful in the treatment of arthrosis, which occur with the presence of synovitis.
Bishophyte- oil derivative, brine extracted during drilling of oil wells.He gained his fame thanks to the drillers, who were the first to pay attention to his therapeutic effect with arthrosis.While working on oil wells from constant contact with a brine of oil from the drill, arthrose nodules on their hands occurred.In the future, it turned out that Bishophyte has a moderate anti -inflammatory and analgesic effect, and also acts warmly, causing a feeling of pleasant heat.
Medical bile- Natural bile mined from the bile bubbles of cows or pigs.Bile has a absorbable and warming effect and is used in the same cases as bischophyte, but has some contraindications: it cannot be used for pustular diseases of the skin, inflammatory diseases of the lymph nodes and ducts, feverish states with an increase in body temperature.
5. Intra -articular injections (injections in the joint):
Intra -articular injections are often used to provide emergency care for arthrosis of the knee joint.In many cases, intra -articular injection can really alleviate the patient's condition.But at the same time, injections in the joint with arthrosis are made much more often than necessary.It is about this incorrect, in my opinion, trends, I want to talk in more detail.
Most often, drugs of corticosteroid hormones are introduced into the joint: triamcinone, betamethasone, hydrocortisone.
Corticosteroids are good in that they quickly and effectively suppress pain and inflammation with synovitis (edema and swelling of the joint).It is the speed with which the therapeutic effect is achieved that is the reason that corticosteroid injections have gained particular popularity among doctors.
But this led to the fact that intra -articular injections of hormones began to be carried out even without real need.For example, I have repeatedly faced the fact that hormones were introduced into the patient’s joint for a preventive purpose in order to prevent the further development of arthrosis.
However, the problem is that just the arthrosis itself corticosteroids are not treated and cannot be treated.So, they cannot prevent the development of arthrosis!Corticosteroids do not improve the condition of the articular cartilage, do not strengthen bone tissue and does not restore normal blood circulation.
All that they can reduce the response inflammatory reaction of the body to one or another damage in the joint cavity.Therefore, it is pointless to use intra -articular injections of hormonal drugs as an independent treatment method: they should be used only in the complex therapy of arthrosis.
For example, the patient detected gonartrosis of the II stage with a swelling of the joint due to the accumulation of fluid in it.The accumulation of liquid (synovitis) makes it difficult to conduct medical procedures: manual therapy, gymnastics, physiotherapy.In such a situation, the doctor performs an intra -articular injection of the hormonal drug to eliminate the synovitis, and in a week begins to other active therapeutic measures - this is the right approach.
Now imagine another situation.The patient also has stage II gonartrosis, but without accumulation of fluid and joint edema.Is it necessary to enter corticosteroids in the joint in this case?Of course, no.There is no inflammation - there is no “point of exposure” for corticosteroid hormones.
But even if the intra -articular introduction of corticosteroids is really necessary, a number of rules must be observed.Firstly, it is undesirable to make such injections in the same joint more often than 1 time in 2 weeks.The fact is that the introduced medicine will “work” in full force immediately and the doctor will be able to finally evaluate the effect of the procedure just after 10 - 14 days.
You also need to know that usually the first injection of corticosteroids brings more relief than subsequent ones.And if the first intra -articular administration of the drug did not give a result, it is unlikely that it will give the second or third introduction of the same drug to the same place.In case of ineffectiveness of the first intra -articular injection, you need to either change the drug, or if the change of medicine has not helped, more precisely, choose the injection site.
If even after that the introduction of a corticosteroid into the joint did not give the desired result, it is better to abandon the very idea of treating this joint with hormonal drugs.Moreover, the injection of hormones in the same joint is more than four to five times in general, it is extremely undesirable differently differently increased the likelihood of side effects.
Unfortunately, in practice, you have to face excessive “determination” of doctors who, over and over again, introduce corticosteroids into the same joint, without achieving at least the minimum effect with the first three injections.Two such cases struck me more than others.
One of the patients did “only” ten injections of a Kenalog, while the procedure was carried out daily, even without a ten -day break necessary to evaluate the results of the injection.And the second patient was introduced into the hormones inside the knee joints, observing the interval (though only 3 to 5 days), but at the same time, the poor fellow received twenty to twenty -five injections of corticosteroids in one joint for the course of treatment!
It would seem that the doctor “went too far” a little - it's okay.Can there be any harm from such treatment?It turns out, maybe!
Firstly, with each injection, the joint, although slightly, is injured by a needle.Secondly, with intra-articular injection, there is always a certain risk of infection in the joint.Thirdly, frequent hormones introduction provoke a violation of the structure of the joints of the joint and the surrounding muscles, causing relative “decaying” joints.
And most importantly, frequent injections of corticosteroids worsen the condition of those patients in whom joint damage is combined with diabetes mellitus, high blood pressure, obesity, renal failure, ulcer of the stomach or intestines, tuberculosis, purulent infections and mental diseases.Even introduced exclusively into the joint cavity, corticosteroids affect the entire body and can aggravate the course of these diseases.
It is much more useful to administer hyaluronic acid drugs in the knee joint affected by arthrosis (another name for hyaluronic acid - sodium hyaluronate).They appeared on sale about 15 years ago.
Hyaluronic acid preparations (sodium hyaluronate) are also called “liquid prostheses” or “liquid implants”, since they act on the joint as a healthy synovial fluid - that is, as a natural “joint lubrication”.
Hyaluronic acid preparations are very useful and effective drugs: sodium hyaluronate forms a protective film on the damaged cartilage, protecting the cartilage tissue from further destruction and improving sliding of the contacting cartilage surfaces.
In addition, hyaluronic acid preparations penetrate into the depths of the cartilage, improving its elasticity and elasticity.Thanks to hyaluronidase, “dried” and thinning with arthrosis, the cartilage restores its shock -absorbing properties.As a result of the weakening of mechanical overload, pain in the sick knee joint decreases and its mobility increases.
At the same time, the joints administered correctly into the joint cavity, hyaluronic acid preparations practically do not give side effects.
Treatment with hyaluronic acid preparations is carried out in courses: in total, 3-4 injections are required for the course of treatment in each sore knee, the interval between injections is usually from 7 to 14 days.If necessary, the course is repeated in six months or a year.
From my point of view, the main and only serious drawback of hyaluronic acid drugs is their high price.So, in 2020, hyaluronic acid is represented in our market in the main import drugs.
But returning to the issue of savings, I want to note that despite the relatively high cost of hyaluronic acid preparations, their use literally allowed many patients from those who before, before these drugs, it would definitely have to be operated on.
And given the cost of the operation on the joints, it turns out that the timely use of hyaluronic acid (even for several years) in any case and in every sense costs the patient much cheaper than surgery for endoprosthetics of the knee joint.Of course, provided that the doctor conducting such injections owns the introduction technique.
It is important to know: hyaluronic acid preparations are instantly destroyed in that joint in which pronounced inflammatory processes are underway.Therefore, it is practically useless to introduce them to those patients in whom gonarthrosis proceeds against the background of the active stage of arthritis.But it is useful to use them with persistent arthritis remission to treat phenomena of secondary gonarthrosis.
With primary gonarthrosis, you also need to pay attention to such moments.For example, if the patient’s joint “bursts” from the accumulation of excess, pathological fluid, it makes sense to first “extinguish” the phenomena of the synovitis (inflammation) and remove the excessive pathological fluid with the help of a preceding intra -articular injection of hormones or taking non -steroidal anti -inflammatory drugs.And only then to introduce hyaluronic acid into the joint, freed from inflammatory elements.
In addition to corticosteroid hormones and hyaluronic acid preparations, attempts to introduce various chondroprotectors into the joint.
But these drugs are many times inferior in effectiveness of hyaluronic acid drugs.They help from the strength of 50% to patients, and guess whether the effect of their use or not, is impossible in advance.In addition, the course of treatment requires 5 to 20 injections in the joint, which, as we said, is fraught with possible injury to the joint and various complications.
6. Manual therapy and physiotherapy:
Manual therapy for gonartrosis of the I and II stage often gives a great result.Sometimes several procedures are enough for the patient to feel significant relief.Particularly well manual therapy of random joints helps, if you combine it with the joint extension, the intake of chondroprotectors and intraarticular injections of the point.
Such a combination of therapeutic procedures, from my point of view, is much more effective than the numerous physiotherapeutic measures proposed in any clinic.I will give one example from practice.
The case from the practice of the doctor.
A 47 -year -old woman with arthrosis of the right knee joint of the II stage came to the reception.By the time of our meeting, she had been sick for 5 years.Over the years, the woman managed to experience all possible methods of physiotherapy that can be proposed in our district clinics: laser, magnetotherapy, ultrasound, phonophoresis, etc. Despite all the efforts of physiotherapists, the patient's condition of the patient continued to deteriorate - and this is natural, since, let's say, chondroprotectors were appointed to the woman only once, only once, a woman was appointed to a woman, only once, a woman was appointed.short course.
Completely desperate, the woman decided on extreme measures - she underwent a course of treatment with cauterizing wormwood cigarettes according to the oriental methodology.As a result, the knee was covered with scars from burns, but it didn’t move better.Yes, and it was unlikely that I could, despite all my respect for Eastern medicine, I understand that wormwood cauterization cannot eliminate bone deformations and increase the distance between the bones articulated in the knee.
After the woman did not help the numerous physiotherapeutic procedures and even cauterization in wormwood cigarettes, she practically almost agreed to surgical treatment.But then she still changed my mind and decided to try the complex method I proposed.
The first treatment session passed, as they say, “with a creak” - we managed to only “stir up” the joint with the help of manual mobilization a little.Therefore, we scheduled the next session after preliminary preparation: within 3 weeks, the woman took chondroprotectors, made self -massage and compresses with dimexide.After 3 weeks, I again began with the mobilization of the joint, and then made a reposition (“reduction”) of the joint using manual manipulation.There was a click and suddenly the joint began to move much easier and more free.The woman felt clear relief.
In the next two sessions using mobilization, we fixed the achieved improvement, after which we fixed the success of two intra -articular injections of the point.And after a month and a half from the beginning of our not very intense treatment (after all, we needed only six meetings), the woman was finally able to discard the wand that had bored with her and began to move quite freely.
Two years have passed since then.Twice a year, the patient takes chondroprotectors in a short course, and occasionally comes to my control technique, where I am happy to note that the condition of the knee is only better from year to year.And now, even the first stage of arthrosis would be very difficult to assume - the patient’s knee joint was restored almost completely.
Thus, only six treatment sessions (manual therapy plus intra -surveillance injections of Orenil) in combination with the course of chondroprotectors were more effective than five years of physiotherapy.
From this story (and by no means the only one like that) it becomes clear why I consider physiotherapy an important, but only an additional part of the medical program for gonarthrosis.In this sense, I like laser therapy, thermal treatment (ozokerite, paraffin therapy, therapeutic mud) and especially cryotherapy (treatment with local cooling).
7. Diet:
The diet with arthrosis is also very important.
8. Using cane:
Based on the stick when walking, patients with arthrosis of the knee joints seriously help their treatment, since the stick takes on 30 - 40% of the load intended for the joint.
It is important to choose a stick according to your height.In order to do this, stand straight, lower your hands and measure the distance from the wrist (but not from the fingertips!) To the floor.It is such a length that there should be a cane.When buying a wand, pay attention to its end - it should be equipped with a rubber nozzle.Such a stick is amortized and does not slip when they rest on it.
Remember that if your left leg hurts, then the stick should be held in your right hand, and vice versa.Taking a step by the patient with a foot, transfer part of the body weight to a stick.
9. Therapeutic gymnastics:
The most important treatment for arthrosis of the knee joints is special therapeutic gymnastics.Almost no person who has a gonartrosis can achieve a real improvement in the state without therapeutic gymnastics.
After all, it is impossible to strengthen the muscles, “pump” blood vessels and activate blood flow as much as this can be achieved using special exercises.
At the same time, the doctor’s gymnastics is almost the only treatment method that does not require financial costs for the purchase of equipment or drugs.All that the patient needs is two square meters of free space in the room and a rug or blanket thrown to the floor.
There is no longer nothing to consult a gymnastics specialist and the desire of the patient himself to do this gymnastics.True, just with such a desire, most of the sufferers do not burn.Almost every patient, in whom I reveal arthrosis, I have to literally persuade the physiotherapy exercises.And it is most often possible to convince a person only when it comes to the inevitability of surgical intervention.
The second “gymnastic” problem is that even those patients who are configured for physiotherapy exercises often cannot find the necessary sets of exercises.Of course, there are brochures for patients with arthrosis on sale, but the competence of a number of authors is doubtful - after all, some of them do not have a medical education.
So, such “teachers” do not always understand the meaning of individual exercises and the mechanism of their action on sore joints.Often, gymnastic complexes simply thoughtlessly correspond from one brochure to another.At the same time, there are such recommendations in them that it is just right to grab your head!
For example, many brochures prescribe the patient with arthrosis of the knee joints "to carry out at least 100 squats per day and walk as much as possible."
Often, patients follow such advice, without previously consulted with a doctor, and then sincerely perplexed why they got worse.Well, I’ll try to explain why the condition of the sick joints from such exercises, as a rule, only worsens.
Let's imagine the joint as a bearing.Damaged by arthrosis, the sore joint has already lost its ideal shape.The surface of the "bearing" (or cartilage) ceased to be smooth.Moreover, cracks, potholes and “burrs” appeared on it.Plus, the lubrication inside the sphere thickened and dried up, it has clearly not been enough.