275
About 60% of all patients who have sought an appointment with a rheumatologist are interested in how he treats joints. The relevance of the problem of osteoarthritis is increasing every year.
The previous diagnosis of "osteoarthrosis" was changed to "osteoarthritis" today.
The scientific approach to the problem associated with the treatment of joints has changed radically. What was previously considered to be the result of degenerative changes is now recognized as immune inflammation.
Any trigger mechanism, be it trauma, degeneration or banal inflammation, serves as a signal to start the immune inflammatory process. The systemic nature of this disease is confirmed by the fact that pathological changes are not limited to one tissue, everything is damaged: cartilage, bones, muscles, ligaments, and joint capsule. Modern joint treatment tactics are significantly different from previous recommendations.
From the point of view of pathological anatomy, osteoarthritis is characterized by aggressive catabolism with gradual destruction of bone tissue.
When and how to treat joints (osteoarthritis)?
The sooner the treatment with chondroprotectors will be started from joint pain, the more pronounced the result will be. That is, the effectiveness of therapy directly depends on the stage of osteoarthritis.
How to diagnose osteoarthritis?
One x-ray study of the affected joint is not enough today. This study is not very informative and gives almost no idea about the function of the affected part of the musculoskeletal system. By the way, if you take a picture of, for example, the knee joint, then only in a standing position.
A modern, informative and fairly widespread method of diagnosing joint diseases is ultrasound examination (ultrasound).
MRI is an even more accurate, but unfortunately more expensive research method, and therefore less accessible. MRI is used for difficult diagnostic cases and allows establishing a diagnosis of aseptic necrosis, inaccessible to other methods. By the way, MRI allows you to examine the menisci of the knee joints and pathological changes in them in detail.
How to treat joints
There is no universal method of treating joint diseases, first it is necessary to examine the patient and establish the cause of the pathology.
How to treat joints in which microfractures and medullary hypertension are diagnosed - only with non-steroidal anti-inflammatory drugs. First, diclofenac, ibuprofen and their analogs will be ineffective in this case, and secondly, they can aggravate the pathological process. In this case, therapy should be aimed at improving microcirculation in the affected area. They use drugs such as emoxipin, phlebodin, which improve the flow of blood through the venous channel.
How to treat joints in which there are osteophytes (proliferation of synovial and periosteal endings) - NSAIDs are suitable here, but these drugs are prescribed topically in combination with dimexide. Ultrasound or diclofenac gel lotions in combination with dimexide gel guarantee rapid clinical improvement. Ultrasound with hydrocortisone is widely practiced in clinics. Intra-articular administration of hyaluronic acid preparations is also effective.
How to treat joints in which stretching or inflammation of the capsule (bursitis) is diagnosed - non-steroidal anti-inflammatory drugs are prescribed. A simple ultrasound scan is enough to diagnose bursitis, which helps estimate the amount of effusion in the joint capsule. Often, drug treatment has to be supplemented with joint puncture, which is performed by a specialist under ultrasound control.
How to treat inflamed joints with non-steroidal anti-inflammatory drugs in adequate doses.
How to treat joints in which pain appeared due to pathology in periarticular muscles (periarthritis) - spasm of the muscles surrounding the joint, increasing pain sensations - the appointment of muscle relaxants (midokalm, carbamazepine) is considered mandatory.
How to treat joints with damaged ligaments (sprains) — an ultrasound method is used for diagnosis — the affected joint must be rested (plaster or orthosis), locally prescribed NSAIDs, ultrasound with hydrocortisone. At the stage of convalescence, ointment of the trencher is indicated.
How to treat enthesitis (inflammation at the site of attachment of ligaments to the bone) — a pathological process characteristic of systemic arthritis, including rheumatoid arthritis — NSAIDs are recommended for long-term use. Preference should be given to the safest drugs, in particular nimesulide.
How to treat blocked joint pain - rest, fixation, puncture to remove effusion. Ultrasound makes it possible to clarify the presence and position of the "joint mouse".
How to treat reflected joint pain - according to experts, pain often radiates downward, but never upwards. If the patient complains of pain in the hip joint, and no pronounced pathological changes are found during the examination of this joint, then the cause of the pain should be sought in the spine. Treating the consequence is not only useless, but also harmful. And until the cause, possibly spondylitis or spondyloarthritis, is found, any therapy will be ineffective.
European recommendations for the treatment of joints
HLS
Fibromyalgia - "everything hurts" - such complaints are often presented by elderly patients. Antidepressants (amitriptyline) are effective in such cases.
NSAIDs (non-steroidal anti-inflammatory drugs) are prescribed for exacerbation in a course of 5 — 10 days.
Side effects
activity
NSAIDs
gastrointestinal bleeding
bleeding from the small intestine
increase in blood pressure
fluid retention, edema
nephropathy, renal failure
GK (glucocorticoid hormones) are prescribed only if there is significant effusion in the joint bag.
collateral
actions of the GC
on cartilage - calcification of cartilage
on the bone - osteoporosis
Chondroprotectors - chondroitin sulfate, gluclsamine sulfate, structum, diacerin, Dona, stopoarthrosis - the effectiveness directly depends on the stage of the disease. The earlier the treatment is started, the more effective it will be.
Hyaluronic acid is responsible for the visco-elastic properties of connective tissue, improves lymph circulation, accelerates the diffusion of nutrients and removal of metabolic products, stops inflammation, including immune inflammation.
Today, the pharmacy chain has a fairly wide range of hyaluronic acid preparations, including low-molecular, medium-molecular and high-molecular.
Low-molecular hyaluronic acid can be administered periarticularly, accelerates recovery and improves blood and lymph circulation, is suitable for small joints and tendons.
High-molecular hyaluronan can perform the functions of "prosthesis" of synovial fluid. It is introduced into the joint under ultrasound control once an hour, prolongs the "life" of the joint and allows you to delay prosthetics.
