It should immediately be noted that treatment of arthrosis (osteoarthrosis) with the traditional approach rarely achieves the desired treatment result.
The traditional treatment program for deforming osteoarthritis includes 3 areas:
- elimination of joint pain and reactive synovitis
- basic therapy (preventing the progression of the degenerative process)
- improving joint function
I. elimination of joint pain and reactive synovitis
Use of drugs for general effects
Non-steroidal anti-inflammatory drugs (NSAIDs) are used - Diclofenac, Ortofen, Naklofen, Movalis, Indomethacin, Ibuprofen and many others. Administered orally or parenterally.
These drugs have an anti-inflammatory and, as a result, analgesic effect. The effect is temporary in most cases. It is necessary to remember the possibility of side effects and complications (in particular, as a result of effects on the mucous membrane of the stomach and duodenum).
It is necessary to use these drugs for the treatment of arthrosis for a relatively short time (on average, 5-7 days). It is believed that long-term use of these drugs contributes to the degeneration of articular cartilage.
Intra-articular and periarticular administration of drugs
Intra-articularadministration of drugs (steroid hormones, proteolysis inhibitors) is used only to relieve synovitis. It is first necessary to evacuate excess fluid from the joint cavity.
Extra-articularadministration of drugs is used to relieve pain.
Application of ointments to the joint area
anti-inflammatory(painkillers) ointments are used: indomethacin, butadione ointments, voltaren or diclofenac in the form of a gel, etc.
Ointments are rubbed into the skin in the area of the painful joint. If well tolerated, compresses from these ointments can be used.
To enhance the anti-inflammatory and analgesic effects, ointments can be combined with dimexide applications.
Physiotherapy
physiotherapeutic procedures for pain relief:
- electrophoresis of novocaine, analgin with dimexide
- Beranar dynamic currents - diadynamic therapy (DDT)
- sinusoidal modulated currents (SMC) - amplipulse therapy
- ultrasound
- shock wave therapy (SWT)
physiotherapeutic proceduresto relieve synovitis:
- ultraviolet irradiation (UVR)
- UHF electric field
- decimeter waves
- magnetic therapy
- ultrasound (hydrocortisone phonophoresis)
Reflexology
physiotherapeutic reflexology
- impact of microwave electromagnetic field on acupuncture points
- transcranial electroanalgesia is the application of electric current to the brain for the purpose of pain relief. The procedure stimulates the production of endorphins in the brain, which causes an analgesic effect.
acupuncture reflexotherapy (ART) - the impact of acupuncture needles on acupuncture points.
II. basic therapy
Aimed at preventing the progression of the degenerative process in joint tissues.
Unloading sore joints
Long walking, prolonged standing on your feet (static loads are tolerated much worse than dynamic loads), carrying heavy objects, and frequent ascents and descents of stairs are prohibited.
Walking should alternate with a 5-10 minute rest. If necessary, use a cane or crutches.
Normalization of body weight
Body weight in most patients is increased. Excess body weight significantly increases the load on joints.
To normalize body weight, a hypocaloric diet (table No. 8), fasting days, and general massage are used.
An effective complement to these activities is prolonged acupuncture.
Improving the metabolism of articular cartilage and microcirculation of bone tissue
- treatment with chondroprotectors (hyalgan, synvisc, coxartrum, osteonil, arthra, hyalual, artrum, durolan, fermatron, euflex, orthovisc, suparz, chondroitin, glucosamine, rumalon, arteparon, artron, mucarthrin, etc.)
Chondroprotectors are drugs that improve the metabolism of cartilage, slowing down or preventing its destruction. They usually contain biologically active substances of cartilage - mucopolysaccharides (proteoglycans, glycosaminoglycans), chondroitin sulfates, etc. They are administered intramuscularly, intraarticularly or orally.
Chondroprotectors do not restore articular cartilage!
Treatment with chondroprotectors is indicated at I-II clinical and radiological stages of deforming osteoarthritis. In stage III arthrosis, treatment with these drugs is not advisable.
- intra-articular injection of artificial synovial fluid (“lubricant”)
To improve the congruence of articular surfaces and reduce damage to articular cartilage. Hyaluronic acid or 15% polyvinylpyrrolidone (PVP), as well as hemodez (6% PVP) are used.
The method is based on the fact that with arthrosis there is a deficiency of synovial fluid, and its rheological properties also change (it ceases to function as a protector and shock absorber. Artificial synovial fluid replaces the deficiency of natural synovial fluid.
- intra-articular administration of proteolytic enzyme inhibitors (protease inhibitors)
Trasylol (contrical), gordox are used. Indicated for severe pain and reactive synovitis. They are administered intra-articularly in combination with steroid hormones (to prevent transient exacerbation).
Slow down the degeneration of articular cartilage by inhibiting proteolytic enzymes (trypsin, chymotrypsin, cathepsins, lysosomal enzymes), which cause proteolysis and destruction of cartilage.
- improvement of microcirculation in the subchondral parts of the articular ends of bones
antiplatelet agents are used (curantil, trental, xanthinol nicotinate
- metabolic therapy
aimed at improving metabolic processes in articular cartilage. As monotherapy, it does not have a significant effect on the course of arthrosis, but plays a positive role in complex therapy.
Riboxin (inosine), sodium ATP, phosphadene, pyridoxal phosphate, potassium orotate, anabolic steroids (retabolil, matandrostenolol) are used.
- antioxidant therapy
Antioxidants suppress the processes of lipid peroxidation, reduce the formation of free radicals, thereby inhibiting the destruction of articular cartilage.
Vitamin E (tocopherol acetate), orgoteine (superoxide dismutase) are used.
Basic physiotherapy treatment
Improves the metabolism of articular cartilage and slows down its destruction. It also improves microcirculation of subchondral bone tissue, articular capsule, and periarticular soft tissues.
In addition, it relieves pain and synovitis.
- Inductothermy (short-wave diathermy)
- Microwave therapy
- Ultrasound therapy
- Sinusoidal modulated currents and Bernard currents (amplipulse therapy and diadynamic therapy)
- Electrophoresis
- Laser therapy
- Magnetic therapy
- Coolant applications
- Local barotherapy
- Balneotherapy
III. improvement of joint function
Therapeutic exercise (physical therapy)
Exercise therapy classes are carried out using a gentle method in the mode of unloaded joints (lying or sitting, exercise therapy in the pool is advisable).
The painful joint should move, but avoid overload. Movements should not be too intense, painful, or traumatic. The range of movements should be increased very carefully, gradually.
Massage
Improves tissue elasticity and venous circulation, reduces muscle spasm, reduces increased nervous excitability.
It should be gentle, aimed not at the joint itself, but at the regional muscles.
Spa treatment
Patients with stage I-II arthrosis are referred. without synovitis or with mild exacerbation.
Contraindicated in arthrosis of the III degree. with a sharp exacerbation of synovitis.
Mud therapy, radon or hydrogen sulfide baths are indicated.
Orthopedic treatment
А. Conservative
- Elastic bandaging (for fixing the area of attachment of ligaments and tendons)
- Use of support (cane, crutches, walker)
Б. Operational
- corrective osteotomy
- arthroplasty
- joint replacement
