How is arthrosis of the knee joint treated? Drug treatment of arthrosis of the knee joints

Excess weight, age, and injuries serve as the basis for the development of gonarthrosis.

Questions arise: “How to treat arthrosis of the knee joint? How helpful is drug treatment? What methods are offered for treatment, besides drugs?

Hyaline cartilages become flattened, lose fluid, and with it their shock-absorbing capabilities. The synovial fluid becomes viscous and stops washing and lubricating the joint ends. The first “bell” of arthrosis is arthralgia of the knee joint - pain when moving.

The cartilage is thinned, compensatory areas of calcification and ossification (osteophytes) grow along the edges of the bones, the joint gap narrows, and transudate (excess fluid due to inflammation) accumulates. Arthralgia of the knee joint becomes permanent. The knees bend with difficulty and crunch. Exertion is accompanied by pain.

Hyaline cartilage is completely destroyed. The joint gap closes. The joint is deformed, dislocations and subluxations occur. Movements become impossible or their amplitude is minimal. The pain is sometimes unbearable. Requires constant relief with analgesics. The patient walks with support or is immobilized.

Which doctor diagnoses and treats arthrosis of the knee joint? Contact the clinic. After the X-ray examination, an orthopedist, rheumatologist, and neurologist will be able to carry out observation and treatment. The qualifications of these specialists allow them to develop treatment regimens, monitor the development of arthrosis, and evaluate the effectiveness of therapy.

ABOUT modern methods diagnosis of arthrosis of the knee joint, you can read

The knee joint hurts. How to treat?

Treatment can be divided into traditional medication and non-traditional treatment using traditional methods, acupuncture.

Traditional schemes work in two directions:

1. Restoration of destroyed cartilage;
2. Elimination of pain, restoration of mobility in the joint.

Preparations for restoring damaged cartilage

Chondroprotectors are the only medications for the treatment of arthrosis of the knee joint, making it structural. They enhance the production of synovium, relieve inflammation, and enhance metabolism in the affected area.

Pharmacologists have developed 4 generations of chondroprotectors. For the treatment of osteoarthritis knee joints use drugs of all generations. But maximum effectiveness is achieved with intra-articular use of hyalgan, hialubrix, ostenil, crespin gel in combination with oral or injection administration of combined chondroprotectors (chondroitin sulfate, hyaluronic acid in combination with analgesics, sulfur derivatives) 3-4 generations: Movex, Teraflex Advance, Artron complex, chondroitin complex.

Additionally, for the treatment of arthrosis, chondroxide and chondroflex ointments are used, which contain chondroitin sulfate and hyaluronic acid - the main components of chondroprotectors.

The effect of protectors is not immediate. It takes six months, sometimes up to 3 years, before the effect appears.

Symptomatic drugs

• . Relieves reactive inflammation and pain. Preference is given to enolic acid derivatives - movalis. It does not inhibit the natural repair of cartilage. Does not have ulcerogenic properties (erosions, stomach ulcers). Ibuprofen and diclofenac are also prescribed. Unlike movalis, the latter irritate the gastric mucosa. And according to new data, they increase the destruction of cartilage, causing the progression of arthrosis. Therefore, long-term use of diclofenac is not recommended;
• Vasodilators. Trental, cinnarizine, relieve vasospasm. improve blood flow, normalize nutrition of joint elements;
• Muscle relaxants. Mydocalm will relieve muscle spasms and increase blood flow to blood vessels. Not used for people with cerebral vascular pathologies. May cause confusion;
• Adrenal hormones. Hydrocortisone and Kenalog are injected into a joint affected by arthrosis. Quickly relieve inflammation, swelling, pain. There are restrictions on the number of injections, up to 3 per joint. The positive effect is short-term.

What is a knee block?

Some medications for gonarthrosis are administered intra-articularly or para-articularly: chondroprotectors, analgesics (lidocaine, trimecaine), hormones (diprospan, Kenalog-40, hydrocortisone). This is generally called a "blockade". They are aimed at removing pain syndrome or to deliver medication directly into the joint cavity.

The effect of intra-articular injection of chondroprotectors for gonarthrosis of the knee joints is compared with prosthetics. They are even called “liquid prostheses”.

Procedure method:

• The patient lies on his back, and a cushion is placed under the knee;
• Under anesthesia, the needle is inserted under the patella from the outside, penetrating into the joint cavity;
• The doctor calculates the amount of medicine.

How many invasive blockade procedures have contraindications:

• immaturity of bones, cartilage;
• not sanitized foci of infection;
• diseases of the cardiovascular and respiratory organs;
• thrombophlebitis, thromboembolism in the acute stage;
• infectious diseases, acute period.

Knee arthrotomy

A surgical intervention in which the joint capsule is opened through special accesses. Manipulations directly in the bag become possible. With the help of arthrotomy of the knee joint, fragments of destroyed cartilage and bone growths (“joint mice”) are removed, ligament plastic surgery is performed in case of a “loose” joint, displaced menisci are put in place, and mobility is restored in case of ankylosis (fusion of the articular ends of the femur and tibia).

Innovative

The method is considered minimally invasive, endoscopic. A flexible fiberscope is inserted into the joint through a tiny incision in the skin. They perform manipulations to remove “joint mice,” pump out inflammatory fluid, or to diagnose meniscus injuries or tumors.

Auxiliary methods of therapy for gonarthrosis

Diet for arthrosis of the knee joint;

It is impossible to single out a product that can cure arthrosis. The whole diet is aimed at losing weight. Reducing weight will free the limbs from the load. Calculate ideal weight Just. The specified formula will allow you to determine your body mass index (BMI). Try to keep it below 25.

BMI= weight(kg)/height(m)*height(m)

You can add dietary supplements to your diet: extracts from soy, avocado, dandelion root, ginger extract. They improve nutrition, cartilage metabolism, and relieve inflammation.

Physiotherapeutic techniques;

Electrotherapy, magnetic therapy, inductothermy, UHF therapy, ultrasound therapy, shock wave therapy, the use of lasers, aeroion therapy, light therapy can alleviate the patient's condition by relieving spasms and pain.

Massage for arthrosis of the knee joints;

The massage is carried out manually, with the help of devices, even with a stream of water. It will strengthen the muscles. Relieves pain, spasms, swelling. Will increase the distance between bones, reduce friction.

Traction (traction);

You can only trust a great chiropractor. The strength of traction depends on the weight and condition of the patient’s muscles. The procedure separates the articular surfaces. Gives excellent results in the hands of a specialist. The effect is equivalent to surgical treatment.

A set of gymnastic exercises;

Prefer classes with a static load. Most exercises are performed lying down, at a slow pace. Indispensable supervision of a trainer or doctor - exercise therapy instructor. The range of movement is individual.

The quality criterion is the absence of increased pain. Pilates, exercise on a fitball in a gentle mode, swimming, walking with Nordic poles are suitable.

Osteoarthritis of the knee joint can be treated in sports clinics. The advantage of classes at the clinic is considered individual approach and controllability of classes. Instructors will separately write a special program for each case, which takes into account the patient’s physical abilities and concomitant diseases. Control over execution will not allow you to be lazy and will ensure excellent results in short time.

Clinic rehabilitation programs include exercise therapy, massage of the necessary areas, physiotherapeutic procedures, and classes on specially designed simulators for knee joints, for example, “Artron”.

Is there a place for sports with arthrosis of the knee joints? We will answer this question in

Let's pay special attention to the treatment of arthrosis with the help of medications. No matter what pharmacists say, there is no “magic” drug that can cure a diseased joint. In the first stage of the disease, you will have to do intravenous and intramuscular injections, intra-articular injections, take NSAIDs, use anti-inflammatory ointments, chondroprotectors and make compresses with Novocaine.

Sections of the article:

They will help relieve pain and eliminate pain from arthritis of the knee joint in a short period of time. During exacerbation of the disease, medications that suppress the inflammatory process are indispensable.

Most effective medicines The following are recognized for relieving pain in arthrosis: Nimesulide, Nise, Xecofam, Nurofen, Movalis, Rofecoxib, Piroxicam, Aceclofenac.

Be careful: all strong anti-inflammatory drugs have a negative effect on the gastrointestinal tract. Therefore, it is worth taking any anti-inflammatory drug under the cover of stomach-coating agents (for example, Omez, Phosphalugel, etc.). The opinion that anti-inflammatory drugs administered intramuscularly do not have any effect is considered erroneous. negative impact on the gastrointestinal tract.

In addition to taking anti-inflammatory drugs for inflammation of the knee joint, you need to relieve the load on it. To do this, a tight bandage and reduced physical activity will be enough.

When taking non-steroidal drugs, remember that their main purpose is to relieve acute pain, and not to treat. The mechanism of their action is simply not aimed at stopping the destruction process cartilage tissue joint

A blow to the disease: intra-articular injections

Chronic arthrosis with periodic exacerbation is best not treated with corticosteroid injections (Medrol, Prednisolone, Kenalog), oxygen therapy (enrichment of joints with oxygen cells) and injections of hyaluronic acid, but only during a period of stable remission.

When resorting to injections, remember the following important rules:

1. They contain hormones, so it is advisable to use them for joint swelling.
2. It is strictly unacceptable to inject them without a history of symptoms.
3. They have a large number of side effects. For example, using them in large quantities without justifiable reasons leads to increased bone resorption.
4. Corticosteroid injections are allowed only once every 2 weeks. Otherwise, the risk of joint injury, infection, ligament or muscle damage increases.
5. Administration of the drug for prophylactic purposes is strictly prohibited.

Hyaluronic acid has a beneficial effect on the surface of the joint, forming a protective film on it. Preparations based on hyaluronic acid are prescribed by a doctor to a patient for acute deficiency of synovial fluid.

In this case, the hyaluronic acid will act as a lubricant for the knee joint. Injections with hyaluronic acid significantly increase the firmness and elasticity of the joint. It has virtually no contraindications - it all depends on the individual’s tolerance to the drug. Injections with hyaluronic acid should be carried out as a course of treatment: once every six months, only 3 - 4 injections with a short interval (1 - 2 weeks).

It is used together with Ostenil, Sinvix, Duralan and other drugs. Its main drawback is the price, which is completely justified by its effectiveness. Among the cheap analogues of hyaluronic acid is the drug "Giastat", the price of which is 30-40% lower than imported analogues.

Hyaluronic acid injections are strictly prohibited in case of acute inflammatory processes, since in these cases it turns out to be completely useless and can harm the joints. It is best to inject acid during a period of stable remission.

Oxygen therapy allows you to normalize the metabolism of nutrients in the joint and achieve stable remission. The essence of this treatment is that ozone irradiated by a laser beam is injected into the joint. Oxygen therapy is quite effective in the early stages of arthrosis of the knee joint.

Injections are carried out in a course - no more than four times with an interval of two days.

Chondroprotectors are aimed at restoring the cartilage tissue of the joint, replenishing the deficiency of glucosamine and chondroitin sulfate.

The drug is quite expensive. Many patients speak negatively about it, considering it ineffective. On the one hand, chondroprotectors are not a magic cure for the disease. They simply replenish the deficiency of glucosamine and chondroitin sulfate, easing the course of the disease. In addition, they should not be confused with painkillers. Their only function is to protect the cartilage of the joint.

Very often, doctors prescribe chondroprotectors when the cartilage has already been destroyed. Naturally, taking the medicine is already empty and cannot bring any results.

Thirdly, chondroprotectors should be taken prophylactically. Doctors and patients always make one big mistake - after the first course of treatment, the drug is not prescribed in the future. Therefore, in order to have stable positive results, you should definitely take them cyclically, with short breaks. Many patients take chondroprotectors for several years.

Chondroprotective ointments are much more useless than tablets. Often, due to unfair advertising, patients begin to use the ointment already at a late stage of arthrosis. Although in fact, chondroprotective ointments can slow down the process of destruction of tissue and cartilage only in the early stages of the disease.

In the treatment of arthrosis of the knee joint, doctors most often prescribe the following chondroprotectors: Alflutop, Dona, Structum, Elbona, Chondroitin and others.

Ointments for the treatment of arthrosis of the knee joint

For arthrosis of the knee joint, ointments with a warming and irritating effect are often prescribed. They help not only relieve minor inflammation, but also block pain.
For warming and irritating effects, Menovazin, Nicoflex and Capsaicin are usually used.

In case of synovitis, ointments containing non-steroidal anti-inflammatory drugs are prescribed: Voltaren, Ketonal, Nise, Nurofen, Fastum-gel.
However, do not forget that the effect of ointments on inflammation is ineffective. They usually provide short-term pain relief and, according to their mechanism of action, cannot compete with non-steroidal ones.

Compresses

In the initial stages of arthrosis of the knee joint, homeopathy has proven itself to be effective.

It is recommended to use compresses for arthrosis of the knee joint only in special cases:

• in the presence of edema and fluid accumulation;
• to improve joint mobility (in chronic form).

Compresses made from “Bishofite”, “Dimexide” and “Medical Bile” help relieve pain, swelling and inflammation most effectively.

Compresses will be much more effective than anti-inflammatory or warming ointments, due to their ability to penetrate into tissues. It is strictly prohibited to use in the presence of pustular skin rashes. Often, instead of saline solution, Novocaine is used together with Dimexide or Bischofite, which has not only a resolving and anti-inflammatory effect, but also pain relief. Very often, both drugs improve metabolism in joint tissues.

It is worth considering that during an exacerbation of the disease, it is undesirable to make compresses, since they only “warm up” the inflammation process.

The effectiveness of the compress directly depends on whether it was prepared correctly. To prepare compresses, you need to mix a one to four solution of Dimexide or Bischofite with saline. Soak a sterile bandage or gauze in the resulting mixture and apply to the site of inflammation. Cover the compress with cotton and secure cling film. It is recommended to carry out the procedure once a day for 20-30 minutes for about two weeks.

Please remember to take special precautions:

• You cannot prepare a compress in advance, because due to a chemical reaction with saline solution, the active substance loses its properties;
• For the compress, only sterile materials should be used, since the main active substance penetrates deep into the layers of the dermis, attracting with it all the elements dissolved in it. Therefore, in order not to provoke an allergic reaction, use only sterile materials.
• to prevent chemical burns, apply the drug “Dimexide” or “Bishofite” for no more than 20-30 minutes;
• for acute pain in the knee joint, replace the saline solution with Novocain. The drug will have an analgesic effect on the joint.

Vitamin complexes

A lack of a group of vitamins in the body is often one of the main reasons for the rapid development of arthrosis of the knee joint, since when they are deficient, the affected tissues do not receive the necessary nutrition for recovery. To improve his condition, the patient needs to completely reconsider his diet.

Food should be healthy and balanced. These should be abandoned bad habits like alcohol and smoking. However, a balanced diet is not always able to enrich damaged tissues with useful microelements in a short time.

To improve metabolism in tissues, the patient should take vitamin complexes. They will not only replenish the deficiency of microelements, but will also help relieve inflammatory process in tissues and improve overall well-being.

With arthrosis, first of all, it is necessary to “feed” the body with the following microelements: vitamins A, B, D, PP, zinc, calcium and magnesium. The Vitrum, Supradin, etc. complexes are perfect.

However, arthrosis of the knee joint is a rather difficult disease to treat, and medication treatment alone is often not enough. Therefore, arthrosis should be treated with a whole range of measures, including medication, physiotherapy and spa therapy. One way or another, treating the disease will take a lot of time and effort. But in any case, treatment of the disease should be undertaken at its initial stage, so that there is no need for surgery.

Arthrosis of the knee joint (syn. - gonarthrosis) is a chronic degenerative-dystrophic process that affects the cartilaginous tissue of the articular surfaces. In advanced stages, severe irreversible structural and functional disorders form in the knee joint. Complex treatment arthrosis of the knee joint is aimed at preventing these disorders.

Main directions of treatment

Treatment of arthrosis of the knee joints includes:

• Elimination of pain;
• Improving nutrition of cartilage tissue;
• Improving local blood microcirculation;
• Elimination of concomitant inflammation - arthritis;
• Expanding range of motion in the knee;
• Strengthening the muscles of the lower limb;
• Restoring the original configuration of the knee joint.

For this purpose they use various methods treatments, including:

• Medicines;
• Massage and physiotherapeutic procedures;
• Therapeutic physical education (physical therapy);
• Special orthopedic devices;
• Traditional medicine recipes;
• Surgical intervention.

Medicines

Drug treatment arthrosis of the knee joint includes the following main groups of drugs:

• Nonsteroidal anti-inflammatory drugs (NSAIDs);
• Chondroprotectors – drugs that restore articular cartilage;
• Steroid hormones;
• So-called means distraction therapy;
• Drugs that improve blood microcirculation;
• Vitamin and mineral complexes.

NSAIDs are believed to be the main drug group in the treatment of knee arthrosis. These products, mainly used topically, in the form of gels and ointments (Diklak gel, Voltaren Emulgel, Ketoprofen and Indomethacin ointment) effectively eliminate the main symptom of arthrosis - pain, and with it the accompanying inflammation. Locally irritating ointments – Finalgon, Gevkamen, Apizartron – have a similar effect. But all these remedies in no way eliminate the main cause - cartilage degeneration. Moreover, according to some observations, NSAIDs negatively affect metabolic processes in joint tissues.

When arthrosis is combined with inflammation (arthritis), fluid (exudate) can accumulate in the joint cavity. In these cases, puncture (puncture) of the joint and removal of exudate are indicated. Instead of removed exudate, injections of antibiotics (in the presence of infection) or steroid hormones (Diprospan, Kenalog) are given into the joint cavity, which suppress local inflammation. But these drugs also have a cytostatic effect (slow down cell growth), and, therefore, inhibit the restoration of articular cartilage.

The basis of drug treatment for arthrosis is the use of chondroprotectors. These products improve the trophism of articular cartilage, and thereby contribute to their restoration. In this regard, medications based on Glucosamine and Chondrotin, the main components of cartilage tissue, have proven themselves to be excellent - Structum, Artra, Chondrolone, Elbona. The most effective medicine from this group is Chondroitin Complex in tablets. It should be borne in mind that to achieve an effect, all medications from the group of chondroprotectors should be taken regularly for a long time. In addition to all these drugs, immunostimulant medications, drugs that improve microcirculation in capillaries, vitamin complexes, and calcium supplements are used in the treatment of gonarthrosis.

Massage and physiotherapeutic procedures

Massage helps strengthen the muscles of the lower limb, improve local blood circulation, and, to some extent, stabilize the knee joint. The massage technique involves different kinds influences on the massaged areas in the form of stroking, tapping, vibration, squeezing. Each of these effects is repeated 4 to 6 times. Moreover, first they massage the thigh, and then the knee using circular or concentric movements. Then they move on to the thigh again, but the number of repetitions is halved, and then they return to the knee joint, where they massage it side surfaces. The final stage– several flexions and extensions of the knee and concentric stroking of the joint in places of greatest pain.

Effective treatment of gonarthrosis involves complex use physical procedures, including electrical stimulation of muscles, electrophoresis, phonophoresis, paraffin, ozokerite. All these methods lead to strengthening muscles, relieving intra-articular inflammation, external swelling, and improving local blood microcirculation. Magnetotherapy combines all these effects. This method involves staying on the knee joint for 15-20 minutes. in an alternating magnetic field generated by special equipment. Nowadays, instead of traditional stationary devices for magnetic therapy, special portable devices for individual use are used.

Exercise therapy

Neither medications, nor massage, nor physiotherapeutic procedures can completely strengthen the muscles of the lower extremities, stabilize the knee, and restore range of motion. For this you need physiotherapy. It should be borne in mind that active movements involving flexion and extension of the knees, jumping and squats, running, increase the load on the knee and significantly lead to wear and tear of the joint knee cartilage. Therefore, all intense and wide-amplitude movements with knee arthrosis are unacceptable.

The main emphasis is on static loads, which largely strengthen the thigh muscles. Exercises are performed in a supine position. First, the straightened leg is raised 15-20 cm above the floor level and immediately lowered. Then the raised leg is held in a fixed position for several seconds, gradually increasing the duration of fixation. At first, the exercises last no more than 10 minutes, and then their duration can be increased to half an hour. But the patient should not experience pain.

Folk remedies

Traditional treatment of gonarthrosis mainly involves the use of various herbal preparations in the form of compresses, infusions and decoctions. Here are some of them:

• 3 lemons, 120 g garlic and 250 g celery roots or nettles. Mix all this, after grinding in a meat grinder. Then place in 3 liter jar and pour boiling water over it, then wrap it up. Leave covered for about a day. After this, strain. Take 70 g 3 times a day half an hour before meals.
• 3 tbsp. Mix spoons of apple cider vinegar with 1 tbsp. spoon of honey and treat the sore knee. Cover the top with a fresh cabbage leaf. Wrap it all in polyethylene or warm cloth. This compress can be kept for up to several days.
• 1.5 kg. pour 8 liters of chopped Jerusalem artichoke. boiling water Once the water has cooled a little and become warm, use it as a bath, lowering the sore knee into it.
• Grind 1 ficus leaf in a meat grinder and pour 100 g of regular vodka into it. Infuse for 3 weeks. in a cool, dark place. Then strain. Use as a knee rub, preheat.

Contrary to the assurances of numerous “healers,” it is impossible to completely cure arthrosis with folk remedies - it is a chronic irreversible process that can only be stopped. But here, in addition to folk remedies

other treatments are needed.

Other methods Arthrosis can be treated with unconventional methods , including acupuncture, manual therapy and osteopathy. Acupuncture involves the use of needles (or lasers, electric currents) on certain points

, corresponding to the knee joint. Manual therapy is carried out by direct manual influence on the affected joint and on the lumbosacral spine.

Osteopathy is somewhat similar to manual therapy, but it is carried out more gently, and, unlike the latter, it has practically no contraindications. During periods of exacerbation of pain, in order to reduce the load on the knee when walking, it is recommended to use special devices, including a cane, crutches or orthoses - orthopedic products made like splints, but, unlike the latter, tightly fitting and securely fixing the knee. Unfortunately, conservative methods do not always lead to desired result . Pronounced structural changes in the knee, ankylosis (complete immobility) of the knee joint, atrophy of the muscles of the lower extremities - all this is an indication for surgical intervention. Currently in use latest methods