- Symptoms and signs of osteoarthritis
- The difference between arthritis and osteoarthritis?
- A little about degrees, or stages
- Basic principles of arthritis treatment
- Medicines for osteoarthritis
- Etoricoxib (Arcoxia, Kostarox, Etoriax)
- Advantages and disadvantages
- Diclofenac (Voltaren, Orthofen, Diclac, Dylogene, Diclogen, Diclonac, Naclofen)
- Strengths and weaknesses
- Ketoprofen (Ketonal, Arthrosilen, Arthrum, Flamax, Flexen)
- Advantages and disadvantages
- Meloxicam (Movalis, Amelotex, Arthrozan, Genitron, Myrlox, Movasin, Revmart),
- Advantages and disadvantages
- Lornoxicam (Xefocam, Zornica)
- Advantages and disadvantages
- Nimesulide (Nimesil, Aponil, Naise, Naisulide, Nemulex, Nimesan, Nimica)
- Advantages and disadvantages
- Topical hormones for intraarticular administration
- Betamethasone (Dipropane, Betaspan, Flosterone)
- Advantages and disadvantages
- Topical remedies for arthritis
- Nayatox (snake venom, camphor, methyl salicylate, eucalyptus oil)
- Advantages and disadvantages
- Diclofenac (Voltaren Emulgel)
- Advantages and disadvantages
- Artificial joint lubricant
- Advantages and disadvantages
*Review of the best according to the editors. About the selection criteria. This material is subjective, not an advertisement, and does not serve as a guide to purchase. Consultation with a specialist is required before purchase.
Today our story is about osteoarthritis. There is probably not a single elderly person, or even middle-aged person, who would not have recurrent joint pain. In this case, the pain is not accompanied by signs of inflammation. What it means? Signs of inflammation include reddening of the skin over the joint, swelling or sensation of swelling, intense or slight pain, skin burning to the touch, and impaired function in the form of limited mobility.
Osteoarthritis also causes pain, but it does not have these inflammatory symptoms, but is accompanied by a crunch at the beginning of movement, and then, as the motion activity continues, the joint gradually “works up” and the pain disappears. So if you are struggling to get out of bed in the morning because of knee pain, groaning, and then half an hour later you realize that the pain has disappeared and the comfort of movement has returned, then you undoubtedly have knee arthritis. How many people in our country are suffering from this disease?
The statistics, even the crudest one, is disappointing. There are more than 10 million patients in our country who have been diagnosed with arthritis (i.e. patients who have actually undergone all the necessary examinations) and are under medical supervision. and that’s only the sick. That is, these are the people who have this diagnosis, and who periodically go to the doctor with certain complaints, medical records are kept. It is quite possible to double or triple this number if we add here those patients who have intermittent pain in certain joints, but who have never been examined and have not sought medical help.
However, the number of patients with newly diagnosed arthritis is only increasing, and according to official data, from 2001 to 2005 the incidence of arthritis increased by almost 50%.
The reason for this is sedentary office work in the urban population, and high physical activity in the rural population, if the condition would be wider coverage of medical care in the countryside, with a normal level of diagnosis. It is discouraging that the incidence of arthrosis is increasing at a relatively young age, starting at 45. If you take international statistics, the WHO calculates that one of the leading causes of disability is knee joint osteoarthritis, and it is fourth among all causes in women and eighth in men in general age categories. Before we begin our review of medications for the treatment of various forms of arthrosis, let us remind you what this pathological condition is, and what arthrosis is.
As we recall, the ending “-osis” does not mean an inflammatory process, but an overgrowth, an abundance of some tissue. This is a deformation and overgrowth (compensatory) of the bone tissue, on which the articular cartilage lies, due to a disturbance of its nutrition, or dystrophy, and subsequent destruction, or degeneration.
Now the official term called “dystrophic-degenerative pathology of articular cartilage” becomes clear. Such a disease as osteoarthritis, regardless of which joints have these changes, has many synonyms. If you hear the names of diseases such as: osteoarthritis, deforming osteoarthritis, deforming osteoarthritis, these are all the same.
Of course, osteoarthritis is often combined with secondary inflammation, that is, the symptoms of arthritis. In such a case, they speak of arthritis arthritis, or osteoarthritis. In any case, it is all the same condition associated with the destruction and malnutrition of cartilage tissue, changes in the structure of the bones at the base of the joints. Only in one case, the process proceeds with the presence of an inflammatory component, and in the other case, without the presence of inflammation. Usually, arthritis without the presence of inflammation covers the entire joint, because eventually not only the cartilage itself is affected, but also the synovial sheath, the bone under the cartilage, or the subchondral bone.
The joint capsule is then involved, and in advanced cases, the periarticular muscles are affected. It goes without saying that the ligaments in the joint cavity, such as the cruciate ligaments of the knee, are also involved in the inflammatory process.
Generally speaking, the knee joint is one of the largest joints in the human body and is under quite a lot of stress. Osteoarthritis of the knee joint is called gonarthritis, and people “of age” most often have problems with their legs, and just the knees. Crunching in the knees, clicking, pain in the knee joints occur much more often than in the ankles, or hips. You can read about the current state of the problem of gonarthrosis in the electronic journal “Modern Problems of Science and Education”, which is reviewed by VAK, or the All-Russian Attestation Commission.
How does osteoarthritis manifest itself??
Symptoms and signs of osteoarthritis
As stated above, arthritis most often occurs in the knee joints, and there are specific reasons for this. It would seem logically that the joints that carry the most weight should be the ones under the most strain, and in this case it is the cartilage of the ankle joints, which carry almost the entire weight of the human body. But these joints are so arranged that the manifestation of arthritis in them is infrequent, but the knee joints (gonarthrosis), suffer much more often. In second place is hip arthritis (coxarthrosis), and next are arthritis of the big toe, ankle joint, and arthritis of the small joints of the fingers. How can you suspect symptoms of classic osteoarthritis in yourself? Here they are:
The first, and main symptom is pain in the extremities, or more precisely, in the corresponding joints. The pain is not at rest, but when you are moving, often the pain is starter, and then disappears as you continue moving.
What does this disappearance of pain have to do with? Start pain appears when initially, before the start of movement, the articular surfaces are uneven, lumpy, they are covered with the so-called tissue detritus, which is a kind of “boltup” of destroyed cartilage, which has a very small size. Detritus gradually settles out of the synovial fluid at night, at rest, onto the surface of the cartilage, like sand on the bottom, stirred up by the passage of a large ship.
Once movement begins, this detritus and irritates the articular surfaces and surrounding tissues, causing starting pain. After 15-20 minutes, it is pushed from the surfaces to the periphery of the joint and the pain disappears.
The more arthritis progresses, the more intense the pain syndrome becomes, and the second stage of arthritis results in pain occurring already under light load, and the third stage is characterized by constant pain when the joint is not even loaded. In addition, nocturnal pain is also characteristic in some cases, due to the obstruction of the outflow from the affected joint.
The second characteristic symptom is a crunch in the affected joint, which is dry and “rough.
This crunch is heard from a distance, and it is clear that it indicates the destruction of articular cartilage, and the more progressive the arthritis, the greater the intensity of this crunch;
The third symptom is a gradual decrease in the amplitude of movement, or freedom in the corresponding joint.
Naturally, this is a later symptom than the previous ones. It occurs due to secondary muscle spasm, which is already chronic in nature. The second cause of stiffness is a decrease in the lumen of the articular cleft, due to impaired cartilage synthesis, as well as due to changes in bone tissue, that is, the development of growths – bone spines, or osteophytes. Many have seen in this picture a description of an x-ray in osteochondrosis, when, for example, there is a decrease in the height of the intervertebral discs in the thoracic and cervical spine, the development of hook-shaped osteophytes on the edges of the vertebrae, and so on. There is nothing unusual in this, because osteochondrosis of the intervertebral discs, or osteochondrosis of the spine is the same arthrosis, only localized in the small joints between the vertebrae.
Finally, in advanced stages, due to the inflammatory component (Due to the constant friction of the surrounding tissues by the destroyed cartilage), the volume of synovial fluid also increases.
The joint changes its external shape, configuration, the so-called reactive synovitis occurs. The pressure of the synovial fluid from within causes the joints to become deformed, swollen, and in a constant, nagging, and crushing pain. This stage includes, for example, the so-called phenomenon of ballotization of the patella. If the patient has a marked accumulation of synovial fluid in the knee joint, it contributes to the swelling of the patella outward. Outwardly it is not noticeable against the background of a swollen joint, but if you press the patella and push it inward, it will sink deep and then be pushed outward again by the pressure of the synovial fluid. This floating motion is well felt under the fingers of an orthopedic traumatologist.
The difference between arthritis and osteoarthritis?
How to distinguish arthritis from osteoarthritis? Above we have already described the classic signs of arthritis, which in “pure” arthritis is not observed. It should be added that all the symptoms of arthritis are associated with varying degrees of inflammation. Here are the main differences:
Arthritis can occur at any age, for example, children or teenagers can have autoimmune juvenile arthritis, and osteoarthritis begins at around age 40;
Arthritis can affect virtually any joint, and quite often rheumatologists encounter such pathology as polyarthritis. Osteoarthritis is not capable of this combination from the start and affects small joints. We can say that osteoarthritis “bluntly” affects large joints with a lot of stress;
A classic sign of the difference is the difference in pain. With osteoarthritis we know, pain occurs with movement, is strongest when you start moving, when you get out of bed, and is of a starter nature. In arthritis, on the other hand, the pain is not motion-dependent, but mostly results from a pronounced inflammatory edema. And this swelling is most likely to occur at night when the joint is immobile. Osteoarthritis at night in its initial stages will never hurt;
In terms of various research methods, such as MRI, osteoarthritis is primarily the destruction of cartilage tissue, which is perfectly visible on CT scans. Arthritis, on the other hand, does not lead to the destruction of cartilage, but primarily manifests as a reaction of other tissues.
Finally, it is imperative that age is taken into account. Arthrosis almost always occurs over the age of 40, and is manifested by gonarthrosis, or knee arthrosis, or coxarthrosis-arthrosis of the hip joint. It is coxarthrosis that most often leads to disability and the need for endoprosthetics.
For those readers who are actively interested in the development, that is, in the pathogenesis of osteoarthritis, we refer to the article by Pilipovich A.a., k. m. n. Associate Professor of the Department of Neurology at the First Moscow State Medical University named after M.V. Lomonosov. i.m. The article published in the electronic Russian Medical Journal (RMJ) of the Sechenov Russian Ministry of Health (Sechenov University).
A little about degrees, or stages
What makes joint pathology so “good” is that it does not require a great deal of research to determine the stages, or degrees. Thus:
the initial stage has virtually no symptoms, with occasional mild pain on movement and on exertion;
At the second stage, the pain already changes and becomes worse. Yes, the patient can tolerate it, but it is no longer fleeting, but quite palpable. It is at this stage that the first osteophytes appear, which are clearly visible in X-rays, dystrophy and degeneration of cartilage tissue is noticeable, the very crunch appears;
The third stage is a full-blown clinical picture. The support pads of the joints themselves are grossly deformed, this leads to changes in the axes of rotation and even to deformities of the limbs themselves.
Joint ligaments are reflexively shortened, pain becomes constant, the amplitude of joint motion is reduced, and the size of the joint gap is drastically reduced. At the end of this stage, the joint is almost completely destroyed, and ankylosis occurs, that is, a state of complete immobility. It is at this stage that conservative treatment is no longer possible, and endoprosthetics are necessary.
However, one should not think that it is possible to start the process and not treat it for as long as one wants, because “as a result, one can still put a new artificial joint”. This is a serious misconception. Yes, of course, the affected joint can be “thrown out” and a new one put in. But it must be remembered that severe and neglected arthritis changes the condition of the surrounding ligaments, muscles, and there is no way to replace and remove them. Therefore, the more advanced the process is, the more serious, difficult and time-consuming is the subsequent rehabilitation process, even when the most advanced and expensive imported endoprostheses are installed.
Basic principles of arthritis treatment
It is clear that in far advanced stages the only type of treatment, which preserves the quality of life, eliminates pain, and restores freedom of movement, is a modern surgical intervention, that is, endoprosthetics. But the treatment of osteoarthritis begins from the first stages, when non-drug therapy is of great importance. So, it is necessary:
reduce the load on the damaged joints, for example, by reducing body weight;
- You should use a bicycle, or scooter, instead of taking long walks;
Sometimes it is necessary to change the working conditions. So, if a patient stands for hours at a conveyor belt and osteoarthritis of the knee joints progresses, he should be transferred to other working conditions;
- The patient is prescribed the correct orthopedic regimen;
He does swimming and does therapeutic exercise sessions;
Different physiotherapeutic procedures are prescribed;
Proper nutrition plays an important role, aimed at improving the trophism of articular cartilage and improving the quality of connective tissue in general.
But between the second and third degrees of arthrosis, the pain syndrome, as well as the frequent occurrence of associated inflammation, probably the most severely worsen the quality of life of patients, and here drug therapy is already necessary, including – and intraarticular blocks.
A wealth of experience in treating patients with various types of arthritis summarizes L. i. D. Alekseeva, associate of the V.V. Alekseeva Scientific Research Institute of Rheumatology of the Russian Academy of Medical Sciences.a. Nasonova. This article was published in Practical Medicine, Vol. 2, May 2015. Despite the fact that more than 5 years have passed since this article was published, the main points of diagnosis and treatment of various types of arthritis have not lost their relevance. You can read this material in its entirety at this link, on the CyberLenin website.
Finally, we move smoothly to an overview of medications that are used to treat arthritis.
Medicines for osteoarthritis
First of all, the original drugs are presented and described, not the generics. In the names of drugs, the INN, or the international nonproprietary name common to the entire “drug cluster” is given first, if available, followed by the first, original representative (the first drug created). Then there are examples of generics, or commercial copies of the original drug.
The prices are valid for retail sales of drugs for February 2021 in the Russian Federation. The order in which drugs are listed is not a rating scale or ranking, they are placed in random order according to their classes, or groups.
The list is also not an advertisement, or an invitation to buy. Only a physician can prescribe medicines, taking into account the indications and contraindications. All information about medications was taken solely from public sources, and posted on the Internet official instructions for use. All these drugs are recommended for treatment of arthrosis and arthritis of different etiology, according to national and international clinical guidelines, as well as treatment protocols for patients with inflammatory, and dystrophic-degenerative joint lesions.
And we will begin our review of remedies with the most popular group, or non-steroidal anti-inflammatory drugs.
|NSAIDS||1||Etoricoxib (Arcoxia, Kostarox,Etoriax)||441 €|
|2||Diclofenac (Voltaren, Orthofen, Diclac, Diclogen, Diclonac, Naclofen)||223 €|
|3||Ketoprofen (Ketonal, Arthrosilen, Artrum, Flamax, Flexen)||133 €|
|4||Meloxicam (Movalis, Amelotex, Arthrosan, Genitron, Myrlox, Movasin, Revmart),||71 €|
|5||Lornoxicam (Xefocam, Zornika)||211 €|
|6||Nimesulide (Nimesil, Aponil, Naise,Naisulide, Nemulex, Nimesan, Nimica)||47 €|
|Topical hormones for intraarticular injection||1||Betamethasone (Dipropane, Betaspan, Flosterone)||100 €|
|Topical agents for arthritis||1||Nayatox (snake venom, camphor, methyl salicylate, eucalyptus oil)||154 €|
|2||Diclofenac (Voltaren Emulsion)||736 €|
|Artificial joint lubricant||1||Synvisc||16 950 €|
Let’s say right away that the drugs in this group do not affect joint cartilage in any way either. This is why they are called “anti-inflammatory” because they reduce the symptoms of inflammation. This means that they are primarily indicated for patients who have an inflammatory component, that is, arthritis. But don’t think that even if there are no signs of inflammation, these drugs will be ineffective. After all, the pain that occurs in a variety of diseases is formed not only as a nerve response, but also as a reaction to the destructive action of tissue detritus that accumulates in the joints, to secondary damage to muscles and ligaments.
And non-steroidal anti-inflammatory drugs do not only fight inflammation, but can also relieve fevers and have strong analgesic effects. There is a general law: it is necessary to prescribe the drug in short courses, and in the presence of pathology of the stomach and duodenum, – with gastritis, peptic ulcer, heartburn be covered with drugs, proton pump inhibitors, which had a whole article, the most common is the simple drug omeprazole.
Let’s list the most well-known, effective, modern, and frequently used remedies for dystrophic-degenerative joint pathology from this group. Thus, very effective is the “ancient” and rather crude remedy – diclofenac (Voltaren, Orthofen), but it is quite possible to apply very short courses at exacerbation, no longer than 3 days. Arcoxib, or etoricoxib, may be considered a newer, safer drug. Ketoprofen, meloxicam may be considered commonly used remedies.
It is not advisable to combine two NSAIDs at the same time. Although this results in a higher therapeutic effect, it also leads to an even higher rate of side effects. Let’s get acquainted with the representatives of NSAIDs closer. The main thing to remember: NSAIDs are the main, and practically irreplaceable group of drugs for the treatment of arthrosis and arthritis. Over 239,000 original articles on non-steroidal anti-inflammatory drugs have been published on Pubmed, the world’s largest server of studies, articles and databases, and clinical reviews.
Etoricoxib (Arcoxia, Kostarox, Etoriax)
Arcoxia copes with pain and inflammation, but breaking the mechanism of inflammation and easing symptoms does not necessarily mean eliminating the cause of inflammation. Therefore, this drug should best be prescribed in short courses, in the first days after the onset of acute joint pain.
Arcoxia is not only a type 2 selective cyclooxygenase inhibitor, but it also shows a high degree of selectivity. Almost 95% is a link to the correct isoform of the enzyme, COX 2. That is why this drug is safe, and can be used even in patients with compromised mucous membrane of the stomach and duodenum, that is, in patients with various forms of gastritis and even peptic ulcer disease, although in remission and with the cover of certain drugs (Omeprazole). Etoricoxib, or Arcoxia, can inhibit cyclooxygenase, depending on the dose. It has no effect on the first type of enzyme, which is affected by very “ancient” drugs such as Diclofenac. Produced by the German company Merck, and the cost of 7 tablets of 0.09 grams in January 2020 is from 345 rubles. Kostarox (India) will cost from 267 rubles, and Etoriax from Slovenia (KRKA), will cost about the same.
Advantages and disadvantages
The contraindication to use is a universal combination of bronchial asthma, sinus polyposis and aspirin intolerance. It is also the presence of ulcerative bleeding whenever either, or an active condition of erosive gastritis or gastric and duodenal ulcer. Generally, these are all exacerbations of inflammatory bowel disease, such as Crohn’s disease or ulcerative colitis. Do not use Arcoxia with low blood clotting, as well as with severe renal and hepatic failure. The drug Arcoxia is contraindicated in pregnancy and during breastfeeding, as well as children and adolescents, young boys and girls under the age of 16 years. The drug can be used, but with caution in the presence of a history of ulcers, Helicobacter infection, persons with diabetes and chronic alcoholism, as well as those taking anticoagulants such as Warfarin, or antiplatelet agents such as Curantil, Clopidogrel or acetylsalicylic acid.
On the plus side, it has a high safety spectrum, and a low risk of developing complications.
Diclofenac (Voltaren, Orthofen, Diclac, Dylogene, Diclogen, Diclonac, Naclofen)
Diclofenac, which is produced in ampouled form by the Serbian company Chemopharm, is very cheap: 47 rubles for 5 ampoules. Why ampoules?? Because they work faster and are more effective than pills. By the way, and the Russian company Biochemik produces exactly the same ampoules, 3 ml, but the packaging is 10 ampoules, and at the same price. Which package to purchase as prescribed by your doctor – a small Serbian, or a large domestic one – is up to you, but the small one is better. Very high quality is Voltaren, manufactured by Lek from Slovenia, but then a pack of 5 ampoules will cost from 226 rubles. This drug is almost 5 times more expensive than the Serbian drug, but it is the original product.
Diclofenac is the honorary “grandfather” in the family of non-steroidal anti-inflammatory drugs, and despite its rather low safety spectrum, it is still loved and used. Assign Diclofenac is necessary for a variety of diseases of the musculoskeletal system, arthritis, Behterev’s disease, in dentistry and orthopedics, it also finds its application. Gynecologists prescribe it for algodysmenorrhea, i.e. painful periods. But most of all it is used by neurologists, traumatologists and orthopedists. Many variants of arthritis, acute back pain, neuralgia and radiculitis, exacerbation of protrusion of intervertebral hernia – this is still not a complete list of indications for the use of Diclofenac.
It is very important to remember that a single dose is 1 ampule. The drug must be administered deeply intramuscularly, and the drug can be repeated no sooner than 12 hours later. You can be treated with diclofenac injections for no longer than 2 days. In other words, buying a pack of 5 ampoules is the best solution when it comes to sudden and brief pain syndrome.
Strengths and weaknesses
If Diclofenac had no disadvantages, it would cost significantly more because it is very effective in relieving inflammation, and fights pain, but not for nothing the drug is limited to two days. It can cause gastritis, inflammatory bowel changes, pancreatitis and liver necrosis, the fulminant, that is, the lightning-fast form of toxic drug-induced hepatitis. It is very dangerous to use Diclofenac for ulcers, patients with various forms of gastritis, and especially erosive-ulcerative. Therefore, they are “covered” with omeprazole tablets if necessary.
Headache, dizziness, skin rash, and other side effects often occur. In addition, the official instructions have an impressive list of contraindications, which the doctor must necessarily consider, and especially if we are talking about patients in the elderly. But for all that, short courses of Diclofenac are able to put a person on his feet, even in acute pain syndrome, and its cheapness and good quality of the imported drug makes it a competitor even for more powerful means.
Ketoprofen (Ketonal, Arthrosilen, Arthrum, Flamax, Flexen)
Ketonal is a more modern drug than Diclofenac, the next generation. Its active ingredient is ketoprofen, and each 2 ml ampule contains 100 mg of it. It is indicated for use in cases of severe pain syndrome of different origin, with, of course, in the first place – it affects the musculoskeletal system. These are various arthritis, gonarthrosis and coxarthrosis in the third stage, bursitis and tendinitis, osteochondrosis and gout, rheumatoid arthritis and Bechterew’s disease, psoriatic arthritis. It is also used for pain syndrome due to malignant tumors, migraines, headaches, and radiculitis.
Ketoprofen in ampoules should not be used more than two ampoules per day. It is desirable that the course of treatment with ketonalom not exceed 3-5 days, and it is desirable to use the drug in the smallest dosages that bring the effect, for example, 1 ampoule daily in the evening for 3 days. Produces Ketonal company Lek from Slovenia, and a pack of 10 ampoules costs an average of 227 rubles.
Advantages and disadvantages
A big plus of Ketonal is the permission of the official instructions to use it during pregnancy, of course, with extreme caution, and as short a course as possible. It should not be used only in the third trimester, when there may be a disruption of labor. Contraindications to the use of the drug are about the same as in other cases. In addition to hypersensitivity is an allergy to NSAIDs, that is, a combination of aspirin asthma, nasal polyposis and aspirin intolerance. It is an exacerbation of peptic ulcer disease, low blood clotting, childhood, expressed hepatic and renal insufficiency. It is contraindicated if there is a high risk of bleeding of various types. But in the event that it in the case of various arthritis is prescribed a short course in the absence of contraindications, it is just as capable of bringing significant relief to patients with pain syndrome of the most different genesis.
Meloxicam (Movalis, Amelotex, Arthrozan, Genitron, Myrlox, Movasin, Revmart),
Movalis, or Meloxicam is the last drug we considered for deep intramuscular injections to relieve pain and inflammation, as well as to relieve excruciating pain in the neglected form of arthritis and the presence of arthrosoarthritis. The first open of the group of oxycams – COX 2 inhibitors. Movalis is the original meloxicam, produced by German company Boehringer Ingelheim, and a pack of 3 ampoules will cost 850 rubles. Movalis belongs to the group of non-steroidal anti-inflammatory drugs, can reduce all the classic signs of inflammation: redness, fever, soreness and swelling. The action of the drug is based on blockade of prostaglandin synthesis.
The drug is indicated in diseases of the musculoskeletal system, various forms of arthritis, arthrosis and osteoarthritis. The classic indication for Movalis is acute low back pain, lumbago, other forms of dorsopathy, shoulder periarthritis, and other conditions. In the case of uncomplicated pain syndrome, such as osteoarthritis, one 1.5 ml ampoule containing 7.5 mg of Movalis is administered intramuscularly. In severe cases, two ampoules a day, such as in rheumatoid arthritis. Do not administer more than two ampoules daily, i.e. more than 15 mg.
Advantages and disadvantages
The drug is packed in 3 ampoules: this is enough for three days of primary relief of acute pain syndrome. Contraindications and side effects of Movalis are typical for all NSAIDs, they have been repeatedly named above, and we will not dwell on them. Of course, the high cost of the drug is striking: one ampoule for injection costs 283 rubles, and one ampoule of diclofenac, even if you take an expensive imported package, will cost 8 rubles. We find that one day of treatment with diclofenac is 32 times cheaper than one injection of Movalis. This is exactly the situation described above. If diclofenac didn’t have so many side effects, it would be much more expensive. It’s not expensive Movalis, it’s too cheap Diclofenac. And in general, the most affordable meloxicam in injections, or one of the most affordable is 50 rubles for 3 ampoules of domestic production.
Lornoxicam (Xefocam, Zornica)
Lornoxicam has a high safety profile, and also belongs to the class of oxycams, just like Movalis. This medicine is good for pain and relieves inflammation. Lornoxicam perfectly helps in back pain, locomotor system pathology, and inflammatory and dystrophic-degenerative joint damage.
Xefocam, like all other drugs from the group of anti-inflammatory drugs, is a symptomatic and pathogenetic treatment. Yes, they relieve mild to moderate pain syndrome of muscle and joint origin, in tendinitis, tendovaginitis, arthritis and arthrosis, relieving the condition and improving quality of life. But they have no direct effect on the cause of pain. Osteoarthritis can occur due to excess weight, poor nutrition, and neither anti-inflammatory agent is able to eliminate these causes.
Xefocam for arthritis is usually taken in tablets, 8 mg, and one pack of 10 tablets will cost from 80 to 240 rubles. Xefocam is made by a famous pharmaceutical company called Takeda, formerly Nycomed. Xefocam is used once a day, 8 mg, the maximum daily dose is 2 tablets, or 16 mg. The drug is also available in ampoules for intramuscular or intravenous administration, to achieve the most rapid effect, which is convenient for exacerbations of osteoarthritis.
Advantages and disadvantages
Xefocam works quickly and is well tolerated. After taking Xefocam, or after an intramuscular injection, the pain in the strained, dystrophic joint may subside, and the person may undergo the necessary radiological studies, or prescribed physical procedures against the background of taking the drug.
Xefocam should not be taken permanently because, like all drugs of the NSAID group, it can cause erosive-ulcer bleeding in the presence of gastric ulcer in the acute stage, lead to anemia, palpitation, and often causes abdominal discomfort, diarrhea. This drug cannot be taken by children under 18 years of age (but they usually do not have severe arthritis), individuals with aspirin intolerance, bleeding disorders, and immediately after aortocoronary bypass surgery, and individuals with severe liver failure. Also, Xefocam should not be prescribed to pregnant women, and women during lactation.
But if Xefocam is used in short courses, with all precautions, and in conjunction with topical medications to treat arthritis, it will significantly improve quality of life, reduce pain, and increase the range of motion in the joint affected by arthritis.
Nimesulide (Nimesil, Aponil, Naise, Naisulide, Nemulex, Nimesan, Nimica)
Nimesil is one of the few NSAIDs that is not available in ampoules for intramuscular injection. The most common are powders for solution in water and ingestion, tablets, and various creams and gels, which will be discussed below. One of the best remedies indicated for joint pain, arthritis and arthrosis, muscle pain, and toothache is Nimesil and its quality analogs, such as Naiz. Nimesil has a “milder” action than meloxicam. Not only does it fight inflammation and relieve pain, but it also helps lower the temperature, which can be helpful for acute respiratory infections. The drug can even be used for painful periods (algodysmenorrhea).
It is advisable to use Nimesil and its analogues one packet twice a day, the duration of intake should not exceed 2 weeks. Although many patients with low-intensity joint pain can get by with just one packet, which puts half the burden on the liver. Nimesul is produced by the same company Berlin-Chemie, and one pack of 30 pouches for a two-week course will cost from 600 to 750 rubles. Nimesulide by Marbiopharm is available locally for the price from 250 roubles up to 590 roubles., But the cheapest are pills, not powders of the same name. Even a dosage of 20 pieces is sold in pharmacies at a price of 40 rubles, and even lower. A great compromise between price and quality is Indian Nais: a pack of 20 tablets of 100 mg can be bought at an average price of 200 rubles, and even find one for 160 rubles.
Advantages and disadvantages
Nimesil has the same contraindications as Movalis. It is not recommended in cases of severe blood clotting disorders, alcoholism and drug addiction. It is also contraindicated in pregnant and nursing women, and can cause side effects typical of NSAIDs, of which nausea, diarrhea, or even vomiting are the most common. As in the previous case, any nimesulide should be used with minimal effective doses and a minimally short course. Also, this drug should not be combined with other drugs from the NSAID group. This can increase its aggressiveness, which in very rare cases can lead to drug-induced liver damage.
Topical hormones for intraarticular administration
Local hormonal preparations, which are corticosteroids of prolonged action – are a real panacea for patients with prolonged, persistent pains, in the third stage of advanced arthrosis with the onset of arthritis symptoms, with synovial effusion and increased volume of synovial fluid. You can not take the hormones orally. For arthritis and arthrosis arthritis, intraarticular injection with a syringe and needle in the hospital is necessary.
If the product is administered into the joint cavity, it acts quickly, with no or minimal side effects, since it does not enter the bloodstream, and the drug can have a very long-lasting effect. The best known drugs used in arthrology to treat chronic pain and relieve inflammation in arthritis are Dipropan and Kenalog.
As a result, steroid hormones, for a long period of time, (up to six months after one injection!) allow the patient to improve range of motion, increase mobility in the joint, reduce pain, and relieve inflammation.
But at the same time, despite the elimination of unpleasant symptoms, they do not lead to the restoration of articular cartilage. Let us consider an example of local hormonal therapy of betamethasone, with the example of such a drug as Dipropan. This will be quite enough, since there are a total of 2 corticosteroid hormones used in medicine for intra-articular injections. The first of these is betamethasone, which will be described below, and the second is triamcinolone, which is available as the drug Kenalog. Since they are from the same group, they have a lot in common.
Betamethasone (Dipropane, Betaspan, Flosterone)
Dipropan is a quality suspension consisting of two compounds of betamethasone. It has a clear, yellowish or colorless color, slightly viscous consistency, which has whitish particles. The ampoule also contains additional substances. Each ampule contains one milliliter of this suspension. The remedy has a high anti-inflammatory, as well as anti-allergic and immunosuppressive action. We are interested in just the first effect, so in the first place Dipropan is used in diseases of the musculoskeletal system, and of course, in various types of arthritis, and especially with an inflammatory component.
A very important and valuable property of diprospan is considered to be its very slow release from the depot, in this case from the joints. In various types of arthritis, Dipropan is used not only intra-articularly, but also peri-articularly, and it must be remembered that it cannot be used intravenously or subcutaneously. If local administration is necessary, you can usually avoid using a local anesthetic, and usually one to 2 mL per joint is sufficient for administration to large joints.
The duration of the clinical effect after a single injection can last up to a month or longer, with a very good response – up to six months. You can buy one ampoule of Dipropan in pharmacies at a price of 260 rubles, respectively, the same amount will cost one injection, and for a large, for example, for the knee joint, it may be 2 milliliters. If we consider that there may be pronounced gonarthrosis with pain both on the right and left, the maximum dosage for all two knee joints will be 4 ml, that is about 1000 rubles. The cost of the drug.
Advantages and disadvantages
The main advantage of intra-articular hormones is the low probability of systemic effects, such as increased blood pressure, decreased plasma potassium, or “classics” – gastrointestinal erosive-ulcerative damage, reduced wound healing rate and so on. These side effects usually occur with systemic administration of corticosteroid drugs. The second advantage is a fairly long action, but still need to remember the main contraindications to the prescription of corticosteroid hormones, even for intra-articular administration. First of all, it is systemic mycosis, that is, fungal infection, with damage to internal organs and penetration into the bloodstream, the presence of an acute joint infection, such as brucellosis, or tuberculosis arthritis, the presence of hypersensitivity to betamethasone. It is best to refrain from using hormones, even intra-articularly, for pregnant women.
Topical remedies for arthritis
There are a lot of local remedies designed to treat arthritis, arthritis, and other pathologies of the musculoskeletal system: these include warming compresses, knee pads made of dog and camel hair, and Kuznetsov or Lyapko applicators. People apply ozokerite and paraffin to joints, make Dimeksid and Bischofit compresses.
We describe over-the-counter ointments, creams and gels that serve as first aid remedies. What’s the difference between an ointment, a cream and a gel?? When to apply them for arthritis and arthrosis-arthritis?
The ointment is best applied at night in case of aggravated pain, pronounced crunching. Ointments are oily, usually on petroleum jelly or lanolin, take a long time to absorb, but absorb deeply, stain clothes during the day, but have a long lasting healing effect. It is therefore wise to give the ointment time to soak for a few hours after application overnight, it can be applied under an occlusive dressing, for example, under parchment paper + elastic, mesh bandage.
Cream is an emulsion, a suspension of fat in water, or solvent. The most popular and well-known cream can be considered mayonnaise sauce, in which tiny drops of vegetable oil are distributed in the egg white or yolk. A cream absorbs more quickly than an ointment, in a matter of minutes, especially if you carefully massage the spot in question.
The gel is not a fat-soluble emulsion, but an aqueous-alcoholic mass that evaporates very quickly, it leaves a protective film on the skin. Gel penetrates deep into tissues the least, so it is reasonable to apply anti-inflammatory gels in the projection of large joints, where there is the least muscle and subcutaneous tissue, such as on the knee or elbow area. You can apply gel to the intercostal area, but trying to apply it to an obese person’s buttock to get it “through it” to the sciatic nerve is unlikely to be successful.
Of course, ointments, gels, creams “for joints” – a huge number. There are warming ointments, and there are cooling ointments. Here are some of them:
Nayatox (snake venom, camphor, methyl salicylate, eucalyptus oil)
RatingNayatox is a Vietnamese ointment, and the main active ingredient is cobra venom. This product irritates the skin, cools and relieves pain, and is best for musculoskeletal disorders. It is arthritis, sciatica, neuralgia, sciatic nerve inflammation or sciatica, osteoarthritis. This ointment should be applied to the skin in one to two teaspoons, rubbing once a day. In severe pain syndrome it can be applied twice. The drug can be used for up to 10 days without a doctor’s prescription. A 20 g package will cost between 200 and 250 rubles in February 2021.
Advantages and disadvantages
Nayatox should not be used in cases of fever, active tuberculosis or infection, exhaustion, insufficient cerebral circulation (stroke), patients who have recently had a heart attack, or patients with unstable angina. It is forbidden to apply the ointment to pregnant and lactating women, as well as persons with skin lesions at the site of application of Nayatox. However, Nayatox, on the second or third day after the emergence of symptoms of exacerbation of arthrosis or joining inflammation, helps to dissolve the inflammatory focus, and due to the irritating, distracting influence of camphor slightly cools, reducing pain and discomfort when moving.
Diclofenac (Voltaren Emulgel)
Novartis produces Voltaren Emulgel, in the form of gel for external use. Tube of 1% diclofenac weighing 50 g will cost 356 rubles. Diclofenac when applied topically, relieves pain, swelling, inflammation, reduces fever in the joint, relieves sleep in nighttime pain and improves range of motion.
Voltaren Emulgel is indicated for a variety of pain due to musculoskeletal pathology, rheumatoid arthritis, muscle bruises and sprains. It should be applied 3 times a day, the amount – no larger than a cherry or walnut. It is advisable to wash hands after rubbing, as the gel has a specific smell.
Advantages and disadvantages
The drug is usually not absorbed into the blood in large quantities, unless, of course, too large areas of skin are smeared. Very rare and when applied topically there may be urticaria, Quincke’s edema, and contact dermatitis and rash can develop quite often, but still less frequent than one case per 10 uses. The drug is contraindicated for use on the skin with a tendency to aspin asthma, intolerance to aspirin, pregnant and lactating women, children under 12 years of age, as well as in the presence of wounds and scratches where applied. You must be very careful when using this remedy in chronic hepatic and renal failure, and avoid getting the gel on the mucous membranes. But if it is used correctly, there will be no consequences, and the pain in the joint will recede.
Artificial joint lubricant
Artificial lubricant, or synovial fluid, is always needed quality. It performs many functions: it nourishes cartilage, reduces friction in the joint, absorbs shock, and acts as a shock absorber. Natural lubricant is a permanently renewable, viscoelastic polymer. It is always on the surface of the cartilage, lubricates it, and also nourishes. Patients should remember that already since 2003, the World Health Organization recommends the use of artificial lubricants, in the complex treatment of arthrosis, when conservative treatment becomes ineffective.
If there are prosthetic joints, i.e., endoprostheses, the artificial joint fluid can also be called synovial, or joint fluid prosthesis. The main indication for its use is pain, discomfort during movement, as well as stiffness in the joints. When there is not enough natural lubrication, then an artificial preparation is used, and it is administered intra-articularly in the synovial fissure, just like hormones.
There are many proven effects of artificial synovial fluid. If the patient undergoes a course of injections, then for several months, and even up to a year, he will return to easy and painless movement. Usually 5 injections are given at regular intervals during each course, and the duration of the effect depends on the quality and the choice of drug.
Of course, the maximum effect is achieved by the timely administration of a joint fluid substitute, and this is the initial stages of arthritis. If there are already serious changes, then any remedy will bring less effectiveness, because the cartilage will already be destroyed. Even good quality lubrication of severely damaged gears in any engine will not fix the problem: it will hum and decay further.
What are the common contraindications against the introduction of artificial synovial fluid? These are:
Any local inflammation in the joint, since any artificial joint fluid that consists of hyaluronic acid, and the natural one as well, is destroyed against the background of the inflammatory focus;
prosthetic synovial fluid is not used in autoimmune pathology, such as rheumatoid arthritis, but that is not the purpose of our article;
A rather unpleasant fact can be an allergic reaction to natural synovial fluid, which is of animal origin, and this reaction can be up to anaphylactic shock, so it is best to prescribe synthetic synovial fluid prostheses, although they are more expensive.
The better the medication, the less often the patient will have to undergo repeat treatment, and the longer the medication will work. What does the effect of the medication depend on?? From the size of the drug molecules. It is preferable to use high molecular weight products, because they are more slowly eliminated from the body and slowly destroyed, having a so-called prolonged effect. If the molecular weight of the product is small, then the hyaluronic acid molecule is quickly broken down into fragments, separated, and removed from the joint.
Recall that the natural, natural joint fluid, which is the benchmark, has a mass of about 3 million daltons. Low molecular weight drugs are up to 800.000, and artificial joint fluid with a high molecular weight of more than 2.5 million. units. As one of the reference drugs that make up an artificial joint lubricant, here we will present the American drug Synvisc.
Those who are interested in “prosthetics” of joint, minovial fluid, we can recommend a good article of the Voronezh Clinics network about these preparations.
It comes in a package of 3 ampoules, 2 ml each, costing 24500 rubles. Accordingly, the price of 1 ml will be just over 4000 rubles. Such a high price is quite justified, vest Sinvisk is a highly viscous, elastic fluid, with an average molecular weight of about 6 million. Daltons, that is, 2 times thicker and heavier than the natural lubricant. It consists of hyalanes, not hyaluronic acid, hyalanes are derivatives of hyaluronic acid, which consist of repeating disaccharine links. These are acetyl glucosamine and sodium hyaluronate. Naturally, it should be injected strictly into the joint cavity, unless there is a large amount of effusion.
In the case of osteoarthritis of the knee, 3 injections one week apart each are needed as a course of treatment. With this dosing regimen, the usual effect of use was maintained for 26 weeks, and in the case of osteoarthritis of the knee, the best response was 52 weeks, after 1 course of three injections. Therefore, the quality explains the high cost of this remedy, but it should be remembered that it is considered expensive in our country, because for it you need to pay about the average monthly salary. In the U.S., a skilled worker receives about $25 per hour of work, and in Russia this figure is just over $3, so in the country – the manufacturer of this product is eight times cheaper.
Advantages and disadvantages
Synvisc contains a little bit of chicken protein. Therefore, if the patient has an intolerance, or hypersensitivity, you need to be careful. The injection procedure is usually well tolerated, and occasionally there may be brief pain or swelling, but this is rare. Some disadvantage is the method of application. First requires intra-articular injection, removal of a certain amount of synovial fluid, in an amount equal to the injected, warming the drug to room temperature, compliance with strict aseptic rules, selection of needle size and length depending on the joint. Therefore, medical professionals need to learn the rules of administering this drug. However, such rules are required for the administration of absolutely all prosthetic synovial fluid without exception, and the only difference is the packaging, volume, price and quality. In many cases, the drug is injected under X-ray control.