Contents
NSAIDs: ambulance for joints – pros and cons
Non-steroidal anti-inflammatory drugs (NSAIDs) are the most common group of drugs used for pain and inflammation of any organs.
The most famous representatives are:
aspirin
indomethacin
diclofenac
ibuprofen
nimesulide
diflunisal
lysine monoacetylsalicylate
sulindac
aceclofenac
etodolak
lornoxicam
ketoprofen
flurbiprofen
you are not
Mechanism of action
The wide popularity is due to the rapid elimination of symptoms due to the triple effect of this group of medicines:
anti-inflammatory;
painkiller;
antipyretic.
The anti-inflammatory effect is due to other mechanisms than those of hormonal drugs, which is emphasized in the name – non-steroidal drugs. It is maximally expressed in indomethacin, flurbiprofen and diclofenac, and a minimal anti-inflammatory effect should be expected from ibuprofen, amidopyrine and aspirin.
These medications block prostaglandins, inflammatory mediators that are released when tissues are damaged. As a result, all symptoms of inflammation are reduced: redness, swelling, pain, fever and impaired function.
Pain syndrome is better eliminated by ketorolac, ketoprofen, diclofenac and indomethacin. Aspirin, ibuprofen and naproxen have less analgesic activity.
The strength of the action of different drugs depends on the structure of the molecule. However, individual sensitivity to different drugs cannot be ruled out.
Undesirable reactions
Long-term use of NSAIDs, necessary in the treatment of gonarthrosis, is limited by the development of dangerous adverse reactions, most often from the digestive tract and kidneys.
Since the anti-inflammatory action appears to be blocking prostaglandins, a side effect is a decrease in the protective factors of the stomach. Most of the representatives of this group of medicines are acids, so they additionally irritate the gastric mucosa.
The result can be NSAID-gastropathy: erosive or ulcerative defects of the mucosa of the gastrointestinal tract, the most severe manifestation of which is gastrointestinal bleeding.
It is believed that indomethacin, ketoprofen, piroxicam are more aggressive in this regard. Less often, such complications develop when taking small doses of ibuprofen and diclofenac.
How to avoid side effects from the gastrointestinal tract:
With a high acidity of the stomach, a history of gastritis and ulcers, severe comorbidity, in the elderly, the likelihood of gastrointestinal bleeding increases. In such situations, the use of selective drugs (meloxicam, nimesulide, celecoxib) is more justified, which do not reduce the protective factors of gastric mucus and can be used for a long time.
Gastric acid-reducing drugs (proton pump inhibitors) can be used, but long-term therapy is considered uneconomical.
Side effects of NSAIDs are often manifested by the development of cardiovascular complications in the form of strokes, heart attacks and thrombosis. Naproxen and ibuprofen are considered safer in this regard. The use of diclofenac significantly increases the risk of heart and vascular diseases.
The development of arterial hypertension, heart failure, acute renal failure may be the result of a decrease in blood flow in the renal vessels due to inhibition of prostaglandin synthesis.
Perhaps the development of aspirin bronchial asthma, Reye’s syndrome (bleeding) and many other side effects.
Such formidable adverse reactions do not allow self-medication and dictate certain rules for use:
NSAIDs should not be taken long term. They are used as an ambulance, quickly and effectively eliminating the symptoms of arthrosis of the knee joint.
Taking anti-inflammatory drugs masks the picture of the disease without eliminating its cause, which often causes a belated visit to the doctor.
The choice of drugs is wide both in terms of strength of action and side effects. The doctor will be able to choose the optimal drug in a safe dosage and prescribe the necessary studies to prevent the development of complications.
Chondroprotectors: is it possible to restore cartilage tissue?
Since arthrosis of the knee joint is caused by damage to the cartilage of the articular surfaces, the ideal drug should be able to restore them. Such a hope appeared when a group of chondroprotectors (CP) was identified, the most studied representatives of which were glucosamine (GA) and chondroitin sulfate (CS).
The last 25 years of numerous studies have accumulated an extensive base, both confirming the effectiveness of CP, and refuting it. Reviews on the use of drugs are just as contradictory.
You should not expect a speedy recovery while taking chondroprotectors: the minimum results should be assessed no earlier than after a month of their use. Reducing the dosage of NSAIDs in the treatment of arthrosis of the knee joint is the first symptomatic effect of the use of CP. They are most effective at stages 1 and 2 of arthrosis.
Glucosamine and chondroitin, like nonsteroidal drugs, have anti-inflammatory effects by suppressing “inflammatory cells” (interleukins and prostaglandins). However, unlike NSAIDs, chondroprotectors have excellent tolerance.
Preventing the progress of the disease (on the x-ray – slowing down the rate of narrowing of the joint space) is also an important effect of this group of medicines.
At first, GA and CS were used in isolation and in the form of injectable forms, which limited their use. Then oral forms of release were developed. Let us give an example of several drugs with chondroprotective action.
Preparations containing chondroitin sulfate
Chondrolon (Russian company “Microgen”) – is available in the form of dry matter ampoules for intramuscular injection.
Chondroitin AKOS (Sintez, Russia) – capsules for oral administration of 250 mg and ointment for topical use. You need to take 4 capsules per day.
Structum (“Pierre Fabre”, France) – capsules of 250 and 500 mg. Daily dosage – 1000 mg.
Preparations containing glucosamine
A study conducted in Belgium showed a greater effectiveness of glucosamine in osteoarthritis of the knee joint than cholesterol.
Elbona (CJSC Moscow Pharmaceutical Factory) is a drug for intramuscular injection of 400 mg of the active substance in an ampoule.
Dona (“Rottapharm”) – is available in the form of powder and capsules for oral administration, as well as a solution for intramuscular injections. 1 sachet of powder contains 1500 mg of the active substance, and one capsule contains 250 mg.
Preparations containing HA and cholesterol
Thanks to numerous studies, there is evidence that the effectiveness of the two components improves the result of treatment by 60%, and monotherapy – by 30%.
Artra (Unipharm, USA) and Teraflex (Bayer, Germany) – complex preparations containing both chondroprotectors, differ somewhat in the dosages of the incoming components: 500 mg of HA and cholesterol in the first and 500 mg of HA and 400 cholesterol in the second.
Topical medicines
Preparations for local therapy are additional methods for the treatment of osteoarthritis of the knee joint. Usually the active substance is an NSAID, such as in the preparations Voltaren-gel, Fastum-gel, Menovazin, diclofenac ointment, indomethacin and butadione. Therapeutic compresses with bischofite (oil derivative), dimexide (anti-inflammatory drugs), medical bile expand the range of therapeutic measures for gonarthrosis.
Absorption of the drug with local treatment is no more than 7-8%, so monotherapy is rarely effective.
Since the course of the disease is accompanied by periods of exacerbation and remission, it is important to combine different methods of treatment, apply effective physiotherapy, spa treatment, and possibly traditional medicine.
The doctor will help with recommendations at any stage of the disease!
[Video] Scientific review – what to take for joints? Pill Alternatives
Boris Tsatsulin – Do your joints hurt and crunch? True reasons. What to do?