The most effective treatment for osteoarthritis. New opportunities in the treatment of osteoarthritis What medicine is better to treat osteoarthritis

The destruction of the articular surfaces in osteoarthritis leads to pain and a deterioration in the quality of life. Timely assistance can slow down the development of the disease and prevent the patient from becoming disabled. To understand what and how to treat osteoarthritis, you need to have information about the methods of therapy.

Basic treatment

Osteoarthritis occurs more often in patients who have crossed the forty-year milestone. Preferential localization: large joints of the legs -,. Dysfunction seriously affects lifestyle, so it is important to start treatment at the first sign of illness.

The basic therapy of osteoarthritis is aimed at stabilizing the process and preventing further changes in the cartilage tissue. It includes not only

unloading

To slow the progression of the disease, the patient is advised to reduce the impact on the joints of the legs:

1. Long walks or standing should be avoided.
2. You should use the elevator and not climb the stairs.
3. At initial manifestations, an orthosis is recommended that fixes the knee or ankle joint.
4. It is recommended to purchase a cane or crutches.
5. If professional activity is associated with a load on the lower limbs, you should change jobs.

Normalization of body weight

In most cases, patients with osteoarthritis are overweight. The normal body mass index ranges from 19 to 25. It is easily calculated by the formula: mass (in kg) must be divided by the square of height (in meters). An increase in this value indicates a need.

Medical treatment

Symptomatic drugs of slow action in the treatment of osteoarthritis protect the cartilage from the inflammatory process. Their reception allows to achieve remission and significantly reduce the dosage of painkillers. This treatment is better tolerated by patients.

There are main groups of drugs:

• agents that suppress inflammation;
• artificial joint fluid.

Chondroprotectors - products containing active substances of cartilage tissue - chondroitin sulfate, glycosaminoglycans. They are administered intramuscularly, courses 2 times a year. The effect of therapy does not develop immediately, but periods of improvement are up to 6 months. Rheumatologists use: Chondrolon, Alflutop, Teraflex, Chondroxide, Structum, Don.

Means that suppress the production of substances that support chronic inflammation in the joint - Diacelerin (or Artodarin, Artoroker). The drug is taken orally, in courses of 4 weeks, possibly long-term treatment on the recommendation of a doctor.

Artificial synovial fluid. A change in the composition of the intra-articular environment occurs already at the initial stage of osteoarthritis. The introduction of a replacement agent based on hyaluronic acid improves the functioning of the joint and slows down cartilage damage. To improve the tolerability of this therapy, patients are given hydrocortisol injections simultaneously with the synovial fluid. This treatment has a high cost, but has proven to be effective method joint protection. Prescribe such drugs: Fermatron, Dyuralan.

On a note!

Previously, symptomatic treatment was supplemented with drugs that improve blood flow (chimes), antioxidants (vitamin E), vitamin B6. Such drugs do not have proven effectiveness, but in the presence of concomitant diseases, they can be prescribed.

Physiotherapy

When asked by patients: how to stop the progression of osteoarthritis, rheumatologists advise including a course of therapy with non-drug drugs. :

• stimulate blood circulation in surrounding tissues;
• improve cartilage metabolism, slowing down their destruction;
• relieve pain;
• fight synovitis.

As part of the basic treatment, exposure to microwaves, ultrasound therapy, Bernard's diadynamic currents, electrophoresis with novocaine or analgin, magnetotherapy, thermal applications on the joints are recommended. The duration is determined by the doctor, the average course consists of 8-12 procedures.

Bathtubs and tubs

Such treatment of osteoarthritis of the joints has a beneficial effect on metabolic processes in cartilage tissue.

For local use, baths with Bischofite are prepared. This remedy is a saline solution containing calcium, potassium, iodine, bromine, iron and silicon, molybdenum ions. For foot baths, dissolve 1 glass of Bischofite in 2 liters of hot water. The procedures are carried out for 2 weeks, after which they take a break for 2 months.

Balneotherapy for osteoarthritis includes the use of radon, iodine-bromine, hydrogen sulfide, turpentine baths. The duration of the course of treatment is up to 12 procedures for 10-15 minutes.

On a note!

So radon baths are recommended for elderly patients, people with stage 1 and 2 osteoarthritis. Hydrogen sulfide and turpentine should be taken by patients with obesity and atherosclerosis at stages 1 and 2 of the disease without inflammation of the joint membrane. Iodine-bromine procedures are effective for patients with background diseases of the nervous system, women in menopause.

Contraindications to balneotherapy are:

• exacerbation of synovitis;
• acute inflammatory diseases;
• hypertonic disease;
• cardiac ischemia;
• severe atherosclerosis.

Treatment to reduce pain and inflammation

This part of osteoarthritis therapy includes medication and physiotherapy methods. They are aimed at the speedy relief of an attack of the disease and help alleviate the condition with inflammation of the membrane. The most common localization of synovitis is the knee joint.

Systemic therapy with rapid-acting drugs

Standards for the treatment of osteoarthritis include the mandatory use of drugs that quickly relieve pain and reduce inflammation within the joint. They only work when taken. There is no delayed effect. A number of patients require long-term courses of treatment in combination with drugs from the basic therapy group.

1. You should not make sudden movements and exercise "through force."
2. The patient should take a position that eases the load on the joint - lying, sitting.
3. Enough attention should be paid to breathing exercises.
4. Outside the exacerbation of osteoarthritis, patients are allowed to swim, ride a bike.

For patients who, for health reasons, cannot engage in physiotherapy exercises, kinesitherapy on special simulators is recommended.

Massage in case of joint damage is aimed at weakening nervous excitability in chronic inflammation, improving local blood flow, and working with muscle tone.

On a note!

The technique is characterized by soft, relaxing movements. Intensive rubbing in the area of ​​​​the joints should be abandoned, especially in the presence of an exacerbation of the disease.

Polymodulators

These funds are not included in the basic standards of osteoarthritis therapy. Initially, they were recommended for the management of patients during menopause and those with reduced parathyroid function. The action of polymodulators is aimed at preserving and restoring bone tissue. Raloxifene works with receptors for the female hormone estrogen, and Teriparatide is an analogue of the parathyroid hormone. These drugs are used to treat osteoporosis, which aggravates the course of osteoarthritis.

How to deal with osteoarthritis pain

In clinical studies, it has been proven that in a number of patients with joint damage, chronic pain syndrome may not be associated with the presence of an exacerbation or remission of the disease. Sometimes painful sensations cannot be alleviated with traditional drugs from the category of basic or fast-acting remedies. Changes in the X-ray and ultrasound of the joints in these patients also did not correspond to the existing complaints.

It was found that the pain in their case is due to completely different mechanisms associated with adrenaline receptors. For such patients drug treatment osteoarthritis includes the appointment of drugs atypical for this disease - anticonvulsants (Lyrika) or antidepressants (Cymbalta, Velaksin).

Treatment with folk remedies

Patients often wonder if osteoarthritis can be cured by taking conventional therapy. Some of them believe that pills and injections can only worsen the course of the disease and "cause a certain dependence on drugs." Such reasoning leads to refusal of treatment and attempts to help diseased joints with folk remedies.

On a note!

It is impossible to completely get rid of the manifestations of osteoarthritis by conservative methods. can also have only a local anesthetic and absorbable effect, without affecting necessary measure on the state of cartilage and bone tissue of the joint.

However, followers of alternative medicine recommend various methods of treatment.

1. . The use of leeches is especially important in case of damage to the knee joint. This method works due to biologically active substances secreted by these animals that improve blood circulation and help fight swelling and inflammation around the joint. Such treatment is carried out only in the clinic under the supervision of a specialist.
2. Apitherapy. Bee stings in osteoarthritis also have a local effect on inflammation. You should not resort to this method of treatment if the patient has a tendency to allergic reactions, since the outcome of the procedure can be unpredictable. Moreover, you should not practice apitherapy at home.
3. To reduce inflammation in the joint, it is recommended for oral administration. The following ingredients are taken equally: marigold and elderberry inflorescences, willow bark, birch leaves, nettle grass and horsetail, dried. 3 art. l. raw materials pour 900 ml of boiling water and insist for 10 hours. The drug is taken 100 ml 3 times a day for 2 months.
4. Topically apply a mixture of castor oil and turpentine in a ratio of 2:1. The agent is applied to the joints at bedtime no more than 3 times a week. For osteoarthritis, this blend of natural oils improves blood circulation and helps clear up stagnant inflammation.
5. Compresses with ointment are recommended for the treatment of knee and ankle joints. The product is prepared from 70 g of butter and chopped vegetable raw materials (about 1 tablespoon of hop cones, St. John's wort shoots and sweet clover flowers). The oil is mixed with herbs and applied to the joint area. From above they cover with a piece of cotton fabric, polyethylene, warm with a woolen scarf. The duration of the procedure is 2 hours, the treatment is carried out every other day for 2 weeks.

Surgical treatment

Surgical treatment is recommended for patients with a rapidly progressive course of the disease, a pronounced dysfunction of the joint. It is carried out at stages 3 and 4 of osteoarthritis and joints, completely replacing the affected surfaces.

On a note!

After the operation, patients have a long rehabilitation. It includes: exercise therapy, massage, unloading, drug treatment.

Osteoarthritis of the joints of the lower extremities is a common pathology of the musculoskeletal system, leading to disability even in people of working age. Competent treatment started in time helps patients maintain their usual quality of life.

If you feel stiffness or difficulty in moving in the morning when you wake up, as well as pain in the joints, then most likely you have arthrosis. If these symptoms occur, it is necessary to undergo a comprehensive comprehensive diagnosis. Consequences in the absence of treatment of arthrosis can lead to disability.

Arthrosis is a permanent disease of the articular joint, which leads to the destruction of cartilage tissue. The disease develops in the bone material under the cartilage and in the muscles that connect the joints and ligaments. The factor of the disease is a poor metabolic process in the body, but the resulting injuries in the articular part, inflammatory processes, excessive weight and high physical exertion can serve as an impetus for its development.

Deforming osteoarthritis

Deforming osteoarthritis is the most common type of joint disease diagnosis. Osteoarthritis affects more than 16% of all people on the planet. This disease is most common in women in the age group from 45 to 55 years, and at the age of 60 it occurs in almost every first.

With this type of joint disease, the process of cartilage tissue wear, deformation and cracking occurs. This disease most often affects the joints located in the hip region and knees.

The manifestation of this disease occurs when walking. You feel pain in the hip joint, and it goes down to the knee, or when walking on steps in the knee. Joint pain increases towards the end of daytime activity and subsides at night's rest. Upon awakening, short-term pain may occur.

Hearth this disease initially located in one joint, but later spreads to others. Usually those who took Active participation in the physical unloading of the diseased joint.

This type of disease is detected by clinical studies:

• blood test;
• Ultrasound diagnostics and X-ray of the joints.

During treatment, it is necessary to observe a sedentary and less physically demanding lifestyle.

Anti-inflammatory and cartilage-protecting drugs are prescribed. Physiotherapeutic methods of treatment are also used, therapeutic exercises are carried out. If it is already too late to apply joint treatment, then there is only one method left to restore the functionality of the joint - this is prosthetics.

Types of arthrosis

Arthrosis is the common name for a disease of the joints of the human body, but there are 8 types of diagnosis in medicine:

Gonarthrosis or knee arthrosis

Most often, this disease affects women who have crossed the 45-year threshold and who suffer from varicose veins and overweight. Also, people who have received injuries and bruises of the knee joints are susceptible to this disease. Diagnosis of the disease occurs with the help of x-rays with tripartite images of the leg bent at a diseased joint at an angle of 60 degrees.

Arthrosis of the joints in the hip region or coxarthrosis

The main sign of the development of arthrosis of the joints in the hip region are acute pain in the hip region when touched or when moving, but there is no swelling in this place. It occurs in both males and females, but women are more difficult to tolerate this disease, since there is a greater likelihood of a severe stage. This disease affects people of pre-retirement and retirement age.

Arthrosis of the cervical vertebrae or uncoverable

Symptoms that are harbingers of arthrosis of the cervical vertebrae are expressed in a feeling of heaviness in the shoulders and curvature of posture. This disease is caused by the natural aging process of the body.

Complications caused by arthrosis of the cervical vertebrae: severe headaches, arterial hypertension, tinnitus and blurred vision.

Shoulder arthrosis

This type of arthrosis can be attributed to occupational diseases. It affects more men who perform heavy physical work hands, athletes or people who have had injuries, bruises or sprains shoulder joints, people who have poor metabolism, congenital joint diseases or pre-hereditary.

Arthrosis of the hands and fingers or Heberden's nodules

Symptoms are burning, decreased mobility and tingling in the phalanges. It usually occurs in women during menopause. Nodular formation in the phalanx of the finger the size of a pea.

Arthrosis of the spine

Arthrosis of the spine is divided into subspecies, depending on the place of development:

1. Dorsarthrosis - arthrosis of the thoracic region;
2. Cervicoarthrosis - arthrosis of the cervical region;
3. Lumbarthrosis - lumbar spine.

Constant aching pain during a change in the position of the spine and stops at rest. It usually develops with excessive stress on the spine.

Arthrosis of the ankle joints

Symptoms of arthrosis of the ankle joints - crunching, aching pain, limited mobility, swelling and atrophy of muscles in ankle joint. Potential patients are at risk in active sports involving running and jumping, while wearing high-heeled shoes. The causes of occurrence are sprains, dislocations and bruises.

Polyosteoarthritis or Kellgen's disease

Usually, polyosteoarthritis occurs in women during menopause and captures all the limbs of the body.

Symptoms of arthrosis

The symptoms of this disease can be divided into 4 classes. They appear with any type of arthrosis, but from the place that hurts and can be given to another area of ​​the body:

• Joint pain is different from any other pain. It occurs during the movement of the diseased joint, sharply and creates discomfort, but as soon as the joint is brought to a state of rest, the pain begins to subside and eventually completely falls silent. If you do not resort to treatment, the pain begins to increase and after a while the slightest movement of the diseased joint will cause severe pain.
• Crunch. The movement of the diseased joint begins to be accompanied by another crunch. This is due to the fact that the cartilage has been worn away and the bones begin to rub against each other.
• Decreased joint mobility. Due to the erasure of cartilage, the joint space disappears, which leads to a decrease in joint mobility.
• Joint deformity. In the later stages of the development of the disease, osteophytes grow on the surface of the bone and the amount of synovial fluid increases.

Causes of arthrosis

There are two types of causes of osteoarthritis:

1. The first type or idiopathic arthrosis is the occurrence of arthrosis for no apparent reason.
2. The second type of causes or pathological arthrosis occurs:

Diagnosis of the disease occurs in 4 clinical ways:

1. The easiest way is x-ray. At the first stage of the development of arthrosis, x-rays will show ossified joint tissues, a not very narrowed gap and uneven cartilage surfaces. At the second stage, the images will show a significant narrowing of the joint space, approximately 2-3 times less than the norm, as well as the formation of bone processes. And at the extreme, third stage of the development of arthrosis, there is no joint space, a complete absence of cartilage tissue, and an increase in bone tissue.
2. The second diagnostic method is a blood test for ESR, it increases to a maximum of 25 mm / h.
3. The third way is to take a sample of synovial fluid. In the presence of arthrosis, the number of neutrophils in it decreases.
4. The fourth method is a histological examination of synovia. Atrophic villi appear, the number of vessels decreases, and there is a complete absence of proliferation of integumentary cells.

Treatment of arthrosis

Treatment of joint disease is prescribed by the attending physician and occurs in a complex of several methods:

• The use of medications;
• Reducing the overweight of the patient;
• Kinesiotherapy;
• Physiotherapy;
• If the stage is too advanced, then surgical intervention.

Over time, the disease progresses and the symptoms begin to manifest themselves more and more, but the speed with which it develops is always different.

Treatment of this disease proceeds according to the standard scheme: exercise therapy, the use of anti-inflammatory drugs, physiotherapy, and so on. If the cartilaginous tissues are destroyed, then arthroplasty is used.

Treatment of arthrosis with medicines

The purpose of medications is to reduce pain and inflammatory syndromes. The drugs are administered intravenously or intramuscularly, which eliminates their effect on the alimentary tract and speeds up the healing process.

The use of various ointments and gels for arthrosis is not very effective. These drugs belong to the group of non-steroidal anti-inflammatory drugs. This group is also supplemented with drugs that improve the processes of cartilage tissue repair and improve the performance of synovial fluid.

These medications, unlike the first ones, are introduced into the body in a six-month course, if after this time there are no improvements, then they are canceled. Hyaluronic acid-based medications are also administered. The connective tissue of the joints is made up of this acid. These two groups of drugs are administered intra-articularly into the body.

If arthrosis occurs due to the overweight of the patient, he is prescribed a special diet. This is necessary in order to reduce the load on healthy ligaments. But at the same time, foods containing collagen should be included in the diet - cartilage tissues are formed on the basis of this material.

Alcohol is contraindicated for the patient and products with a high content of vitamins B and C are welcome to use.

A patient with arthrosis is prescribed courses physiotherapy exercises, the so-called kinesitherapy, for general improvement the state of the muscles and blood circulation of the body:

• Massage;
• Mechanotherapy - classes on specialized simulators, on which gymnastic exercises are performed that protect the diseased joint;
• Joint traction - there is a stretching of the joints with the help of a technique to reduce the load on it.

A very useful way to treat arthrosis is physiotherapy:

1. Shock wave therapy. With the help of ultrasonic waves, osteophytes are scattered - processes of bone tissue in the form of spikes, but this method has many contraindications and is used very carefully.
2. Myostimulation - electrical stimulation of muscle tissue, used in severe diseases, when physical activity is impossible.
3. Phonophoresis - due to the use of ultrasonic waves, it improves the work of the drug method.
4. Ozone therapy - a course of several injections by introducing an ozone mixture into the joint space. This procedure improves joint mobility.

The most difficult method of treatment for emergency and advanced cases is surgical:

What is osteoarthritis

Osteoarthritis is a permanent ailment of the knee joint without inflammation, accompanied by severe stabbing pain when moving. With this disease, cartilage is destroyed, which supplies lubricating material to all bone joints.

In the early stages, it is easily treated and should not be delayed until irreversible situations.

Symptoms of osteoarthritis

The main symptoms that indicate the presence of osteoarthritis in a patient's life include:

• Sharp pain in the knee area when moving. Over time, the pain intensifies and appears even with the slightest movement;
• The appearance of edema in this area;
• The appearance of sounds in the knee when moving;
• Discomfort when moving and feeling as if the bones were rubbing against each other.

These symptoms begin to appear by the age of 45 and are mainly affected by female representatives. At this age, about 15% of all visits with pain in the knee joint will be diagnosed with osteoarthritis, and by the age of 60, the number of visits reaches almost 100%.

Causes of osteoarthritis

The main reason is age, as with age, cartilage tissue “dries out” from the lubricant. Also, the manifestation of the disease is affected by various injuries of the knee joint, sprains and dislocations.

Osteoarthritis can be triggered by the following diseases:

1. Paget's disease - causes deformation and fragility of bones, metabolic processes in the body worsen;
   infections in the human body;

Treatment of osteoarthritis

After the diagnosis of osteoarthritis, the doctor prescribes a comprehensive treatment regimen, including:

• Dietary nutrition - weight loss helps to reduce the load on the diseased joint;
• Physical education of the treatment plan - is selected by the doctor based on the results of tests and X-ray images of the joints;
• Medications - the doctor determines which drugs will help the patient relieve symptoms. The use of injections is often prescribed, which are injected into the damaged joint.

Among the most effective medicines to combat arthrosis and osteoarthritis are:

Methods of treatment of osteoarthritis differ from the treatment of arthrosis only by physiotherapy exercises.

With this diagnosis, the following are usually prescribed: swimming, calm walking on flat terrain for at least half an hour a day and cycling. The use of special shoes and various fixing bandages are also prescribed.

Differences between osteoarthritis and osteoarthritis

The main differences between osteoarthritis and arthrosis include:

1. essence of the disease. Arthrosis is the general name for the disease of any joint in the human body. Osteoarthritis is the name of a certain severe stage of arthrosis that occurs in the knee joint.
2. Causes of these diseases. Most often, arthrosis occurs in females and is transmitted to heirs through the genetic line. Osteoarthritis occurs when mechanical overload of the joints.
3. Diagnostics. At the first appearance of nodules in the articular part, the doctor assigns the diagnosis of osteoarthritis. Osteoarthritis is a disease of the joints of the fingers of the extremities (most often the thumb), and arthrosis can be a disease of any joint of the body (usually the knee).

For the successful treatment of arthrosis, a person at the first signs of the disease must seek advice from a specialist with a higher education. medical education. Self-medication leads to the neglect of the disease and the occurrence of unpleasant consequences. The doctor will prescribe a comprehensive treatment regimen. Arthrosis should not be started from a young age. Watch your joints and old age will not be a burden!

The content of the article

Deforming osteoarthritis is a chronic and constantly progressing pathology. In order to maintain a normal and active life for a long time, it must be timely, constant and multicomponent. Traumatologists-orthopedists believe that the first signs of osteoarthritis can be noticed already at the age of about 30 years, and if you do not turn a blind eye to them, you can delay a visit to the operating room for many years.

The treatment of arthritis and arthrosis is similar in many ways, because the main goal is to reduce pain and maintain or improve the functioning of the affected joint. Let's start with general recommendations.

To reduce trauma and, as a result, the development of inflammation, patients should reduce the load on the affected joint:

• Change jobs if the work is associated with heavy physical exertion.
• Sports also should not force the affected joint to work in an enhanced mode.
• If the patient is obese, you need to contact a nutritionist and adjust your diet.
• In the presence of systemic or endocrine pathologies, it is recommended to contact the appropriate specialists who will prescribe adequate treatment.
• In case of damage to the joints of the lower extremities of the II-III degree, the use of a cane when walking is recommended.
• To maintain mobility in the joint and prevent atrophy of the muscles that are attached to it, you need to undergo a massage course at least 2 times a year.

Diet is also an important aspect of the treatment of osteoarthritis, because the normalization of your diet will not only help in the fight against excess weight, but also improve the absorption of microelements and vitamins necessary for cartilage restoration.

To improve the passage of food through the intestines, try to eat daily wholemeal bread, cereals that are boiled in water, a large number of fruits and vegetables. If you are a fan of meat food, buy lean meat or fish.

Conservative treatment of arthrosis

Many patients do not understand the seriousness of this disease and self-medicate or turn to "traditional healers" for help. But you should know that the only correct answer to the question "where to treat arthrosis?" sounds like this - medical institution under the guidance of an orthopedic traumatologist. Only a doctor can determine as accurately as possible at what stage of development arthrosis is in a particular patient, and prescribe adequate therapy.

complex procedures can only stop the development of the disease, there is no guarantee for a complete cure

Despite the fact that deforming osteoarthritis is considered one of the oldest diseases, its complete cure is impossible. Conservative treatment of arthrosis is based on three "pillars":

• "Basic therapy", the main goal of which is to slow down the development of cartilage degeneration as much as possible.
• Relief of pain syndrome.
• Preservation of the functional activity of the joint.

It is mandatory in the treatment of osteoarthritis. Some chondroprotectors - Rumalon, Artron - stimulate the synthesis of cartilage tissue, improve the composition of the intra-articular fluid, which leads to easier sliding of the articular surfaces. Other drugs - Arteparon - reduce the activity of proteolytic enzymes, inhibit cartilage degeneration.

The advanced technology for the treatment of arthrosis is the introduction of artificial synovial fluid into the joint cavity:

• the effect of this therapy lasts more than 6 months;
• artificial "lubrication" relieves inflammation, improves metabolism in the affected joint and inhibits local autoimmune processes;
• indispensable component conservative therapy drugs that improve microcirculation in the joint are considered - Curantil, Trental, Theonicol. They reduce capillary spasm and have an antiplatelet effect.

Pain is one of the most pronounced symptoms of osteoarthritis. To stop it, as well as to reduce and eliminate the inflammatory reaction, non-steroidal anti-inflammatory drugs are used. Indomethacin, ibuprofen, naproxen, voltaren - all these drugs should be used with caution, because they can cause exacerbation or the appearance of gastric or duodenal ulcers.

If the pain syndrome is expressed, intra-articular administration of drugs is used. Despite the rather high probability of infection of the joint, reviews of the treatment of arthrosis of the joints with this method are distinguished by a positive color.

The normal functioning of the joint can be preserved by the following methods:

• massage course 2 times a year;
• physiotherapy exercises daily;
• Spa treatment;
• orthopedic therapy: the imposition of an elastic bandage, the use of a cane.

Surgical treatment of osteoarthritis

Many patients are afraid of surgical treatment of osteoarthritis, considering it a direct path to disability. They forget that medicine does not stand still and new methods of treating arthrosis of the joints have appeared:

1. Arthroscopic removal of deformed cartilage zones or arthroscopic joint debridement.
2. Osteotomy - the affected bone is aligned to restore the correct axis of the limb.

the purpose of orthopedic surgery is to correct curved areas of bone joints

Arthroscopic debridement is used at stages I-II of the development of deforming osteoarthrosis. After its implementation, patients note an improvement in the function of the affected joint, a decrease in the intensity of the pain syndrome. But with severe deformity of the joint, this operation is ineffective. During an osteotomy, the bones that form the joint are sawn and then fixed at a certain angle. The result of the operation is a change in the distribution of the load on the joint, which leads to the almost complete disappearance of pain. The effect persists for 5 years.

And the last method of surgical treatment is joint arthroplasty. The operation is complex and traumatic, but after it, patients will be able not to depend on outside help and lead an active life again.

Advances in the study of the pathogenesis of osteoarthritis have made it possible to consider this disease “as a heterogeneous group of joint diseases of various etiologies, but with similar biological and clinical signs and outcome, leading to complete loss of cartilage and concomitant damage to other components of the joint (subchondral bone, synovium, ligaments, capsule and periarticular muscles).
The main clinical manifestation of osteoarthritis is pain, often preceding radiographic manifestations of the disease. The pain is accompanied by impaired function of the affected joint. Both pain and limitation of mobility of large joints of the lower extremities contribute to the development of significant functional limitations in daily activity, therefore, the treatment of the disease is aimed primarily at reducing pain and, as a result, improving joint function.
Treatment of osteoarthritis should include various non-pharmacological methods: patient education, physical therapy, transcutaneous stimulation, etc. However, if non-pharmacological methods of treatment are insufficiently effective, drug therapy is required. Non-opioid (paracetamol) and central (tramadol) analgesics, non-steroidal anti-inflammatory drugs (NSAIDs), intra-articular corticosteroids, and hyaluronic acid preparations are widely used in the treatment of osteoarthritis. Simple analgesics are usually used for early stage diseases or in the presence of intense pain in the joints, as well as as an adjunct to NSAIDs. Intra-articular injections of corticosteroids are rare, because. they exacerbate cartilage degeneration. The most widely used NSAIDs, without which complex therapy of osteoarthritis is not conceivable. The positive effect of NSAIDs in osteoarthritis is determined not only by their anti-inflammatory effect, but also by a distinct analgesic effect.
Unfortunately, the effective use of non-steroidal anti-inflammatory drugs is limited by the threat of serious adverse effects, primarily from the gastrointestinal tract. NSAID gastropathy is of the greatest clinical importance - erosion and ulcers of the stomach and / or duodenum, which can be complicated by gastrointestinal bleeding, perforation and obstruction. NSAIDs reduce the effectiveness of some antihypertensive drugs, and in patients with arterial hypertension, they can lead to an increase in blood pressure.
Of undoubted interest is the creation medicines, which have not only an effect on the symptoms of the disease, but also the ability to slow down the progression of the disease. Such means are structure-modifying drugs: chondroitin sulfate (CS) and glucosamine sulfate (GS).
According to the experts of the European Antirheumatic League (EULAR), oral chondroprotectors (GS and CS) are the means of treating arthrosis with the most proven effectiveness. Favorable immediate and long-term results of their use have been obtained in many studies that are credible.
In order to provide a structure-modifying effect on bone and cartilage tissues, as well as anti-inflammatory and analgesic effects, the creation of the Bora-Bora (BB) preparation was calculated. The composition of 1 BB capsule includes 2 mg of boron, in the form of an easily digestible and well-established in the USA dietary supplement from FutureCeuticals "Fru-tex-B" - "FruiteX-B" (US patent: US Patent No. 5962049). The BB also includes a complex of ingredients containing 13 mg of soy isoflavones, 48 ​​mg of bromelain, 15 mg of oligoproantacids, 9 mg of curcumin, 33 mg of boswellia extract, 67 mg of ginger extract, 50 mg of vitamin C and 200 IU of vitamin D3.
The aim of our study was to study the clinical efficacy and safety of Bora-Bora in patients with osteoarthritis.
Materials and methods
The study included 45 patients (all women aged 40 to 70 years; mean age 53.2 ± 9.25 years) with osteoarthritis of the knee according to the classification criteria of Altman et al. (1991). In 27 (60%) patients, I was diagnosed, in 14 (31%) - II, in 4 (9%) - III stage diseases. The average duration of the disease was 6.2±0.98 years (from 1 to 20 years). Deterioration in the form of an increase in pain syndrome, a decrease in joint mobility was observed in 24 (53%) patients examined for 1 to 3 weeks, in 21 (47%) patients - within 1 month.
26 (58%) patients within 2 months. before inclusion in the study, various non-steroidal anti-inflammatory drugs (NSAIDs) were constantly taken: 7 patients (16%) - diclofenac sodium at a dose of 100 mg / day, 6 (13%) - ibuprofen 800 mg / day, 10 (22%) - nimesulide 200 mg/day, 3 (7%) - meloxicam 15 mg/day. NSAIDs were occasionally taken by 19 (42%) patients. All patients received paracetamol as an analgesic at the time of the study.
Arterial hypertension was detected in 21 (46.7%) of the examined patients: in 12 (26.7%) - I degree, in 9 (20%) - II degree. Five patients suffered from chronic gastritis without exacerbation. Chronic pyelonephritis without exacerbation was detected in 3 patients, uterine myoma was previously diagnosed in 4 patients.
As antihypertensive therapy, patients received ACE inhibitors (enalapril, fosinopril), calcium antagonist amlodipine, indapamide.
Inclusion criteria for the study were: diagnosis of gonarthrosis with X-ray stage I-III, in the presence of pain syndrome of at least 40 mm on the visual analogue scale, age of patients from 40 to 70 years, patients of childbearing age using contraceptive methods, or patients in menopause at least 2 years. All patients signed an informed consent to participate in the study. The study did not include patients with secondary osteoarthritis, pregnant, lactating mothers or women of childbearing age who refuse to use contraceptive methods during the study period, patients who received intra-articular injections of glucocorticosteroids within 4 weeks before the start of the study, patients who do not want to stop taking NSAIDs and chondroprotectors at the time of the study, patients with severe concomitant diseases (IHD, heart failure, cerebrovascular diseases, diabetes), as well as patients with impaired liver and kidney function.
Patients were randomized into two subgroups: patients of the main group (25 patients) received Bora-Bora, patients of the comparison group (20 patients) received only analgesics. The duration of therapy was 2 months. The patients were examined three times. During the initial examination, informed consent was signed, inclusion/exclusion criteria were determined (gonarthrosis stage, pain intensity, functional activity). When a patient was included in the study, blood was taken for tests (biochemical parameters of kidney and liver function, complete blood count, ECG). All patients kept diaries, where they indicated the need for analgesics (the number of paracetamol tablets daily), blood pressure figures. Bora Bora was prescribed for two months, one capsule 3 times a day. A re-examination was carried out in a month (visit 1), the final visit was carried out after 2 months (visit 2). The effectiveness of Bora-Bora was evaluated according to the generally accepted criteria for evaluating drugs for the treatment of osteoarthritis: the total Lequesne index, pain at rest according to the visual analog scale (VAS), when walking (VAS), the need for analgesics (paracetamol), evaluation of the effectiveness of treatment by a doctor and patients . The patients of the two groups were comparable in age, gender, and main clinical manifestations (Table 1).
Results and discussion
Against the background of Bora-Bora therapy, a clear positive trend was revealed - a decrease in the Lequesne index throughout the entire observation period. After 1 month from the beginning of treatment, an increase in the functional mobility of the affected joints was noted. In all patients treated with Bora Bora, a decrease and change in the nature of the pain syndrome, assessed by patients according to the VAS, was confirmed. We studied the intensity of pain at rest, when walking on level ground, the presence of “starting pain” in the studied knee joint, and the intensity of night pain (Table 2). The analgesic effect was achieved on the 2nd week of therapy and increased by the 4th week. There was a significant decrease in pain at rest (p<0,05), ночной боли (р<0,05), болей при физической нагрузке (р<0,05), «стартовой боли» (р<0,05) при приеме Бора-Бора (рис. 1-4).
In the main group, a decrease in the number of patients in need of additional paracetamol was noted, which made it possible to carry out Bora-Bora monotherapy in 60% of patients from the 2nd week, in 40% of patients a significant (p<0,01) уменьшение потребляемой дозы парацетамола.
In the control group treated with paracetamol for pain, a decrease in the dose consumed by the 6th week was noted, however, the change in the dose of the drug was not statistically significant (Table 3, Fig. 5).
In the main group, in patients without arterial hypertension, there was no increase in blood pressure; in patients with arterial hypertension, there was no increase in the dose of antihypertensive drugs.
Throughout the study period, Bora Bora was well tolerated, adverse events when taking Bora Bora were noted in 4 (2%) patients in the form of discomfort in the epigastric region. However, these symptoms were mild, short-lived and did not require discontinuation of treatment. All laboratory parameters and ECG parameters during therapy did not differ from the initial ones.
A positive (good and moderate) effect of therapy, according to the doctor, was noted in 85% of the treated patients. According to patients, positive results of treatment were achieved in 90% of cases.
Thus, the study showed the therapeutic efficacy of Bora-Bora in the treatment of gonarthrosis. The drug has a pronounced symptom-modifying effect, manifested by a significant decrease in pain, an increase in the functional activity of the affected joints, and a significant decrease in the dose of the analgesic. Bora Bora was characterized by good tolerance.

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