Treatment methods for osteoarthritis

Osteoarthritis- a disease that develops over many years with predominantly damage to certain joints.Most often, painful changes affect large joints - knee, hip, shoulder, etc. Pain and difficulty moving in them complicate a person's life physically and emotionally, and given the fact that osteoarthritis often occurs at a young age, it can interfere with the achievement of professional and personal goals.Therefore, it is important to diagnose the disease as early as possible and begin a comprehensive treatment of osteoarthritis.

Treatment of osteoarthritis

In the initial phase of arthrosis, conservative methods are used that do not involve surgical intervention.Meanwhile, the correction methods used make it possible to stop the progression of the disease, maintain motor activity, reduce the severity of the main symptoms of osteoarthritis and generally improve a person's quality of life.

1. Medical treatment:
   • NSAIDs;
   • GCS;
   • chondroprotectors.
2. PRP therapy.
3. Therapeutic exercise.
4. Massage and manual therapy.
5. Pull therapy.
6. Physiotherapy.

Physiotherapy techniques widely used for osteoarthritis:

• magnetic therapy;
• UHF;
• inductothermy;
• ultrasound treatment;
• balneotherapy;
• surgical treatment.

Treatment with drugs

There is a widespread opinion among patients that taking drugs with an analgesic effect (orally in the form of tablets or by injection - intramuscularly) is the most important method of relieving pain in osteoarthritis.In fact, the use of medicine is a method of quick pain relief, which should only be prescribed during the acute period.The fact is that the drugs that are widely prescribed for these purposes have serious side effects, which increase with long-term and especially with uncontrolled use.We are talking about unwanted effects from the digestive, cardiovascular and nervous systems, which can very likely lead the patient to a hospital bed (stomach bleeding, heart rhythm disturbances, effects on the liver and kidneys, etc.).

Non-steroidal anti-inflammatory drugs

1. NSAIDs- non-steroidal anti-inflammatory drugs, many of which are available without a prescription and are largely taken by patients on their own.This group includes drugs with different chemical structures.The drugs have a pronounced anti-inflammatory and analgesic effect, can reduce pain in the joint area and adjacent muscle tissue, but do not affect the development of the disease.They are used only to reduce symptoms at all stages of the disease.Effective in simultaneous synovitis (fluid accumulation in the joint).

2. GKS- glucocorticosteroids have a strong anti-inflammatory and analgesic effect.It is advisable and effective to administer them periarticularly.However, patients often have a negative attitude towards the use of these drugs in treatment, which is associated with possible side effects: infectious complications, deterioration of the ligaments, articular surface and cartilage degeneration.However, with periarticular administration, the risk of these complications is minimal.

3. Chondroprotectors— substances are natural components of cartilage tissue, which, when taken orally, contribute to the gradual restoration of cartilage, normalize its density and elasticity.These active components are usually used in combination and are included in various medicines and auxiliary products.Chondroprotectors do not have a quick analgesic effect;improvement develops with long-term use of drugs based on those associated with partial restoration of cartilage tissue.Recommended at all stages of the disease.

PRP therapy

One of the most modern methods of restorative medicine used for sports injuries and degenerative-dystrophic joint diseases is PRP therapy (PRP - platelet-rich plasma) or plasma biorevitalization, autoplasma therapy.The technique is actively used abroad.

The essence of the procedureconsists of injecting platelet-rich plasma directly into the site of injury, in this case the joint.The drug for administration is obtained from the patient's own blood, so the method is considered not only very effective, but also safe for humans.Growth factors and other biologically active substances (serotonin, bradykinin, prostaglandins, etc.) contained in platelet-rich plasma contribute to the activation of regeneration processes and the synthesis of their own basic substances.

The resulting platelet-rich plasma is injected both periarticularly and directly into the affected joint, achieving partial recovery of tissue, primarily cartilage.

The technique is most applicable to stages 1-2 of osteoarthritis.Shows good results and allows you to delay the rapid development of the disease due to the release of growth factors by platelets.The method is relatively new, but has proven to be extremely effective.PRP therapy was first used in surgery;today the technique is used successfully in many areas of medicine, including rheumatology and orthopedics, neurology and cosmetology.Performing autoplasma therapy allows you to increase the life of the joint without other aggressive interventions.

Synovial fluid protectors- a group of drugs based on hyaluronic acid, which is injected directly into the joint cavity (injection) and plays the role of a viscous lubricating fluid in the case where natural synovial fluid is almost completely absent (it is this that provides the role of lubrication of the articular surfaces).Used in the later stages of osteoarthritis.

Medicines in this group are also called "synovial fluid prostheses", "biological replacements for synovial fluid".The effect after administration of the medicines is long-lasting - from 6 to 13 months, depending on the medicine used.

Some applyother groups of substances- antispasmodics, muscle relaxants, B vitamins in therapeutic (high) doses, but all of them only have auxiliary value in the treatment of osteoarthritis.

Therapeutic exercise

Special therapeutic exercises can and should be used even during an exacerbation, at all stages of osteoarthritis.Such measures can reduce pain and prevent severe limitations in joint movement.However, the method is unpopular among patients with osteoarthritis, as most of them are mistaken in the belief that in case of pain it is necessary to limit any movements.Timely start of physical training, on the contrary, promotes faster recovery and reduction of symptoms, primarily pain.

Physiotherapy in water, joint movements in a relief position (lying, sitting, hanging) and moderate walking on a flat surface are particularly effective.If necessary, for example in case of severe pain, a special bandage can be placed on the joint, but physical education should be started as early as possible.

Massage and manual therapy

Methods of mechanical impact on the joint, muscles and ligaments can reduce the severity of pain, increase mobility, improve blood circulation and metabolism in the area of the affected joints, relieve muscle spasms and normalize muscle function.

Pull therapy

In a hospital environment or a medical sanatorium, it is possible to carry out traction therapy - this is traction on the joint (hip, knee) using a special technique using various loads.The standard pulling program is designed for 28 days with a gradual increase in load and exposure time.Classical techniques are used and more modern ones using simulators.Their effectiveness is almost the same, but the simulators are more comfortable for the patient.

Physiotherapy

The use of various physiotherapy techniques in the initial stages of osteoarthritis can achieve significant pain relief and increased mobility in the affected joints.Physiotherapy courses help to slow down the pathological process and prolong the period without exacerbations.

Physiotherapy techniques widely used for osteoarthritis:

1. Magnetotherapy— local exposure to a constant or alternating low-frequency magnetic field.In the area of the affected joint, metabolic processes are accelerated, blood circulation and the supply of nutrients to the joint structures are increased, the processes of regeneration and synthesis of the own substances necessary for the functioning of the joint are activated.

   Magnetic therapy has anti-edematous, analgesic, anti-inflammatory effects almost from the first session, which has a positive effect on the general condition of the patient.Magnetic therapy is successfully used in hospitals and sanatoriums, where medical equipment of various modifications is used.

   A great advantage for patients with osteoarthritis is the ability to carry out independent courses of magnetic therapy at home, as prescribed and under the supervision of the attending physician.Timely use of portable magnetic therapy devices allows you to stop the development of pain, the beginning of an exacerbation or carry out a preventive course - that is, maintain normal health.

   A positive aspect of magnetic therapy can also be called the beneficial effect of the procedures on the state of the cardiovascular and nervous system.Given that most patients with osteoarthritis are middle-aged and elderly people with an existing set of chronic diseases (arterial hypertension, coronary heart disease, atherosclerosis, etc.), the mild calming and stabilizing effect of magnetic therapy will be very useful.

2. Ultrasound treatmentmore often used in combination with the effects of drugs with anti-inflammatory, analgesic, restorative effects - ultraphonophoresis or phonophoresis.Ultrasound increases the permeability of tissues to drugs, so their main effect is enhanced.Even without a medical component, the method is highly effective for osteoarthritis: ultrasound has a mechanical effect on tissue (micromassage), activates local immune and regenerative processes in the joint area and adjacent muscles, and has a pronounced analgesic and anti-inflammatory effect.

3. Laser therapy– one of the most common and widespread procedures.The therapeutic effect is based on the reflex expansion of blood vessels over the site of the pathological process.This leads to an improvement in local blood flow, activation of the metabolism, removal of underoxidized metabolic products and a decrease in the intensity of pain.Due to its low penetration depth, laser therapy has a minimally pronounced systemic effect, while at the same time improving the therapeutic effect of other procedures.

4. Shock wave therapy– high energy method of influence.It is based on the piezoelectric effect.By applying a piezoelectric discharge to a pathological focus, a number of effects are achieved.Non-viable cells are destroyed, leading to activation of local immunity.Hibernating (inactive) cells are stimulated, which promotes regeneration processes.At the same time, the intensity of the pain syndrome is significantly reduced (although the procedure itself is painful).The undoubted advantage of the method is its use once every 4-7 days.

5. Diadynamic therapy– a method of therapeutic effects on the body with diadynamic pulse currents.The diadynamic currents used in this method rhythmically excite skin receptors, which indirectly leads to the activation of descending physiological mechanisms of pain suppression and leads to a reduction of the patient's pain up to complete analgesia.Therefore, such procedures are effective for severe pain.

6. Electromyostimulation– exposure to electrical current on muscle tissue.With arthrosis of large joints, the work of surrounding muscles is disturbed, which leads to atrophy of some and overloading of others.Gait disturbances develop.When subjected to electrical alternating current according to a special program, the muscles contract rhythmically, producing a certain amount of work, which leads to the restoration of their volume and function.

7. Cryotherapy- a simple and effective treatment method, unfortunately rarely used.Local exposure to low temperature reduces the sensitivity of pain receptors and the synthesis of biologically active substances that stimulate the development of inflammation.After cryotherapy, a reflex expansion of blood vessels occurs, local blood flow accelerates and recovery processes are activated.This method is especially effective in combination with shock wave therapy.

8. Balneotherapy.In sanatorium-resort conditions, hydrotherapy is carried out - medical baths, among which radon baths are especially effective for arthrosis.There is a general effect on the body of the radioactive decay products of radon dissolved in water.The main effect is the activation of metabolic processes.

   A similar, although less pronounced effect is characteristic of therapeutic muds (peloids), hydrogen sulphide and carbon dioxide baths.

Surgical treatment

Surgical techniques are used in the late stages of osteoarthritis, when joint mobility is severely limited or absent, affecting the patient's quality of life.All over the world, different joint replacement methods are used, which make it possible to completely restore range of motion and return the patient to an active life at any age.

The tactics and extent of surgical intervention are determined by the attending physician;the choice is based on parameters such as the patient's general condition, age and the presence of concomitant diseases, obesity and others.The best results after endoprosthetics were achieved in young and middle-aged patients (almost complete recovery of the range of motion), but also in elderly people there is a significant improvement in their condition, since after a successful operation and recovery, they can fully support themselves in everyday life and move not only in the apartment, but also go outside without limiting themselves in communication.

Prevention

Osteoarthritis belongs to the group of diseases of upright walking and develops mainly as a result of age-related changes in the joints, enhanced by the influence of external negative factors.Attention to the condition of the musculoskeletal system, prevention of joint diseases and treatment of arthrosis in the early stages allows you to maintain physical activity and avoid massive medical intervention in the future.