There are many ways to treat arthritis. One of the main methods of traditional medicine is drug therapy, which is aimed at eliminating inflammation, alleviating symptoms of the disease and restoring joint function. What medications are used for this? Let's talk in more detail about the pros, cons and features of each group of medications.
Analgesics are drugs that relieve pain. There are several types of analgesics: acetaminophen-based (available from pharmacies without a prescription), opioid analgesics (available with a doctor's prescription), and combination medications that contain both acetaminophen and an opioid.
Acetaminophen-based medications (such as Tylenol) are suitable for relieving moderate pain and discomfort. Opioid and mixed analgesics - Oxycodone, Methadone, Tramadol, Morphine, Oxycontrine, Vicodin, etc. - are prescribed for severe pain.
Opioids (synthetic drugs) bind to receptors in cells of the brain, spinal cord and gastrointestinal tract and thus “turn off” pain centers and block the transmission of pain impulses. Opioid pain relievers are more effective than acetaminophen in many cases, but they are more likely to cause side effects. These medications are taken either on demand or on a schedule at regular intervals.
Opioids used to be used primarily to relieve acute pain (such as after surgery or a serious injury), but they are now also prescribed to relieve chronic pain, including arthritis. These drugs are a suitable option for patients suffering primarily from severe pain rather than inflammation.
Non-narcotic acetaminophen-based analgesics work in a different way: they inhibit the synthesis of certain enzymes involved in the formation of prostaglandins, which are the cause of pain. More details about prostaglandins a little further.
The advantages of analgesics over non-steroidal anti-inflammatory drugs (specifically in terms of pain relief) are higher efficiency and the absence of side effects from the gastrointestinal tract. A significant disadvantage of painkillers is that they do not relieve inflammation, and with prolonged use they can become addictive.
If you are recommended to treat arthritis with analgesics, know:
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Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used to treat arthritis by reducing inflammation and pain.
While analgesics directly combat pain, NSAIDs reduce both of the most unpleasant symptoms of the disease: pain and inflammation. This group of medications includes Motrin, Advil, Ecotrin, Celebrex, Clinoril, Voltaren, Naprosyn, etc.
Non-steroidal anti-inflammatory drugs block the work of hormone-like substances - prostaglandins. These substances perform an important function - they protect the gastric mucosa from their own digestive fluids. At the same time, it is prostaglandins that are involved in pain and inflammation. NSAIDs block the work of prostaglandins. Pain and inflammation decrease, but the gastric mucosa becomes more vulnerable to the formation of ulcers and bleeding.
Nonsteroidal anti-inflammatory drugs show excellent results in the treatment of arthritis, but the use of these medications has its own nuances:
Different DMARDs have different principles of action, but the same positive effect is achieved in all cases - the progression of the disease either stops or slows down. The use of DMARDs helps prevent damage to joints and internal organs.
This group includes drugs: Plaquenil, Arava, Neoral, Imuran, Cytoxan.
Disease-modifying antirheumatic drugs are most often prescribed to patients who are at high risk of irreversible joint destruction. The use of these medications is indicated for rheumatoid, psoriatic and juvenile idiopathic arthritis.
The main advantage of DMARDs is that even with long-term use they do not cause addiction or serious side effects. A significant disadvantage of this group of medications is their slow action. That is why, in the treatment of arthritis, DMARDs are often used in combination with other drugs that have a faster effect, for example, NSAIDs, corticosteroids, etc.
Biological agents (biological response modifiers) are medicines obtained by genetic engineering from living organisms (viruses, genes or proteins).
Popular biological agents prescribed for arthritis: Actemra, Orence, Rituximab, Simponi, etc.
The purpose of these medications is to stimulate the body's natural response to infection or disease. The target of biological agents entering the body are proteins, cells and intercellular communication pathways responsible for the symptoms and destructive effects of rheumatoid and other types of arthritis. These drugs work in one of the following ways:
The use of biological response modifiers, like any other medication, entails certain risks:
Corticosteroids are medications that mimic the effects of the hormone cortisol, which is naturally produced in the body by the adrenal glands. Cortisol affects various systems of the body, including the immune system.
This group includes Celeston, Prednisolone, Diprospan, Metipred, etc.
Corticosteroids lower prostaglandin levels and disrupt the interaction between certain white blood cells (T and B lymphocytes) involved in the immune response. Due to this, corticosteroids control inflammatory processes. Medicines are available in various forms: tablets, mixtures, sprays, drops, injections, ointments, etc. They act quickly and are often prescribed to patients suffering from arthritis and similar diseases. Compared to NSAIDs, corticosteroids have a more powerful anti-inflammatory effect, and these medications are simply irreplaceable for autoimmune diseases, when it is necessary to suppress the body's immune response. However, due to this action, the body becomes more vulnerable to infections - this is the main drawback of these drugs.
Medicines in this category can be used either alone or in combination with other medicines. Remember:
Only a doctor can prescribe the appropriate drug, correctly calculate the dosage and draw up a medication regimen.
A huge variety of medications to relieve symptoms and treat arthritis allows you to choose the optimal treatment regimen for each patient, taking into account all the features of a particular situation. If one method is not suitable, you can try another or combine drugs from different groups. The most important conditions for successful treatment of an illness are reliable information about the state of the body (features of the functioning of certain organs, the presence or absence of diseases), a clearly drawn up treatment regimen and the correct dosage of medications.
At the end of the last century, one of the ways to stop the destruction of bone tissue was found - bisphosphonates were discovered that can inhibit the process of destruction of bone cells. Humanity has been familiar with the problem of decreased bone density—osteoporosis—for many centuries. This is evidenced by archaeological excavations dating back to the third millennium BC. For a long time, medicine was powerless against this insidious disease. [/vc_column_text][/vc_column][/vc_row]
In this article we will talk about the mechanism of action of bisphosphonates and list drugs based on them, created to combat osteoporosis . are still used in medicine to treat osteoporosis However, the world needs new developments in the treatment of osteoporosis , because the use of bisphosphonates makes bones denser, but not stronger. The bone becomes like cast iron: if you drop it, it will split.
Bisphosphonates - alternatively known as diphosphonates - are artificially synthesized substances consisting of two phosphonates. In their chemical structure, they are very close to pyrophosphonates , which in our body are responsible for retaining calcium in bone tissue. Unlike their natural biological counterparts, these unique compounds have much greater biological activity and, as a result, an expanded range of pharmacological properties. Let us consider the mechanism of action of bisphosphonates for the treatment of osteoporosis in more detail.
The healthy state of bones directly depends on the metabolic processes occurring in them. Bone tissue, like any other, has the ability to renew and regenerate. This process is carried out with the help of creator cells osteoblasts and their antagonists - osteoclasts , which perform the function of utilizers. In a healthy, strong body, the number of both is approximately at the same level, and the number of destroyer cells is strictly regulated, and, if necessary, the process of their self-destruction is launched - apoptosis . Disruption of this balance can lead to very serious consequences. With increased catabolism, osteoclasts turn from reliable helpers into the worst enemies and killers of bone tissue.
Bisphosphonates unique in that they stimulate osteoclast apoptosis , thereby helping to stop bone destruction . Once in the body, the molecules of these substances bind to calcium ( Ca ), the maximum concentration of which, as is known, is concentrated in the bones. By promoting the retention of this mineral in bone tissue, bisphosphates at the same time become an easy target for proliferating osteoclasts, but manage to complete their main mission before death. Unfortunately, these substances cannot restore the former integrity of bones, and since the world is still waiting for new innovations in this area, modern medicine prescribes bisphosphonate drugs to prevent further development of osteoporosis .
Surprisingly, bisphosphonates were not originally intended to treat osteoporosis , and certainly not such a huge number of drugs based on them were available. The use of bisphosphonates in medicine began only almost a hundred years after their discovery. The synthesis of these substances was first carried out in the middle of the 19th century by German scientists. This discovery has found wide application in the textile and oil refining industries. Bisphosphonates actively used in agriculture: for the production of mineral fertilizers and water softening during artificial irrigation of land.
Meanwhile, the enlightened minds of their time struggled unsuccessfully to solve the problem of decreased bone density . Astley Cooper, is considered to be a pioneer in the study of osteoporosis . In 1824, he was the first to hypothesize that increased bone fragility in older people was associated with the presence of some pathological disease.
In the 20s of the last century, the supposed ailment finally found its scientific name, but at that time no effective way to get rid of it was found. The revolution in the fight against osteoporosis was carried out by Swiss researcher Herbert Fleisch in 1968. While conducting an experiment in which inorganic pyrophosphate was combined with biological fluids (blood plasma and urine), the scientist noticed that the substance used prevented the precipitation of calcium. To protect pyrophosphate from the aggressive effects of enzymes and increase its biological activity, the phosphorus atom was replaced with a carbon atom. the bisphosphonate was chemically recreated and its unique biological property was discovered.
The first drug based on the action of bisphosphonates was developed and approved for use only in 1995. Various analogues of this drug for the treatment of osteorosis are still actively used in medical practice.
According to the international classification, bisphosphonates for the treatment of osteoporosis are usually divided into two large groups:
Let us consider in detail each of these compounds and list the most famous bisphosphonate drugs for the treatment of osteoporosis used today in medicine.
Bisphosphonate Clodronate or clodronic acid (Acidum clodronicum) is one of the first bisphosphonates synthesized for medical purposes; it is a derivative material for such drugs as Bonefos , Clobir , Clodron ( "Clodron") " Loron " ("Loron"), " Sindronate " ("Sindronat").
The pharmacological feature of clodronate is, in addition to the inhibition of osteoclast destroyers, a significant reduction in pain in osteoporotic lesions and metastases in the bones. Similar drugs are also used for the prevention and treatment of breast cancer in the early stages. By retaining calcium in the bones, clodronate simultaneously reduces its volume in the blood plasma, and therefore doctors prescribe it to prevent the development of hypercalcemia . It is also prescribed for osteolysis - the dissolution of bone tissue due to demineralization.
Tiludronate , also known as tiludronic acid (Acidiumtiludronicum), serves as the basis for the drug " Skelid ". An important feature of this bisphosphonate is its ability to mineralize and, as a result, increase bone density. Therefore, tiludronate is often recommended for complex fractures, Paget's disease , a condition in which bones become extremely weak and brittle, and osteodystrophy , a bone disease caused by a local metabolic disorder.
Etidronate or etidronic acid (Acidium etidronicum) is another substance in the group of nitrogen-free diphosphonates used to combat osteoporosis . The most well-known drugs created on the basis of this bisphosphonate are Didronel , Xydifon , Pleostat and 99 mTc .
The diseases that these bisphosphonate-based drugs are designed to combat include heterotopic ossification - the occurrence of bone tumors in soft tissues, rheumatoid arthritis, bronchial asthma, inflammatory processes in the kidneys - nephritis, kidney stones. Etidronate also exhibits antitoxic properties, helping with heavy metal poisoning.
The use of alendronate or alendronic acid (Acidium alendronicum) to solve the problem of decreased bone density began in the mid-90s of the last century, when the first drug “FOSAMAX” was developed on its basis . Its analogues currently include “ Alendronate ”, “Alental”, “ Alendrokern ”, “ Ostalon ” , Osterepar ” ), " Tevanate " and Forosa ".
Alendronate is designed to stabilize metabolic processes in bone and cartilage tissue. It is prescribed for various types of osteoporosis, including postmenopausal women. In addition, lendronate promotes the formation of proper bone structure. This bisphosphonate does not cause bone demineralization.
Aredia , Pomegara, and medak are currently produced the basis of pamidronate or pamidronic acid .
This bisphosphonate was created to counteract the development of malignant tumors, including myeloma - damage to the bone marrow. Drugs based on this bisphosphonate are often prescribed as an adjunct to antitumor therapy. This allows you to reduce pain caused by bone metastases, and in some cases, avoid surgery or a course of radiation therapy.
Pamidronate osteoclasts somewhat differently than other bisphosphonates . It does not activate the self-destruction of destructive cells, but prevents their ripening. Thus, the catabolic process in bone tissue slows down sharply, allowing osteoblasts to perform their creative function.
The most well-known drugs based on the action of risedronate or risedronic acid (Acidium risedronicum) are Actonel , Atelvia , Gemfos , Risendros ), " Risofos ", " Risebon " and Risedronate -Teva".
Risedronate has significantly greater biological activity than alendronic acid, but at the same time has a less irritating effect on the mucous membrane of the stomach and esophagus. Its use is approved for all known types of osteoporosis, including postmenopausal osteoporosis in women and glucocorticoid osteoporosis - provoked by long-term treatment with hormonal drugs in men.
Ibandronate or ibandronic acid (Acidibandronicum) serves as a derivative material for the drugs Bonviva , Bondronat , Bandrone .
This bisphosphonate is considered effective for the prevention of spinal fractures. In addition, it fights the proliferation of cancer cells. By selectively acting on bone tissue, ibandronate can not only slow down the production of destructive osteoclasts, but also activate their activity when necessary. Like alendronate , this bisphosphonate maintains bone mineral composition at optimal levels. However, these drugs are contraindicated for men, since they were developed primarily for the treatment of postmenopausal osteoporosis.
The mechanism of action of zoledronate or zoledronic acid (Acidiumzoledronicum) is not fully understood, but this does not prevent it from being one of the most well-known drugs for combating osteoporosis . On its basis, third-generation drugs are created, such as “ Aclasta ”, “ Blaztere ”, “ Veroklast ”, “ Zometa ”, “ Zoldonat ” ( "Zoldonat", " Zoldria ", " Zoledron ", " Zoltero ", " Zoledrex ", " Zoledronate -Teva Teva"), " Resorba ", " Rezoklastin ", Reclast ".
Due to its similarity to the bone structure, zoledronate has an antitumor effect and prevents the formation of metastases. bisphosphonate also considered effective in the fight against progressive osteoporosis.
diphosphonates are prescribed :
Due to the specificity of each bisphosphonate , it is unacceptable to take these drugs without a doctor’s prescription.
What was considered positive about bisphosphonates :
General contraindications to taking bisphosphonates include:
When taking bisphosphonates, the following requirements must be observed:
Side effects of bisphosphonates include :
To neutralize the side effects of bisphosphonates antacids or a special calcium diet, with a predominance of dairy products in the diet, are usually prescribed It must be remembered that an attempt at self-medication can lead to very serious consequences. Thus, inducing a gag reflex to cleanse the stomach is fraught with irritation of the esophagus. Therefore, if you notice the above symptoms, you should immediately seek help from a doctor.
The introduction of bisphosphonates into medical practice did not solve the problem of decreased bone density. The disease is considered incurable. Recently, there has been increasing research showing that bisphosphonates cause more harm to bones than good. Advanced countries are abandoning them. One can cite, for example, a study published in The New England Journal of Medicine. The UK's Quality Assurance Authority concluded that, firstly, bisphosphonates are used inexcusably widely - and 70% of women with osteopenia could be treated with something gentler than bisphosphonates. By the way, it has been proven that taking drugs based on bisphosphonate acids for more than three years causes only harm to bones, not benefit.
Osteoporosis cannot truly be cured, but it can be stopped. This is exactly what Doctor of Medical Sciences, Professor V.I. Strukov , who has devoted more than 50 years of his medical practice to the treatment of patients with osteoporosis, believes.
Professor Strukov became a co-developer of a natural-based drug. Observations of patients and enormous knowledge of this topic allowed us to put forward a number of hypotheses and study them. The professor was looking for a composition that could increase bone mineral density, but without side effects, harmless. Now, based on the development of Professor Strukov, three drugs are being produced for different purposes: “ Osteomed ” - to normalize metabolism and help the birth of new bone cells, “ Osteomed Forte ” - to help with advanced osteoporosis and accelerate the healing of fractures, “ Osteo Vit ” - vitamins for strengthening bones.
The first and most important discovery was the Osteomed composition . After much research, a natural substance with testosterone similar to human testosterone was found and tested - drone brood, known for its unprecedented medicinal properties for thousands of years. It is testosterone that ultimately triggers the process of birth of new bone cells, which swell with calcium. And it is precisely this that is the raw material for estrogen, which is important for a woman’s body. Therefore, it is indicated for use by both men and women. Research has shown that voids in bones are filled with calcium. And there are no side effects.
In addition to solving the problem of reducing bone density, the drug " Osteomed " is effective for diseases that are markers of osteoporosis - arthritis, arthrosis, periodontal disease, as well as for the prevention and healing of fractures of varying complexity, because all these diseases are to one degree or another associated with the skeletal system. " Osteomed " does the main thing - it affects the cause of osteoporosis, accelerates the process of birth of bone cells.
Rheumatoid arthritis is the most problematic disease in rheumatology. Until now, modern medicine has not established the etiology of the disease, and the rheumatoid process, once emerging, actively progresses further. As the patient's medical history shows, the main threats to joint disease are complications of rheumatoid arthritis.
Rheumatoid arthritis is a chronic progressive disease of peripheral joints. The mechanism of the appearance and development of pathology (pathogenesis - medical) may be associated with the presence of individual foci of infection in the human body. It is no coincidence that the medical history of patients, when confirming the diagnosis of rheumatoid arthritis (RA), begins with the story that RA was preceded by a viral infection. However, this and other factors are unproven by science, so the etiology (cause - medical) of the disease in each case remains unclear.
The consequences of the pathological process, which is rheumatoid arthritis, are manifested by damage to the small joints of the hands, feet, as well as the wrist, knee and elbow. Scientific research confirms that the pathogenesis of the disease resembles a malfunction of the immune system, when the body produces substances that damage joint tissue.
In the initial stage of the disease, small joints are affected, and then the process is transferred to others. Rheumatology statistics make a depressing impression. In 70% of cases, the medical history contains an entry stating disability due to rheumatoid arthritis. In addition, arthritis is dangerous because even new generation drugs - Nise, leflunomide, chondroprotectors - cannot stop its development.
The main risk factors influencing the pathogenesis of rheumatoid arthritis are heredity, age (from 45 years and after), hormonal factors (women get sick more often). External risk factors, which include viral and bacterial infections, also increase the likelihood of developing RA.
It is a proven fact that during pregnancy, the pathogenesis of rheumatology in women changes for the better, and the symptoms of joint disease weaken. But after childbirth, its symptoms become more acute. This is also an argument in favor of the fact that the etiology of the disease is a complex of internal processes that can activate external risk factors. However, there is no risk of a sick person infecting a healthy person.
Autoimmune pathologies, which include RA, cause inflammation not only of the joints, but also of the tissues adjacent to them. Although risk factors that influence the pathogenesis of this pathology have been established, the etiology of autoimmune reactions has not yet been revealed.
It is known that most patients have a history of joint disease after the age of 30, but children can also develop rheumatoid arthritis. And youthful RA is identified as its special form.
In clinical practice, the disease is classified according to its main forms and degrees of severity. The main forms of RA are predominantly articular and articular-visceral, occurring with damage to the heart, lungs, eyes, kidneys, nervous and reticuloendothelial systems (RES). Special clinical forms of the disease include Felty, Kaplan, and Sjögren syndromes.
Classification according to the severity of rheumatoid arthritis:
According to the level of activity, rheumatoid arthritis can be low (1st century), moderate (2nd century), high (3rd century).
According to immunology, RA is characterized as seropositive if rheumatoid factor (RF) is present in the blood serum or seronegative if it is absent. Detection of RF in a high titer is important not only when making a diagnosis, but also for prognosis in order to stop RA.
The patient's functional abilities are classified by degree: 0 - preserved; І - professional abilities are preserved, ІІ - abilities for the profession are lost, ІІІ - the ability to serve oneself is completely lost.
When diagnosing RA, the doctor is guided by the list of criteria proposed by the American Rheumatological Association (presentation - 1987). According to it, the main manifestations of the disease are joint stiffness in the morning (at least 1 hour), arthritis of 3 or more joints, arthritis of the hands, symmetry of arthritis, rheumatoid nodules, RF titer value - ? and higher in the initial stage (first 6 months) are found in the synovial fluid, and then in the blood.
The classic history of the disease is gradual and slow damage to the joints.
In 10% of cases, patients with RA are treated for a long time for mono and oligoarthritis of large joints.
In a small proportion of patients, the history of joint disease may begin acutely, with a high fever. At the same time, the clinical picture of the disease is characterized by intoxication and systemic manifestations (carditis, leukocytosis, enlarged lymph nodes, liver, spleen, etc.). Articular syndrome in such cases manifests itself after several weeks or months.
A rare variant of the onset of RA is recurrent arthritis, when repeated attacks of arthritis precede the typical polyarthritis (persistent) characteristic of the rheumatoid form.
In other cases, the pathogenesis of the disease is manifested by the formation of rheumatoid nodules. They can be found under the skin and in internal organs. The joints are affected later.
The stage of development of the disease is determined from X-ray images. Moreover, X-rays reveal changes in the joints of the hands and feet in the early stages of the disease.
Modern diagnostic methods, including external examination data, laboratory tests and X-ray results, make it possible to correctly determine the form of RA, carry out adequate treatment, and eliminate the serious consequences of the disease.
RA is dangerous not only due to joint damage. It affects the heart, kidneys, skin, nervous system, gastrointestinal tract, lungs and muscles. It is difficult to even list how many different complications this disease causes.
Patients are often diagnosed with gastritis, indigestion, or ulcers. The patient's condition may worsen due to pericarditis and myocarditis. The condition of the skin changes. There are hemorrhages on it, and small subcutaneous nodules appear. A serious complication of rheumatoid arthritis is renal amyloidosis, which can lead to kidney failure.
Those who get sick are usually concerned with the question: how many years does the disease take them? According to statistics - from 3 to 7 years. Although information about the quality of such life is more relevant. That is, patients, how do you live with rheumatoid arthritis?
The patient's medical history is drawn up by the doctor according to the general scheme. First, a detailed clinical diagnosis is formulated in accordance with the requirements of ICD-10 and the working classification of the disease.
Rheumatism. Active phase. Second degree of activity, recurrent rheumatic carditis. Combined mitral heart disease. Continuously relapsing course. NIIB.
Then there are passport details, a list of information about the patient: place of work, date of admission to the clinic, diagnosis upon admission and date of supervision.
Next, fill out the following sections:
The structure of the medical history must include a list of prescriptions and doctor’s recommendations.
There is no clear answer to the question of whether a woman diagnosed with rheumatoid arthritis can become pregnant.
As a rule, the gynecologist and rheumatologist who treat her argue in favor of refusing pregnancy. Their position is explained by the high risk of pregnancy complications. These may include miscarriages and ectopic pregnancies. In addition, the patient needs to take antirheumatic drugs during exacerbation of the disease, which can affect the child’s health.
If a woman wants to give birth, then she needs to find out how many months before pregnancy she needs to stop taking all medications, and then, after consulting with an obstetrician-gynecologist and rheumatologist, plan for pregnancy. During the entire subsequent period, after conceiving a child, she will have to visit a rheumatologist (once a month) to adjust the dosage of medications.
It is quite possible that with the onset of pregnancy, the woman’s well-being will improve (by the end of the first trimester), and the symptoms of RA will weaken.
The safest methods of relieving pain during pregnancy are physiotherapeutic procedures, massage, and homeopathy. However, in case of exacerbation of the disease during pregnancy, the patient is given blockades.
After childbirth, rheumatoid arthritis can enter an active phase, as caring for the baby increases the stress on the joints of the hands. Treatment of the disease after childbirth excludes the use of antirheumatic drugs. But breastfeeding after childbirth is good for a woman’s health.
Modern medicine offers a large selection of anti-inflammatory and antirheumatic drugs that are used in traditional therapy for rheumatoid arthritis. These include nonsteroidal anti-inflammatory drugs, aminoquinoline derivatives, COX-2 inhibitors, glucocorticosteroids, cytostatics, and gold preparations.
Nise is considered one of the most popular non-steroidal anti-inflammatory drugs. Indications for the use of Nise in the treatment of rheumatoid arthritis are its analgesic, antipyretic, anti-inflammatory, and antiplatelet properties.
The Nise technique allows you to relieve pain in the joints during movement and at rest, quickly eliminating their stiffness and swelling. In addition, Nise does not accumulate in the body with long-term use.
Nise can be prescribed for the treatment of diseases: osteoarthritis, ankylosing spondylitis, neuralgia. Nise - gel is used for application to the painful area for RA and psoriatic arthritis, bursitis and lumbago.
Nise tablets are taken orally before or after meals as prescribed by a doctor. Nise is not recommended for use during pregnancy, high blood pressure, heart failure, diabetes and children under two years of age.
The presentation of new basic anti-inflammatory drugs shows that the gold standard among DMARDs - methotrexate - has received worthy reinforcement - leflunomide. In cases where treatment cannot be carried out with methotrexate, leflunomide is now prescribed.
Domestic and foreign studies have shown that leflunomide is effective after the first 4 weeks of administration. The drug leflunomide is prescribed to relieve swelling and pain in the joints. At the same time, leflunomide improves the indicators of articular syndrome from 64% to 96%. Leflunomide is especially effective in the early and late stages of rheumatoid arthritis.
Studies also confirm the sustainability of the therapeutic effect that leflunomide has. Moreover, leflunomide reduces the appearance of erosions in the joints of the hands and feet after six months of use (with methotrexate therapy - after a year).
Experts from the American College of Rheumatology recommend starting the use of first-line drugs (methotrexate and leflunomide) at the first severe symptoms of arthritis.
Chondroprotectors are a group of drugs that have medicinal properties for the restoration and nutrition of articular cartilage. Chondroprotectors prescribed for the treatment of RA must necessarily contain active ingredients such as chondroitin sulfate and glucosamine.
New generation chondroprotectors slow down destruction in joints and delay or eliminate surgical intervention. At the same time, chondroprotectors cannot be considered a panacea for this disease. Chondroprotectors cannot do more than stop the destruction of cartilage. In addition, chondroprotectors are recommended for use only in the initial stages of the disease.
For rheumatoid arthritis, patients are prescribed chondroprotectors such as Movek (to relieve pain), Teraflex (it contains chondroprotectors and an anti-inflammatory drug - indomethacin), Arthron complex (effective for severe joint pain) and Dona. Chondroprotectors are especially effective in the complex treatment of RA.
Additional methods for relieving inflammation and pain are used in the complex therapy of rheumatoid arthritis as an auxiliary treatment. These include homeopathy.
Homeopathy is a system of treatment with small, frequently taken doses of drugs. A harmless medicine, correctly selected taking into account a person’s individuality, in a small dose can provoke a reaction of the immune system, as a result of which the body begins to heal itself.
Homeopathy does not view symptoms as a negative effect of a disease. On the contrary, homeopathy uses them as attempts to resist disease. And since rheumatoid arthritis is autoimmune in nature, homeopathy helps to achieve the necessary therapeutic effect.
Therapeutic gymnastics exercises for RA must be performed to prevent deformities of the fingers and contractures in the joint. If you have painful joints, then exercise will help strengthen the muscles around it. Also, exercises will reduce pain, improve blood circulation, and therefore increase hand mobility.
However, it is not recommended to do exercises despite pain. Exercises will bring real benefits if they are performed regularly. The intensity of the load on the joints must be agreed upon with the specialist selecting the therapeutic exercises. Useful hand exercises for RA are of the stretching or rotational type.
Exercises for hands with RA:
All exercises are performed while sitting at a table or at a computer.
To achieve treatment results, doctors recommend that patients learn to live with rheumatoid arthritis, and even better, make friends with the disease. If a person has to live with RA, then the main thing should be the desire to fight for quality of life. To do this, you need to start the day with exercise, eat right and remain optimistic.
Arthritis is an inflammatory disease of the joints. According to statistics, every hundredth person in our country has arthritis.
The reasons for the development of such a serious pathological process with its complications can be various factors, among which scientists consider genetic predisposition to be the main catalyst (this primarily applies to women).
The second factor is injuries associated with excessive stress on the joints. In third place is hypothermia. In addition, arthritis can develop as a complication after a sore throat or viral infection. This phenomenon is especially common in childhood.
Arthritis affects all joints, but the most vulnerable are the hips and knees, small joints of the hands, and less commonly, the elbows and ankles. If left untreated, joint deformity and immobility inevitably develop.
The disease is not limited by age, but middle-aged women are diagnosed with this diagnosis somewhat more often than representatives of the stronger half. The exception is infectious reactive arthritis, which is diagnosed mainly in men aged 20-40 years (more than 85% of patients with reactive arthritis are carriers of the HLA-B27 antigen).
It is worth taking a closer look at rheumatoid arthritis (RA), which is an autoimmune disease of unknown etiology. The disease is a common pathology - approximately 1% of the population suffers. Cases of self-healing are very rare; 75% of patients experience stable remission; in 2% of patients the disease leads to disability.
With this disease, the inner surface of the joints (cartilage, ligaments, bones) is destroyed and replaced with scar tissue. The rate of development of rheumatoid arthritis varies - from several months to several years. Features of the clinical picture of one or another type of inflammation of the joints make it possible to suspect the disease and prescribe the necessary examinations to confirm the diagnosis. In accordance with ICD-10, RA is classified as seropositive (code M05), seronegative (code M06), juvenile (code MO8)
Some types of arthritis only affect children and teenagers, so they should be classified separately.
Juvenile rheumatoid arthritis (ICD-10 code M08) affects children after bacterial and viral infections. As a rule, one knee or other large joint becomes inflamed. The child experiences pain with any movement and swelling in the joint area. Children limp and have difficulty getting up in the morning. Without treatment, joint deformation gradually develops, which can no longer be corrected.
Reactive childhood arthritis (ICD-10 code MO2) appears two weeks after an intestinal infection. If the process develops in the knee joint, then external signs are clearly visible: the skin turns red, swelling is visible under the kneecap without clear boundaries. The child often has a fever, which decreases with antipyretic drugs, but pain in the knee area remains.
In addition to infectious, reactive, rheumatoid arthritis, children are often diagnosed with diseases of an allergic nature. The illness begins suddenly in a child - immediately after allergens enter the blood. The joints quickly swell, shortness of breath and urticaria appear. Angioedema and bronchial spasm may develop. When the allergic reaction is eliminated, the signs of arthritis disappear.
Arthritis of the knee joint can develop as an independent disease or be a complication after injury and illness.
The knee joint affected by arthritis swells and pain occurs when it moves. The skin in the joint area changes color (turns red or becomes “parchment”), but this is not a reliable sign of an inflammatory process.
The main reason for the appearance of swelling and visually noticeable enlargement of the kneecap is the accumulation of fluid inside the joint. Excessive pressure on the walls of the joint tissue causes severe pain. The volume of fluid steadily increases over time, so the pain becomes more intense.
In addition, uric acid crystals, which look like thin needle-shaped spikes, settle in the joint. They injure small vessels, which is the basis for the development of associated infections.
Arthritis of the knee is severe not only due to intense pain, but also due to disruption of the functioning of functional systems. The cardiovascular and endocrine systems are particularly affected. Shortness of breath, tachycardia, low-grade fever, sweating, poor circulation in the extremities, insomnia and other nonspecific symptoms are observed.
Symptoms vary depending on the degree of dysfunction, stage and etiology of the disease:
The first degree is characterized by moderate pain, there is a slight limitation of movement when rotating the knee, when lifting or while squatting.
Second degree – the pain intensifies, the limitation of motor activity is such that it leads to a decrease in working capacity and limitation of self-care.
In the third degree - inability to self-care, significant loss of mobility in the joint (joints).
According to the nature of occurrence in medicine, several forms of arthritis are distinguished:
Reiter's syndrome (according to ICD-10 code 02.3) can develop in two forms - sporadic (causative agent - C. Trachomatis) and epidemic (Shigella, Yersinia, Salmonella).
The clinical picture differs from other types of arthritis, since concomitant signs of the disease are lesions of the mucous membranes of the oral cavity, prostatitis (in men), vaginitis and cervicitis (in women). A common symptom is inflammation of the eyes (conjunctivitis, iridocyclitis), which manifests itself in redness of the sclera, the appearance of purulent discharge, and swelling of the eyelids.
Arthritis of the knee joint should be differentiated from other pathological processes, the most common of which are arthrosis and bursitis. An experienced specialist can easily distinguish bursitis, which is an inflammation in the synovial bursa, from arthritis at the first appointment.
Firstly, with bursitis, the mobility of the knee is slightly limited, and secondly, the area of articular inflammation has clear contours. By palpation, the doctor quickly determines the boundaries of the inflammatory focus. As for arthrosis, differentiation is more difficult, since these diseases, which have completely different etiologies, have many similar signs.
Arthrosis is a degenerative process in cartilage and bone tissue that occurs due to metabolic disorders and is not associated with an inflammatory component. The main group of patients are elderly people (by the age of 60, most people are diagnosed with dystrophic changes in the joints).
Arthritis is always inflammation, which over time, as the disease progresses (with an autoimmune nature), spreads to the entire body. That is why there are many accompanying signs of autoimmune arthritis - fever, low-grade fever, headache, and general malaise. Rheumatoid arthritis seriously affects the cardiovascular system.
To make a diagnosis of “arthritis of the knee joint” (gonarthritis), it is necessary to conduct multidirectional diagnostic studies. In some cases, doctors make a diagnosis of “arthrosis-arthritis of the knee joint” when they carry out a differential diagnosis between arthrosis and arthritis, usually in the initial stages of pathologies.
Differential diagnosis table for knee arthritis
Knee arthritis can be diagnosed at home by carefully studying the symptoms of the disease. Regardless of the etiology, symptoms such as swelling, redness in the joint area, general malaise, and external signs of deformation of the joint tissue appear.
However, you should not wonder how to treat arthritis of the knee joint on your own, especially using dubious traditional healing recipes. This can lead to irreversible consequences. The decision on how to treat knee arthritis is made only after a comprehensive examination.
Doctors must determine the nature of the disease in order to prescribe adequate treatment. Referrals for laboratory and instrumental studies are given by orthopedic traumatologists, surgeons, and rheumatologists. The treatment regimen is developed by a specialized specialist (this may be a phthisiatrician, dermatologist-venereologist, cardiologist and other doctors).
The first stage to determine the disease (according to ICD 10) is a visual examination and medical history.
The second stage is laboratory blood tests (with inflammation, an increase in ESR, leukocytosis, the inflammatory marker CRP, and other specific reactions are observed).
The third stage is radiography. In the presence of arthritis, curvature of the articular surface and bone ankylosis are detected.
The fourth stage is MRI, ultrasound (prescribed to differentiate arthritis from arthrosis, ankylosing spondylitis and bursitis). In case of erased signs, which occur during a sluggish chronic process, additional hardware examinations of the joint may be prescribed - tomography of the joint tissue, CT, pneumoarthrography.
At the same stage, joint puncture and collection of synovial fluid for laboratory testing are indicated (if indicated, biopsy).
When determining the type and degree of reactive arthritis (ICD-10 code), biological material is examined (general blood and urine tests), a urogenital and ophthalmological examination is performed, a test is prescribed for the presence of HLA-B27, ECG, thymol test, sialic test, determination of ALT, AST , inoculation of biological fluids.
Treatment of reactive arthritis, in accordance with ICD-10, is carried out in two directions - therapy using antibacterial agents and elimination of joint syndrome (pain, stiffness).
Despite the non-leading role of radiography in the diagnosis of arthritis, we must remember that in the early stages of the disease, pathological changes are not always visible in the images. Arthrography is of informative value for doctors when examining large joints, but for polyarthritis this diagnostic method is not effective. To identify the causative agent of arthritis of an infectious nature, serological tests are used.
Treatment of arthritis is a long process and requires not only following the doctor’s recommendations regarding drug therapy, but also undergoing rehabilitation courses.
The diet for arthritis of the knee joint must be strictly followed. Avoid foods rich in carbohydrates, smoked meats, fatty meats, and legumes. When switching to dietary nutrition and using individual therapy, a positive effect is observed. In general, treatment of knee arthritis includes the following areas:
Among the medications prescribed, NSAIDs, cytostatics, hormonal agents, antibiotics, etc. The range of medications directly depends on the type and etiology of arthritis. Table 2 shows treatment regimens for rheumatoid arthritis.
auranofin – 6 mg/day, maintenance dose – 3 mg/day.
Due to the fact that the RA treatment regimens indicated in the table are not always effective, in practice several combinations of basic agents are used, among which the most widespread combinations of methotrexate with sulfasalazine, methotrexate and delagil. Currently, the most promising treatment regimen is one in which methotrexate is combined with anticytokines.
In medical practice, cases of lack of effect from treatment are often observed (for example, with reactive arthritis, inflammation does not go away even when taking antibiotics in combination with NSAIDs), when patients continue to have disease activity and rapid progression of joint deformities.
Doctors draw a conclusion about the need to change the therapy program if the patient has been treated for six months using at least three basic drugs.
Evidence of the ineffectiveness of therapy is the negative dynamics of laboratory tests and the persistence of the focus of inflammation. In this case, you need an alternative solution on how to treat knee arthritis. Medical statistics confirm the positive dynamics when using pulse therapy using hormonal drugs (methylprednisolone intravenously, isotonic solution for three days - three courses are repeated after one month). Methylprednisolone is prescribed with caution in combination with cyclophosphamide due to the high toxicity of the drugs.
A new direction in the treatment of rheumatoid arthritis is therapy that involves the use of so-called biological agents. The action of the drugs is based on inhibition of the synthesis of cytokines (TNF-? and IL-1?).
It has been reliably established that in 60% of patients with active rheumatoid joint syndrome, even with the third degree of the disease, there is a decrease (or absence) in the progression of articular changes during maintenance therapy with Remicade. However, the use of this form of treatment is justified if basic therapy does not produce the expected effect.
The importance of a number of NSAID drugs, previously actively used in the treatment of knee arthritis, has decreased somewhat as other treatment programs have emerged that are more effective.
Non-steroidal anti-inflammatory drugs (Movalis, Diclofenac - in tablets and injections) continue to be prescribed for a diagnosis of arthritis, since these medications have a pronounced anti-inflammatory effect and contribute to a general improvement in the patient’s condition.
However, it has been reliably established that non-steroidal anti-inflammatory drugs do not have a significant effect on the course of the disease of an autoimmune nature - this is evidenced by both X-ray data and laboratory tests. However, the nonspecific process responds well to treatment with NSAID drugs.
Massage, exercise therapy, mud therapy - all these methods are applicable only if the rheumatologist has determined that the inflammatory process is localized by drug therapy, and the stage of remission has begun. Special exercises and therapeutic massage are aimed at restoring mobility of the knee joint.
When performing rotational movements, pain may occur, but this is quite normal, since the tissue has lost its elasticity as the disease progresses. All training and massage sessions should be carried out under the supervision of a doctor - this will help to avoid accidental injuries that occur when physical effort or stress is exceeded.
Balneological therapy is a very effective procedure in a comprehensive treatment program for knee arthritis. However, this direction of rehabilitation is indicated for those patients who do not have serious diseases of the cardiovascular system, neoplasms of a malignant nature, and have not previously had a heart attack or stroke. All procedures using medicinal biological components are prescribed with great caution.
Since there are many types of arthritis and joint pathologies, it is necessary to consult a doctor when the first signs of the disease appear. The sooner the causes of the inflammatory process are determined, the greater the chance of curing the disease completely.
Under no circumstances should you try to create a treatment regimen yourself, much less take medications. This is not only ineffective, but also dangerous. Medical techniques used in recent years in the treatment of arthritis of various etiologies are highly effective, which is a compelling argument for the use of treatment methods offered by official medicine.
Methotrexate for rheumatoid arthritis is only part of the complex therapy prescribed during the illness. In addition, a number of other medications are usually taken to repair damaged tissue and relieve pain.
This article will describe complete instructions for using methotrexate.
Rheumatoid arthritis is an inflammation of the joints, the exact cause of which is still unknown. Most likely, it is caused by infections; changes in blood tests characteristic of infectious processes suggest this.
Due to infection, the body begins to actively produce and accumulate antibodies. This leads to direct damage to the joints and disruption of their function.
Treatment of the disease can be medicinal (prescription of drugs that reduce pain and slow down the progress of the disease) and surgical.
In the absence of contraindications, methotrexate is most often prescribed as the main method of treatment. Its advantage is its undeniably strong effect and action in the later stages of the disease. You can also note the minimal risk of remission and restoration of immunity.
The disadvantages include a long wait for the effect: from one to three months. Treatment of rheumatoid arthritis in itself is considered a very long process, however, the effects of methotrexate usually last a long time.
Since the treatment is complex, in addition to methotrexate, several more basic drugs (sulfasalazine, leflonumide) are usually prescribed, which have a weaker effect.
The active ingredient of the drug is methotrescat, a strong nitostatic. The drug is one of the cytostatics that slows down the development of the disease. Thanks to the active substance, the growth of tumors is inhibited and the development of the disease is slowed down.
Before prescribing a medicine (no matter in what form), the following must be carried out:
To determine the form of the disease, special blood tests are performed for rheumatoid factor.
All these tests will allow not only to determine the patient’s indications for the prescription, but also to calculate the required dosage. Under no circumstances should you calculate it yourself; this must be done by a doctor.
The drug is produced by most manufacturers in two forms:
Methotrexate is available in the following forms and dosages:
Methotrexate-Ebeve is available in various forms.
Injection:
The duration of taking the drug, the period of increasing and decreasing dosages, and the optimal maximum dose are calculated by the doctor for each patient individually; you should never calculate the dose yourself.
The drug is taken orally, before meals.
The injections are usually given intravenously. Methotrexate injections are prescribed when complications of the digestive system occur.
The result will begin to appear in 6-12 weeks and will last throughout the therapy. If it is discontinued, arthritis may reappear within a few weeks.
The main principle of taking methotrexate is compliance with the dosage regimen. The dosage increases over time if no negative effects of the drug on the body have been noticed.
Methotrexate for rheumatoid arthritis includes a starting dose of about 7.5 mg intravenously once a week.
If the drug is taken in tablets, then take 2.5 mg every 12 hours (3 times). The dose is increased gradually, but should not exceed 12 mg.
After taking methotrexate, side effects may include the following:
If you take methotrexate for a long time, the following complications of the cardiovascular system may occur:
Complications of the respiratory system:
Complications of the digestive system:
Manifestations of allergies, skin rashes, and dysfunction of the reproductive and nervous systems are also possible.
Contraindications to taking the drug:
Taking methotrexate and folic acid together reduces the effectiveness of the drug, since these two substances are antagonists.
Medicines that increase the likelihood of methotrexate intoxication:
A decrease in renal clearance is possible when taking methotrexate and drugs from the penicillin group simultaneously.
Neurological disorders may develop when taking methotrexate and medications containing acyclovir simultaneously.
Severe intoxication with the possibility of death is possible when taking methotrexate and large doses of non-steroidal anti-inflammatory drugs.
During pregnancy and lactation, treatment with methotrexate is contraindicated. During the period of taking the drug, contraception should be used.
For children, the injection dosage is selected depending on age:
When taking the drug, the following rules should be observed:
The following drugs are analogues of methotrexate:
Methotrexate Lachema - from 650 rubles.
Methortritis - from 661 rub.
Vero-Methotrexate - from 136 rubles;
Methotrexate-Teva - from 72 rubles.
Which is better: Arava or methotrexate?
Methotrexate is a generally recognized “classic” treatment for arthritis, which has stood the test of time and proven to be effective. The drug Arava was created later specifically for the treatment of rheumatoid arthritis. The active ingredient is leflunomide, which has been tested and proven to be effective and safe.
Methotrexate: hormonal drug or not?
No, this is not a hormonal drug.
Use of the drug for psoriatic arthritis
Methotrexate is prescribed only to patients with severe arthritis that has not responded to other types of treatment. Dosages for psoriatic arthritis are increased.
Should I take the drug before or after meals?
Methotrexate is taken before meals.
How to properly stop the drug?
Discontinuation of methotrexate is undesirable and is prescribed only for special indications, including unexpected complications after the drug, surgical interventions, although the negative effect of methotrexate therapy during recovery after surgery has not been proven.
Methotrexate is a generally recognized effective drug for the treatment of rheumatoid arthritis. It is prescribed by a doctor and is available only with a prescription.
The effect of methotrexate in rheumatoid arthritis is observed 6-12 weeks after the start of therapy, and discontinuation of the drug is prescribed in case of complications or severe side effects.