The large number of anti-arthrosis injections and tablets available in pharmacies and some stores can confuse a patient suffering from diseases of the musculoskeletal system. The breadth of products is understandable - arthrosis is accompanied by many symptoms of different nature, so therapy should simultaneously be aimed at relieving signs of inflammation, pain relief, restoration, or rather, stopping the progression of changes in the structure of cartilage tissue, as well as the general strengthening of the body and immunity. We will tell you about the most popular and sought-after medications for joint arthrosis in this article.
For the treatment of arthrosis, vitamins that strengthen the immune system are most often prescribed.
Medicines for arthritis and arthrosis will primarily differ from each other in the form of release. Remedies for arthrosis can be produced in the pharmacological form of gels, ointments, sprays, aerosols, tablets and capsules. A special niche is occupied by injectable drugs for injection into the joint.
However, the main classification of drugs for arthrosis and arthritis is based on their mechanism of action. Pharmacological groups by type of action:
World-famous scientists have long excluded the term “arthrosis” from their vocabulary. Recently, the disease has been considered as a chronic, slowly progressive disease with an inflammatory component. In this regard, the treatment of arthrosis is increasingly including drugs that were previously recommended exclusively for the treatment of rheumatological diseases, for example, biological agents, glucocorticosteroids, and long-acting nonsteroidal anti-inflammatory drugs.
It is difficult to imagine treating arthrosis and arthritis with medications without adequate analgesic therapy. Only after eliminating pain and inflammation can you move on to auxiliary therapy: massage, physical therapy or physiotherapy. Eliminating pain significantly improves a person’s standard of living and their ability to self-care. Currently, recommendations have been developed for three stages of pain relief, at each of which different combinations of agents are used.
Meloxicam belongs to the class of drugs "non-steroidal"
In medical practice, various pharmacological groups are used at the first stage for analgesic purposes. The most popular are NSAIDs (non-steroidal anti-inflammatory drugs). These include Meloxicam, Diclofenac, Indomethacin, Ketoprofen, Nimesulide, Aceclofenac, Celecoxib. In addition to the analgesic effect, non-steroidal anti-inflammatory drugs for arthrosis effectively eliminate signs of inflammation, therefore they are more often recommended during exacerbations. However, experts warn that it is undesirable to use drugs for arthrosis for a long time, since NSAIDs have a number of undesirable side effects. In order to prevent negative effects, doctors recommend combining non-steroidal anti-inflammatory drugs for arthrosis and taking them, taking into account selectivity according to the following principle:
Some painkillers for arthrosis have a negative effect on articular cartilage. For example, uncontrolled use of certain NSAIDs reduces the synthesis of proteoglycans, the molecules of which are responsible for retaining fluid in cartilage tissue. As a result, the affected joint deteriorates faster. That is why non-steroidal drugs must be taken under the strict guidance and supervision of a doctor.
Painkillers will help relieve severe pain
The next group used to obtain an analgesic effect are herbal medicines, for example those containing essential oils of rosemary, fir, herbal and berry extracts, all of which were used in ancient times to relieve joint pain. The advantage of local painkillers is that they are delivered directly (through the skin) to the affected joint without causing side effects on the body as a whole. However, local remedies also have certain disadvantages. They cannot be used to treat large joints, since the pronounced subcutaneous fat will not allow the active ingredient to penetrate into the joint. Sometimes local therapy with natural products causes allergic reactions: hives, skin itching, redness. When the drug is discontinued, side effects usually disappear.
When pain is combined, muscle relaxants are often used. The drugs relieve muscle spasms, which often cause severe pain in the joints and spine. In addition, the group eliminates muscle stiffness, facilitates voluntary movements in the joint, and also improves peripheral blood supply to tissues. Popular muscle relaxants are Mydocalm, Pregabalin, Gabapentin.
Sometimes antidepressants can be prescribed for pain relief, for example Rexetine, which is a serotonin reuptake inhibitor. In this situation, a decrease in pain will be due to a decrease in the level of anxiety and relief from depression. At the final stage of analgesic therapy, narcotic analgesics are recommended. Painkillers and injections of the group of narcotic analgesics are recommended as a last resort when all other methods of therapy are ineffective.
It is difficult to imagine the treatment of any degenerative damage to articular cartilage without the use of chondroprotectors. This group includes such advertised drugs as Dona, Structum, Chondroitin, Stop-arthrosis, Arthril. The list can be continued endlessly, but it should be understood that all drugs for the treatment of arthrosis and arthritis of the chondroprotector group contain only two active components: glucosamine and chondroitin sulfate.
Contrary to popular belief, chondroprotectors still affect the level of pain.
Therefore, in many English-language publications the name of the group is “symptom-modifying agents”, and not “structural-modifying”, as is customary in our country. The main effect of using the group is to slow down the progression of articular cartilage degeneration. The drugs improve the production of joint fluid, normalize its lubricating properties, and activate substances that improve the structure and cellular composition of cartilage tissue.
At the same time, one should not overestimate the effect of these funds. Chondroprotectors exhibit better properties in the initial stage of the disease, but are practically useless in the third or fourth stage, when the cartilage tissue is almost completely destroyed and ankylosis (fusion of articular surfaces) has developed. It should also be remembered that chondroprotectors are slow-acting drugs: their use should last at least 3-4 months, 2 times a year.
Repisan belongs to the class of homeopathic drugs
The next group - vasodilators for arthrosis are not prescribed so often. Articular cartilage does not have its own blood vessels, so medications will not act directly, but vasodilators will improve blood flow in the periarticular tissues and joint capsule. Popular names: Trental, Xanthinol nicotinate, Pentoxifylline.
Homeopathic tablets for joint arthrosis do not have proven clinical effectiveness. The popularity and active use of homeopathy in recent years is explained by a minimum of side effects and good advertising. At the same time, there is a certain group of patients in whom homeopathic medicines for arthrosis reduce the level of pain. Osteochel S, Repisan, Tsel T are often used.
The following can also be used in complex therapy:
Recently, intra-articular injections have been widely used for arthrosis. Injections into the joint are represented by injections of hyaluronic acid and hormones. Injection therapy is prescribed according to strict indications, for example, glucocorticosteroids (hormones) are administered for severe pain and signs of inflammation. Hormonal injections for arthrosis are administered no more than 3 times a year and are prescribed exclusively by a rheumatologist.
Hyaluronic acid preparations can be used for intra-articular administration. Injections into the joint compensate for the lack of its own synovial fluid, thereby improving the function of the organ and the quality of human life. Preparations with hyaluronic acid are administered according to the schedule and show their effect within 6-12 months after treatment with injections. Injections for arthrosis into the joint should only be administered by a specialist; self-administration is prohibited.
Recently, all experts agree that the effectiveness of treatment increases significantly with the combined use of different pharmacological forms of drugs. The doctor will tell you which combinations are most successful. The following pharmacological forms of drugs are often prescribed:
Most of them are NSAIDs, for example Voltaren cream, Diclofenac, Fastum gel. Local therapy reduces pain and makes the patient feel better without the risk of the most dangerous side effects. The bioavailability of local forms is very low; only 5-7% of the active substance penetrates the skin. Therefore, they can be applied to small and medium-sized joints: hands, elbows, knees (in the absence of obesity), feet. In addition, ointments and gels do not in any way affect the cause of the disease, and therefore cannot restore cartilage tissue. Local use of NSAIDs is symptomatic. Their direct purpose is to remove the pain symptom. The effect of creams and ointments based on herbal ingredients is similar (as mentioned above).
Used to relieve inflammation and for pain relief. For compresses, Dimexide, medical bile, and bischofite are most often used. Dimexide is a liquid that has good analgesic and anti-inflammatory properties. The substance penetrates well deep into the skin and is a conductor: it improves the absorption of other components of the compress. Dimexide also has some absorbent properties and improves metabolism. Bishofite is a petroleum product. The substance relieves inflammation well, has analgesic and warming effects. Medical bile: the product has known analgesic, anti-inflammatory, local irritant and absorbable properties.
It is unacceptable to inject yourself - only a doctor can do this
About injections for arthrosis it was said above. Treatment with injection medications allows you to get a quick effect, but you should not abuse injections, since any intra-articular injection increases the risk of inflammation in the joint and tissue infection. Intramuscular administration is practiced for the NSAID group in patients who have difficulty swallowing tablets, as well as in the presence of dyspepsia when taking drugs orally.
For arthrosis of various localizations, the use of EHF therapy, magnetic therapy, and phototherapy is effective. For example, the EHF device CEM TESN in the EHF and FRI® mode is also used in the acute stage of the disease; it is placed in areas with maximum pain or temperature. The procedure helps reduce pain, inflammation and improves blood supply to problem joints. The optimal treatment zones are selected by the doctor using a personal thermal imager.
The ideal medicine for arthrosis should be selected by a professional. Some advertised new products, including traditional medicine, do not have the stated effects, but are outright deceiving people. Therefore, when choosing, be guided by proven facts.
We should start the review with the drugs that have the maximum number of clinical trials: Dona and Structum. Release form Dona is a powder for the preparation of a solution for oral administration of 1.5 g and a solution for intramuscular administration in ampoules of 400 mg. The active ingredient of the drug is glucosamine sulfate. The powder helps to replenish the endogenous deficiency of glucosamine, improves the synthesis of proteoglycans and hyaluronic acid by synovium, and also to some extent restores enzymatic processes in the cells of the synovial membrane and articular cartilage.
Structum is available in capsules containing 500 mg of chondroitin sulfate. Medicine for joint arthrosis helps in restoring and maintaining the normal structure of the joint matrix. The drug reduces the anabolic activity of chondrocytes and stimulates the synthesis of the main components of joint fluid. Structum is prescribed, 1 capsule 2 times a day. The degenerative disease is treated for at least 3-6 months.
Stop arthrosis. The drug is in powder form. The main active ingredient contained in Stop Arthrosis is glucosamine sulfate 1200 mg. The powder has a similar effect to the Dona mentioned above. It is prescribed orally after meals, after dissolving the contents of the sachet in 50 ml of water. Drink the solution immediately after preparation. The minimum duration of the course is 3 months. The permissible break between treatment is 2 months.
Meloxicam is a selective non-steroidal anti-inflammatory drug. Has good analgesic and anti-inflammatory effects. Tablets for arthrosis are used in 2 dosages: 7.5 mg 2 times a day and 15 mg 1 time a day. Meloxicam is also available in solution for intramuscular administration.
Artrisamine. The drug belongs to the dietary supplements. 1 tablet contains glucosamine sulfate, extracts of burdock, nettle, white willow bark, green tea, zinc-containing, chromium-containing and selenium-containing spirulina, beta-carotene, calcium stearate and lactose. The tablets have an analgesic and anti-inflammatory effect. According to the instructions, the tablets should prevent arthrosis, but treatment with dietary supplements is not advisable. For the purpose of prevention, it is recommended to drink 1-2 tablets 1-2 times a day for 1-2 months.
Diprospan is a glucocorticosteroid hormone in injections for intramuscular, periarticular, intrabursal, intradermal injections and injection into joints. The injections have high glucocorticoid and low mineralocorticoid activity, and have immunosuppressive, anti-inflammatory, and antiallergic effects.
In Art. 37 of the Federal Law of the Russian Federation No. 323-FZ, entitled “ Procedures for the provision of medical care and standards of medical care” , it is stated that medical care is organized and provided in accordance with the procedures for the provision of medical care, mandatory for execution on the territory of the Russian Federation by all medical organizations, as well as based on standards of care.
Procedures for the provision of medical care and standards of medical care are approved by the authorized federal executive body.
The procedure for providing medical care is developed according to its individual types, profiles, diseases or conditions (groups of diseases or conditions) and includes:
1) stages of medical care;
2) rules for organizing the activities of a medical organization (its structural unit, doctor);
3) standard of equipment for a medical organization and its structural divisions;
4) recommended staffing standards for a medical organization and its structural divisions;
5) other provisions based on the specifics of the provision of medical care.
The standard of medical care is developed in accordance with the nomenclature of medical services and includes average indicators of the frequency of provision and frequency of use:
1) medical services;
2) medicinal products registered on the territory of the Russian Federation (indicating average doses) in accordance with the instructions for use of the medicinal product and the pharmacotherapeutic group according to the anatomical-therapeutic-chemical classification recommended by the World Health Organization;
3) medical devices implanted into the human body;
4) blood components;
5) types of medical nutrition, including specialized medical nutrition products;
6) otherwise based on the characteristics of the disease (condition).
The prescription and use of medications, medical devices and specialized medical nutrition products that are not included in the relevant standard of medical care are allowed in the case of medical indications (individual intolerance, for health reasons) by decision of the medical commission.
It must be emphasized that Part 1 of Art. 37 of the Federal Law of the Russian Federation No. 323-FZ comes into force on January 1, 2013.
Medical products . According to Part 1 of Art. 38 of the Federal Law of the Russian Federation No. 323-FZ, medical products are any instruments, devices, instruments, equipment, materials and other products used for medical purposes separately or in combination with each other, as well as together with other accessories necessary for the use of these products for their intended purpose , including special software, and intended by the manufacturer for the prevention, diagnosis, treatment and medical rehabilitation of diseases, monitoring the condition of the human body, conducting medical research, restoration, replacement, changing the anatomical structure or physiological functions of the body, preventing or terminating pregnancy, the functional purpose of which is not implemented through pharmacological, immunological, genetic or metabolic effects on the human body. Medical products can be recognized as interchangeable if they are comparable in functionality, quality and technical characteristics and are capable of replacing each other.
Medical products are divided into classes depending on the potential risk of their use and into types in accordance with the nomenclature classification of medical devices. The nomenclature classification of medical devices is approved by the authorized federal executive body (Part 2 of Article 38).
The circulation of medical devices includes technical tests, toxicological studies, clinical trials, examination of the quality, effectiveness and safety of medical devices, their state registration, production, manufacturing, import into the territory of the Russian Federation, export from the territory of the Russian Federation, confirmation of conformity, state control, storage, transportation, sales, installation, commissioning, use, operation, including maintenance provided for in the regulatory, technical and (or) operational documentation of the manufacturer, as well as repair, disposal or destruction (Part 3 of Article 38).
According to Part 4 of Art. 38 of the Federal Law of the Russian Federation No. 323-FZ on the territory of the Russian Federation allows the circulation of medical devices registered in the manner established by the Government of the Russian Federation and the federal executive body authorized by it. These provisions regarding approval of the procedure for state registration of medical devices apply from July 1, 2012.
Medical products that are manufactured according to individual orders of patients, which are subject to special requirements for the prescription of medical workers and which are intended exclusively for personal use by a specific patient, are not subject to state registration (Part 5 of Article 38).
The procedure for importing medical devices into the territory of the Russian Federation for the purpose of state registration is established by the authorized federal executive body (Part 6, Article 38).
Import into the territory of the Russian Federation and export from the territory of the Russian Federation of medical devices as part of doping control is carried out in the manner established by the Government of the Russian Federation (Part 7, Article 38).
According to Part 8 of Art. 38 of the Federal Law of the Russian Federation No. 323-FZ, for the purpose of state registration of medical devices in the manner established by the authorized federal executive body, conformity assessment is carried out in the form of technical tests, toxicological studies, clinical trials and examination of the quality, effectiveness and safety of medical products, as well as testing for the purpose of approving the type of measuring instruments (in relation to medical devices related to measuring instruments in the field of state regulation of ensuring the uniformity of measurements, the list of which is approved by the authorized federal executive body).
For state registration of medical devices and examination of the quality of effectiveness and safety of medical devices, a state fee is charged in accordance with the legislation of the Russian Federation on taxes and fees (Part 9 of Article 38 of Federal Law of the Russian Federation No. 323-FZ).
In the manner established by the Government of the Russian Federation, the federal executive body authorized by it maintains the state register of medical devices and organizations engaged in the production and manufacture of medical devices, and places it on its official website on the Internet (Part 10, Article 38 of the Federal RF Law No. 323-FZ).
Based on Part 11 of Art. 38 of the Federal Law of the Russian Federation No. 323-FZ, the following information is entered into the state register of medical devices and organizations engaged in the production and manufacture of medical devices:
1) name of the medical product;
2) the date of state registration of the medical device and its registration number, the validity period of the registration certificate;
3) the purpose of the medical device established by the manufacturer;
4) type of medical device;
5) class of potential risk of using a medical device;
6) code of the All-Russian Product Classifier for a medical device;
7) name and location of the organization - the applicant of the medical device;
8) name and location of the organization - manufacturer of the medical device or organization - manufacturer of the medical device;
9) address of the place of production or manufacture of the medical device;
10) information about interchangeable medical products.
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What should a joint be like in a healthy state, that is, ideally?
It's simple! In a healthy state, the joint should not bother you.
It is necessary to sound the alarm at the very first signs of the development of the disease:
· sharp short-term pain
· severe swelling of the limbs at the end of the day
If you start treatment at the very beginning, the disease can be stopped after the first course of laser procedures and not remembered until old age. 2-3 preventive courses once every six months will help consolidate the result.
Therefore, having an ORION laser device at home is convenient and practical.
And now about everything in detail and in order.
Arthrosis or osteoarthrosis (from the Greek arthron - joint) is a degenerative change in the joints associated with metabolic disorders in cartilage tissue, nearby bones, joint capsule, muscles and ligaments. Unlike arthritis, arthrosis is rarely an inflammatory disease. These diseases are often confused, however, the treatment regimen for arthritis differs significantly from the methods for treating joint arthrosis.
Arthrosis occurs as a result of infectious diseases, intoxications, injuries, fractures of the articular ends of bones, and damage to articular cartilage. Often the disease is provoked by significant functional overload of the joints associated with professional activities. For example, arthrosis often occurs in athletes, ballet dancers, loaders, and hot shop workers.
The basis of the disease is a violation of the epiphyseal (articular) ends of the bones, damage and changes in the patency of the blood vessels that feed the bone. As a result, aseptic necrosis occurs, which aggravates joint damage.
Most often, arthrosis develops in the knee, hip and metatarsophalangeal joints. The disease is progressive and mainly affects people aged 40-65 years. But over the past decade, the disease has become much younger, and often the first signs of the disease can appear before the age of 30.
Treatment of joint arthrosis:
Symptoms and course of arthrosis:
Painful sensations with arthrosis are especially pronounced in movement - running, squats, walking up the stairs. At rest, as a rule, the pain stops. But such symptoms are typical for the initial stage of the disease. As the disease progresses, pain occurs even with minor exertion, and subsides only after a long rest.
The most severe cases, even with advanced forms of arthrosis, are characterized by pain even at rest - the destroyed joints “twist” when the weather changes, at night. Patients are concerned about severe pain, accompanied by muscle spasms, and a dry crunching sound that occurs from friction of the articular surfaces. The cartilage becomes thinner, joint stiffness increases, bone tissue grows and forms osteophytes - growths in the form of spines. Tissue breakdown contributes to muscle atrophy and other irreversible changes leading to disability.
There are two forms of arthrosis – primary and secondary. Primary is hereditary in nature - genetic predisposition. The secondary form is the result of trauma and other provoking factors arising from the outside. This may be excess weight or, for example, failure to treat varicose veins in the legs in a timely manner, leading to venous stagnation and lack of oxygen in the ankle joints, or vascular changes requiring treatment of vascular atherosclerosis.
Treatment of hip arthrosis, arthrosis of the foot and other types of this disease is mainly outpatient. Drug therapy is prescribed, including painkillers (central-acting analgesics), hormonal agents, chondroprotectors (“cartilage protectors” administered intra-articularly), physiotherapeutic procedures, massage, and therapeutic exercises. In the absence of inflammation in the joints, paraffin applications are indicated to relieve muscle spasms and improve blood circulation.
A good effect is achieved in sanatorium-resort conditions. However, in severe cases, surgical treatment of arthrosis may be indicated: arthroplasty or arthrodesis.
The success of combating most diseases directly depends on the correct diagnosis in the early stages of development. This applies to the treatment of trophic ulcers of the lower extremities, and the treatment of spinal osteochondrosis, and the treatment of bronchial asthma - that is, completely unrelated diseases. As for arthrosis, timely seeking medical help plays a decisive role in preventing the development of serious complications.
Orion device: Treatment of arthrosis at home
Thermal procedures cannot be used to treat arthrosis. The optimal method is laser therapy. Laser procedures can be performed at home using laser devices ORION STEP or ORION PLUS. An infrared beam with laser precision penetrates directly into the lesion and helps eliminate the cause of the disease! The ORION laser helps to qualitatively and permanently relieve pain, inflammation, swelling, restore the composition of synovial fluid and cartilage, improves blood circulation in surrounding tissues, provides an influx of oxygen, which helps restore motor functions and restores the mobility of the joint as a whole.
The use of laser therapy has no side effects and no age restrictions. arthritis, arthrosis, osteochondrosis, varicose veins, trophic ulcers, hypertension, allergies and more than 200 diseases of both inflammatory and non-inflammatory nature can be successfully treated The results of laser therapy are supported by numerous clinical studies, thousands of doctors and patients.
Other names for this disease: gonarthrosis , deforming arthrosis of the knee joint, according to the American classification - osteoarthritis of the knee joint.
Women suffer from arthrosis of the knee joints somewhat more often than men. Arthrosis usually develops after forty years, although sometimes there are cases of “young” gonarthrosis - after injuries or in professional athletes.
Arthrosis of the knee joints most severe in obese women, as well as in those who have severe varicose veins in the legs.
The disease begins gradually, with minor pain in the knee when walking. The most difficult thing for patients is going up or down stairs. Pain also often occurs when a person needs to get up from a sitting position (from a chair or bed) - the first steps are usually the most painful. Then, if you move away, the pain in your knees decreases slightly. But when walking for a long time and after it, the pain returns again.
At rest, sitting and lying down, the pain usually goes away.
Note from Dr. Evdokimenko.
The initial pain sensations with arthrosis of the knee joints (gonarthrosis) do not arise “in a second,” that is, they do not appear immediately, in one day. A period of intense pain with gonarthrosis is almost certainly preceded by a period of many months or even many years of mild pain that occurs exclusively during long walking, exertion, walking up stairs or getting up from a chair.
If the pain arose suddenly, in one day or, even more so, in one second, and before there was no pain in the knee, then this usually indicates some other disease or damage. For example, a pinched meniscus, a pinched synovial membrane of a joint, or a piece of cartilage (chondromic body) getting between the cartilages of the knee.
* However, with gonarthrosis, such troubles can also occur, and then they will complicate the course of arthrosis and add sharp pain. And then knee arthrosis will have to be treated taking into account the above complications. But initially, the diagnosis of “arthrosis of the knee joint” is confirmed precisely by the gradual development of pain symptoms.
Despite the intense pain at times, at first, at the first stage of gonarthrosis, the bones of the knee retain their original shape and are almost not deformed. But the joint itself may look a little swollen.
At first, such a change in the shape of the joint may be associated with synovitis (synovitis is the accumulation of pathological fluid in the knee).
If too much fluid “accumulates” in the joint, it even spreads to the back surface of the knee, to the area of the popliteal fossa.
This accumulation of fluid is called a Baker's cyst.
The term “Baker's cyst” often frightens patients, since the name makes many people think that we are talking about an oncological process. However, this condition has nothing to do with oncology and tumors. A Baker's cyst is just a term for a collection of fluid in the knee. Sometimes, when too much of this fluid accumulates, it breaks out under the knee and below - onto the back of the lower leg. But even in this case, nothing terrible happens: Baker's cyst usually shrinks easily under the influence of anti-inflammatory drugs or the injection of hormonal drugs into the knee. Accordingly, Baker's cyst needs to be treated. But under no circumstances does it need to be operated on!
At the second stage of gonarthrosis , several months after the onset of the disease, the pain in the knee becomes clearly stronger. Painful sensations appear already from minimal exertion or immediately after it.
That is, pain is now caused by almost any movement in the affected knee. But the knee hurts especially badly after prolonged exercise, long walking, or carrying even small weights.
After a sufficiently long rest, the pain usually goes away completely, but with the next movement it immediately reappears.
Around this time, a crunching sensation in the knee joint when moving the pain It differs significantly in volume from the barely audible clicks that occasionally accompany individual movements of healthy joints.
As the disease progresses, such a crunch, weakly expressed at first, becomes more audible and distinct.
I want to emphasize once again: do not confuse a rough arthritic crunching in a joint, which is almost always accompanied by pain, with a harmless cracking of the joints that occurs in some healthy people and is not accompanied by pain.
Painless soft cracking of the joints may simply be a consequence of a weak ligamentous apparatus, or a consequence of excessive joint mobility or some other individual characteristics in the structure of the joints of a given person.
Typically, such soft crunching does not threaten anything, does not have negative consequences, and does NOT increase the risk of joint diseases in the future.
Knee arthrosis, arthritis, meniscus damage, etc.
In parallel with the intensification of pain and the appearance of a crunch, in the second stage of gonarthrosis, the ability to bend the leg normally at the knee decreases . When you try to bend the knee “all the way”, sharp pain occurs in the joint, and more often than not, full bending of the knee simply becomes impossible. Sometimes the knee bends only to an angle of 90 degrees, and then goes further with difficulty and pain.
At the same stage of the disease, it becomes noticeable that the joint is deformed - first of all, this concerns bone deformations, changes in the shape of the bones of the joint (when you feel the knee, you can notice that its bones have changed their shape, they have become wider and “rougher”).
In addition, changes in the shape of the joint are aggravated by the accumulation of pathological fluid in the joint (synovitis). Synovitis at this stage of gonarthrosis occurs much more often and is sometimes expressed much more strongly than at the beginning of the disease, in its first stage.
At the third stage of gonarthrosis, the pain in the knee intensifies even more. Now the knee hurts not only when moving and walking. Pain begins to bother a person even at rest. It is difficult for the patient to find a comfortable position in bed, to arrange the affected knee so that it does not hurt. And yet, having found the right position, a person can usually fall asleep. Although, if the destruction of the joint is combined with impaired blood circulation, then the joints begin to “twist” even in the middle of the night, usually when the weather changes, or, as the patients themselves say, “towards the rain.”
At this time, the mobility of the knee joint is reduced to a minimum. It is absolutely impossible to bend the knee more than 90 degrees. And sometimes the knee hardly bends at all. In addition, the opportunity to fully extend, that is, straighten the leg, often disappears. In this case, the sick person always walks on slightly bent legs.
Compared to the second stage, during the third stage of gonarthrosis, the bones of the joint are deformed even more, and in some cases, “varus” or “valgus” deformity of the legs develops - the legs become O-shaped or X-shaped. As a result, in people with similar leg deformities, the gait often becomes unstable - a so-called “waddling gait” occurs.
A video with gymnastics for the treatment of arthrosis of the knee joints can be viewed here
Says Dr. Orna Ophir, medical director of the Assuta™ network of medical centers: “When it comes to Assuta™ standards, you need to understand that we mean quality standards that apply to all departments of the medical institution.”
Assuta™ quality standards meet the most stringent and diverse requirements; they are the basis for the successful treatment received by patients of medical centers belonging to the Assuta™ system. Assuta™ standards are based on the following principles: quality of care, high level of professionalism, work in accordance with regulations, administrative support provided to hospital departments and verification of the results of their work.
“Doctors, nurses, administrative or support staff - we are all obliged to follow the standards and requirements that govern our activities and ensure the highest quality of the treatment process. To be honest, I am not familiar with other medical institutions where the quality of treatment is at the same level as in Assuta™. We are characterized by holistic (integrated) thinking and approach. We delve into all the details and pay attention to even the most seemingly insignificant details,” adds Dr. Ophir.
Hand washing facilities are provided in every room and next to every hospital bed. As an additional measure to prevent infections, a thorough examination and health check of patients before admission to hospital is practiced. At Assuta™, great attention is paid to pain control - painkiller therapy is prescribed to each patient after surgery. All patients undergo preoperative preparation, including a conversation with an anesthesiologist and a nurse.
An important component of the special quality standard of Assuta™ is, without any doubt, the patient’s right to choose a treating physician. Dr. Ophir: “It should be noted that without exception, all the doctors collaborating with Assuta™ - and there are 1,500 of them - are leading specialists. Many of them hold the position of head or deputy head of a department in one of the public Israeli hospitals. To start their activities in Assuta™, they are required to obtain special permission and go through a rather complex administrative procedure. Add to this constant monitoring of the work activities and performance of each operating surgeon. Again, we are talking about our own mandatory quality standards.”
To find an effective solution to any problem, no matter what area it relates to, hospital patients have the opportunity to take advantage of consultations with medical specialists. Leading doctors with extensive experience are ready to answer all patients’ questions. In fact, at Assuta™, communication with the treating staff is maintained 24 hours a day, 7 days a week.
“To our list of achievements,” says Dr. Ophir, “we should add having one of the best radiology departments in Israel. Modern high-tech X-ray equipment allows us to perform instrumental checks of the highest level, as well as carry out invasive procedures under X-ray control. For example, we perform catheterizations using computed tomography, and in the near future we will be able to perform biopsies under magnetic resonance imaging guidance.”
Preoperative preparation plays a huge role in the prevention of postoperative complications. One of the Assuta™ standards is the reception of patients within the preoperative clinic. Thanks to this method of preparing the patient for surgery, it is possible to significantly improve the quality and safety of the treatment process, as well as reduce the likelihood of future complications and emergency situations.
Another important component of the complex of preventive measures is the presence of strict regulations regulating the work of doctors. According to Dr. Ofir, the high quality standards that exist at Assuta™ are largely due to this strict regulation. “I mean an extensive system of documents regulating the treatment process: the admission of a patient to hospitalization, the activities of the operating unit personnel, the exact schedule of control procedures and data collection before the start of a surgical operation and upon its completion, detailed instructions and medical recommendations of doctors and nursing staff who is received by the patient before discharge.”
When listing the special standards of Assuta™, you should remember one more thing: Assuta™ is a territory in which the patient does not experience pain. Each patient has the opportunity - of course, taking into account the doctor's recommendations - to choose the type of anesthesia that suits him. In the medical centers of the Assuta™ system, many surgical operations are performed under regional anesthesia, without the use of general anesthesia. In addition, there are precise instructions on the technique of postoperative pain relief. The nursing staff carefully ensures that the patient receives the necessary medications, the purpose of which is to minimize the severity of pain after surgery. This approach allows you to improve the quality of treatment and achieve a speedy recovery.
“Great credit,” notes Dr. Ophir, “goes to our internal control department. This department has developed a model for controlling internal processes that can serve as a model for other Israeli medical institutions. We are talking about a constant check of the quality of work, an uncompromising, thorough and comprehensive check. This model allows us to constantly “keep our finger on the pulse” and, as necessary, improve and develop management methods. Our goal is to minimize the number of errors, since medicine is an area where their cost is too high. I am proud that our dialysis and phototherapy departments and sleep laboratories are the first in Israel to receive ISO 9002 quality certification.”
The procedure for providing medical care in the Russian Federation is regulated by Article 37 of the Federal Law of November 21, 2011 N 323-FZ “On the fundamentals of protecting the health of citizens in the Russian Federation”, and specifically for the “oncology” profile, also by the Order of the Ministry of Health of the Russian Federation of November 15, 2012 N 915n.
According to Art. 19 Federal Law of November 21, 2011 N 323-FZ “On the fundamentals of protecting the health of citizens in the Russian Federation” everyone has the right to medical care in a guaranteed volume, provided without charging a fee in accordance with the program of state guarantees of free medical care to citizens.
Free medical care, including diagnostics, is provided within the scope of the approved standard of examination and treatment of the underlying disease. Such standards for a specific disease are adopted by the Ministry of Social Health Development of the Russian Federation and the Ministry of Health of the region on the basis of federal standards. Standards are adopted for inpatient treatment and outpatient treatment. The standards indicate, among other things, diagnostic tests that should be done free of charge for a specific disease.
The responsibility of a medical organization is to carry out medical activities, including in accordance with the standards of medical care (in accordance with Article 79 of Federal Law No. 323).
“medical organizations participating in the implementation of the program of state guarantees of free medical care to citizens are obliged to:
1) provide patients with information about the procedure, volume and conditions for the provision of medical care in accordance with the program of state guarantees of free provision of medical care to citizens;
2) ensure the provision of medical care to citizens within the framework of the program of state guarantees of free provision of medical care to citizens and territorial programs of state guarantees of free provision of medical care to citizens.”
However, if you need to receive medical care beyond what is provided free of charge, and you were unable to obtain a quota for high-tech care, then in accordance with paragraph 4 of Article 84 323-FZ, medical care will be provided for a fee:
“medical organizations participating in the implementation of the program of state guarantees of free provision of medical care to citizens and the territorial program of state guarantees of free provision of medical care to citizens have the right to provide paid medical services to patients:
4) when independently applying for medical services"