Therapy for arthrosis of the shoulder joint should be comprehensive, including medicinal and non-medicinal methods. The main component of therapy is considered to be drug treatment, and physiotherapy, exercise therapy, massage and other methods complement it. There are different forms of medications for shoulder arthrosis, some for systemic use, others for local use. Their therapeutic effect also differs: some eliminate symptoms, others affect the mechanism of disease development. Drugs for treatment are selected taking into account the stage of the disease, its cause, and the set of symptoms.
With arthrosis, cartilage tissue is gradually destroyed, and bone tissue changes structure and becomes deformed. This disease manifests itself as pain with moderate or severe signs of inflammation. The range of motion in the joint is limited, and spasms of the muscles that surround and stabilize it are possible. Drug therapy helps relieve pain, eliminate muscle spasms, and protect joints from destruction. For the treatment of arthrosis of the shoulder joint:
These groups of drugs are intended for the primary treatment of arthrosis. Since the joints suffer from a deficiency of vitamins and minerals, which are not always contained in food in sufficient quantities, vitamin therapy is used as an auxiliary treatment. It also helps strengthen overall immunity. Vitamin and mineral complexes are selected by the doctor taking into account the general condition of the patient. If degenerative-dystrophic processes in the joint are caused by disturbances in its blood supply, drugs may be prescribed to treat vascular diseases and normalize blood microcirculation. Muscle relaxants, which relax skeletal muscles, are resorted to if persistent muscle spasms cannot be relieved by non-drug means.
For the symptomatic treatment of arthrosis of the shoulder joint, medications are selected taking into account the prevailing symptoms and severity of symptoms. Pain and inflammation are relieved with non-steroidal and hormonal anti-inflammatory drugs, non-narcotic and narcotic analgesics, and local anesthetics.
For moderate inflammation and low-intensity pain, NSAIDs are prescribed. They have a combined effect: anti-inflammatory, analgesic and antipyretic, but some block pain to a greater extent, others relieve inflammation. The action of non-steroidal anti-inflammatory drugs is based on the suppression of the activity of cyclooxygenase (COX), one of the isoforms of which triggers the inflammatory response. But this enzyme also has another isoform, which stimulates the production of mucus necessary to protect the gastrointestinal tract. Non-selective NSAIDs (ibuprofen, indomethacin, diclofenac sodium) suppress both isoforms of COX and negatively affect the gastric and intestinal mucosa. They are contraindicated for people with gastroenterological disorders. Selective drugs are preferable (meloxicam, nimesulide).
NSAIDs are available in a variety of forms:
For arthrosis, oral medications and ointments, gels, and creams are mainly used. Almost all drugs for external use belong to the 1st generation and are non-selective. The exception is Nise-gel (nimesulide). When prescribing anti-inflammatory therapy, it is necessary to inform the attending physician about existing gastroenterological, cardiovascular, allergic and other diseases. When choosing a drug and selecting a dosage, contraindications and restrictions for use are taken into account. NSAIDs cannot be used in long courses, but this is usually not required; they quickly relieve the symptoms of inflammation.
If the acute inflammatory process cannot be stopped with NSAIDs, blockade with hormonal drugs is performed. These are hydrocortisone, Kenalog, Celeston, Diprospan, Depo-Medrol. They produce a pronounced anti-inflammatory effect, but have a moderate analgesic effect. In addition, intra-articular blockade, in which the needle pierces the soft tissue and all layers of the joint capsule, is a rather painful procedure. To reduce pain, local anesthetics are administered along with glucocorticoids. Only with diprospan injections no additional anesthesia is required.
When treating inflammation with hormones, a number of important points need to be taken into account:
The choice of analgesic drugs for shoulder arthrosis is determined by the intensity of pain.
You can also block pain with local anesthetics - novocaine, lidocaine. They are injected, blocking the peripheral nerves of the brachial plexus, combined with hormonal drugs for intra-articular blockades, and also delivered to the site of pain via electrophoresis.
The name suggests that drugs in this group are intended to protect cartilage tissue. They slow down the process of destruction of articular cartilage, stimulate its repair and regeneration (restoration). But it is easier to prevent destruction than to restore what has already been destroyed. The further the degenerative-dystrophic processes have progressed, the less effective chondroprotectors are, therefore they are not prescribed at stage 3 of arthrosis.
The first chondroprotectors were made from animal raw materials: cattle and fish cartilage, bone marrow, and crustacean shells. Some components were also obtained from legumes, avocados. These drugs contain a mucopolysaccharide polyester of sulfuric acid, a glycosaminoglycan-peptide complex. Their therapeutic effect is weakly expressed, and due to insufficiently thorough cleaning of the raw materials, there is a high risk of allergic reactions. Almost all drugs of this generation are injectable. In the 2nd generation, drugs based on chondroitin (Structum, Chondroxide, Artradol, Artrin) and glucosamine in the form of hydrochloride (Artron Flex) or sulfate (Dona) appeared:
Both active components of 2nd generation chondroprotectors have a mild analgesic and anti-inflammatory effect, so when treating with these medications, the dosage of NSAIDs can be reduced. Compared to the first generation, they are better absorbed by the human body, and the number of side effects has decreased. In the 3rd generation, they began to produce polydrugs that contain both components. These are Artra, Arthron Complex, Chondroitin Complex, Theraflex. Some medications, along with these two components, also contain diclofenac (Movex Active), ibuprofen (Teraflex Advance) or an organosulfur compound with an anti-inflammatory effect - methylsulfonylmethane (Artron Triactive Forte).
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Modern pharmaceuticals offer various drugs for the treatment of arthrosis. The breadth of products is explained by the variety of symptoms that accompany joint disease. For this reason, arthrosis therapy is complex, simultaneously affecting the relief of signs of inflammation, pain, stopping the progression of changes in the structure of cartilage tissue, strengthening the immune system and the body as a whole. These are the medications that will be discussed in this article.
In order to relieve pain due to arthrosis, non-steroidal anti-inflammatory drugs are popular, among which are:
A group of such medications relieves pain and inflammation, and is therefore prescribed during periods of exacerbation of arthrosis. However, it is undesirable to use such drugs for a long time, since the drugs have adverse reactions. To avoid negative effects, it is recommended to combine non-steroids according to the following principle:
A number of medications negatively affect the cartilage tissue of the joint. Thus, taking some NSAIDs in an uncontrolled manner reduces proteoglycan synthesis, the molecules of which are responsible for preserving fluid in cartilage tissue. This can lead to joint destruction.
Also, in case of arthrosis, pain is relieved with herbal medicines containing essential essences of rosemary, fir, various herbs and berries. Such products are used topically. The advantage of the drugs is their direct effect on the body through the skin, which eliminates the occurrence of side effects. At the same time, there are also disadvantages:
In the last stages of arthrosis, when the pain becomes unbearable, narcotic analgesics are prescribed. Then tablets or an injection method of treatment are prescribed, which are used in extreme cases when it is impossible to achieve results with conservative methods.
This group of medications is prescribed in the presence of combined types of painful sensations. Medicines help:
In some cases, for arthrosis, antidepressants related to serotonin reuptake inhibitors are prescribed. Then the relief of pain syndrome is caused by a decrease in the level of anxiety and relief from depressive conditions.
This group of drugs is primarily used in the treatment of arthrosis. These drugs contain two active substances: glucosamine and chondroitin sulfate. Medicines improve the production of fluid that is part of the cartilage, normalizing lubricating properties, activating substances that improve the structural and cellular parameters of joint tissue.
It is important not to overestimate the effect of these drugs. The high effectiveness of chondroprotectors is achieved in the initial stages of arthrosis and is reduced to almost zero in the final stages of development, characterized by complete destruction of cartilage tissue with the subsequent development of ankylosis, which is the fusion of articular surfaces. It should also be remembered that chondroprotectors have a delayed but prolonged effect.
This group of drugs is prescribed relatively rarely for arthrosis, which is explained by the absence of its own blood vessels in cartilage. This eliminates the effect of drugs on the joint. At the same time, vasodilator drugs improve blood flow in the periarticular tissues.
Complex therapy involves the use of the following groups of drugs:
This therapy consists of joint injections with hyaluronic acid and hormones. Glucocorticosteroids are also used, which are used for severe pain and high-intensity inflammation. Hormone injections should be given three times during the year.
Hyaluronic acid is also used, which compensates for the deficiency of synovial fluid in the joint, improves the functions of the organ, having a beneficial effect on the quality of life. This therapy is carried out according to a clear therapeutic scheme, showing a therapeutic effect after six months from the start of treatment
For arthrosis, the following are most often used:
1. Ointment and gel formulations
Such drugs belong to the group of NSAIDs, represented by Voltaren cream, Diclofenac and Fastum-gel. Local exposure reduces pain, which improves the condition without the risk of adverse reactions. The bioavailability of local forms is characterized by a low degree, since no more than 7% of the active substance penetrates the skin, which makes it possible to apply the drug to small and medium-sized joints. At the same time, ointments and gels do not affect the cause of the disease, which excludes the restoration of cartilage tissue through such means. Thus, the use of NSAIDs is purely symptomatic. The purpose of such drugs is to relieve pain. Creams and ointments based on components of plant origin have a similar therapeutic effect.
Also used for pain relief and inflammation relief. Suitable for compresses:
Injection therapy for arthrosis helps to achieve a therapeutic effect in a short period of time, but long-term treatment increases the risk of inflammatory processes in the joint with subsequent infection of tissue structures. Injection of drugs into muscles is used in patients who are unable to independently take drugs orally, or in the presence of dyspeptic disorders.
Arthrosis of varying severity can be treated by:
The latter method of therapy is recommended for acute arthrosis. EHF is used on areas where there is a maximum level of pain or temperature. The procedure is useful:
For arthrosis, the following drugs are recommended:
Available in the form of a powder intended for the preparation of a solution for oral use, as well as in the form of ampoules, the contents of which are used to prepare injections for intramuscular administration. The active ingredient of the drug is glucosamine sulfate. The medicine helps:
Available in capsules in a dosage of 500 mg containing chondroitin sulfate. The product copes with the restoration and subsequent maintenance of the joint structure.
A drug for arthrosis in powder form, in which glucosamine sulfate is the active ingredient. It has a similar therapeutic effect as Dona. Prescribed at the end of a meal with preliminary dissolution in 50 ml of water.
Belongs to the group of selective non-steroidal anti-inflammatory drugs, having analgesic and anti-inflammatory effects. Produced in tablets and solution for the preparation of intramuscular injections.
The product belongs to dietary supplements. The drug is based on glucosamine sulfate and various medicinal plants. Due to its rich composition, the drug has an analgesic and anti-inflammatory effect.
It is a hormone of the glucocorticosteroid group, intended for injections in:
The drug has effective immunosuppressive, anti-inflammatory and antiallergic effects.
Calcium plays an important role in the treatment of arthrosis, since its deficiency negatively affects the health of the joints, which gradually begin to thin out and collapse. This is accompanied by a decrease in the quantity and quality of synovial fluid, which is fraught with destructive processes in the joints.
For this reason, in the treatment of arthrosis, it is important to normalize the disturbed metabolism of the calcium microelement. This can be done by using a complex with biological activity in the form of Osteomed, which contains a calcium salt of organic origin.