Corticosteroid ointments - what is it, names and prices. What are steroidal anti-inflammatory drugs? List of steroid pain medications

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Steroid anti-inflammatory drugs. Classification. Mechanism of action and pharmacological effects.

Steroid anti-inflammatory drugs are created on the basis of glucocorticoids of the natural hormones of the adrenal cortex.

Classification

Natural glucocorticoids: cortisone, hydrocortisone. Synthetic glucocorticoids Non-halogenated: methylprednisolone, prednisolone. Halogenated (fluorinated): betamethasone (diprospan*), dexamethasone, triamcinolone (kenalog*, polcortolone*, triacort*).

Mechanismactionspharmacologicaleffects

Glucocorticoids- Hormones produced by the adrenal cortex. Their secretion is regulated by adrenocorticotropic hormone (ACTH) from the pituitary gland. Glucocorticoids act intracellularly at the level of nuclear structures, interacting with specific glucocorticoid receptors in the cytoplasm of target cells. The resulting hormone-receptor complex undergoes conformational changes, is activated, penetrates into the cell nucleus, where, by binding to DNA, it affects the expression of a number of genes. Influencing the transcription of a wide range of genes, glucocorticoids have a significant impact on carbohydrate, protein, fat, purine metabolism and water-salt balance. By activating gluconeogenesis in the liver through the utilization of amino acids and reducing the uptake of glucose by cells of peripheral tissues, glucocorticoids increase the concentration of glucose in the blood and glycogen in the liver. They inhibit protein biosynthesis and increase its catabolism in muscles, connective tissue and skin, and have an antianabolic effect. With their prolonged use, muscle weakness, osteoporosis, slowing down of regeneration processes, growth retardation in children, redistribution of fat occurs with an increase in its content in the upper half of the body, the concentration of fatty acids and triglycerides increases, and hypercholesterolemia develops. Due to the mineralocorticoid activity, glucocorticoids retain sodium and water and increase the excretion of potassium and calcium.

In medical practice, glucocorticoids are used as highly active anti-inflammatory, anti-allergic, anti-shock and immunosuppressive agents.

Mechanism of anti-inflammatory action. Glucocorticoids are active inhibitors of all phases of the inflammatory response. By stabilizing the membranes of cells and organelles (especially lysosomal ones), they limit the release of proteolytic enzymes from the cell, inhibit the formation of free oxygen radicals and lipid peroxides in membranes, and prevent tissue destruction. By acting on gene expression, they induce the biosynthesis of lipocortins of protein inhibitors of phospholipase A2 in leukocytes and reduce the formation of COX-2 in the focus of inflammation, which limits the production of arachidonic acid from phospholipids of cell membranes and the synthesis of its metabolites of inflammatory mediators (prostanoids, leukotrienes and platelet-activating factor ). Under the influence of glucocorticoids, the number of mast cells that produce hyaluronic acid in the focus of inflammation decreases, small vessels narrow, capillary permeability decreases, and fluid exudation decreases. Glucocorticoids prevent the adhesion of neutrophils and monocytes to the vascular endothelium, limit their penetration into tissues, reduce the activity of macrophages and fibroblasts, inhibit lymphopoiesis, the synthesis of glycosaminoglycans and proteins, and inhibit the proliferation phase.

Given the immunosuppressive effect of glucocorticoids, in case of inflammation of an infectious origin, they should be combined with antimicrobial therapy.

Immunosuppressive effect glucocorticoids is caused by a decrease in the level of circulating lymphocytes and macrophages, a violation of the production and action of a number of interleukins and other cytokines that regulate various phases of the immune response, suppression of the activity of T- and B-lymphocytes, a decrease in the production of immunoglobulins, a decrease in the complement content in the blood, the formation of fixed immune complexes, inhibition formation of a factor that inhibits the migration of macrophages.

Antiallergic action glucocorticoids is due to the suppression of various stages of immunogenesis. They slow down the maturation and reduce the number of circulating basophils, block the synthesis and release from sensitized mast cells and basophils of immediate-type allergy mediators (histamine, heparin, serotonin, etc.) and reduce the sensitivity of effector cells to them, suppress the development of lymphoid and connective tissue, reduce the amount T- and B-lymphocytes and mast cells, inhibit antibody production.

Antishock and antitoxic effect glucocorticoids is due to their participation in the regulation of vascular tone, water-salt balance, as well as an increase in the activity of liver enzymes involved in the processes of biotransformation of endogenous and exogenous substances. They increase the sensitivity of blood vessels to catecholamines and enhance the action of angiotensin II, reduce vascular permeability, retain sodium and water, resulting in an increase in blood plasma volume, hypovolemia decreases, vascular tone normalizes, myocardial contractility improves, and blood pressure rises.

General characteristics of funds

Steroidal anti-inflammatory drugs (SAIDs) are derivatives of glucocorticoid hormones produced by the adrenal glands. They are divided into the following types:

Natural. Synthetic: non-halogenated and halogenated.

The first group includes such drugs as Hydrocortisone and Cortisone. Non-halogenated steroid agents are presented in the form of Methylprednisolone and Prednisolone. Fluorinated - Triamcinolone, Dexamethasone and Betamethasone.

The effect of taking such substances is provided by the impact on the body at the cellular level. By binding to DNA, drugs can have a strong effect on various processes. The main ones include such as:

Water-salt exchange. Protein. Carbohydrate. Zhirov and others.

Among the most pronounced actions of glucocorticoids, the following can be distinguished as antipruritic, antiallergic, and naturally, anti-inflammatory. They produce products for both external and internal use. Very often, various gels, ointments and creams are used to treat skin diseases, and injections are used for joint diseases.

The use of SVP should only be prescribed by a doctor, since self-use can lead to various negative consequences.

Mechanism of action of SPVP

The principle of action of SPVP is based on intracellular action. During the use of such funds, the following processes occur:

When entering the body, substances begin to interact with the receptors of the cytoplasm of cells, penetrating into the nucleus. Due to their action on DNA, some of the genes are influenced, which allows you to change the balance of purines, water, proteins and fats. The mechanism of action includes the process of activating gluconeogenesis, which increases the amount of glucose in the blood and increases the concentration of glycogen in the liver cells. This, in turn, helps to prevent protein biosynthesis and enhance the breakdown of structures located near muscle fibers, connective tissue and skin.

In the presence of an inflammatory process in the body, it includes protection against various pathogenic microflora. If the immune system is weakened, this protection is not enough, which often leads to the destruction of joints, tissues, as well as the development of other pathologies. The affected areas turn red and painful sensations begin to appear.

SPVP relieve pain and eliminate the inflammatory process. According to their chemical structure, they are classified as 17, 11-hydroxycorticosteroids. The first substance of the group that was obtained is a glucocorticoid from the adrenal glands. Now there is a large selection of these substances, both synthetic and natural origin.

Glucocorticoids help to inhibit the process of protein synthesis, while enhancing catabolic reactions in muscle fibers, connective tissue and skin, providing an anti-anabolic effect. If such drugs are used for a long time, muscle weakness, slowdown in regenerative processes, developmental delay, an increase in body fat and other adverse reactions may develop. In this regard, before taking such substances, you should consult a doctor.

The effect of the use of SPVP

The anti-inflammatory effect that steroid drugs provide is due to their ability to be inhibited through lipocortin. They also inhibit the gene that encodes the production of COX-2, which is actively involved in inflammation sites. Glucocorticoids also inhibit prostaglandin activity. They provide an antioxidant effect by slowing down lipid oxidation and keeping cell membranes intact. Thus, there is an obstacle to the spread of the inflammatory process.

The main actions of the SPVP include:

Anti-inflammatory. Glucocorticoids are inhibitors of all inflammation in the body. They contribute to the stabilization of cell membranes, ensure the release of proteolytic enzymes from cells, prevent destructive changes in tissues, and also slow down the formation of free radicals. When a substance enters the body, the number of mast cells in the areas of inflammation decreases, small vessels narrow, and capillary permeability decreases. Immunosuppressive. SPVP reduce the level of circulating lymphocytes and microphages. They disrupt the production and action of interleukins and other cytokines that regulate various immune responses. There is a decrease in the activity of B and T-lymphocytes, a decrease in the production of immunoglobulins and the amount of compliment in the blood composition. Fixed immune complexes are formed, and the formation of factors that inhibit the movement of microphages is inhibited. Antiallergic. This action is provided by the suppression of various stages of immunogenesis. Glucocorticoids slow down the process of formation of circulating basophils, as well as reduce their number and prevent the development of the synthesis of sensitized cells, basophils that contribute to the development of an allergic reaction and reduce the sensitivity of effector cells to them. There is a suppression of the production of connective and lymphatic tissues, as well as inhibition of the formation of antibodies. Antitoxic and antishock. SVPs are involved in ensuring vascular tone, water and salt balance. They improve the activity of liver enzymes that are involved in the process of converting exogenous and endogenous substances. There is an increase in the sensitivity of blood vessels to catecholamines and their permeability decreases. The amount of blood plasma increases, as substances retain sodium and water in the body. This allows you to reduce hypovolemia, improve vascular tone and the process of myocardial contraction. Antiproliferative. This action is associated with a decrease in the migration of monocytes in areas of inflammation and a slowdown in the process of fragmentation of fibroblasts. There is a suppression of the synthesis of mucopolysaccharides, which helps to slow down the binding of plasma protein and water to tissues that have entered the site of inflammation.

Each of the drugs, depending on its type, is able to provide a certain effect. The selection of funds should be done only by a specialist.

Difference between non-steroidal anti-inflammatory drugs and SSAIDs

Steroid and non-steroid drugs are used to treat various health problems. Non-steroidal anti-inflammatory drugs (NSAIDs) are used if the disease has not reached an advanced stage. They are of two types:

Selective. Non-selective.

The first group includes substances that affect the COX-1 and 2 enzymes. The second group includes agents that affect the COX-2 enzyme. The COX-1 enzyme takes an active part in various processes of the body and provides its important functions. He acts constantly. COX-2 is an enzyme that is produced only in the presence of an inflammatory process.

According to their active substance, non-selective NSAIDs are of the following types: Ibuprofen, Diclofenac, Paracetamol. The selective ones include: Meloxicam, Nimesulide, Celecoxib. Non-steroidal anti-inflammatory drugs have the following effect:

Painkiller. Antipyretic. Anti-inflammatory.

These drugs help reduce pain, eliminate fever and inflammation. Unlike glucocorticoids, they do not cause as many negative effects.

Most NSAIDs are prescribed for acute and chronic diseases that occur with severe symptoms in the form of pain and inflammation. Their use is relevant in cases where the disease is not advanced. Most often, they are prescribed for arthritis, osteoarthritis, gout, fever, renal colic, migraine, headache, dysmenorrhea and other disorders.

SVPs also have an effect on COX-2, but have no effect on COX-1. Very often, they are prescribed in combination with NSAIDs. Glucocorticoids are used in various fields of medicine. With their help, joints, dental diseases, skin and others are treated.

Glucocorticoids suppress the immune system, have anti-inflammatory, anti-allergic and anti-shock effects. They are prescribed in cases where the use of NSAIDs has not brought positive results. Also, the difference between these funds in the list of adverse reactions. NSAIDs have fewer.

Indications

Anti-inflammatory steroid drugs relieve the inflammatory process by suppressing immune functions. They provide a decrease in the production of leukocytes and anti-inflammatory enzymes, which makes it possible to achieve relief of foci of inflammation. These drugs are most often prescribed in the presence of the following disorders or diseases:

States of shock. Skin diseases. Systemic connective tissue diseases. Various types of hepatitis. Allergies. Pathology of the joints and muscles. Violations in the work of blood vessels. Inflammatory processes in internal organs and tissues.

Glucocorticoids are often used for rheumatism and rheumatic heart disease, osteochondrosis, diseases of the hematopoietic organs, dermatomyositis, lupus erythematosus and other diseases. With the help of anti-inflammatory steroid drugs, a variety of diseases can be cured. In order for the effect of the funds to be as effective as possible, they are most often administered locally.

SVPs are very powerful drugs, so you should not make a decision about their use on your own. The selection of funds and the determination of the dosage should be handled only by a doctor.

The most popular SPVP

Steroidal anti-inflammatory drugs do a good job of reducing the inflammation process and relieve pain. The tools most commonly used in medical practice include:

Dexamethasone. It is used in inflammations that require the immediate administration of such substances and in various states of shock. The product is sold as an injectable solution. Cortisol. It can be used both inside and intramuscularly, if necessary, to eliminate pain and acute rheumatoid arthritis of the course. Presented as a suspension. Sinalar. Used for skin diseases. Most often, with psoriasis and dermatitis, as well as other lesions of the skin, accompanied by itching. It can be produced both in the form of a gel and an ointment. Bematetasone. Sold in the form of a gel, which is applied to the skin for allergies and inflammation with itching.

New anabolic agents are also now being introduced. They have pronounced effects and are used to treat various diseases. The most popular of them include:

Celeston. It is used for dermatitis, allergic conjunctivitis and inflammation of internal organs. Produced in injectable and tablet form. Mendrol. It is prescribed for severe situations of stress, multiple sclerosis and slow development in children. Sold in tablet form. Urbazon. Used in states of shock. Available in injectable form. Momat. Relieves inflammation and also eliminates itching. Used for various skin diseases. Sold as a cream or ointment. Berlikort. It is prescribed for asthma, acute rhinitis and allergies. Available in tablet form.

Each of the drugs is prescribed by a doctor, taking into account the individual characteristics of the patient, the nature of the course of the disease and its type. Dosage and course of treatment are also determined only by a specialist.

Contraindications and adverse reactions

Steroidal anti-inflammatory drugs are the most powerful in pharmacology, so they should not be taken arbitrarily. Treatment is prescribed by a specialist. The main contraindications include:

Tissue damage of an infectious nature. Diseases caused by bacteria. Risk of bleeding. Taking blood thinners. Significant erosive lesions of the joints and tissues. Weakened immunity. During pregnancy and breastfeeding. Intolerance of an individual nature. In cases of performing three injections of SVP per month.

If the patient has various lesions and diseases of an infectious nature, steroids cannot be used. The active substances that make up the products help to reduce the body's defenses and suppress the immune system. In turn, this does not allow the body to overcome pathogens, which increases the spread of infection.

If the patient is taking blood thinners and there is a risk of bleeding, steroid medications can cause severe bleeding at the injection sites. Such drugs should not be used more than three times a month, as there is a possibility of infection as a result of tissue weakening.

Steroids belong to the group of hormonal drugs, so they can not be used for a long time. This is due to the fact that there is a risk of developing various adverse reactions. The main ones include:

Hypertension. Exacerbation of peptic ulcer. Puffiness. Osteoporosis. Decreased protective functions of the immune system. Increased blood clotting. Masculinization in women. Increase in subcutaneous fat.

In order to avoid such undesirable consequences, the use of anti-inflammatory steroid drugs should last no more than two weeks. It is also advisable to take them with meals.

Prevention of negative reactions

It is not recommended to take anti-inflammatory steroid drugs during gestation and lactation. It is necessary to take into account the list of contraindications in which their intake is completely excluded. There are certain recommendations that can reduce the risk of negative consequences. It includes:

Body weight control. Regular measurement of blood pressure. The study of indicators of sugar levels in the blood and urine. Control of the electrolyte composition of blood plasma. Diagnosis of the gastrointestinal tract and the musculoskeletal system. Ophthalmologist's consultations. Testing for infectious complications.

These measures make it possible to avoid various negative consequences, since they are aimed at studying precisely those indicators that may indicate the presence of changes in the body.

Steroidal anti-inflammatory drugs are very strong substances that should only be used for specific purposes. They cannot be used on their own. The appointment should only be made by a doctor, based on the patient's condition and the type of disease.

Steroidal anti-inflammatory drugs (SAIDs) are derivatives of glucocorticoid hormones produced by the adrenal glands. They are divided into the following types:

Natural.
Synthetic: non-halogenated and halogenated.

Water-salt exchange.
Protein.
Carbohydrate.
Zhirov and others.

The use of SVP should only be prescribed by a doctor, since self-use can lead to various negative consequences.

Mechanism of action of SPVP

The principle of action of SPVP is based on intracellular action. During the use of such funds, the following processes occur:

When entering the body, substances begin to interact with the receptors of the cytoplasm of cells, penetrating into the nucleus. Due to their action on DNA, some of the genes are influenced, which allows you to change the balance of purines, water, proteins and fats.
The mechanism of action includes the process of activating gluconeogenesis, which increases the amount of glucose in the blood and increases the concentration of glycogen in the liver cells. This, in turn, helps to prevent protein biosynthesis and enhance the breakdown of structures located near muscle fibers, connective tissue and skin.

The effect of the use of SPVP

The main actions of the SPVP include:

Anti-inflammatory. Glucocorticoids are inhibitors of all inflammation in the body. They contribute to the stabilization of cell membranes, ensure the release of proteolytic enzymes from cells, prevent destructive changes in tissues, and also slow down the formation of free radicals. When a substance enters the body, the number of mast cells in the areas of inflammation decreases, small vessels narrow, and capillary permeability decreases.
Immunosuppressive. SPVP reduce the level of circulating lymphocytes and microphages. They disrupt the production and action of interleukins and other cytokines that regulate various immune responses. There is a decrease in the activity of B and T-lymphocytes, a decrease in the production of immunoglobulins and the amount of compliment in the blood composition. Fixed immune complexes are formed, and the formation of factors that inhibit the movement of microphages is inhibited.

Antiallergic. This action is provided by the suppression of various stages of immunogenesis. Glucocorticoids slow down the process of formation of circulating basophils, as well as reduce their number and prevent the development of the synthesis of sensitized cells, basophils that contribute to the development of an allergic reaction and reduce the sensitivity of effector cells to them. There is a suppression of the production of connective and lymphatic tissues, as well as inhibition of the formation of antibodies.
Antitoxic and antishock. SVPs are involved in ensuring vascular tone, water and salt balance. They improve the activity of liver enzymes that are involved in the process of converting exogenous and endogenous substances. There is an increase in the sensitivity of blood vessels to catecholamines and their permeability decreases. The amount of blood plasma increases, as substances retain sodium and water in the body. This allows you to reduce hypovolemia, improve vascular tone and the process of myocardial contraction.
Antiproliferative. This action is associated with a decrease in the migration of monocytes in areas of inflammation and a slowdown in the process of fragmentation of fibroblasts. There is a suppression of the synthesis of mucopolysaccharides, which helps to slow down the binding of plasma protein and water to tissues that have entered the site of inflammation.

Each of the drugs, depending on its type, is able to provide a certain effect. The selection of funds should be done only by a specialist.

Difference between non-steroidal anti-inflammatory drugs and SSAIDs

Selective.
Non-selective.

Painkiller.
Antipyretic.
Anti-inflammatory.

These drugs help reduce pain, eliminate fever and inflammation. Unlike glucocorticoids, they do not cause as many negative effects.

Indications

States of shock.
Skin diseases.
Systemic connective tissue diseases.
Various types of hepatitis.
Allergies.
Pathology of the joints and muscles.
Violations in the work of blood vessels.
Inflammatory processes in internal organs and tissues.

SVPs are very powerful drugs, so you should not make a decision about their use on your own. The selection of funds and the determination of the dosage should be handled only by a doctor.

The most popular SPVP

Steroidal anti-inflammatory drugs do a good job of reducing the inflammation process and relieve pain. The tools most commonly used in medical practice include:

Dexamethasone. It is used in inflammations that require the immediate administration of such substances and in various states of shock. The product is sold as an injectable solution.

Cortisol. It can be used both inside and intramuscularly, if necessary, to eliminate pain and acute rheumatoid arthritis of the course. Presented as a suspension.
Sinalar. Used for skin diseases. Most often, with psoriasis and dermatitis, as well as other lesions of the skin, accompanied by itching. It can be produced both in the form of a gel and an ointment.
Bematetasone. Sold in the form of a gel, which is applied to the skin for allergies and inflammation with itching.

New anabolic agents are also now being introduced. They have pronounced effects and are used to treat various diseases. The most popular of them include:

Celeston. It is used for dermatitis, allergic conjunctivitis and inflammation of internal organs. Produced in injectable and tablet form.
Mendrol. It is prescribed for severe situations of stress, multiple sclerosis and slow development in children. Sold in tablet form.
Urbazon. Used in states of shock. Available in injectable form.
Momat. Relieves inflammation and also eliminates itching. Used for various skin diseases. Sold as a cream or ointment.
Berlikort. It is prescribed for asthma, acute rhinitis and allergies. Available in tablet form.

Contraindications and adverse reactions

Steroidal anti-inflammatory drugs are the most powerful in pharmacology, so they should not be taken arbitrarily. Treatment is prescribed by a specialist. The main contraindications include:

Tissue damage of an infectious nature.
Diseases caused by bacteria.
Risk of bleeding.
Taking blood thinners.
Significant erosive lesions of the joints and tissues.
Weakened immunity.
During pregnancy and breastfeeding.
Intolerance of an individual nature.
In cases of performing three injections of SVP per month.

Steroids belong to the group of hormonal drugs, so they can not be used for a long time. This is due to the fact that there is a risk of developing various adverse reactions. The main ones include:

Hypertension.
Exacerbation of peptic ulcer.
Puffiness.
Osteoporosis.
Decreased protective functions of the immune system.
Increased blood clotting.
Masculinization in women.
Increase in subcutaneous fat.

In order to avoid such undesirable consequences, the use of anti-inflammatory steroid drugs should last no more than two weeks. It is also advisable to take them with meals.

Prevention of negative reactions

Body weight control.
Regular measurement of blood pressure.
The study of indicators of sugar levels in the blood and urine.
Control of the electrolyte composition of blood plasma.
Diagnosis of the gastrointestinal tract and the musculoskeletal system.
Ophthalmologist's consultations.
Testing for infectious complications.

These measures make it possible to avoid various negative consequences, since they are aimed at studying precisely those indicators that may indicate the presence of changes in the body.

The hormonal status of the human body is a system that is in dynamic balance. In this state, it is supported by all hormone-producing glands, as well as their target organs. With irrational intervention in this state, the balance is disturbed, which can provoke serious deviations in the work of all organs and systems. We will talk about what hormones exist in the human body, about hormonal preparations and the rules for their use in today's article.

Hormones are biologically active substances of a protein nature, complex in their chemical structure, which are synthesized in the human body and have specific properties.

There are several classifications of human hormones. They are distinguished by their chemical structure, place of synthesis, functions, etc. According to the chemical structure, hormones are divided into catecholamines, thyroid, peptide and steroid. What steroid hormones are and in what preparations they are found will be discussed further.

So, steroid hormones are characterized by the fact that their precursor is cholesterol.

Reference. Cholesterol is a complex, fat-soluble organic substance. It is found in all cell membranes of the human body. Most of it is synthesized by the body in the liver on its own from various organic acids that come with food. A certain proportion of cholesterol enters the body from outside.

It is from cholesterol that all steroid hormones are synthesized. These include estrogens, androgens, mineralocorticoids, and glucocorticoids. Of all classes of steroid hormones, the most pronounced glucocorticosteroids have an anti-inflammatory effect. These are biologically active substances that are synthesized in the adrenal cortex and have a number of important functions. They are part of all hormonal anti-inflammatory drugs.

Differences between NSAIDs and SPVS

Consider what non-steroidal and steroidal anti-inflammatory drugs are and how they differ.

Non-steroidal anti-inflammatory drugs (NSAIDs) are a group of drugs that are synthesized from various organic acids (salicylic, acetic, propionic) and do not contain hormonal components.

Steroidal anti-inflammatory drugs (SPVS) are drugs that contain glucocorticosteroids as the main active ingredients.

Mechanism of action

In response to various injuries, inflammation develops in the human body. This process is characterized by fever, hyperemia (local redness of the inflamed area), pain and swelling. Inflammatory symptoms are caused by the action of so-called inflammatory mediators.

Reference. Inflammatory mediators are biologically active substances that are synthesized either by damaged tissue cells or white blood cells and cause clinical symptoms of inflammation.

These include prostaglandins, leukotrienes, biologically active substances, lysosomal enzymes.

The difference between steroidal anti-inflammatory drugs and non-steroidal anti-inflammatory drugs is that they block the inflammation process at different levels and in different ways.

NSAIDs block the enzyme cyclooxygenase, which helps to stop the synthesis of inflammatory mediators.

Reference. Cyclooxygenase (COX) is an enzyme that is a large protein molecule, its main task is to catalyze the synthesis of inflammatory mediators from arachidonic acid.

Steroid hormones have a different mechanism of action. They have many effects and block the process of inflammation from different sides. Glucocorticosteroids reduce the level of cyclooxygenase, reduce the motor and synthetic activity of monocytes, macrophages, lymphocytes and other cells that are present in the focus of inflammation.

Reference. Monocytes, macrophages and lymphocytes are types of white blood cells (leukocytes). They differ from each other in shape, size and functions. What unites these cells is that they are all responsible for the formation of human cellular immunity and prevent the penetration and spread of foreign substances in the body.

Due to the action of glucocorticoids in tissue cells, the production of the phospholipase enzyme, which is responsible for the synthesis of biologically active substances that contribute to the development of inflammatory reactions, is reduced.

Indications for use

Glucocorticoids have not only an anti-inflammatory effect, but also a number of other useful properties. They have anti-allergic, immunosuppressive, anti-shock and anti-toxic effects on the human body. In this regard, glucocorticoids can be used to relieve various pathological conditions.

The main indications for the use of glucocorticosteroids are acute life-threatening conditions (shock, toxic lesions, acute allergic reactions), acute inflammatory diseases (blood system diseases, infectious mononucleosis, etc.), chronic inflammatory diseases (collagenosis, autoimmune diseases, etc.), conditions after organ and tissue transplantation, adrenal insufficiency.

The anti-shock effect of hormones is associated with their ability to increase blood pressure, vasoconstriction, activation of liver enzymes, and stabilization of the state of cell membranes. All this helps to establish internal balance in the body and remove it from a state of shock.

In acute inflammatory diseases, glucocorticoids reduce the activity of the inflammatory response by reducing the number of inflammatory mediators. By stopping the synthesis of cyclooxygenase, the amount of prostaglandins and leukotrienes decreases, swelling, pain and redness in the focus of inflammation decrease.

Reducing the production of phospholipase by cells also reduces the amount of inflammatory mediators. In addition, glucocorticosteroids help to reduce the cellular response of specific cells, such as lymphocytes, monocytes, macrophages, etc.

In chronic inflammation, these hormones stabilize the cell membranes of leukocytes, which causes a decrease in their reactivity, that is, cells with less activity respond to an irritating agent. This reduces chronic inflammation and stabilizes the condition of a patient with autoimmune diseases.

By stopping the synthesis of inflammatory mediators, steroid drugs have an analgesic effect, but the pain syndrome as such is not considered an indication for the appointment of such drugs.

The use in transplantation of organs and tissues is also justified by reducing the reactivity of leukocytes. A new transplanted tissue or organ is perceived by the body as a foreign agent that must be destroyed. Therefore, as with any ingestion of a “foreign” substance, the mechanisms of inflammation and elimination are activated. Glucocorticoids help reduce inflammation and rejection processes.

Note. Also, glucocorticosteroids are prescribed as a replacement therapy when, for some reason, these hormones are not enough in the body, for example, with congenital underdevelopment of the adrenal glands. In this case, the missing doses are added from outside.

Contraindications

Due to the peculiarities of the effect on the body, glucocorticoids are contraindicated in pregnancy, osteoporosis, peptic ulcer of the stomach and duodenum, in conditions with acquired immunodeficiency, for example, after recent operations, in some acute infectious diseases (syphilis, active forms of tuberculosis, acute endocarditis) .

Since such drugs have a pronounced effect on carbohydrate metabolism, these drugs are contraindicated in diabetes mellitus. Also, individual intolerance to this group of drugs is a contraindication.

Side effects

Side effects of drugs containing glucocorticoids are directly related to the mechanism of their action.

For example, the immunosuppressive effect, which is used as the main one in the treatment of chronic inflammatory diseases, can also act as a side effect. When using glucocorticoids as replacement therapy, one must be prepared for a sharp decrease in the immune status. This will lead to an exacerbation of chronic infections, disturbances in the normal microflora, the appearance of fungal diseases of the skin and mucous membranes.

Glucocorticoids have a significant effect on the metabolism of carbohydrates, fats and proteins in the body. They increase blood sugar levels, promote the redistribution of fat and protein. From the limbs, the fat layer goes to the abdomen, face and neck. Due to the increased destruction of building protein, muscle mass decreases, the muscles of the limbs become thin and flabby. Due to the increase in sugar levels, a condition such as steroid diabetes mellitus can develop.

These hormones also affect the metabolism of electrolytes. With systemic use, complications such as steroid osteoporosis, a decrease in calcium and potassium levels may occur. Steroids help reduce the absorption of calcium ions in the gastrointestinal tract, increase its excretion by the kidneys.

Popular steroid drugs

Here are the most commonly prescribed drugs for this group of patients.

Steroid anti-inflammatory drugs

Steroidal anti-inflammatory drugs include glucocorticoids. For systemic use in inflammatory diseases, drugs are often used, which include prednisolone, dexamethasone, triamcinolone.

This is due to the fact that these substances are absorbed better than others in the gastrointestinal tract, enter the bloodstream faster and have a systemic effect. It is important to understand that the better the drug is absorbed and the more pronounced the systemic effect it has, the stronger the side effects will be.

In the distribution network of pharmacies, these active ingredients are present in the composition of such drugs as Medopred, Decortin, Dexafar, Dexamed, Maxidex, Oftan, Kenalog, Fluorocort, etc. All these drugs belong to the class of prescription drugs and are released only on prescription.

Steroid anti-inflammatory ointments

As a local therapy for allergic skin lesions, drugs are used that are poorly absorbed into the systemic circulation and have only a local anti-inflammatory effect without any side effects.

This group includes fluocinolone, flumethasone. These active ingredients are part of such well-known ointments as Flucinar, Ezacinon, Synaderm, Lorinden, etc.

Anabolic steroid

Anabolic steroids are well known and widely used drugs. Their popularity is associated with the development of power sports, primarily bodybuilding.

It is worth noting that This group of drugs has no anti-inflammatory effect. These drugs in their chemical structure are analogs of testosterone.

Reference. Testosterone is a male sex hormone that belongs to the group of androgens. It is synthesized in the adrenal cortex, in the testes in men and in small amounts in the ovaries in women.

Anabolics have two types of influences on the human body - anabolic and androgenic. The anabolic effect is manifested in a sharp increase in muscle mass, an increase in protein synthesis in the body. That is why these drugs can be used as doping.

Androgenic action is manifested in the appearance or increase in the severity of male sexual characteristics. This is expressed in a coarsening of the voice, an increase in body hair, baldness, short stature.

In women, the use of such drugs can also lead to a violation of the ovarian-menstrual cycle, a decrease in the mammary glands, an increase in the clitoris, and infertility.

This group of drugs includes "Methandienone", "Mesterolone", "Inosine", "Magnesium Orotate", etc.

The main indication for the use of such drugs is testosterone deficiency in the body, which can occur with insufficient development of the testicles in men.

Attention! The use of anabolic steroids as doping is prohibited throughout the Russian Federation and is criminally punishable.

Conclusion

The use of hormonal drugs is widely used in clinical practice for the treatment of various pathological conditions. It is important to understand that the hormonal background is an extremely fragile matter.

With incorrect intervention, the balance can be forever lost, which will lead to a huge number of problems. Therefore, you can take hormonal drugs only as prescribed by a doctor after passing all the necessary examinations. Do not self-medicate. This is dangerous for your health.

For the treatment of joints, various groups of drugs are used. Some are necessary for the relief of pain, others - for the restoration of cartilage tissue, and others - for the removal of the inflammatory process. Anti-inflammatory drugs include steroid and non-steroidal drugs, their difference from each other is what you need to know for the correct prescription of a course of treatment.

Glucocorticosteroids (hormones of the adrenal cortex) began to be used for the treatment of joints more than 50 years ago, when their positive effect on the severity of the articular syndrome, the duration of morning stiffness became known.

The most popular means from the group of steroids in rheumatology are:

Prednisolone (Medopred);
Triamcinolone (Kenakort, Kenalog, Polcortolone, Triamsinolol);
Dexamethasone;
Methylprednisolone (Metipred);
Betamethasone (Celeston, Diprospan, Flosteron).

It should be noted that nonsteroidal hormones are not used in the treatment of joint diseases.

Mechanism of action

The pronounced anti-inflammatory effect of steroid structure drugs is achieved in several ways:

an obstacle to the movement of neutrophils (the main cells of inflammation) from the vessels into the tissues, to the affected area;
a decrease in the permeability of biological membranes, which inhibits the release of proteolytic enzymes;
suppression of the formation of cytokines;
influence on epithelial cells;
stimulation of the formation of lipocortin.

This mechanism of action, which slows down all phases of the inflammatory response, leads to a rapid relief of symptoms and an improvement in the condition of patients.

Indications

All anti-inflammatory steroid drugs have a strict list of indications for prescription. This is due to the fact that hormones have a large number of side effects. Therefore, they are a reserve group in the treatment of joint diseases.

Steroid drugs are prescribed for conditions such as:

high disease activity.
Systemic manifestations of pathology.
Weak effectiveness of non-steroidal anti-inflammatory drugs.
The presence of contraindications to the appointment of NSAIDs that prevent their use.

Side effects

Like any other drugs, steroid hormones have a number of undesirable effects. These include:

dyspeptic symptoms (feeling of nausea, abdominal pain, urge to vomit, bloating, hiccups, loss of appetite, taste perversion);
increase in the pH of gastric contents;
development of myocardial insufficiency, in its presence - aggravation of the condition;
increase in blood pressure numbers;
liver enlargement;
thrombus formation;
obesity;
increased excretion of potassium and calcium, retention of sodium ions;
osteoporosis;
muscle weakness;
skin rashes;
increased sweating;
weakness;
depressive states;
allergic local and systemic reactions;
weakened immunity, reduced body resistance to infections, exacerbation of chronic diseases;
increased blood sugar levels;
deterioration of wound healing;
menstrual irregularities, etc.

Almost all steroids to a greater or lesser extent have the listed side effects. Their number and strength of action depend on the method of administration of the drug, dosage and duration of use.

Contraindications

Anti-inflammatory steroid drugs should be prescribed with caution in the following conditions:

The listed contraindications do not mean that steroid preparations cannot be used. However, comorbidities should always be taken into account when prescribing medications.

Non-steroid drugs (NSAIDs, NSAIDs)

The history of the creation of nonsteroidal drugs goes deep into antiquity. Even our ancestors knew that when the temperature rises, you need to make a decoction of willow tree twigs. Later it turned out that the composition of the willow bark contains the substance salicyl, from which sodium salicylate was later created. And only in the 19th century, salicylic acid, or aspirin, was synthesized from it. It was this medicine that became the first non-steroidal remedy for inflammation.

Pathogenetic mechanism, effects

Non-steroidal anti-inflammatory drugs can inhibit the synthesis of prostaglandins (the main inflammatory mediators) from arachidonic acid. This is possible by blocking the action of the enzyme cyclooxygenase (COX).

It was found that non-steroidal drugs act on 2 types of enzyme: COX-1 and COX-2. The first affects the activity of platelets, the integrity of the lining of the gastrointestinal tract, prostaglandins, and renal blood flow. COX-2 predominantly acts on the inflammatory process.

Non-steroidal drugs that inhibit COX-1 have a large number of undesirable properties, so the use of selective NSAIDs is more preferable.

For therapeutic purposes in traditional medicine, the following properties of non-steroidal anti-inflammatory drugs are used:

Analgesic: drugs well relieve pain of mild to moderate intensity, which is localized in the ligaments, articular surfaces, skeletal muscle fibers.
Antipyretic: acute stages of inflammatory diseases of the joints are often accompanied by an increase in general body temperature. NSAIDs do a good job of reducing it, while not affecting normal temperature.
Anti-inflammatory: The difference between NSAIDs and steroids lies in the strength of the effect. The latter have a different mechanism of action and a more powerful effect on the pathological focus. For the purpose of treating articular manifestations, Phenylbutazone, Diclofenac, Indomethacin are most often used.
Antiaggregatory: more characteristic of aspirin. It is used not only for the treatment of diseases of the joints, but also for concomitant pathology in the form of coronary heart disease.
Immunosuppressive: Non-steroidal anti-inflammatory drugs somewhat suppress the immune system. This is due to a decrease in capillary permeability and a decrease in the possibility of interaction of antigens with antibodies of foreign proteins.

Indications

Unlike steroid drugs, NSAIDs for the treatment of joints are prescribed in the following cases:

the need for long-term medication;
elderly and senile age of patients (more than 65 years);
severe somatic pathologies;
the occurrence of side effects from taking hormonal medications;
peptic ulcer (only for COX-2 inhibitors).

Treatment of almost all joint diseases is associated with the use of non-steroidal anti-inflammatory drugs. Therapeutic courses differ in duration, dosage, method of drug administration.

It is important to remember that NSAIDs do not affect the pathogenesis of rheumatic diseases. The drugs significantly alleviate the condition of patients, relieving pain and stiffness. But they are not able to stop the pathological process, prevent joint deformity or cause remission.

Side effects

The main negative symptoms that are noted when using non-steroidal drugs are gastrointestinal disorders. They manifest themselves in the form of dyspeptic disorders, the development of erosive and ulcerative disorders and perforation of the mucous membranes of the stomach and duodenum. Most of all, side effects are characteristic of COX-1 inhibitors (Aspirin, Ketoprofen, Indomethacin, Ibuprofen, Diclofenac).

Other adverse events include the following:

impoverishment of renal blood flow and renal failure;
analgesic nephropathy;
development of anemia;
bleeding from damaged surfaces of the skin and mucous membranes;
hepatitis;
allergic reactions;
spasm of the muscles of the bronchi;
weakening of labor activity and lengthening of pregnancy.

These side effects of nonsteroidal drugs should be taken into account when choosing a treatment regimen for patients with joint diseases.

Contraindications

NSAIDs should not be prescribed to patients with comorbidities such as:

Ulcers of the gastrointestinal tract, especially in the acute stage of the disease.
A significant decrease in the functional capacity of the kidneys and liver.
Pregnancy.
Cytopenic conditions (anemia, thrombocytopenia).
The presence of an allergic reaction to the components of the drugs.

Differences between steroid and non-steroid drugs, their comparative characteristics

The main differences between the drugs of the two groups in the treatment of joint diseases are as follows:

Pathogenetic mechanism of influence. Unlike NSAIDs, steroid drugs have not only local, but also systemic effects. Their influence is stronger, multi-component.
Application in the treatment of joints. The range of use of non-steroidal drugs is wider, they are used not only in the treatment of inflammatory pathologies (arthritis), but also in pain syndrome associated with osteochondrosis of any localization.
Side effect. The spectrum of adverse events is much wider in steroid hormonal preparations. This is due to the fact that drugs have an affinity for endogenous compounds in the body.
Contraindications. Steroids affect almost every system in the human body. It is impossible to achieve selectivity of action using adrenal hormones. Therefore, many conditions exclude the use of this group of medicines. Selective NSAIDs (COX-2 inhibitors), on the contrary, can affect only the inflammatory component, which significantly expands the therapeutic possibilities of this group of drugs. On the other hand, steroid drugs have a weaker negative effect on the gastric and intestinal mucosa. It is this factor that is often decisive when choosing a medicine.
Features of the course of treatment. As a rule, NSAIDs are the first-line drugs for the treatment of articular syndrome. If the product is chosen correctly, it can be used for a long time. Only in case of insufficient effectiveness, steroid medications are prescribed. They are not used for a long time, they always try to resume taking NSAIDs. It is important to remember that the abolition of steroids can have a detrimental effect on the state of the body, a withdrawal syndrome occurs. This quality is not possessed by nonsteroidal drugs.
Release forms. Steroid and non-steroid drugs are available in the form of ointments, solutions for intramuscular, intravenous, intraarticular administration, gels, suppositories, tablets for oral administration. This allows you to avoid local reactions and choose the right shape for maximum impact on the inflammatory focus.

Steroid and nonsteroidal drugs are necessary for the most effective course of treatment of rheumatic diseases. You can not use them yourself without first consulting with a specialist. Only strict adherence to the proposed treatment regimen can provide permanent relief from articular manifestations and avoid undesirable effects.

This article is for informational purposes only and is not, in any way, a guide to action. If there are inflammations and injuries, you should contact a specialist traumatologist, and not self-medicate.

It should also be noted that this article is purely about sports injuries and inflammation, which are caused by damage from exercise, other cases will not be dealt with.

1. Inflammatory process.

Inflammatory process- a pathological process that has arisen on damage to cellular structures (muscles, joints, bones, ligaments or tendons). Most often in sports, the inflammatory process occurs due to injury, it can be a tear, rupture or damage to a muscle, joint, ligament or tendon.

Symptoms of inflammation:

Redness.
Local rise in temperature.
tissue swelling.
Pain.

Types of inflammation:

Acute inflammation– duration from several minutes to several hours.
subacute inflammation- duration from several days to several weeks.
chronic inflammation- duration from several months to life.

stages of inflammation:

Alturation- cell damage.
Exudation- the exit of fluid and blood cells into cells and tissues from the blood.
Proferation- cell proliferation and tissue growth. At this stage, the integrity of the tissue is restored.

Inflammation must be removed as quickly as possible, a prolonged inflammatory process can lead to degenerative changes (decrease in bone, ligament or other tissue). Therefore, with a prolonged inflammatory process, the following more serious injuries are possible, and the inflammatory process is also accompanied by pain.

Before starting the description of drugs, it should be added, that all anti-inflammatory drugs also have an analgesic effect (pain reliever). Therefore, when taking them, it is necessary to completely remove heavy training so that, against the background of an anesthetic injury, it is not aggravated by an inadequate load.

2. Non-steroidal anti-inflammatory drugs (NSAIDs).

Non-steroidal anti-inflammatory drugs are divided into two types:

non-selective drugs affect the enzyme COX-1 and COX-2.
Selective drugs - affect the COX-2 enzyme.

Enzymes COX-1 and COX-2- Cyclooxygenases (very concise and short description).

COX-1 - The enzyme functions continuously and performs physiologically important functions.
COX-2 - enzyme, begins to function during inflammation.

Conclusion: Selective NSAIDs are more preferable, since they only affect COX-2, actually relieving inflammation, and do not affect COX-1, acting on this enzyme, all side effects appear.

Preparations (according to the active substance):

Non-selective:

Diclofenac - side effects on the stomach.
Paracetamol is very toxic to the liver.
Ibuprofen - side effects on the stomach.

Selective:

Nimesulide.
Celecoxib.
Meloxicam.

The best course of NSAIDs(examples only, consult your doctor before use).

Many specialists allocate drugs that they consider more preferable in a given situation, but almost everyone agrees that it is best suited for sports injuries Nimesulide. Since the drug is best suited for relieving inflammation in muscles, tendons, ligaments and joints.

A course of treatment: From 7-12 days, 200 mg per day for 2 doses, consumed after meals and drink plenty of water.

3. Steroid anti-inflammatory drugs (SPVP).

Almost all SVPs go to glucocoticoids. As well as NSAIDs, they act on the COX-2 enzyme, but at the same time do not affect COX-1 at all. The course of treatment is sometimes combined with NSAIDs.

Preparations:

Cortisone and hydrocortisone- natural glucocorticoids.
Dexamethasone - synthetic analogue of glucocorticoid.
Diprospan- glucocorticoid drug.

A course of treatment SPVP usually lasts from one to two months, this is due to the fact that SPVP is already resorted to in critical situations when NSAIDs have not worked. However, in some cases, the course of treatment may be short, up to several days, when the treatment of SPVS begins immediately after the injury. It should also be remembered that SPVP are most often injected locally, at the site of injury.

How and when to take SSAIDs.

Immediately after injury after some time, the first phase of the inflammatory process (acute inflammation) begins in the damaged area. In some cases, if SVP is administered immediately after injury, inflammation can be stopped already at the first stage of exudation. In this case fit Dexamethosone, since this drug works more quickly and stops working quickly (about 4 hours), thus it will work quickly and will not cause significant harm. In some cases, 1-3 injections of 1 ml of desamethasone are sufficient.

If the injury has already passed subacute or chronic inflammation, most likely it is necessary to use SPVS for a longer time, from three to four weeks. In this case, it is better to take a drug that works for a long time, and there is no need to inject it often, Diprospan is suitable here. Approximately 3-4 injections once a week can completely remove the inflammation.

Type of exchange
1. Protein	1. Antianabolic (inhibition of protein synthesis). 2. Catabolic (protein breakdown) => increase in the concentration of amino acids in the blood and urine (negative nitrogen balance).
2. Carbohydrate	1. Reduced utilization (uptake) of glucose by tissues => increase in the concentration of glucose in the blood. 2. An increase in the amount of glycogen in the liver (activation of gluconeogenesis processes - the synthesis of glucose and glycogen from amino acids and fats).
3. Fatty	Lipolytic (breakdown of adipose tissue => increase in the concentration of triglycerides in the blood).
4. Water-salt	1. Delay in the body of Na + and water. 2. Excretion of K + from the body. 3 Destruction of vitamin D => decreased absorption of Ca2+ ions from the intestine.

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