Non-steroidal anti-inflammatory drugs for the treatment of joints. Non-steroidal anti-inflammatory drugs (NSAIDs) for the treatment of joints. Non-steroidal anti-inflammatory drugs

From this article you will learn: which non-steroidal anti-inflammatory drugs are prescribed for the treatment of joints, what other anti-inflammatory drugs are used. List of pills, classification and review of popular and effective drugs.

Article publication date: 06/22/2019

Article last updated: 11/29/2019

Anti-inflammatory drugs for joint diseases help reduce or stop the inflammatory process, as well as eliminate the symptoms that accompany it (pain, swelling, fever, and others).

The most common and widely used are non-steroidal anti-inflammatory drugs (NSAIDs or NSAIDs). This group includes a large number of medicines with different active substances and mechanism of action. They are united by one thing - there are no hormones (steroids) in the composition of NSAIDs.

NSAIDs - drugs that are prescribed for the treatment of any articular pathologies:

• effectively and quickly relieve the pronounced symptoms of certain diseases of the joints (reactive arthritis, exacerbation of arthrosis);
• long-term use helps to postpone the next exacerbation (with rheumatoid, psoriatic arthritis).

In addition to NSAIDs, corticosteroids with hormones in the composition are used for articular pathologies. They are prescribed in combination with NSAIDs or after a course of NSAID treatment if:

• inflammation and symptoms of the disease are very strong (for example, with rheumatoid arthritis, articular rheumatism);
• manifestations cannot be removed by other drugs.

1 - non-steroidal anti-inflammatory drug Ibuprofen; 2 - glucocorticosteroid Medrol

Anti-inflammatory drugs for the joints are selected and prescribed by the attending physician - a rheumatologist, orthopedist, traumatologist.

Classification of anti-inflammatory drugs for the treatment of joints

NSAIDs

The vast group of drugs under the general name "NSAIDs" includes a large number of drugs that differ from each other in the mechanism of action and active substances.

Classification of non-steroidal anti-inflammatory drugs (NSAIDs):

COX-1 is a cyclooxygenase enzyme (abbreviated as COX-1), which protects the cells of the gastric and intestinal mucosa, COX-2 is a cyclooxygenase enzyme, which is synthesized directly in the foci of inflammation and is responsible for the development of an inflammatory reaction.

Non-selective inhibitors have the same effect on all types of cyclooxygenase, affecting the activity of COX-1 and COX-2. Therefore, against the background of taking non-selective NSAIDs, side effects appear in the form of inflammatory and erosive diseases of the stomach and intestines (gastritis, ulcers).

Corticosteroids

Corticosteroids for the treatment of joints are usually divided into groups according to the duration of the action of the drugs and the effectiveness:

NSAIDs: advantages and disadvantages, prices

General properties of these drugs

Non-steroidal anti-inflammatory drugs have a number of common qualities:

1. Restrain the development of inflammation, affecting the process at the stage of its occurrence (regardless of the causes of origin).
2. In addition to anti-inflammatory, they have antipyretic and analgesic effects.
3. Reduce swelling, aggregation (clumping) of platelets, prevent the formation of blood clots.
4. They inhibit the production of ATP (participates in the processes of energy metabolism), which is necessary for the development of a violent inflammatory reaction.
5. Bioavailable (quickly absorbed, binding to plasma proteins, excreted before 6 or after 6 hours of "work", stay longer in the synovial fluid).

The mechanism of action of NSAIDs is based on the ability of active active substances to suppress the activity of the cyclooxygenase enzyme, which is involved in the synthesis of inflammatory mediators (prostaglandins).

Influencing the amount of COX:

• non-steroidal anti-inflammatory drugs interrupt the chain of chemical transformations;
• reduce the amount of substances responsible for the development of local inflammation, irritation of nerve endings, the appearance of pain, swelling, and an increase in local and general temperature.

These drugs are highly effective drugs:

• analgesic effect occurs within a few hours after ingestion;
• anti-inflammatory - after 1-4 weeks from the start of therapy.

Indications

Indications for the appointment of NSAIDs are:

1. Joint diseases (arthritis, Bechterew's disease, osteoarthritis, osteochondrosis).
2. Injuries and post-traumatic diseases of the joints (traumatic arthritis, arthrosis).
3. Neurological complications of articular pathologies (sciatica, sciatica, lumbago).

NSAIDs are used for pain of any origin (headache, postoperative, dental, post-traumatic) and with an increase in body temperature.

Side effects

Of the side effects of taking NSAIDs, you should keep in mind:

• possible deterioration of the functions of the liver, kidneys, gastrointestinal tract;
• development of allergic reactions (from skin to Quincke's edema);
• coagulation disorder, decrease in the number of blood cells (leukocytes, erythrocytes);
• asthma attacks in patients with chronic bronchitis, asthma.

It is better not to take NSAIDs for patients with acute diseases of the stomach and intestines (with an ulcer, gastritis, colitis), since the likelihood of bleeding is too high.

Contraindications

Non-steroidal anti-inflammatory drugs for joints are not prescribed for:

• intolerance of components;
• pregnancy;
• severe violations of the function of the kidneys, liver;
• leukocytopenia and thrombocytopenia (lack of blood cells).

Choice of drug

Only the attending physician can choose the most effective medicine. Despite the apparent monotony of NSAIDs, one drug from one group may be the best, while another will be completely ineffective. In this case, the selection is made:

1. Prescribing new and canceling non-working medicines.
2. Determining the maximum and maintenance dosage.
3. Evaluating the results of treatment after some time.

When prescribing the drug, the doctor starts from general information about the patient and his disease (diagnosis, presence of concomitant diseases, age, etc.)

General rules for taking NSAIDs

Anti-inflammatory drugs for articular pathologies are prescribed:

• from 1 to 3 times a day (in tablets, in injections);
• 2 to 4 times a day (in the form of ointments);
• ointments, gels and creams are rubbed into the joint (gel and cream - lightly, ointment - until completely absorbed);
• tablet preparations are washed down with water (after meals);
• the general course of treatment for NSAIDs does not exceed 14 days, sometimes the doctor can extend the time to a month or more (with rheumatoid arthritis, maintenance doses are taken for years).

Combining (taking at the same time) several different NSAIDs is not recommended. This combination can cause side effects.

Below in the article is an overview of some popular NSAIDs.

Review of drugs, COX-1 inhibitors

diclofenac

One of the oldest drugs of the group (developed in the 60s of the last century). Since then, it has been successfully used for the treatment of articular pathologies, for pain in the joints.

The active substance is diclofenac. The tool is available in different forms - in the form of a gel, ointment, injection solution, rectal suppositories (candles) and tablets.

It has a pronounced anti-inflammatory, antipyretic effect, is an analgesic - an effective pain reliever. Diclofenac is a reliable, working and inexpensive drug that does not need to be looked for (it is available in all pharmacies).

Drug price:

• for 1% gel (40 g) - from 135 rubles;
• for 2% ointment (30 g) - from 23 rubles;
• for 20 tablets (50 mg each) - from 39 rubles;
• for 10 ampoules (3 ml each) - from 42 rubles.

Indomethacin

The active ingredient in the composition is indomethacin. The drug is produced in the form of rectal suppositories (candles), ointments and tablets. Indomethacin effectively and quickly relieves joint pain, quickly relieves inflammation. A noticeable anti-inflammatory effect occurs on the 5-7th day of continuous use.

It is a good local anesthetic (acts as an anesthetic). In the form of an ointment and gel, it has a pronounced anti-inflammatory, anti-edematous effect, reduces morning stiffness, stiffness of any joints (for example, the knee).

• for 10% ointment (40 g) - from 58 rubles;
• for 30 tablets (25 mg each) - from 12 rubles.

Ibuprofen

The active ingredient in the composition is ibuprofen. The drug is produced in the form of an ointment and gel, in the form of tablets and suppositories. Ibuprofen quickly relieves fever, local temperature (an hour after ingestion), anesthetizes (within a few hours), relieves inflammation a little more slowly (you can count on a pronounced anti-inflammatory effect by the end of 2 weeks of taking the tablets).

• for 5% ointment (25 g) - from 34 rubles;
• for a 5% gel (50 g) - from 92 rubles;
• for a pack of tablets (20 pieces of 200 mg each) - from 16.50 rubles.

Review of drugs, COX-2 inhibitors

Selective inhibitors - this is with a selective action (inhibition of the activity of COX-2, which is responsible for pain, inflammation, fever). As a result, selective anti-inflammatory drugs for joints have far fewer side effects. They do not provoke inflammation, ulceration of the mucous membrane of the stomach and intestines.

Movalis

The active ingredient of the drug is meloxicam, it can be purchased in injections, tablets, in suspension (taken instead of tablets) or in rectal suppositories.

Movalis effectively relieves pain (within a few hours after ingestion), as well as inflammation, swelling, fever (pronounced effect occurs on 3-5 days).

Unlike Diclofenac, Ibuprofen, Indomethacin, does not prolong bleeding time.

• for 3 ampoules (1.5 ml each) - from 591 rubles;
• for 10 tablets (15 mg each) - from 469 rubles.

Highly selective COX-2 inhibitors

The latest drugs that selectively act on COX-2, without affecting COX-1 and all processes associated with this enzyme. Due to this, highly selective NSAIDs are much safer than other drugs in the group - they are not able to provoke the appearance of side effects from the digestive tract.

Celebrex

The active ingredient in Celebrex is celecoxib. In pharmacies, the drug is sold in capsules in a gelatin shell.

It is safe for people with chronic diseases of the gastrointestinal tract (in remission), has a strong analgesic, antipyretic and anti-inflammatory effect (usually a course of treatment of 5-7 days is enough).

In people with cardiovascular pathologies, it can cause edema, while taking it with anticoagulants significantly increases the time of blood clotting.

Price for 10 capsules (200 mg each) - from 350 rubles.

Corticosteroids: indications, effectiveness, features

Corticosteroids are a group of medicines that, among other things, are used to treat joints. The active components in the composition of corticosteroids are hormonal substances (hormones of the adrenal cortex). Thanks to them, drugs have a number of common properties:

1. They quickly relieve severe inflammation, swelling, irritation of nerve endings, pain, and allergic reactions.
2. Stimulate the rapid healing of damaged tissues.
3. Affect metabolism.

The mechanism of action of corticosteroids is based on their participation in numerous chemical reactions and inhibition of the synthesis of prostaglandins (inflammatory mediators responsible for the development of the pathological process).

Indications

Corticosteroids are helpful for:

• acute diseases of the joints (spondyloarthritis, rheumatoid arthritis);
• diseases of the joints that are accompanied by synovitis (trauma, osteoarthritis, gouty arthritis);
• inflammation of the periarticular tissues (periarthritis).

Corticosteroids are not intended for long-term use - they are used to treat joints if other drugs (NSAIDs) are ineffective.

Contraindications

Do not prescribe hormones for:

• arthritis of infectious origin;
• lack of inflammation (arthrosis without synovitis);
• obvious deformation and destruction of the joint;
• aseptic (non-infectious) necrosis of bone tissue;
• drug allergies.

Further treatment with corticosteroid injections does not make sense (ineffective) if 2 previous injections did not give the expected result.

Side effects

Hormones have a whole list of side effects:

1. Change, thinning of tissues (up to rupture).
2. When injected into the joint cavity, a short microcrystalline inflammation occurs (the drug crystallizes and settles on the joint tissue, but dissolves after 6-12 hours).
3. Aseptic necrosis of the bones of the joint.
4. Jumps in blood pressure.
5. Violation of the menstrual cycle.
6. Removal of calcium from the body, osteoporosis, muscle weakness.
7. growth retardation.
8. Depression, nervousness.
9. Slow tissue healing.

Performance and Features

Corticosteroids are incredibly effective for treating joints:

• provide a quick result (anti-inflammatory and analgesic), for example, 1-2 hours after the injection of Hydrocortisone;
• "work" for a long time (1 injection is valid from 1 to 6 weeks);
• effective in 90% of cases (although the effect may be temporary until the effect of the drug wears off).

Features of the use of corticosteroids:

• injections into the capsule are not prescribed in a course (in a row), they are repeated after the expiration of the drug (for example, 8 days after the first injection of Hydrocortisone);
• tablets are taken in courses (starting with the maximum and ending with the maintenance dose);
• hormonal ointments are ineffective and are not used for diseases of the joints.

Corticosteroids are prescribed by the attending physician.

Overview of popular drugs in this group

Metipred

The drug with methylprednisolone in the composition is produced in injections and tablets.

The duration of action is up to 2 weeks, the therapeutic effect is moderate (relieves pain and inflammation of moderate severity).

When injected into the joint capsule, it may precipitate as microcrystals and cause short-term inflammation. Metipred does not affect the structure of tissues, so it is often injected into periarticular tissues.

Price for tablets (4 mg), 30 pcs. - from 170 rubles.

Primary sources of information, scientific materials on the topic

• Joint diseases in the practice of a family doctor, a practical guide. Dzyak GV Sections "Rheumatoid arthritis", "Osteoarthritis".
• Rheumatology. Clinical guidelines. Nasonov L. E. Sections "Rheumatoid arthritis", "Osteoarthritis".
• Internal diseases, Makolkin V.I., Ovcharenko S.I. Sections "Diseases of the joints".
• Non-steroidal anti-inflammatory drugs, prospects for use in medicine. Nasonov L. E. M., Anko, 2000.
• Pharmacotherapy of pain: a rheumatologist's view. Nasonov E. L. Council, 2000, No. 1.
• Local therapy with glucocorticoids. Nasonov E. L., Chichasova N. V., Kovalev V. Yu. Russian Medical Journal, 1999, No. 8.

The inflammatory process in almost all cases accompanies rheumatic pathology, significantly reducing the patient's quality of life. That is why one of the leading directions in the treatment of joint diseases is anti-inflammatory treatment. Several groups of drugs have this effect: non-steroidal anti-inflammatory drugs (NSAIDs), glucocorticoids for systemic and local use, in part, only as part of complex treatment, chondroprotectors.

In this article, we will consider the group of drugs listed first - NSAIDs.

Non-steroidal anti-inflammatory drugs (NSAIDs)

This is a group of drugs whose effects are anti-inflammatory, antipyretic and analgesic. The severity of each of them in different drugs is different. These drugs are called non-steroidal because they differ in structure from hormonal drugs, glucocorticoids. The latter also have a powerful anti-inflammatory effect, but at the same time they have the negative properties of steroid hormones.

Mechanism of action of NSAIDs

The mechanism of action of NSAIDs is non-selective or selective inhibition (inhibition) of varieties of the COX enzyme - cyclooxygenase. COX is found in many tissues of our body and is responsible for the production of various biologically active substances: prostaglandins, prostacyclins, thromboxane and others. Prostaglandins, in turn, are mediators of inflammation, and the more of them, the more pronounced the inflammatory process. NSAIDs, inhibiting COX, reduce the level of prostaglandins in tissues, and the inflammatory process regresses.

Scheme of prescription of NSAIDs

Some NSAIDs have a number of fairly serious side effects, while other drugs in this group are not characterized as such. This is due to the peculiarities of the mechanism of action: the effect of drugs on various types of cyclooxygenase - COX-1, COX-2 and COX-3.

COX-1 in a healthy person is found in almost all organs and tissues, in particular, in the digestive tract and kidneys, where it performs its most important functions. For example, prostaglandins synthesized by COX are actively involved in maintaining the integrity of the gastric and intestinal mucosa, maintaining adequate blood flow in it, reducing the secretion of hydrochloric acid, increasing pH, secretion of phospholipids and mucus, stimulating cell proliferation (multiplication). Drugs that inhibit COX-1 cause a decrease in the level of prostaglandins not only in the focus of inflammation, but throughout the body, which can lead to negative consequences, which will be discussed below.

COX-2, as a rule, is absent in healthy tissues or is found, but in small quantities. Its level rises directly during inflammation and in its very focus. Drugs that selectively inhibit COX-2, although they are often taken systemically, act specifically on the focus, reducing the inflammatory process in it.

COX-3 is also involved in the development of pain and fever, but it has nothing to do with inflammation. Some NSAIDs affect this particular type of enzyme and have little effect on COX-1 and 2. Some authors, however, believe that COX-3, as an independent isoform of the enzyme, does not exist, and it is a variant of COX-1: these questions need to be conducting additional research.

Classification of NSAIDs

There is a chemical classification of non-steroidal anti-inflammatory drugs, based on the structural features of the molecule of the active substance. However, biochemical and pharmacological terms are probably of little interest to a wide range of readers, so we offer you another classification, which is based on the selectivity of COX inhibition. According to her, all NSAIDs are divided into:
1. Non-selective (affect all types of COX, but mainly COX-1):

• Indomethacin;
• Ketoprofen;
• Piroxicam;
• Aspirin;
• Diclofenac;
• Acyclofenac;
• Naproxen;
• Ibuprofen.

2. Non-selective, affecting equally COX-1 and COX-2:

• Lornoxicam.

3. Selective (inhibit COX-2):

• Meloxicam;
• Nimesulide;
• Etodolac;
• Rofecoxib;
• Celecoxib.

Some of the above drugs have practically no anti-inflammatory effect, but have a greater analgesic (Ketorolac) or antipyretic effect (Aspirin, Ibuprofen), so we will not talk about these drugs in this article. Let's talk about those NSAIDs, the anti-inflammatory effect of which is most pronounced.

Briefly about pharmacokinetics

Non-steroidal anti-inflammatory drugs are used orally or intramuscularly.
When taken orally, they are well absorbed in the digestive tract, their bioavailability is about 70-100%. They are better absorbed in an acidic environment, and a shift in the pH of the stomach to the alkaline side slows down absorption. The maximum concentration of the active substance in the blood is determined 1-2 hours after taking the drug.

When administered intramuscularly, the drug binds to blood proteins by 90-99%, forming functionally active complexes.

They penetrate well into organs and tissues, especially into the focus of inflammation and synovial fluid (located in the joint cavity). NSAIDs are excreted from the body in the urine. The elimination half-life varies widely depending on the drug.

Contraindications to the use of NSAIDs

Preparations of this group are undesirable for use in the following conditions:

• individual hypersensitivity to components;
• , as well as other ulcerative lesions of the digestive tract;
• leuko- and thrombopenia;
• heavy and;
• pregnancy.

Main side effects of NSAIDs

These are:

• ulcerogenic effect (the ability of drugs of this group to provoke the development of the gastrointestinal tract);
• dyspeptic disorders (discomfort in the stomach, and others);
• bronchospasm;
• toxic effects on the kidneys (violation of their function, increased blood pressure, nephropathy);
• toxic effects on the liver (increased activity in the blood of hepatic transaminases);
• toxic effects on the blood (decrease in the number of formed elements up to aplastic anemia, manifested);
• prolongation of pregnancy;
• (skin rash, anaphylaxis).

Features of NSAID therapy

Since the drugs of this group, to a greater or lesser extent, have a damaging effect on the gastric mucosa, most of them must be taken without fail after a meal, drinking plenty of water, and, preferably, with the parallel use of drugs to maintain the gastrointestinal tract. As a rule, proton pump inhibitors act in this role: Omeprazole, Rabeprazole and others.

Treatment with NSAIDs should be carried out for the shortest possible time and at the lowest effective doses.

Persons with impaired renal function, as well as elderly patients, as a rule, are prescribed a dose below the average therapeutic dose, since the processes in these categories of patients are slowed down: the active substance both has an effect and is excreted for a longer period.
Consider the individual drugs of the NSAID group in more detail.

Indomethacin (Indomethacin, Metindol)

Release form - tablets, capsules.

It has a pronounced anti-inflammatory, analgesic and antipyretic effect. Inhibits aggregation (sticking together) of platelets. The maximum concentration in the blood is determined 2 hours after ingestion, the half-life is 4-11 hours.

Assign, as a rule, inside 25-50 mg 2-3 times a day.

The side effects listed above are quite pronounced for this drug, therefore, at present it is used relatively rarely, giving way to other, safer drugs in this respect.

Diclofenac (Almiral, Voltaren, Diklak, Dicloberl, Naklofen, Olfen and others)

Release form - tablets, capsules, injection, suppositories, gel.

It has a pronounced anti-inflammatory, analgesic and antipyretic effect. Rapidly and completely absorbed in the gastrointestinal tract. The maximum concentration of the active substance in the blood is reached after 20-60 minutes. Almost 100% absorbed with blood proteins and transported throughout the body. The maximum concentration of the drug in the synovial fluid is determined after 3-4 hours, the half-life of it from it is 3-6 hours, from the blood plasma - 1-2 hours. Excreted in urine, bile and feces.

As a rule, the recommended adult dose of diclofenac is 50-75 mg 2-3 times a day by mouth. The maximum daily dose is 300 mg. The retard form, equal to 100 g of the drug in one tablet (capsule), is taken once a day. With intramuscular injection, a single dose is 75 mg, the frequency of administration is 1-2 times a day. The drug in the form of a gel is applied in a thin layer on the skin in the area of ​​​​inflammation, the frequency of application is 2-3 times a day.

Etodolak (Etol fort)

Release form - capsules of 400 mg.

The anti-inflammatory, antipyretic and analgesic properties of this drug are also quite pronounced. It has moderate selectivity - it acts mainly on COX-2 in the focus of inflammation.

Rapidly absorbed from the gastrointestinal tract when taken orally. Bioavailability does not depend on food intake and antacids. The maximum concentration of the active substance in the blood is determined after 60 minutes. 95% binds to blood proteins. The plasma half-life is 7 hours. It is excreted from the body mainly with urine.

It is used for emergency or long-term therapy of rheumatological pathology:, as well as in the case of pain syndrome of any etiology.
It is recommended to take the drug 400 mg 1-3 times a day after meals. If prolonged therapy is necessary, the dose of the drug should be adjusted once every 2-3 weeks.

Contraindications are standard. Side effects are similar to those of other NSAIDs, however, due to the relative selectivity of the drug, they appear less frequently and are less pronounced.
Reduces the effect of some antihypertensive drugs, in particular ACE inhibitors.

Aceclofenac (Aertal, Diclotol, Zerodol)

Available in the form of tablets of 100 mg.

A worthy analogue of diclofenac with a similar anti-inflammatory and analgesic effect.
After oral administration, it is rapidly and almost 100% absorbed by the gastric mucosa. With the simultaneous intake of food, the rate of absorption slows down, but its degree remains the same. It binds to plasma proteins almost completely, spreading throughout the body in this form. The concentration of the drug in the synovial fluid is quite high: it reaches 60% of its concentration in the blood. The average elimination half-life is 4-4.5 hours. It is excreted mainly by the kidneys.

Of the side effects, dyspepsia, increased activity of hepatic transaminases, dizziness should be noted: these symptoms are quite common, in 1-10 cases out of 100. Other adverse reactions are much less common, in particular, in less than one patient per 10,000.

It is possible to reduce the likelihood of side effects by prescribing the minimum effective dose to the patient as soon as possible.

It is not recommended to take aceclofenac during pregnancy and lactation.
Reduces the antihypertensive effect of antihypertensive drugs.

Piroxicam (Piroxicam, Fedin-20)

Release form - tablets of 10 mg.

In addition to anti-inflammatory, analgesic and antipyretic effects, it also has an antiplatelet effect.

Well absorbed in the gastrointestinal tract. Simultaneous ingestion of food slows down the rate of absorption, but does not affect the degree of its effect. The maximum concentration in the blood is observed after 3-5 hours. The concentration in the blood is much higher with intramuscular administration of the drug than after taking it orally. 40-50% penetrates into the synovial fluid, found in breast milk. Undergoes a number of changes in the liver. Excreted with urine and feces. The half-life is 24-50 hours.

The analgesic effect is manifested within half an hour after taking the pill and persists for a day.

Dosages of the drug vary depending on the disease and range from 10 to 40 mg per day in one or more doses.

Contraindications and side effects are standard.

Tenoxicam (Texamen-L)

Release form - powder for solution for injection.

Apply intramuscularly at 2 ml (20 mg of the drug) per day. In acute - 40 mg 1 time per day for 5 days in a row at the same time.

Enhances the effects of indirect anticoagulants.

Lornoxicam (Xefocam, Larfix, Lorakam)

Release form - tablets of 4 and 8 mg, powder for solution for injection containing 8 mg of the drug.

The recommended oral dose is 8-16 mg per day for 2-3 times. The tablet should be taken before meals with plenty of water.

Intramuscularly or intravenously administered 8 mg at a time. Multiplicity of injections per day: 1-2 times. The solution for injection must be prepared immediately before use. The maximum daily dose is 16 mg.
Elderly patients do not need to reduce the dosage of lornoxicam, however, due to the likelihood of adverse reactions from the gastrointestinal tract, persons with any gastroenterological pathology should take it with caution.

Meloxicam (Movalis, Melbek, Revmoxicam, Recox, Melox and others)

Release form - tablets of 7.5 and 15 mg, injection of 2 ml in an ampoule containing 15 mg of the active substance, rectal suppositories, also containing 7.5 and 15 mg of Meloxicam.

Selective COX-2 inhibitor. Less often than other drugs of the NSAID group, it causes side effects in the form of kidney damage and gastropathy.

As a rule, in the first few days of treatment, the drug is used parenterally. 1-2 ml of the solution is injected deep into the muscle. When the acute inflammatory process subsides a little, the patient is transferred to the tablet form of meloxicam. Inside, it is used regardless of food intake, 7.5 mg 1-2 times a day.

Celecoxib (Celebrex, Revmoxib, Zycel, Flogoxib)

Release form - capsules of 100 and 200 mg of the drug.

A specific COX-2 inhibitor with a pronounced anti-inflammatory and analgesic effect. When used in therapeutic doses, it practically does not have a negative effect on the mucosa of the gastrointestinal tract, since it has a very low degree of affinity for COX-1, therefore, it does not cause a violation of the synthesis of constitutional prostaglandins.

As a rule, celecoxib is taken at a dosage of 100-200 mg per day in 1-2 doses. The maximum daily dose is 400 mg.

Side effects are rare. In the case of long-term use of the drug in a high dosage, ulceration of the mucous membrane of the digestive tract, gastrointestinal bleeding, agranulocytosis and.

Rofecoxib (Denebol)

The release form is a solution for injection in 1 ml ampoules containing 25 mg of the active substance, tablets.

Highly selective COX-2 inhibitor with pronounced anti-inflammatory, analgesic and antipyretic properties. Virtually no effect on the mucous membrane of the gastrointestinal tract and kidney tissue.

Be wary appoint women in the 1st and 2nd trimesters of pregnancy, during lactation, persons suffering or severe.

The risk of developing side effects from the gastrointestinal tract increases when taking high doses of the drug for a long time, as well as in elderly patients.

Etoricoxib (Arcoxia, Exinef)

Release form - tablets of 60 mg, 90 mg and 120 mg.

Selective COX-2 inhibitor. It does not affect the synthesis of gastric prostaglandins, it does not affect the function of platelets.

The drug is taken orally, regardless of the meal. The recommended dose directly depends on the severity of the disease and varies between 30-120 mg per day in 1 dose. Elderly patients do not need to adjust the dosage.

Side effects are extremely rare. As a rule, they are noted by patients taking etoricoxib for 1 year or more (for serious rheumatic diseases). The range of adverse reactions that occur in this case is extremely wide.

Nimesulide (Nimegesic, Nimesil, Nimid, Aponil, Nimesin, Remesulide and others)

Release form - tablets of 100 mg, granules for suspension for oral administration in a sachet containing 1 dose of the drug - 100 mg each, gel in a tube.

A highly selective COX-2 inhibitor with a pronounced anti-inflammatory, analgesic and antipyretic effect.

Take the drug inside 100 mg twice a day, after meals. The duration of treatment is determined individually. The gel is applied to the affected area, gently rubbing into the skin. Multiplicity of application - 3-4 times a day.

When prescribing Nimesulide to elderly patients, dose adjustment of the drug is not required. The dose should be reduced in case of severe impairment of the patient's liver and kidney function. May have a hepatotoxic effect, inhibiting liver function.

During pregnancy, especially in the 3rd trimester, it is strongly not recommended to take nimesulide. During lactation, the drug is also contraindicated.

Nabumeton (Synmeton)

Release form - tablets of 500 and 750 mg.

Non-selective COX inhibitor.

A single dose for an adult patient is 500-750-1000 mg during or after a meal. In especially severe cases, the dose may be increased to 2 grams per day.

Side effects and contraindications are similar to those of other non-selective NSAIDs.
It is not recommended to take during pregnancy and lactation.

Combined non-steroidal anti-inflammatory drugs

There are drugs containing two or more active substances from the NSAID group, or NSAIDs in combination with vitamins or other drugs. The main ones are listed below.

• Dolaren. Contains 50 mg diclofenac sodium and 500 mg paracetamol. In this preparation, the pronounced anti-inflammatory effect of diclofenac is combined with the bright analgesic effect of paracetamol. Take the drug inside 1 tablet 2-3 times a day after meals. The maximum daily dose is 3 tablets.
• Neurodiclovitis. Capsules containing 50 mg of diclofenac, vitamin B1 and B6, and 0.25 mg of vitamin B12. Here, the analgesic and anti-inflammatory effect of diclofenac is enhanced by B vitamins, which improve metabolism in the nervous tissue. The recommended dose of the drug is 1-3 capsules per day in 1-3 doses. Take the drug after meals with plenty of fluids.
• Olfen-75, produced in the form of a solution for injection, in addition to diclofenac in an amount of 75 mg, also contains 20 mg of lidocaine: due to the presence of the latter in the solution, injections of the drug become less painful for the patient.
• Fanigan. Its composition is similar to that of Dolaren: 50 mg diclofenac sodium and 500 mg paracetamol. It is recommended to take 1 tablet 2-3 times a day.
• Flamidez. Very interesting, different drug. In addition to 50 mg of diclofenac and 500 mg of paracetamol, it also contains 15 mg of serratiopeptidase, which is a proteolytic enzyme and has a fibrinolytic, anti-inflammatory and anti-edematous effect. Available in the form of tablets and gel for topical use. The tablet is taken orally, after a meal, with a glass of water. As a rule, appoint 1 tablet 1-2 times a day. The maximum daily dose is 3 tablets. The gel is used externally, applying it to the affected area of ​​the skin 3-4 times a day.
• Maxigesic. A drug similar in composition and action to Flamidez, described above. The difference lies in the manufacturing company.
• Diplo-P-Pharmeks. The composition of these tablets is similar to the composition of Dolaren. The dosages are the same.
• Dolar. Same.
• Dolex. Same.
• Oksalgin-DP. Same.
• Cinepar. Same.
• Diclocaine. Like Olfen-75, it contains diclofenac sodium and lidocaine, but both active ingredients are in half the dosage. Accordingly, it is weaker in action.
• Dolaren gel. Contains diclofenac sodium, menthol, linseed oil and methyl salicylate. All these components to some extent have an anti-inflammatory effect and potentiate the effects of each other. The gel is applied to the affected areas of the skin 3-4 times a day.
• Nimid forte. Tablets containing 100 mg of nimesulide and 2 mg of tizanidine. This drug successfully combines the anti-inflammatory and analgesic effects of nimesulide with the muscle relaxant (muscle relaxing) effect of tizanidine. It is used for acute pain caused by spasm of skeletal muscles (popularly - with infringement of the roots). Take the drug inside after eating, drinking plenty of fluids. The recommended dose is 2 tablets per day in 2 divided doses. The maximum duration of treatment is 2 weeks.
• Nizalid. Like nimid forte, it contains nimesulide and tizanidine in similar dosages. The recommended doses are the same.
• Alit. Soluble tablets containing 100 mg of nimesulide and 20 mg of dicycloverine, which is a muscle relaxant. It is taken orally after a meal with a glass of liquid. It is recommended to take 1 tablet 2 times a day for no longer than 5 days.
• Nanogan. The composition of this drug and the recommended dosages are similar to those of the drug Alit described above.
• Oksigan. Same.

Although arthrosis is a degenerative-dystrophic disease, it often causes inflammation in the articular and periarticular structures. Non-steroidal anti-inflammatory drugs have:

• painkiller;
• anti-inflammatory;
• antipyretic action.

The widespread use of "symptomatic" agents is due to their high efficiency. NSAIDs quickly reduce or completely relieve even severe pain. After their application, inflammatory processes fade.

The principle of action of NSAIDs is based on a violation of the synthesis of pain mediators - prostaglandins. Pain mediators are chemical substances that are formed in the tissue when it is damaged. The production of prostaglandins in the human body is controlled by the enzyme cyclooxygenase (COX). The COX enzyme is involved in the conversion of arachidonic acid to prostaglandins.

The disadvantage of medicines is their negative effect on the mucous membrane of the stomach and duodenum. Patients who are often forced to take NSAIDs suffer from erosive and ulcerative lesions of the gastroduodenal zone (gastropathy). Against the background of relief of symptoms of arthrosis, belching, heartburn, nausea, vomiting and pain in the stomach occur. Under the action of NSAIDs, an ulcer of the stomach or duodenum appears.

The progression of the disease of the digestive tract can lead to:

• bleeding;
• penetration (penetration into nearby organs);
• perforation (breakthrough into the abdominal cavity) of ulcers;
• stenosis (narrowing) of the duodenum and stomach.

Traditional NSAIDs inhibit the activity of chondroblasts and chondrocytes (cartilage cells), reduce the synthesis of collagen and hyaluronic acid, contribute to the premature death of chondrocytes and increase cartilage degeneration. With their regular use, arthrosis progresses.

Non-steroidal anti-inflammatory drugs are used to treat large and small joints, as well as ligaments. The disease is accompanied by swelling, pain and hyperthermia. At the same time, prostaglandins are formed in the body - substances that activate the production of hormones in the blood. As a result of the influence on the vessels, the body temperature rises, and inflammatory reactions intensify, which leads to arthritis, osteochondrosis and other unpleasant diseases.

The enzyme cyclooxygenase (COX) is blocked by the non-hormonal action of NSAIDs. Swelling and redness decrease, the temperature returns to normal, inflammation subsides.

General contraindications

Anti-inflammatory non-steroidal drugs for the joints should not be taken if the patient:

Take only under medical supervision for the following disorders:

• arterial hypertension;
• diabetes;
• mental disorders;
• age over 60 years.

The following contraindications to the treatment of joints with non-steroidal anti-inflammatory drugs are distinguished:

• Excessive sensitivity to the drug;
• Diseases of the digestive tract (especially when using NSAIDs inside);
• Hematopoietic disorders, tendency to bleeding;
• Severe pathologies of internal organs, heart, blood vessels;
• Childhood;
• Pregnancy and breastfeeding.

Any anti-inflammatory drug prescribed by a doctor should be used with caution in asthma, diseases of the genitourinary system, in old age and after surgery.

Non-steroidal anti-inflammatory drugs are relatively safe drugs. But they also have some side effects:

• impair kidney function;
• adversely affect the activity of the gastrointestinal tract;
• may contribute to the development of heart or vascular disease;
• can cause rash, nausea, diarrhea;
• can cause miscarriage if there is a pregnancy for up to 20 weeks.

People who have bronchial asthma are contraindicated in these drugs.

Take on an independent guide to medicines is not worth it. Contacting a specialist will help you understand the methods and rules of treatment. To do this, you need to prepare all statements about previous or concomitant diseases and take tests so that the doctor chooses the right treatment.

Tablets are taken immediately after meals with half a glass of water or low-fat milk to assimilate and protect the gastrointestinal tract from harmful effects. In parallel, bifidobacteria should be taken.

If long-term use is planned, then start with a minimum dose, gradually increasing the amount.

Each clinical and pharmacological group of analgesics has its own contraindications. For example, glucocorticosteroids are prohibited for use in bone resorption, osteoporosis. But there are contraindications common to all painkillers. These are severe pathologies of the gastrointestinal tract, liver, kidneys, hematopoietic disorders, pregnancy and lactation, children's age. Preparations for external use should not be applied to the skin if there are microtraumas on it - scratches, cuts, abrasions, burns.

Characteristics and classification of NSAIDs

Non-steroidal anti-inflammatory drugs (NSAIDs) belong to the blockers of cyclooxygenase, a group of enzymes responsible for the development of symptoms of pain and inflammation. Medications have a pronounced analgesic and anti-inflammatory effect, but, unlike glucocorticoids, they have fewer side effects.

The following groups of NSAIDs are distinguished. By chemical composition:

• Acidic - the main active ingredient are derivatives of organic acids (salicylic, indolacetic, pheniacetic, propionic);
• Non-acidic - alkanones or sulfonamides are used as the active ingredient.

According to the mechanism of action:

• Non-selective - inhibit all types of cyclooxygenase;
• Selective - selectively inhibit only cyclooxygenase-2, thereby reducing the likelihood of developing pathologies from the digestive organs.

Release form:

• Preparations for oral administration (tablets, granules, capsules);
• Solutions for intramuscular injections;
• Medicines for external application.

The new generation of non-steroidal anti-inflammatory drugs for joints cause fewer side effects, but they are the same in terms of anti-inflammatory power as the representatives of the previous generation.

Their relative safety is due to the fact that these drugs selectively, that is, selectively inhibit type 2 cyclooxygenase. This distinguishes them from the first generation drugs, which equally block COX-1 and COX-2, cause side effects from the organs of the gastrointestinal tract.

Another advantage of new generation non-steroidal anti-inflammatory drugs for joints is that they do not have an antithrombotic effect and do not affect blood composition.

New generation non-steroidal drugs have a drawback - they increase the likelihood of myocardial infarction, heart failure and hemorrhagic stroke.

When assessing the benefit-risk ratio, selective COX-2 inhibitors for target patients (without a predisposition to cardiovascular diseases) have more benefit than risk.

The new generation includes agents for the treatment of knees, hip, elbow and other joints with the following active ingredients:

Scientists have improved first-generation non-steroidal anti-inflammatory drugs - they came up with "retard" tablets (from the English slowdown, delay), which reduce the likelihood of side effects. The essence of retard tablets is that the active substance is released more slowly and is processed. It is enough to drink one tablet per day to stably maintain the amount of the active substance in the blood.

Representatives of innovative anti-inflammatory drugs "retard":

1. Diclofenac Retard Obolenskoye, Dicloberl Retard;
2. Metindol Retard, Indomethacin Retard.

When creating a new generation of NSAIDs, special attention was paid to reducing the harmful effects on the mucous membrane of the gastroduodenal zone. During the research, isoforms of the COX enzyme were found. The action of traditional NSAIDs was based on blocking the isoforms of COX - 1 and COX - 2. And if the inhibition of COX - 2 had an analgesic and anti-inflammatory effect, then the suppression of COX - 1 caused undesirable effects.

Understanding the role of COX enzyme isoforms led to the discovery of a new generation of NSAIDs. To neutralize the negative qualities of NSAIDs, drugs were created that selectively affect only the COX-2 enzyme. They are called selective COX-2 inhibitors.

Clinical studies have confirmed the low gastrointestinal toxicity of new drugs. Although the risk of developing gastropathy has not disappeared, the frequency of its occurrence has decreased significantly.

New generation NSAIDs for cervical osteochondrosis and its other types are divided into predominantly selective COX-2 inhibitors and specific (highly selective). Predominantly selective drugs are characterized by high selectivity for COX - 2 and low selectivity for COX - 1. Highly selective drugs inhibit only COX - 2.

Although at first glance, highly selective drugs for osteochondrosis are safer, data from clinical studies indicate the opposite. Both isoforms are involved in the development of pain syndrome and inflammatory response. Therefore, the predominant inhibition of COX - 2 allows you to achieve an excellent therapeutic result with minor adverse reactions.

With a significant suppression of only COX-2, additional undesirable consequences arise. The highly selective non-steroidal anti-inflammatory drugs used in arthrosis negatively affect ovulation and the synthesis of prostacyclin (prevents the formation of blood clots).

Selective COX-2 inhibitors are divided into 3 groups of drugs:

1. Sulfonanilide derivatives.
2. representatives of coxibs.
3. Oxycam derivatives.

NSAIDs of the new generation do not exceed the effectiveness of classic drugs. However, they are safer, especially for people suffering from diseases of the gastrointestinal tract.

NSAIDs of the new generation have a positive effect on cartilage, helping to stop the development of arthrosis and restore the functioning of the joint. They force chondrocytes to produce:

• intercellular substance of cartilage;
• glycosaminoglycans (substances that form the matrix of cartilage);
• collagen.

These substances are necessary for the full functioning of cartilage tissue.

At the same time, selective NSAIDs can increase the risk of myocardial infarction, heart failure and stroke.

Selective inhibition of COX-2 can lead to fluid retention in the body, increased blood pressure and exacerbation of heart failure.

It is worth noting that COX is divided into two types. The first produces prostaglandin, which protects the lining of the stomach and intestines from damage. And the second connects prostaglandins that increase the temperature.

Medical technology does not stand still. Every day, hundreds of scientists are trying to develop the latest pills and modernize the time-tested. Non-steroidal anti-inflammatory drugs have not been spared either. New generation drugs act more selectively and thoroughly suppress inflammation. The most important thing here is the absence of a serious effect on the gastrointestinal tract and cartilage tissue.

Among the useful "drugs", Movalis with the active ingredient in the form of meloxicams became the most effective. With arthrosis, a real lifesaver. Long-term use has practically no effect on the work of the stomach and intestines. Analogues work in the same area - Melbek, Mesipol, Mirloks.

The drug Ksefokam has the ability to stretch the effect of the panacea, so that patients do not feel pain for about twelve hours. Most importantly, Ksefokam is not addictive, and the ability to relieve pain is comparable to morphine. However, the high cost does not allow everyone to purchase the drug in the first-aid kit. Produced by prescription.

The antioxidant Nimesulide blocks the action of substances that break down collagens and cartilage. Arthrosis of the joints is treatable, the pain becomes dull, the inflammation disappears. Sold in granules for solution, tablets, in the form of a gel.

Celecoxib was originally called Celebrex. Release form - capsules 200 and 100 mg. A pronounced fight against arthrosis arthritis does not affect the functioning of the gastrointestinal tract, the mucous membrane remains normal.

Etoricoxib is sold under the brand name Arcoxia. Reception up to 150 mg per day does not affect the functioning of the intestines and stomach. The average dose for arthrosis is approximately 30-60 mg per day.

The cost of medicines varies. On the advice of a doctor, the patient can buy a more expensive drug or its analogue, in accordance with contraindications and side effects. Means stop unbearable pain and eliminate inflammation. After taking them, another treatment should be prescribed.

We invite you to familiarize yourself with: Foot sprain treatment causes symptoms what to do with sprain

Indications for the use of NSAIDs for the treatment of joints

It is known from history that the first injections were made in the middle of the 17th century. How and in what way is not clear, since syringes appeared a century later, in 1853. Since then, injections into the knee joint have been the best way to deliver drugs to the diseased organ. Analogues of modern disposable plastic syringes were patented in America in 1956. The novelty has greatly facilitated the work of medical personnel, and the cases of transmission of infection through injections from one patient to another have decreased.

Medicines can enter the human body in several ways:

• directly into the joint (intra-articular injections);
• intravenously;
• intra-arterially;
• intramuscularly;
• subcutaneously.

There are two types of intravenous infusions: jet and drip. Jet syringes with a capacity of 10-20 ml are injected with a small amount of drugs. Large volumes of liquid are infused by drip using disposable systems (droppers). Intra-arterial injections are necessary for large blood loss that occurs with open fractures of the joints with rupture of tissues and blood vessels.

The length of the medical needle can reach 90 mm, diameter - 2 mm

Intramuscular injections are the most common. They are made in the outer upper quadrant of the buttocks. The place of injection of subcutaneous injections is the upper part of the forearm or the anterolateral region of the thigh. For each type of infusion, a needle of the appropriate length and diameter (section) is taken.

For intra-articular injections, syringes with a capacity of 2-5 ml are used. The smaller the cross section of the needle, the more painless its introduction will be. Suspensions (suspensions) are poorly soluble. They can clog the lumen of the needle and make it difficult to administer the medicine. Suspensions require large diameter needles from -1.1 to 2 mm.

Diseases and injections

Indications for injections in the joint area are a number of diseases, the classification of which is as follows:

• inflammatory - arthritis, tendovaginitis, synovitis, bursitis, Reiter's disease, enthesitis;
• degenerative-dystrophic - osteoarthritis, gonarthrosis;
• traumatic - fractures of the joint open or closed, ruptures, tears, sprains;
• arthralgia is a pain syndrome that occurs in response to irritation of the neuroreceptors of the joint with various reagents - allergens, salt crystals, osteophytes (bone growths), etc.

Preparations

One of the reasons for the use of injections for knee joints is the presence of severe, sometimes unbearable pain, swelling, hyperthermia (heat), and inflammation. For their relief, the following drugs are used:

• glucocorticosteroids - synthetic analogs of adrenal hormones;
• anti-inflammatory non-steroidal (non-hormonal) drugs;
• antimicrobials or antibiotics;
• chondroprotectors;
• vitamins.

Diprospan is a long acting corticosteroid.

The action of drugs with the use of injections is aimed at relieving pain, restoring joint mobility, and reducing the patient's disability.

Painkillers for joint pain may be needed at any time. Joint diseases are often accompanied by severe pain. She can overtake suddenly. Often the pain in diseases of the musculoskeletal system is unbearable. It literally immobilizes a person. Back pain can “shoot” at the slightest movement with such force that a person cannot even straighten up. Help in such cases is urgently needed. Regardless of the cause of the pain, immediate effective pain relief is required.

These are the most popular painkillers in the world. They quickly and effectively relieve various types of pain. In addition to pain relief, these drugs have anti-inflammatory and antipyretic effects.

Metamizole is also known as analgin. It has a mild anti-inflammatory and antispasmodic effect. But better than some other analgesics relieves pain and fever. Metamizole injections give faster and stronger pain relief. The duration of action reaches 5-6 hours with mild pain.

Ketorolac (ketanov, ketoprofen) is one of the most powerful painkillers among analgesics. Even pills perfectly relieve very severe pain. The duration of action is about 6-8 hours. If the pain is very severe, the pills will have to be taken more often.

Dexketoprofen (Dexalgin) has a weak anti-inflammatory effect. But it's a good pain reliever and relieves fever. Begins to act 30 minutes after taking the pill inside. The action lasts 4-6 hours.

Lornoxicam (xefocam, larfix) differs from other analgesics in its pronounced anti-inflammatory effect. Tablets or injections are prescribed for moderate pain syndrome. Has antirheumatic action.

Acetylsalicylic acid (aspirin) is one of the weakest painkillers. It is an effective antipyretic. It also has a blood-thinning effect. Available in the form of regular and soluble tablets.

They differ from analgesics in that, in addition to pain relief, they have a therapeutic effect on the joints. The high effectiveness of non-steroidal anti-inflammatory drugs has a downside. These drugs have a negative effect on the gastrointestinal tract. Long-term use is strongly discouraged.

Diclofenac (Dikloberl, Olfen) in tablets relieves severe pain of non-rheumatic origin and swelling. Can be used topically (as an ointment) or rectally (as suppositories). In rheumatic diseases, the drug greatly alleviates the patient's condition.

Ibuprofen is prescribed in the initial stages of joint disease. In terms of strength of action, it is inferior to indomethacin, but it is better tolerated. Relieves moderate pain. Has an immunomodulatory effect. Produced in the form of tablets, suppositories, ointments.

Nimesulide has an analgesic and anti-inflammatory effect, prevents the destruction of cartilage tissue. Has antioxidant properties.

Meloxicam (Revmoxicam, Movalis) is used to treat joint diseases. The drug relieves severe pain and inflammation. Intravenous use of the solution is prohibited. Treatment begins with intramuscular injections. The effect of intramuscular injections is faster and stronger. After 1-2 days, injections are replaced with tablets.

Drugs with a narcotic effect are considered the most powerful painkillers. They are prescribed when nothing else can relieve pain. A serious disadvantage of narcotic analgesics is the patient's addiction to them. The course of treatment with such drugs is usually small. With long-term treatment, several short-term courses of the drug are taken in combination with other types of painkillers.

Narcotic analgesics have a psychotropic effect. This means that a person can become drowsy or, conversely, too alert and fall into a euphoric state. Narcotic analgesics are available in injectable form. But there are drugs in the form of tablets. For example, tramadol or promedol.

Tramadol (tramal) relieves severe pain in 15-20 minutes. In terms of strength, it is second only to morphine. The validity period is up to 6 hours. It can be taken either by injection intravenously or intramuscularly, or orally in the form of tablets, suppositories.

Trimeperidine (Promedol) is a powerful pain reliever. Already after 10-15 minutes its effect is felt. It exists in the form of both injections and tablets. Its advantage is good tolerance by the body.

These drugs are not commercially available. They are sold only by prescription.

Opioid-like drugs are similar in effect to narcotic analgesics, but are not addictive. Also, they do not have a psychotropic effect. The analgesic effect is powerful.

Nalbuphine has a very strong analgesic effect, with fewer side effects than narcotic analgesics. Does not cause addiction, does not change consciousness. Intramuscular injection can give an effect similar to the state after taking morphine. With very severe pain, repetition of injections every 3-4 hours is allowed.

The causes of pain can be different. This may be a muscle spasm in the back or inflammation of the tissues around the joint. Often accompanied by pain, the destruction of the cartilaginous tissue of the joint. The use of drugs that act directly on the cause of pain, help to relieve it. For example, the use of an antispasmodic eliminates the spasm, and the pain caused by it disappears.

Tizalud and midokalm are drugs that effectively relieve muscle spasm, for example, associated with functional and static disease of the spine (lumbar and cervical syndromes).

Glucocorticoid hormones (methylprednisolone, medrol) effectively relieve inflammation. Hormones stop acute inflammatory processes in various types of arthritis, including rheumatoid and gout-induced illness. They are taken topically (in the form of ointments) or orally (in tablets). Injections may be administered intraarticularly, intramuscularly or intravenously.

Combined drugs combine the action of non-steroidal anti-inflammatory drugs with antispasmodics (spasmalgon or renalgan).

The first rule for the use of painkillers is the selection from weak to strong. In other words, in an effort to quickly get rid of the pain, you can not immediately use potent drugs. First, you should try to relieve pain with less strong and safer means.

With very severe pain, a periarticular blockade is performed. Hormonal anti-inflammatory drugs are injected into the affected area. The purpose of the blockade is to bring the medicine to the focus of inflammation.

Blockade helps to quickly relieve pain, inflammation and restore mobility to the joint. The effect lasts for weeks. Acute pain that occurs during inflammation or as a result of injury is easier, faster and more effective to remove with non-steroidal anti-inflammatory drugs.

• Joint pain limits your movement and life...
• You are worried about discomfort, crunching and systematic pain ...
• Perhaps you have tried a bunch of medicines, creams and ointments ...
• But judging by the fact that you are reading these lines, they did not help you much ...

Injections for joints

Anti-inflammatory nonsteroidal drugs for the treatment of joints are available in gels and creams, ointments, tablets, capsules, rectal suppositories and injection solutions.

In the treatment of pathologies of the musculoskeletal system, painkillers are used in all dosage forms:

• solid - tablets, granules, powders, capsules, dragees;
• soft - ointments, liniments, creams, gels, balms, suppositories;
• liquid - solutions for parenteral administration and oral administration, tinctures, decoctions, mixtures.

When choosing a dosage form for a patient, not only the intensity of the pain syndrome is taken into account, but also the general state of health. For example, for pathologies of the gastrointestinal tract, ulcerative lesions of the stomach, it is advisable to use injection solutions, rectal suppositories, ointments.

Tablets

Tablets are easy to use, compared to ointments, they have a quick analgesic effect. To exclude damage to the gastric mucosa, they are covered with enteric coatings. Recently, drugs of prolonged (long-term) action, for example, Ketonal-retard, have been increasingly used.

In the form of tablets in the treatment of joints and spine, drugs of various clinical and pharmacological groups are used:

• muscle relaxants - Sirdalud, Mydocalm, Baclofen;
• NSAIDs - Diclofenac, Ibuprofen, Nimesulide, Ketoprofen, Lornoxicam;
• classic analgesics - Paracetamol, Analgin, Aspirin;
• narcotic analgesics - codeine-containing, Tramadol.

Analgesics in the form of injection solutions are used to eliminate acute, burning, throbbing pains. They usually occur with inflammation of the muscles, infringement of a sensitive nerve ending by a bone growth. In acute pain, intramuscular administration of NSAIDs is practiced - Meloxicam, Diclofenac, Voltaren, Xefocam, Ketorolac.

The undoubted advantage of this dosage form is a quick analgesic effect. The patient's well-being improves after a few minutes. One does not have to expect the coating to dissolve, as with tablets, or the penetration of ingredients through the skin, as with ointments.

Among all dosage forms of analgesics, the safest are agents for local application to the area of ​​pain. These are ointments, creams, gels, balms, sprays. This group can also include transdermal preparations (patches) with the active ingredients of NSAIDs or rare earth metals.

We invite you to familiarize yourself with: Pregnancy with a hernia of the lumbar spine

External agents have their own advantages - a gentle effect on the human body, a rare development of adverse reactions, and ease of use. The disadvantages of ointments and gels are slow penetration into the articular and vertebral structures, relatively weak analgesic activity.

The main reason for the appointment of analgesics in the form of rectal suppositories is the pathology of the gastrointestinal tract. The active ingredients of suppositories are absorbed (absorbed) into the colonic mucosa and enter the systemic circulation in small amounts. For the relief of joint and vertebral pain, suppositories with Paracetamol, non-steroidal anti-inflammatory components - Diclovit, Nurofen, Meloxicam, Movalis, Indomethacin are used.

For various diseases of the musculoskeletal system, injections for the joints can be prescribed. Do not be afraid of this procedure, today it is the most effective way to treat arthritis, arthrosis and rheumatoid diseases.

Recently, the number of diseases of the joints has increased significantly. Today, not only older people complain of knee pain, but such symptoms can also be found in young, socially active people. To restore the joints to their former health, and you - the ability to actively move without pain, medicine has many methods of treatment in its arsenal. One such technique is a non-surgical method of treatment - intra-articular injections or arthrocentesis.

• Methods of treatment and prevention of arthrosis

Arthrocentesis is a method of injecting a drug directly into the joint cavity. With this method of treatment, the drug will act directly at the site of the pathological process.

For the treatment of arthrosis or arthritis, several groups of drugs are used (depending on the presence of symptoms of an active inflammatory process and the purpose of the drug administration).

These include:

• chondroprotectors
• hyaluronic acid preparations

Most often, corticosteroid hormones (Kenalog, Hydrocortisone, Diprospan, Flosteron, Celeston, Depomedrol, Metipred) are injected into the damaged joint. The main purpose of the introduction of such drugs is to quickly eliminate the symptoms of inflammation in the joint. Such an injection will greatly alleviate the patient's condition, relieve him of pain, swelling, redness of the knee.

The course of treatment consists of 4-5 injections at intervals of 2 weeks. It is undesirable to inject more often. It should be noted that relief occurs immediately after the first injection. If this does not happen, then you need to think about the appropriateness of using such treatment.

Due to their action, corticosteroids have gained particular popularity among patients. But you need to know that these drugs, although they effectively eliminate the symptoms of arthrosis, do not prevent the progress of the disease. Therefore, they cannot cure osteoarthritis. Their use is justified in cases of exacerbation of the disease and the presence of symptoms of active inflammation.

A very effective method of stopping the progression of arthrosis is the introduction of chondroprotectors into the joint (Alflutop, Noltrex, Adgelon, Chondrolon). Such treatment should be carried out in a course of 10-15 injections in one joint, the course should be repeated 2-3 times a year.

These drugs, unlike corticosteroids, do not relieve the symptoms of inflammation, but affect the very cause of the disease. They improve the condition of intra-articular cartilage, promote its regeneration.

In the past few years, new drugs for injection into the joint have appeared on the pharmaceutical market - drugs based on hyaluronic acid (Ostenil, Noltrex, Fermatron, Synocrom). Such drugs are called substitutes for intra-articular fluid or a liquid prosthesis.

They increase the viscosity of the synovium, restore its protective and cushioning properties, protect the cartilage from microtrauma, and slow down the degenerative processes of the articular surfaces of the bones.

Sulfonanilide derivatives

One of the first to be produced was a selective COX inhibitor - C 2 Nimesulide (Nise, Nimika, Nimulid, Nimesil). Numerous studies and clinical experience have proven the high efficacy and good tolerability of the drug. For almost 3 decades of using the drug, serious anaphylactic reactions or complications from the digestive system (formation of an ulcer, bleeding) have not been recorded.

A characteristic feature of Nimesulide is the ability not only to inhibit the activity of COX-2, but also to block its production.

Nimesulide refers to predominantly selective drugs. It inhibits the activity of COX-2 by 88% and COX-1 by 45%. At the same time, the effect on COX-2 lasts longer.

The drug is often prescribed to patients with arthrosis because of its ability to reduce the level of collagenase in the synovial (articular) fluid. Collagenase destroys collagen and proteoglycans (substances of the intercellular matrix of connective tissue), stimulating the progression of arthrosis.

After using Nimesulide for cervical osteochondrosis and arthrosis:

• the intensity of pain decreases;
• swelling decreases;
• the inflammatory process subsides.

The joint partially or completely restores its mobility.

Nimesulide is available in the form of tablets, granules for suspension and ointment for external use. The granules are diluted in chilled boiled water (the contents of 1 sachet per 100 ml of water). The prepared suspension is not subject to storage. Tablets or suspension are taken orally 2 times a day. The ointment is applied to the affected area and rubbed lightly.

The course of treatment is 2 - 8 weeks. It is determined by the doctor based on the stage and severity of the disease.

After cases of the development of serious complications from the liver while taking this drug, additional studies were conducted on the subject of hepatotoxicity of Nimesulide. However, the relationship of the drug with the appearance of hepatopathy has not been proven.

The efficacy and safety of Meloxicam (Movalis, Amelotex) has been verified by multiple clinical studies. It quickly relieves pain and relieves inflammation. Among all other NSAIDs of the new generation, Meloxicam is most often recommended for arthrosis and cervical osteochondrosis. The advantage of the drug is the ability to take it for a long time without compromising health.

The effectiveness of treatment with Meloxicam is comparable to the results of treatment with Diclofenac, the "gold standard" of anti-inflammatory therapy. At the same time, the frequency of gastroenterological complications is observed 3 times less frequently. Exacerbation of existing gastritis and peptic ulcers sometimes occurs only after a long course of treatment with Meloxicam (more than six months).

The drug is produced in the form of tablets, suppositories and solutions for intramuscular injections. Tablets are taken orally 1 time per day with meals. Candles are administered 1-2 times a day. Intramuscular administration is indicated only in the first 2-3 days of therapy. Meloxicam ointment does not exist.

Meloxicam is not prescribed for renal and hepatic insufficiency. It is contraindicated in pregnant and lactating women, as well as children under 15 years of age.

Lornoxicam (Xefocam) is a powerful pain reliever. By the strength of the impact, it can be compared with Morphine. The therapeutic effect lasts 12 hours. The drug does not cause disorders of the nervous system and is not addictive.

When taken simultaneously with food, the time to reach maximum concentration increases from 1.5 to 2-3 hours. The drug is available in the form of tablets and powder for intramuscular and intravenous injections. Injections are made 1 time per day. On the first day of treatment, 2 injections may be prescribed. Tablets are taken 2-3 times a day. Dosage form in the form of an ointment does not exist.

A contraindication is a severe form of cardiac, renal and hepatic insufficiency, gastrointestinal or cerebrovascular bleeding, acute peptic ulcer, thrombocytopenia, as well as pregnancy and lactation.

Side effects, contraindications

The choice of analgesic should be done by a doctor. He not only draws up a therapeutic regimen, but also determines daily, single doses, and the duration of the treatment course. One of the selection criteria is the safety of the drug. Many pathologies of the musculoskeletal system have not yet been completely cured. Pain occurs not only during relapses, but also at the stage of remission when the weather changes, hypothermia. The patient is often forced to take drugs, so the doctor selects analgesics with a milder effect on the internal organs.

To make your reception as safe as possible, adhere to the following information:

1. injections - no longer than 3 days;
2. rectal suppositories - no longer than 2 days;
3. tablets and capsules - 10-14 days;
4. ointment, gel and cream - no longer than 14 days;
5. spray for external use - no longer than 3 days.

Representatives of coxibs

Celecoxib (Celebrex) is a highly selective NSAID. It quickly reduces pain and reduces inflammation. Therapeutic doses are safe for humans and do not cause complications. Celecoxib significantly reduces the risk of gastroduodenal ulcers and other diseases of the digestive system. It slightly increases the likelihood of thrombosis.

The drug is rapidly absorbed, reaching a maximum concentration after 2-3 hours. In the case of fatty foods taken before a dose of Celecoxib, absorption is slowed down. The maximum concentration will appear only after 6-7 hours. This indicator is influenced by body weight and sex of the patient. In people with low body weight and in women, the concentration of the active substance is higher than in other patients. Such people need to start therapy with minimal doses.

The duration of therapy depends on the patient's condition. Patients with cardiovascular diseases are prescribed minimal doses and a short course of treatment.

The drug is made in capsules. They are taken twice a day. Celecoxib is not available as an ointment.

Celecoxib is not indicated in patients with severe renal and hepatic impairment and in patients with peptic ulcer during its exacerbation. Contraindications are gastrointestinal bleeding and intestinal inflammation. Do not use Celecoxib:

• people suffering from bronchial asthma;
• children under 18;
• pregnant women;
• lactating women.

Valdecoxib (Bextra) is rapidly absorbed after oral administration. Unlike Celecoxib, fatty foods do not affect its absorption rate. The maximum concentration of the active substance occurs after 3 hours. The negative effect of Valdecoxib on ovulation has been confirmed. However, the action is reversible.

The drug is prescribed with caution to patients with arterial hypertension and heart failure. It is not recommended to use Valdecoxib in the elderly, pregnant and lactating women, patients with impaired liver and kidney function, and in addition, children under 18 years of age. It is forbidden to drink Valdecoxib in the presence of a peptic ulcer in the acute stage, severe heart or kidney failure.

Tablets are drunk 1 time per day. On the first day of treatment, you can take the drug twice. Dosage form of the drug in the form of an ointment does not exist.

What groups of drugs help with pain?

Not all of the active substances presented are used to treat inflammation of the joints. Some of them (paracetamol) have weak anti-inflammatory activity, are used primarily to relieve pain and eliminate fever. This does not cancel their anti-inflammatory effect, they are just weaker.

Non-steroidal active ingredients with the greatest anti-inflammatory activity for the joints:

What is an NSAID?

NSAIDs are drugs that have antipyretic, analgesic, anti-inflammatory effects on the body. They are prescribed as a symptomatic medicine for arthrosis of the joints and arthritis. Medicines of this group relieve signs of inflammation in the pathology of the musculoskeletal system of any nature and are prescribed in the acute period of the disease.

Non-selective NSAIDs inhibit the production of COX-1 and COX-2 enzymes, which causes the appearance of side effects from the digestive tract. The enzyme cyclooxygenase is involved in the synthesis of inflammatory mediators called prostaglandins. At the same time, COX-1 has protective functions for the gastric mucosa, and COX-2 is released during inflammation of the joints.

Inhibition of the production of two fractions of the enzyme leads to a good anti-inflammatory effect and persistent pain relief. However, it often causes side effects associated with the formation of ulcers in the mucosa of the digestive tract and bleeding. Therefore, drugs are prescribed in short courses of 10-14 days while taking funds to protect the gastric mucosa, for example, omeprozole.

Ibuprofen-based drugs are non-selective NSAIDs

Non-selective NSAIDs:

• diclofenac (voltaren, diclovit, orthofen, naproxen);
• ibuprofen (bolinet, advil, dolgit, motrin);
• indomethacin (indobene, indocid, movimed, metindol);
• ketoprofen (artrosilene, ketonal);
• lornoxicam (xefocam);
• piroxicam (pirocam, toldin, erazone, pirox).

Selective NSAIDs are a new generation of drugs. They block the synthesis of only COX-2, thereby selectively acting on the focus of inflammation in the affected joint. At the same time, they have a slightly less analgesic effect, but do not cause irritation of the mucous membrane of the stomach and intestines.

Selective NSAIDs:

• arcoxia;
• nimesulide (aponil, nise, coxtral, nymfast);
• meloxicam (melox, artrozan, movalis, lem);
• celecoxib (ranselex, phlogoxib).

Movalis is an effective anti-inflammatory drug with selective action.

Selective drugs can be prescribed for several months under the supervision of a doctor. It should be borne in mind that repeated courses of NSAID treatment worsen the metabolic processes in the cartilage and should be used with caution in arthrosis of the joints. The pharmacological industry produces NSAIDs in tablets, injections, rectal suppositories and ointments.

Non-steroidal anti-inflammatory drugs are medicines that relieve pain, normalize body temperature and suppress inflammation in the joints. The word "non-steroidal" emphasizes their origin and chemical structure. These are non-hormonal drugs. In this they differ from steroidal anti-inflammatory drugs (glucocorticoids), which provoke many side effects, but have greater anti-inflammatory activity.

Pharmaceutical efficacy

Below is a list of the main non-steroidal medicines for the treatment of joints, ranked by the strength of the anti-inflammatory action:

• Indomethacin (Metindol, Indocollir);
• Diclofenac (Diklovit, Ortofen);
• Piroxicam (Finalgel);
• Ketoprofen (Flamax, Flexen);
• Naproxen (Apranax, Sanaprox);
• Ibuprofen (Dolgit, Faspik, Nurofen);
• Aspirin and its derivatives.

Inflammation is a universal protective process. The task of inflammation is to neutralize the harmful agent. But this process is followed by “side” effects: pain, limitation of movement in the joint, stiffness, swelling, and a decrease in the standard of living.

Regardless of the location of the damage, inflammation always proceeds through the same mechanisms. The task of non-steroidal anti-inflammatory drugs is to neutralize the biochemical chain of inflammation, after which pain will decrease, swelling and stiffness will be eliminated.

Inflammation in the joints develops due to the production of prostaglandins - protein substances that act on pain receptors, increase vascular permeability, create edema, and increase local and general body temperature. The soft tissues of the joint become inflamed, the joint increases in volume, hurts and is limited in movement.

Non-steroidal anti-inflammatory drugs block the biochemical chain of conversion of arachidonic acid into prostaglandins in the joints by inhibiting cyclooxygenase (COX) of the first and second types. So NSAIDs relieve joint pain, reduce swelling and block the entire process of inflammation.

NSAIDs for topical use

In orthopedic practice, the main indications for taking NSAIDs are:

• Rheumatic diseases (rheumatoid and psoriatic arthritis, ankylosing spondylitis, Reiter's syndrome);
• Lesions of a non-rheumatic nature (tenosynovitis, osteoarthritis, other degenerative-dystrophic changes in cartilage tissue);
• Metabolic disorders, accompanied by the deposition of salts in the joints (gout, pyrophosphate arthropathy);
• Bruises, sprains of periarticular tissues;
• Pain and swelling after joint surgery.

Most often, local non-steroidal anti-inflammatory drugs are used to treat the joints of the legs and other large joints. Ointments, gels and creams are effective for diseases and injuries of the joints with mild symptoms, as well as in the postoperative period. The average price is 150-400 rubles, depending on the active substance and the volume of the package. The most popular means for external use are:

• Nurofen, Dolgit - based on ibuprofen;
• Diclovit, Voltaren, - with diclofenac;
• Fastum, Ketonal - with ketoprofen;
• Finalgel - based on piroxicam;
• Indovazin - with indomethacin.

All non-steroidal ointments for the treatment of joints are evenly distributed in a thin layer over the affected areas of the body and lightly rubbed. A single dosage is 2-5 g, the frequency of use is up to 4 times a day. The duration of treatment should not exceed 2 weeks.

1. reduction of pain;
2. improve cartilage trophism in the joints of the legs, shoulders or knees;
3. normalize blood circulation near the joint;
4. relieve swelling of soft tissues and minimize pressure on the affected joint;
5. strengthen the muscular frame of the joint;
6. increase limited joint mobility.

Initially, rest should be provided to the inflamed joint, this is especially true for such joints as the knee, shoulder and elbow, in case of inflammation of which their additional immobilization may sometimes be required. For example, it is desirable to immobilize an inflamed knee with an orthosis, due to the fact that menisci are located inside this joint, which are easily injured during inflammation.

To immobilize the shoulder in order to provide it with rest, as a rule, a simple scarf is enough. It should only be remembered that if arthritis is provoked by trauma, which is especially common in cases where inflammation develops after a dislocation of the shoulder or the knee joint is injured, the lack of immobilization can lead to relapse and aggravation of the injury.

Only after the elimination of acute pain, you can start therapeutic exercises and massage (!)

In the vast majority of cases, non-steroidal anti-inflammatory drugs are used to relieve pain and reduce inflammation. However, they have various side effects that make their long-term use undesirable. In addition, they affect the synthesis of proteoglycans responsible for supplying cartilage with water, as a result of which they can provoke dehydration of cartilage tissue and accelerate the development of degenerative processes, such as osteochondrosis and arthrosis.

And with polyarthritis, especially rheumatoid, they soon develop addiction. Therefore, with rheumatoid joint damage, selective anti-inflammatory drugs are more often used, one of which is movalis. Such remedies for rheumatoid arthritis and inflammation of the joints of the legs, shoulders or others, in cases where the patient has osteochondrosis, are the main drugs used to achieve the elimination of inflammation in the joints.

Various methods of using non-steroidal anti-inflammatory drugs have been developed. Here are the existing options:

• tablets;
• intramuscular injections for joints;
• intra-articular injections;
• candles;
• joint cream;
• ointments.

When the disease of the joints is in severe form, the condition worsens, then strong drugs are used that have a wide range of side effects. The doctor uses injections for the joints so as not to cause great harm to the body. Often such procedures are done with gonarthrosis, coxarthrosis. At the same time, negative substances that affect the gastric mucosa do not penetrate into the gastrointestinal tract, unlike tablets. With the help of injections, useful elements are delivered in large quantities when compared with other methods of application.

Non-hormonal anti-inflammatory drugs are available for oral administration. They are made in the form of tablets.

NSAIDs for oral administration:

• Indomethacin. One tablet contains 25 mg of the active substance. Use one unit of the drug up to three times a day for 5-10 days. With insufficient effectiveness of anti-inflammatory therapy, it is allowed to increase the daily dose to 75-100 mg as prescribed by a specialist. The cost of one package is 60-250 rubles, depending on the dosage and number of tablets;
• Diclofenac. Each tablet contains 50 or 100 mg diclofenac sodium. Use 50 mg of the drug three times a day. The average price is 15-50 rubles, depending on the dosage;
• Piroxicam. The drug is available in the form of capsules and tablets containing 10 or 20 mg of active ingredient. With arthrosis and rheumatoid arthritis, it is necessary to drink 10-30 mg of an analgesic for a long time. In an acute gouty attack, 40 mg of the drug is prescribed once in the first 2 days, then for 4-6 days - 20 mg twice a day. The cost of packaging the drug in capsules is 50-60 rubles, in tablet form - 85-100 rubles;
• Ketoprofen. One tablet contains 100 mg of the active ingredient. Drink one unit of the drug as a whole twice a day. The average price per pack is 130-160 rubles;
• Nimesulide. Each tablet contains 100 mg of the active ingredient. In diseases of the musculoskeletal system, it is necessary to drink up to 200 mg of the drug per day. The cost of one package is 65-80 rubles;
• Ibuprofen. The anti-inflammatory drug is available in tablets containing 0.2 g of the active substance. Adult patients are prescribed up to 0.6 g of the drug three times a day. The price is 25-95 rubles, depending on the volume of packaging;
• Arcoxia. The latest generation drug is available in tablets of 60, 90 and 120 mg. The dosage is set individually. When using a product containing 120 mg of the active ingredient, the duration of treatment should not exceed 8 days. The average cost is 300-600 rubles, depending on the dosage and volume of packaging.

In diseases of the joints, NSAIDs are prescribed as short as possible. If after 5-7 days after the start of treatment with non-steroidal anti-inflammatory drugs there is no pronounced improvement, a change in the therapy regimen or the appointment of another group of medications is required.

What NSAIDs are prescribed for Bechterew's disease, arthrosis and other pathologies?

Anti-inflammatory non-steroidal drugs for joint diseases are prescribed depending on the individual characteristics of the patient: the rhythm of pain, the degree of stiffness, the presence of stiffness in the morning, secondary diseases and the tolerance of a particular drug. The duration of the use of non-steroidal anti-inflammatory drugs for the joints depends on these same properties.

The disease is treated according to clinical protocols developed by experts from the Ministry of Health:

1. ankylosing spondylitis(protocol 2013): celecoxib, meloxicam;
2. arthrosis (2016 protocol): paracetamol, diclofenac, aceclofenac, etoricoxib, lornoxicam, meloxicam, nimesulide;
3. reactive arthritis(2016 protocol): diclofenac, aceclofenac, nimesulide, meloxicam, etoricoxib;
4. rheumatoid arthritis(protocol 2014): ibuprofen, diclofenac, naproxen, celecoxib, etoricoxib;
5. pseudoarthrosis (2014 protocol): ketoprofen, ketorolac, paracetamol;
6. psoriatic arthritis(protocol 2016): diclofenac, aceclofenac, etoricoxib, meloxicam;
7. deforming osteoarthritis(protocol 2016): diclofenac, aceclofenac, etoricoxib, lornoxicam, meloxicam.

Useful video

The program "Live Healthy" tells about the rules for taking non-steroidal anti-inflammatory drugs.

Rules for taking NSAIDs. Live healthy! (22.09.2017)

Side effects and overdose of NSAIDs

1. Allergy.
2. Bronchospasms.
3. Dyspeptic disorders.
4. Violation of renal functions (nephropathy, vessels narrow).
5. Ulcerogenic action (development of erosion or stomach ulcers).
6. Increased blood activity in the liver.
7. miscarriages.
8. In rare cases, bleeding disorders.

During the treatment of joints with NSAIDs, the following side effects are noted:

• discomfort and pain in the abdomen, nausea;
• Stool disorder (constipation, diarrhea), increased gas formation;
• Allergic reactions of a different nature;
• Headache, anxiety, nervousness, sleep disturbances;
• Tachycardia, jumps in blood pressure;
• Frequent urination;
• Increased sweating, thirst, chills.

When using local NSAIDs, rashes, dryness and peeling of the skin in the area of ​​​​contact with the drug are often diagnosed. Exceeding the therapeutic dose increases the risk and intensity of side effects. Treatment for overdose is symptomatic.

Non-steroidal anti-inflammatory drugs are the first choice for joint diseases accompanied by pain and swelling. Medicines are most effective at an early stage of pathology.

Results:

1. Non-steroidal anti-inflammatory drugs are included in international clinical guidelines for the treatment of joint diseases.
2. NSAIDs relieve pain, suppress inflammation and increase joint mobility.
3. Substances with the greatest anti-inflammatory activity: diclofenac, ketorolac, ketoprofen, ibuprofen, indomethacin, piroxicam, meloxicam, nimesulide, flurbiprofen.
4. For the treatment of joints, non-steroidal anti-inflammatory drugs are available in the form of tablets and capsules, injection solutions, rectal suppositories, ointments, gels and sprays for external use.
5. New generation NSAIDs are safer but not recommended for patients with cardiovascular disease. The new generation non-steroidal anti-inflammatory drugs include such substances: meloxicam, celecoxib, nimesulide and etoricoxib.
6. NSAIDs should not be taken by patients with acute gastrointestinal disease, hemophilia and severe conditions.
7. The maximum duration of injections is 3 days, rectal suppositories - 2 days, tablets and capsules - 10-14 days, ointments, gels and creams - 14 days, sprays - 3 days.

The whole truth about: anti-inflammatory drugs for the treatment of joints and other interesting information about the treatment.

Joint pain significantly complicates life and interferes with a full life. Pain does not go away on its own. Therefore, treatment is accompanied, first of all, by anti-inflammatory drugs. Their list is quite wide. In structure, they differ from others in the absence of steroid hormones, which allows a large group of patients to take the medicine.

Non-steroidal anti-inflammatory drugs are used to treat large and small joints, as well as ligaments. The disease is accompanied by swelling, pain and hyperthermia. At the same time, prostaglandins are formed in the body - substances that activate the production of hormones in the blood. As a result of the influence on the vessels, the body temperature rises, and inflammatory reactions intensify, which leads to arthritis, osteochondrosis and other unpleasant diseases.

The enzyme cyclooxygenase (COX) is blocked by the non-hormonal action of NSAIDs. Swelling and redness decrease, the temperature returns to normal, inflammation subsides.

NSAIDs have a positive effect on diseases:

• relieve inflammation;
• have analgesic properties;
• effectively lower the temperature;
• have an antiaggregatory effect - eliminate the adhesion of platelets.

Do not forget that drugs - immunosuppressants, help in the treatment of rheumatism, but have a depressing effect on the immune system as a whole.

Classification of drugs

It is worth noting that COX is divided into two types. The first produces prostaglandin, which protects the lining of the stomach and intestines from damage. And the second connects prostaglandins that increase the temperature.

Therefore, drugs are usually differentiated into two parts:

• selective (they inhibit COX2);
• non-selective.

The latter, in turn, are also grouped. Some act equally on both COX, others on COX1.

The former are prescribed for acute respiratory viral infections, after operations, for injuries, infections, others save from rheumatism and diseased joints, have anti-inflammatory properties.

Indications for the use of NSAIDs for the treatment of joints

Anti-inflammatory drugs are safe for short-term use and in the absence of contraindications.

Medicines are used in chronic and acute inflammatory processes:

• migraine;
• trauma;
• arthritis, rheumatism, ankylosing spondylitis;
• toothache;
• gout;
• renal and hepatic colic;
• inflammatory diseases of the spine, muscles, musculoskeletal system, joints and bones;
• sciatica, sciatica, neuralgia;
• painful critical days;
• infections;
• metastases in cancer.

List of non-steroidal anti-inflammatory drugs

Acetylsalicylic acid (aspirin).

In practice for over a hundred years. Assign to fight SARS, relieve headaches. Together with other substances, they are used for the treatment of osteoarthritis. But in acute inflammation, aspirin is replaced by more powerful medicines.

Diclofenac.

Available in tablets, suppositories, gel and injection. The popular pain reliever is absorbed within twenty minutes and understands the fever.

Ibuprofen.

Release form - candles, tablets. It is easy to carry, has a low price tag. It is prescribed for neuralgia, bursitis, hematomas, sprains, influenza, SARS, rheumatoid arthritis, gout, Bechterew's disease, osteoarthritis, feverish conditions. Ibuprofen has many analogues in different price categories.

Nimesulide.

When using it, the temperature normalizes, the body becomes mobile as a result of anesthesia. The ointment is applied to the arthritic area. There is a slight redness, so the effect of the drug is manifested.

Indometacin is one of the strongest drugs with analgesic effect.

Produced in the form of ointments, suppositories, tablets. Although the medicine is cheap, this does not prevent it from having an incomparable effect on arthritic and arthrotic joints. Before use, a doctor's consultation is required due to the impressive list of side effects.

Meloxicam belongs to the group of NSAIDs.

Available in tablets and in solution for intramuscular injection. Pharmacological action - anti-inflammatory analgesic with antipyretic effect. Indicated for symptomatic therapy, reducing pain and inflammation. Treats osteoarthritis, rheumatoid arthritis, ankylosing spondylitis. It is allowed to use meloxicam under the supervision of a specialist even for several years. Long-term exposure allows you to take one tablet during the day. It is possible to purchase a substance under various names - Movalis, Melbek, Melox, Artrozan, Mesipol, Mataren, etc.

Some drugs, under the strict supervision of a doctor, are allowed to be taken by pregnant women in case of vital necessity, in no case in the third trimester.

The doctor may prescribe:

• diclofenac;
• ibuprofen;
• aspirin;
• ketorolac;
• indomethacin;
• naproxen.

It is forbidden to drink medicines on your own.

NSAIDs of a new generation for the treatment of joints

Medical technology does not stand still. Every day, hundreds of scientists are trying to develop the latest pills and modernize the time-tested. Non-steroidal anti-inflammatory drugs have not been spared either. New generation drugs act more selectively and thoroughly suppress inflammation. The most important thing here is the absence of a serious effect on the gastrointestinal tract and cartilage tissue.

List of new generation non-steroidal anti-inflammatory drugs

Among the useful "drugs", Movalis with the active ingredient in the form of meloxicams became the most effective. With arthrosis, a real lifesaver. Long-term use has practically no effect on the work of the stomach and intestines. Analogues work in the same area - Melbek, Mesipol, Mirloks.

The drug Ksefokam has the ability to stretch the effect of the panacea, so that patients do not feel pain for about twelve hours. Most importantly, Ksefokam is not addictive, and the ability to relieve pain is comparable to morphine. However, the high cost does not allow everyone to purchase the drug in the first-aid kit. Produced by prescription.

The antioxidant Nimesulide blocks the action of substances that break down collagens and cartilage. Arthrosis of the joints is treatable, the pain becomes dull, the inflammation disappears. Sold in granules for solution, tablets, in the form of a gel.

Celecoxib was originally called Celebrex. Release form - capsules 200 and 100 mg. A pronounced fight against arthrosis arthritis does not affect the functioning of the gastrointestinal tract, the mucous membrane remains normal.

Etoricoxib is sold under the brand name Arcoxia. Reception up to 150 mg per day does not affect the functioning of the intestines and stomach. The average dose for arthrosis is approximately 30-60 mg per day.

The cost of medicines varies. On the advice of a doctor, the patient can buy a more expensive drug or its analogue, in accordance with contraindications and side effects. Means stop unbearable pain and eliminate inflammation. After taking them, another treatment should be prescribed.

General application rules

Take on an independent guide to medicines is not worth it. Contacting a specialist will help you understand the methods and rules of treatment. To do this, you need to prepare all statements about previous or concomitant diseases and take tests so that the doctor chooses the right treatment.

Tablets are taken immediately after meals with half a glass of water or low-fat milk to assimilate and protect the gastrointestinal tract from harmful effects. In parallel, bifidobacteria should be taken.

If long-term use is planned, then start with a minimum dose, gradually increasing the amount.

Side effects of non-steroidal anti-inflammatory drugs

1. Allergy.
2. Bronchospasms.
3. Dyspeptic disorders.
4. Violation of renal functions (nephropathy, vessels narrow).
5. Ulcerogenic action (development of erosion or stomach ulcers).
6. Increased blood activity in the liver.
7. miscarriages.
8. In rare cases, bleeding disorders.

Contraindications to the use of NSAIDs

Any, even the most harmless drug, has contraindications. NSAIDs have several of them:

• pregnancy;
• individual intolerance;
• disorders in the work of the kidneys and liver;
• peptic ulcers of the gastrointestinal tract and duodenum;
• thrombo- and leukopenia.

• General classification of drugs for joints
• Non-steroidal anti-inflammatory drugs (NSAIDs)
• Chondroprotectors
• Corticosteroids
• The use of these drugs for arthritis and arthrosis

From the first part of this article, you will learn what modern drugs are recommended by specialists in the pathology of the articular apparatus. The second part describes the treatment regimens for the most common joint diseases - arthrosis and arthritis.

The appointment of any means, control over the dosage and duration of treatment is carried out by the therapist, orthopedist-traumatologist, rheumatologist.

General classification of drugs for joints

Non-steroidal anti-inflammatory drugs

All drugs from the class of non-steroidal anti-inflammatory drugs (they are abbreviated as NSAIDs or NSAIDs) have the following effects in the treatment of:

• reduce inflammation in the tissues of the joint;
• anesthetize;
• contribute to the rapid recovery of motor function;
• reduce body temperature.

The main purpose of NSAIDs is symptomatic therapy: they quickly (within a few hours after administration) eliminate the symptoms of the disease, but only partially eliminate the causes of its occurrence. Therefore, their administration is often combined with other drugs for the treatment of articular pathology (for example, with glucocorticoids, chondroprotectors). According to existing international treatment protocols, NSAIDs are included in the treatment regimens for all joint diseases accompanied by inflammatory or pain syndrome.

The mechanism of the anti-inflammatory action of nonsteroidal drugs is to block the enzyme cyclooxygenase (COX). It is involved in the formation of substances that support the inflammatory process (inflammatory mediators).

Non-selective NSAIDs

There are two types of cyclooxygenase enzyme in the human body: COX-1 and COX-2. The first is produced in the stomach and is responsible for protecting its mucous membrane, the second is synthesized in the foci of inflammation. Non-selective NSAIDs block both types of the enzyme. They are highly effective, but often cause side effects from the digestive system (gastritis, peptic ulcer).

The main representatives of non-selective NSAIDs are shown in the table. The plus sign (+) indicates the existing forms of drug release.

(if the table is not fully visible, scroll to the right)

Non-selective NSAIDs

Selective NSAIDs

Drugs that selectively block the COX-2 enzyme are called selective. When treated with them, the anti-inflammatory effect is less pronounced, but the number of side effects is less compared to non-selective NSAIDs. The action of these funds is long - within a day after the administration of the drug.

The main representatives of the drugs in this group are shown in the table. Plus sign (+) - existing release forms

(if the table is not fully visible, scroll to the right)

Selective NSAIDs

NSAIDs with predominantly analgesic effect

Non-steroidal anti-inflammatory drugs with high analgesic properties are called non-narcotic analgesics. The main indication for use is severe joint pain with minor manifestations of inflammation.

The main drugs of this group are presented in the table. The plus sign (+) indicates existing forms of the drug.

(if the table is not fully visible, scroll to the right)

NSAIDs with analgesic effect

Chondroprotectors

Means that restore the affected hyaline cartilage of the joints are called chondroprotectors. When applied:

• there is no anti-inflammatory and analgesic effect in the treatment;
• therapeutic effect occurs gradually, due to the restoration of damaged areas of cartilage tissue;
• there is a pronounced preventive effect - the destruction of articular cartilage is prevented;
• long-term use (3-5 months) is required.

The composition of chondroprotectors includes substances that form hyaline cartilage of the joint: chondroitin and glucosamine. The first is the main building substance of cartilage, supporting its structure; the second is the basis for the production of intra-articular fluid.

Chondroprotectors can be single-component (contain either chondroitin or glucosamine) and combined (contain both substances). The effectiveness of combined forms is higher than single-component ones.

The main chondroprotectors are presented in the table. The plus sign (+) indicates existing forms of the drug.

(if the table is not fully visible, scroll to the right)

Chondroprotectors

Systemic glucocorticoid hormones

In severe inflammatory and destructive processes in the joints, drugs with a powerful anti-inflammatory effect are needed. Such patients are injected with glucocorticoids (steroid hormones of the adrenal glands). Their anti-inflammatory effect is stronger than that of NSAIDs, but the side effects are more serious (addictive, adrenal suppression). Therefore, glucocorticoids, like any other drugs, should be prescribed by a doctor according to strict indications with constant dose control.

(if the table is not fully visible, scroll to the right)

Glucocorticoid drugs

Drugs for intra-articular administration

If one joint hurts (for example, knee or shoulder), it is advisable to administer drugs directly to the lesion - into the joint cavity. This achieves the maximum concentration of the drug exactly in the place where it is needed for effective treatment, reducing the risk of side effects. Such injections are performed only by an experienced orthopedic traumatologist or surgeon.

Substitutes for intra-articular fluid

The most expensive drugs for the treatment of joint pathology are joint fluid substitutes. They are based on hyaluronic acid.

The main indication for use is arthrosis. Even with advanced forms of this disease, a stable therapeutic effect is achieved. The effect of hyaluronic acid on the joint is complex: cartilage is restored; reduction of inflammation; creation of a liquid environment in the articular cavity, which softens the movement of rubbing surfaces.

The most commonly used products based on hyaluronic acid:

• Singial,
• Hyalual,
• noltrex,
• Gialgan.

Glucocorticoids for injection into the joint

Four mechanisms of therapeutic action of hormonal anti-inflammatory drugs on joint components:

reduction of inflammation;

improved cartilage nutrition;

restoration of the properties of the intra-articular fluid;

softening of ossified tissues and resorption of growths.

Thanks to these effects, intra-articular injections of glucocorticoids not only alleviate the condition of patients with arthrosis and various types of arthritis, but also improve the condition of the articular cartilage.

The most effective drugs:

• hydrocortisone,
• betaspan,
• Diprospan,
• Kenalog,
• Flosteron.

Drugs for intra-articular administration

How to use drugs for the most common joint diseases?

The two most common joint diseases are osteoarthritis and arthritis. The first pathology is the destruction of cartilage tissue, the second is its inflammation.

Treatment of arthrosis with drugs

Drug treatment of arthrosis depends on the phase and stage of the disease. General tactics are presented in the table:

(if the table is not fully visible, scroll to the right)

Medical treatment for arthritis

Arthritis is any inflammation in a joint. Most often it happens:

• Reactive (joint response to any changes in the body: trauma, infections, allergies).
• Rheumatoid (the disease is appropriately called rheumatoid arthritis).
• Psoriatic (with psoriasis).
• Gouty (for gout).

Non-steroidal anti-inflammatory (Naklofen, Movalis, Nimesil). In the acute stage of the disease, intramuscular administration is more appropriate, and with a decrease in inflammation, you can switch to tablet intake. Preparations of this group are indicated for all arthritis, regardless of type and origin.

Systemic glucocorticoids (Methylprednisolone, Dexamethasone, Triamcinolone) have a positive result in any arthritis. In the acute period of polyarthritis, when several joints are inflamed, they are administered intramuscularly or intravenously in high doses. For rheumatoid arthritis, lifelong pills (Metipred) may be indicated to prevent recurrences of the disease.

Intra-articular administration of glucocorticoids (Kenalog, Diprospan) is an effective medical procedure that is indicated for inflammation of one or two joints of any origin (reactive, gouty, rheumatoid, psoriatic).

Chondroprotectors in the form of injections (Alflutop, Dona) or tablets (Movex, Teraflex). Assign after the elimination of inflammation in order to restore the cartilaginous tissue of the cartilaginous tissue, more often with rheumatoid arthritis.

Basic drugs for the treatment of rheumatoid arthritis. They directly treat the disease, as they block the triggers of inflammation, but do not reduce the symptoms of the disease. This group includes gold derivatives (Aurotimarat, Auranofin), cytostatics (Methotrexate, Cyclophosphamide), Sulfasalazine, special immune preparations (Infleximab, Remicade).

Antigout drugs (Colchicine, Allopurinol, Anturan). Used only for arthritis caused by gout.

Uncontrolled treatment with any drugs reduces their effectiveness, increases the risk of side effects and may worsen the course of the disease and its prognosis.

Non-steroidal anti-inflammatory drugs for the treatment of joints are used to reduce the symptoms of arthrosis, arthritis and other diseases. They are designed to stop inflammation, get rid of pain, which is strongly manifested at the 2-3 stage of the development of pathology.

Non-steroidal anti-inflammatory drugs for the treatment of joints were created for specific purposes. There are only two such tasks:

• eliminate joint pain;
• reduce inflammation, prevent it from developing.

Currently, such drugs are widely used, show high efficiency compared to other drugs. They are able to reduce the main manifestations of symptoms of joint diseases.

When arthrosis worsens, you can not do physical therapy, do some physiotherapy. Some patients lean towards traditional medicine, but its methods are very slow. In this situation, non-steroidal anti-inflammatory drugs for the treatment of joints can help.

Popular remedies

There is a diverse range of non-steroidal anti-inflammatory drugs (NSAIDs) that are formulated to treat conditions such as osteoarthritis and arthritis. When using them, the disease ceases to develop, symptoms decrease.

The most famous drugs are:

• "Meloxicam";
• "Ketoprofen";
• "Aspirin";
• "Naproxen";
• "Ibuprofen";
• "Diclofenac";
• "Celecoxib";
• "Indomethacin";
• "Etodolac".

Each medicine has its own characteristics: some are weaker, and some are designed to treat the disease in an acute form. You should not independently decide on the choice of the drug, it must be prescribed by a doctor.

Application methods

Various methods of using non-steroidal anti-inflammatory drugs have been developed. Here are the existing options:

• tablets;
• intra-articular injections;
• candles;
• joint cream;
• ointments.

When the disease of the joints is in severe form, the condition worsens, then strong drugs are used that have a wide range of side effects. The doctor uses injections for the joints so as not to cause great harm to the body. Often such procedures are done with gonarthrosis, coxarthrosis. At the same time, negative substances that affect the gastric mucosa do not penetrate into the gastrointestinal tract, unlike tablets. With the help of injections, useful elements are delivered in large quantities when compared with other methods of application.

Non-hormonal anti-inflammatory drugs are available for oral administration. They are made in the form of tablets.

Precautionary measures

The use of non-steroidal anti-inflammatory drugs is required under the strict instructions of a doctor. The specialist is obliged to issue a prescription that must be followed. If you use the drug in large doses, then there will be problems, complications that can even lead to the death of a person.

People who have problems with the gastrointestinal tract, kidneys, who have allergies, cirrhosis of the liver, diseases of the heart and blood vessels should be careful. The action of the components that are part of non-steroidal anti-inflammatory drugs can reduce the effectiveness of other drugs that are used. Therefore, it is required to combine drugs carefully, it is best to consult a specialist.

The therapy takes a long time. Patients are prescribed about 15 injections or 7 intra-articular injections. It all depends on the stage of the disease and sensitivity to the drug.

Some Important Facts

• proper nutrition;
• taking chondroprotectors;
• massage;
• swimming;
• gymnastics;
• folk methods;

If non-steroidal drugs are taken for a long time, the production of new cells by cartilage tissue is disrupted, this function is inhibited. But arthrosis is characterized by the destruction of cartilage. Therefore, these preparations accelerate the process of deformation. They disrupt the synthesis of proteoglycans, due to which water is lost. Therefore, the duration of treatment with nonsteroidal drugs should also be controlled. You need to know which joint ointments to use in a particular case, so as not to harm.

Non-steroidal anti-inflammatory drugs are relatively safe drugs. But they also have some side effects:

• impair kidney function;
• adversely affect the activity of the gastrointestinal tract;
• may contribute to the development of heart or vascular disease;
• can cause rash, nausea, diarrhea;
• can cause miscarriage if there is a pregnancy for up to 20 weeks.

People who have bronchial asthma are contraindicated in these drugs.

It's important to know

Non-steroidal anti-inflammatory drugs show excellent results in treatment. But there are some nuances:

1. When a patient has a stomach ulcer, asthma, hypertension, serious diseases of the kidneys, liver, heart, then these drugs cannot be used.
2. Taking these drugs can cause bleeding in the gastrointestinal tract. Because of this, tests are constantly being taken to control the situation.
3. A person who takes non-steroidal drugs in any form puts himself at risk of blood clots, stroke or heart attack. They are especially dangerous for those who have problems with the cardiovascular system.
4. A person who has had coronary bypass surgery should stop taking these drugs.

Doctor prescribing various nonsteroidal drugs

Depending on the manifestation of the disease, the doctor may prescribe the following drugs:

1. "Ibuprofen" (tablets). Instructions for use indicate the almost complete absence of side effects. This drug is very effective. It is also available in the form of a solution for injection. Included in ointments.
2. "Ketoprofen". It is available in different forms, namely: ointment, gel, tablets, injections, joint cream. Either form reduces inflammation. Most often, the drug is prescribed for arthritis of the hip joint and rheumatoid arthritis.
3. Meloxicam. Like the previous tool, the release occurs in a variety of variations. A long course of treatment is required.
4. "Celecoxib". The drug is potent, available in the form of capsules. It does not adversely affect the gastrointestinal tract. This can be considered a big advantage.
5. "Indomethacin". Fast acting and quite effective. Available in the form of suppositories, tablets, gels.
6. "Nimesulide". It is a unique tool. With its help, pain is eliminated, inflammation disappears, while the cartilage tissue is not destroyed in the future. Especially often it is used for pathologies of the hip joints.
7. "Sulfasalazine". It has a lasting result, but it takes about 6 weeks for it to be noticeable.
8. "Diclofenac" (ointment). The price of the drug is low, while it differs in its power. It is produced in the form of a solution for injection, tablet preparations (Diclofenac, Voltaren Akti, Ortofen, etc.).

Rules of use

When using nonsteroidal drugs, certain rules must be observed:

1. Follow the instructions strictly.
2. When taking a capsule or tablet, take it with a full glass of water. This will create a certain protection for the stomach, it will not be so much irritated.
3. You can not combine drugs with alcohol. This increases the risk of developing stomach pathologies.
4. It is better for pregnant women to refrain from nonsteroidal drugs.
5. After taking the capsule or tablet, half an hour should pass, after which it is allowed to go to bed. The vertical position of the body contributes to the rapid passage of the drug through the esophagus, this is affected by gravity.
6. If, for example, anti-inflammatory ointments for joints were taken, then other non-steroidal drugs should not be used on the same day. From this, the effect does not become greater, and the side effects are superimposed on each other.
7. If there is no effect from any drug, you need to pay attention to the dosage. You should not increase the dose on your own, this must be agreed with the doctor. You may need to change your medication to something else. This may result in the desired result.

"Ibuprofen"

Reduces fever, relieves headache remedy "Ibuprofen" (tablets). Instructions for use include various nuances of using the drug. In large doses, it is used for diseases of the joints, spine.

• disorders of the gastrointestinal tract;
• dizziness;
• headache;
• increased blood pressure;
• insomnia.

There are other side effects as well as contraindications. You need to carefully read them so as not to get complications. It is best to consult a doctor and then follow his instructions.

"Diclofenac"

One of the effective means is considered "Diclofenac" (ointment). Its price is affordable for many people. The drug has a strong analgesic effect. Doctors often recommend it for pain in the joints or back.

The downside of the drug is the presence of side effects, so it can not be used for a long time. Diclofenac can cause dizziness, headache, tinnitus. This disrupts the activity of the liver. It should not be used if you have asthma, pregnancy or breastfeeding.

diclofenac with paracetamol

"Panoxen" is an effective tool that contains two powerful components. The drug reduces pain in:

• osteoarthritis;
• arthritis;
• arthrosis;
• osteochondrosis;
• neuralgia;
• lumbago and other pathologies.

Side effects do not differ from those of diclofenac. Has the following contraindications:

• renal, hepatic and heart failure;
• bowel disease;
• recent coronary artery bypass grafting;
• active, progressive diseases of the kidneys and liver;
• pregnancy, childhood.

"Indomethacin"

As well as diclofenac, indomethacin relieves inflammation, anesthetizes. That's just this drug is considered obsolete, as it has a number of side effects, contraindications. Do not use this remedy for children under 14 years of age.

There are various anti-inflammatory ointments for joints, creams, tablets, injections, suppositories, which do not contain hormones. They show themselves effectively in the treatment of arthrosis, arthritis and other diseases. Such drugs will not be able to completely get rid of the disease, but only suppress the symptoms. Non-steroidal anti-inflammatory drugs are relatively harmless when compared with hormonal ones. They perfectly relieve the signs of the disease, remove the pain, after which the patient will be able to begin complex treatment.

Non-steroidal anti-inflammatory drugs (NSAIDs) for the treatment of joints

The medical summary of the last few decades shows that diseases of the musculoskeletal system, ligaments and joints, in particular, are in the ranking of the most popular diseases after diseases of the cardiovascular system and neurological abnormalities. In addition, the age threshold of patients has also decreased, an increasing number of people under the age of forty turn to orthopedists with complaints of pain in the joints and ligaments.

After contacting a doctor and determining the diagnosis, treatment is prescribed, which necessarily and primarily includes non-steroidal anti-inflammatory drugs.

General information

Non-steroidal anti-inflammatory drugs - such a pharmaceutical group of drugs that is used in the treatment and prevention of inflammation in the area:

1. Large and small joints.
2. Ligaments.

The main action of NSAIDs is aimed at removing:

• Pain;
• inflammation;
• Heat.

The development of this group of drugs was preceded by the discovery of salicylic acid, obtained from the bark of the willow in 1829. Since then, nonsteroidal drugs have been one of the most indispensable groups of drugs in pharmacology, and their list is updated every year with newer and newer types of nonsteroidal drugs.

The meaning of the treatment of joints and ligaments with non-steroidal anti-inflammatory drugs is based on the suppression of the production of prostaglandins due to cyclooxygenase.

The chemical structure of nonsteroidal drugs divides them into 2 large groups:

1. Acidic - the most common group containing at its core acid (salicylic acid), the directed action of which effectively relieves fever and anesthetizes. These drugs include Ibuprofen, Indomethacin, Meloxicam.
2. Non-acid - anti-inflammatory drugs that direct their action to suppress inflammation and pain. These drugs traditionally include Ortofen, Diclofenac, Ketoprofen and their analogues.

Side effects and contraindications

In medicine, there are no other ways to treat joints and ligaments, except for the appointment of non-steroidal anti-inflammatory drugs. However, despite their powerful effect in relieving inflammation, these remedies have a long list of side effects on many systems in the human body. The most common are:

• stomach disorders;
• Nausea and vomiting;
• Loss of vision and hearing;
• dry mouth;
• Cardiopalmus;
• Violation of hematopoiesis;
• allergies;

• Darkening of the eyes and noise in the ears;
• Pain in various organs;
• Drowsiness.

Due to serious side effects, non-steroidal drugs are contraindicated in persons with:

1. Ulcerative colitis.
2. Gastritis, erosion, stomach ulcers.
3. Children's age up to 12 years.
4. Pregnancy, lactation period.
5. Hypersensitivity to the components of the drug.
6. Liver and kidney failure.

Non-steroidal anti-inflammatory drugs come in various forms. Each patient can choose for himself the most convenient for him. However, there are certain advantages of one form over the other. Sometimes the appointment of a specific form for the treatment of joints and ligaments is fundamentally important. Non-steroidal anti-inflammatory drugs for the treatment of joints have the following forms of release:

1. Injections (shots).
2. Ointments for the treatment of joints (gels, creams).
3. Tablets.
4. Plasters.
5. Suppositories.
6. Suspensions.
7. Capsules.

Advantages and disadvantages

Each release form has its own advantages and disadvantages. Depending on the type of disease, its severity, time of course and form, one or another type of drug and its specific form are prescribed. Sometimes several forms can be prescribed for treatment at once. For example, injections (shots) and tablets at the same time or tablets and ointments, gels at once.

Injections (shots) are prescribed by a doctor for the treatment of joints and ligaments when the course of the disease is in an acute stage, and inflammation and pain must be removed as soon as possible in order to alleviate the patient's suffering and prevent the disease from hitting new foci. Injections can be administered intravenously or intramuscularly, more often intramuscularly for a course of 7 to 10 days twice a day. Injections are the first in the list in terms of the frequency of prescription for patients with pain in the joints and ligaments.

More

Advantages of injections:

• Speed ​​of action;
• Minimal risk of damage to the gastric mucosa;
• No additional time is required for the absorption of the drug into the walls of the stomach.

Disadvantages of injections:

1. Painful insertion.
2. Inconvenience (you need a second person in order to administer the drug).

Tablets, as well as injections, are popular in the treatment of joints and ligaments. Very often prescribed after injections to continue treatment and consolidate the result.

Benefits of tablets:

• Can be taken for a long time (much longer than injections);
• Painless introduction;
• The help of other people is not required;

Disadvantages of the tablet form:

1. Additional time is needed for the absorption of the drug into the walls of the stomach and its entry into the blood.
2. Tablets, getting into the stomach, can injure it, cause erosion, ulcers and gastritis.

Ointments, gels, creams are usually prescribed by doctors in combination with tablets or injections to achieve the best result.

Advantages of gels and ointments, creams:

• Action on the lesion (joint or ligaments);
• Ease of use;
• Strengthening the action of other non-steroidal anti-inflammatory drugs;
• Does not injure the walls of the stomach, liver;
• It has a pronounced analgesic (and sometimes cooling) effect;
• It has much fewer contraindications and side effects than the first two forms of release.

Disadvantages of ointments, gels, creams:

1. It takes time to absorb the product.
2. Valid for a short period.
3. Can leave stains that are difficult to wash on clothes.
4. Leaves a sticky feeling on the skin.

Patches, as well as ointments (gels, creams) are prescribed in combination with other non-steroidal drugs to enhance anti-inflammatory and analgesic effects.

Advantages of patches:

• They have a pronounced analgesic and warming effect;
• Easy to use;
• Do not injure the stomach, kidneys and liver;
• Virtually no side effects;
• They last longer than ointments, gels and creams.

Disadvantages of patches:

1. Visible under clothing.
2. May come off when sweating or moving fast.
3. Leave traces of glue.

Suppositories, or as they are also called, candles, are prescribed as an alternative to injections and tablets. Method of administration - rectally.

Advantages:

• Rapid absorption into the blood (in terms of speed it is equivalent to injections);
• Do not injure the liver, kidneys and stomach;
• Ease of use.

Disadvantages of suppositories:

1. Short shelf life.
2. Strict rules for wounding (in the refrigerator), which makes it difficult to take the drug with you on the road.

Treatment with non-steroidal anti-inflammatory drugs

Damaged joints and ligaments cannot be completely restored, you can only stop the process that has begun and prevent complications from arising.

Anti-inflammatory non-steroidal drugs are the main drugs used for the treatment of joints and ligaments. The form of the drug, the period of use and dosage is determined only by the doctor in accordance with the age of the patient, the diagnosis and the degree of neglect of the disease. Painkillers anti-inflammatory drugs quickly relieve pain, swelling, redness of the joint.

After examining a patient complaining of pain in the joints and ligaments, the doctor comes to a decision which anti-inflammatory drug to prescribe. The following types of non-steroidal anti-inflammatory drugs are usually prescribed:

Diclofenac is a non-acid derivative, prescribed for severe pain in the joints and ligaments. Despite its popularity, it has a large list of contraindications, it is strictly prohibited:

• Pregnant and lactating women;
• Children under 12;
• Patients with problems with the cardiovascular, excretory systems, gastrointestinal tract.

Diclofenac and its more expensive analogues have several forms of release (injections, ointments, gels, patches, tablets).

Ibuprofen is an acid derivative drug with antipyretic and analgesic effects, one of the few drugs that is allowed:

1. Children over 3 months old.
2. Pregnant women.
3. Nursing mothers.

It has several release forms:

• Suspension;
• Tablets;
• Ointments;
• suppositories;
• Gels.

Indomethacin, a drug widely used to relieve inflammation and pain, belongs to the group of non-acid derivatives. It has several release forms:

1. Tablets.
2. Ointment.
3. Candles.
4. Gel.
5. Capsules.

Painkillers of the indomethacin group are prescribed for the treatment of joints and ligaments in adults and children.

Nimesulide is a relatively recently developed drug prescribed for the treatment of degenerative processes in the joints and tissues. The advantages of nimesulide are in a small list of contraindications and side effects. This drug is available in the form:

• Tablets;
• injections;
• Ointments;
• Candlelight.

Ketoprofen is one of the most powerful anti-inflammatory non-steroidal drugs with a powerful analgesic effect. Widely applicable by orthopedists for the treatment of diseases:

Joint treatment More >>

1. joints.
2. Backs.
3. Ligaments.

Ketoprofen and its analogues have the following release forms:

• Tablets;
• injections;
• Gels.

Conclusion

Thus, drugs prescribed for the treatment and elimination of problems of the musculoskeletal system, in particular, joints and ligaments, have analgesic, antipyretic and anti-inflammatory effects.

Nonsteroidal drugs - are mandatory means to get rid of diseases of the musculoskeletal system. Each pharmacological form of release (tablets, injections, gels, ointments, creams, suppositories, patches, suspensions) has its own advantages and disadvantages, and the choice of a particular form depends on the age characteristics of the patient, the type of disease and general health.

Painkillers direct their action to suppress the production of prostaglandins that affect the occurrence of inflammation.

Diseases of the joints and ligaments are a frequent phenomenon and cause a lot of trouble to those who suffer from it. In addition, it requires immediate medical attention and quality treatment, after which you will have to change your lifestyle completely in order to avoid a relapse of the disease.

Anti-inflammatory and analgesic injections: what means to inject

When severe pains appear in the joints of the arms and legs, the primary task of the doctor is to determine the nature of their occurrence. Pain syndrome can be caused by gonarthrosis (arthrosis of the knee joint), coxarthrosis (arthrosis of the hip joint), tendinitis, dislocation or sprain of the ankle, trauma or elbow bursitis.

Whatever caused the pain in the limbs, the patient must be examined by a neurologist, osteopath, traumatologist, orthopedist, perhaps even a gynecologist, urologist and gastroenterologist. After all, often diseases of the joints are associated with pathologies of internal organs.

For example, gouty arthritis is a pathology in which purines (uric acid) accumulate in the body, and various kidney diseases can cause such an imbalance.

Rheumatoid arthritis and osteoporosis often occur in women during menopause. Many joint diseases provoke metabolic disorders.

That is why the survey should be comprehensive. After diagnosing and determining the cause of joint pain, the doctor may prescribe anti-inflammatory, non-steroidal painkillers - NSAIDs and B vitamins to the patient.

How to treat the musculoskeletal system

Modern medicine has a huge arsenal of drugs that are effective in various articular pathologies.

If an inflammatory process develops in the joints, the doctor makes the main therapeutic emphasis on NSAIDs, which can suppress pain, eliminate the focus of inflammation and reduce high body temperature.

After the acute period of the disease has passed, non-traditional methods of treatment are connected to the treatment with medicines:

• massage;
• physiotherapy procedures;
• manual therapy;
• exercise therapy course.

The patient should move as much as possible and perform daily gymnastic exercises aimed at restoring mobility in the damaged joint and strengthening the ligamentous apparatus.

Returning to the topic of medicines, it should be noted that the treatment of diseases of the joints (elbow, knee, shoulder, ankle) requires the appointment of combined vitamin complexes, which also provide moderate pain relief and, most importantly, supply cartilage and bone tissue with essential trace elements.

It is generally accepted that the greatest effect in terms of pain relief can be achieved by taking vitamin B12. This drug has recently been considered in medical practice as a moderate analgesic, since it has the following properties:

1. normalizes muscle innervation;
2. participates in the transmission of excitatory impulses;
3. stimulates metabolic processes;
4. normalizes the functioning of the nervous system;
5. restores damaged nerve tissue.

Numerous clinical studies have shown that the use of vitamin B for the treatment of joint diseases in most cases led to a significant reduction in pain during exacerbation of inflammation.

If oral medication does not eliminate pain in muscle tissues, the patient may be offered injections for inflammation in combination with the stretching method. The essence of this technique is as follows:

• The patient is offered to lie on his back or on his stomach (depending on the location of the pain).
• The doctor finds seals or points on the patient's body where the pain is most severe.
• An injection is made exactly perpendicular to this place with a solution of novocaine.

Immediately after the procedure, it is necessary to passively stretch the muscle. Next, a hot compress is applied to the sore spot. After removing the compress, the patient should maximize the use of the sore muscle with active movements.

The main goal of novocaine blockade is to "turn off" the nerve. Therefore, injections for inflammation should be as close as possible to the exit points of nerve endings.

Preparations for the treatment of joint diseases

B vitamins are also available in the form of tablets that are intended for oral use. However, intramuscular injections for pain in the joints and muscles are most effective.

It is on them that it is worth dwelling in more detail: find out their composition, pharmacological action, indications and contraindications, storage conditions and approximate cost. The composition of all the drugs listed below is the same: Pyridoxine, Lidocaine, Thiamine, Cyanocobalamin.

Milgamma injection drug.

• 5 ampoules - 220 r.
• 10 ampoules - 400 r.
• 25 ampoules - 900 rubles.

Indications for use: Milgamma is prescribed in complex therapy for neurological disorders and diseases of the nervous system:

1. paresis of the facial nerve, neuritis, trigeminal neuralgia;
2. if joints and muscles hurt, there are pains in the spine caused by neurological manifestations and degenerative-dystrophic changes in tissues;
3. alcoholic, diabetic polyneuropathy;
4. nocturnal muscle cramps;
5. shingles.

Kombilipen

• 5 ampoules - 120 r.
• 10 ampoules - 200 rub.

The drug has the following contraindications:

1. acute forms of heart failure;
2. pregnancy and lactation;
3. high sensitivity of the body to the components of the drug;
4. the medicine is not prescribed to children, due to the lack of research in this area.

Neurobion

Price: 3 ampoules - 220 rubles. A distinctive feature of Neurobion is that it does not contain Lidocaine.

Negative manifestations during treatment:

• increased sweating;
• tachycardia;
• skin rashes (extremely rare);
• anaphylactic shock;
• labored breathing.

Overdose:

1. symptoms of intoxication - nausea, vomiting;
2. tachycardia;
3. dizziness.

Trigamma

Price: 5 ampoules - 100 rubles.

All of the above drugs are injected deep into the muscle tissue.

Anti-inflammatory, non-steroidal painkillers

Non-steroidal anti-inflammatory drugs in the treatment of articular diseases are prescribed only as a symptomatic treatment. They are able to eliminate pain in the joints and muscles, but cannot affect the cause of the inflammatory process.

Unfortunately, half of the patients treated with NSAIDs experience side effects, sometimes severe. With this development of events, the medication should be stopped and a doctor should be consulted, who will prescribe another treatment.

Medical scientists have conducted a huge amount of research, the purpose of which was to identify the best painkiller. During these activities, it was found that non-steroidal anti-inflammatory drugs in this regard are not very effective. However, some of these medicines are not cheap.

When choosing an analgesic, doctors advise their patients to pay attention to the fact that some analogues are significantly inferior in their effectiveness to the original drugs. An example is the domestic drug Diclofenac, which cannot be compared with the European original.

Studies have found that Ibuprofen of all NSAIDs is the least toxic and has minimal side effects.

Manufacturers of the new COX-2 inhibitor, Celebrex, claimed that the drug had practically no negative manifestations, but an additional study of the drug proved that this fact has no evidence.

Therefore, when going to the pharmacy to buy anti-inflammatory painkillers, the patient should know that they are all anesthetics, have side effects, but different frequency, severity and intensity of negative manifestations. The price range between one and the other NSAIDs can be very wide.

For example, Indomethacin has pronounced analgesic and anti-inflammatory properties, but it has a destructive effect on cartilage tissue. Therefore, doctors prescribe this drug very rarely.

In some advanced joint pathologies, anti-inflammatory painkillers are of low efficiency, and increasing the dose does not lead to the elimination of pain and inflammation.

In this case, replacing one drug with another does not make sense, you need to look for other methods of treatment.

How to choose an anesthetic drug

If pain in the joints of the extremities is chronic, the doctor must first determine their cause and intensity. Based on this, the doctor can prescribe adequate treatment.

In acute pain, the risk of side effects of prescribed drugs on the gastrointestinal tract should be determined. If such a risk is small and there is no dyspepsia, any non-steroidal anti-inflammatory drugs can be prescribed to the patient.

In the presence of dyspepsia, one of these drugs should be prescribed:

• Ibuprofen.
• Naproxen.
• Diclofenac.
• Miloxicam.
• Nimesulide.

With a high probability of developing cardiovascular complications, the appointment of NSAIDs should be avoided, and Paracetamol should be content. With moderate risk, you can take Nimesulide.

If there is a possibility of gastrointestinal bleeding, proton pump inhibitors must be added to NSAIDs. It is believed that even a single dose of NSAIDs poses a certain risk to the body, so taking this group of drugs (regardless of the likelihood of gastroduodenal bleeding) implies the appointment of proton pump blockers.

Even if the pain subsides within a few days, treatment should not be stopped. The drug should be continued until the pain is completely relieved. If the pain does not subside within seven days, the patient is prescribed muscle relaxants, external anesthetics.

Local injections of corticosteroids are possible in the absence of tuberculosis of the spine or joints. With intense incessant pain, you need to make sure that the nature of the disease is non-infectious. The patient should be examined in the TB and venereal dispensary.

Non-steroidal anti-inflammatory drugs for the treatment of joints

The main purpose of non-steroidal anti-inflammatory drugs is to relieve unpleasant symptoms that occur in diseases of the joints - primarily arthrosis, arthritis and others. Most often, specialists doctors prescribe them to combat inflammation, pain, which become especially acute at the second or third stage of the development of the pathology.

• Targets for non-steroidal anti-inflammatory drugs
• Popular remedies
• Application methods
• Precautionary measures
• Some Important Facts
• Side effects, contraindications
• It's important to know
• Rules of use
  • Ibuprofen
  • diclofenac
• Conclusion

Targets for non-steroidal anti-inflammatory drugs

Having given the idea to create non-steroidal anti-inflammatory drugs for the treatment of joints, pharmacists hoped to solve a number of problems with their help:

• Remove pain in the joint;
• Reduce inflammation by completely stopping this process.

Today, these drugs are among the most widely used, which are superior in effectiveness to many other drugs. With their help, you can significantly reduce pain symptoms in various diseases of the joints.

But it should be understood that, by conducting long-term treatment with non-steroidal anti-inflammatory drugs, one should not expect that arthrosis can be cured with their help. They are designed primarily to relieve the painful manifestations of pathology. Therefore, they are recommended to alleviate the condition in case of a disease that previously prescribed drugs are not able to provide.

During periods of exacerbation of arthrosis, physiotherapy exercises, as well as certain physiotherapy procedures, are contraindicated for patients. Often, patients have a desire to use traditional medicine, but it takes a long time to wait for the effect. The solution in such a situation can be just non-steroidal anti-inflammatory drugs for the treatment of joints.

Popular remedies

Pharmacy chains offer a wide variety of non-steroidal anti-inflammatory drugs, which were originally intended for the treatment of such common joint diseases as arthritis and arthrosis. Regular use of these drugs allows you to completely stop the disease, as well as weaken the manifestation of symptoms.

Among this group of funds, the most common are:

• "Meloxicam";
• "Naproxen";
• "Ibuprofen";
• "Diclofenac";
• "Indomethacin";
• "Etodolac".

Moreover, all these remedies differ from each other in their properties: some do not have such a bright effect, others show themselves well in suppressing acute attacks of the disease. When treating with these drugs, it is important that they are prescribed by a doctor, otherwise you can not only lose precious time, but also face the side effects of an improperly selected nonsteroidal drug.

Application methods

Non-steroidal anti-inflammatory drugs available today in pharmacies are presented in several forms:

• tablets;
• intramuscular injections for joints;
• intra-articular injections;
• candles;
• joint cream;
• ointments.

With an exacerbation of the disease of the joints, which is accompanied by a deterioration in the patient's condition, it is necessary to use potent drugs, which, unfortunately, have many adverse reactions. To minimize harm to the body, doctors prescribe injections for the joints. In most cases, such a measure is resorted to in the treatment of gonarthrosis and coxarthrosis. In comparison with tablets, the active substances entering the body after injection do not penetrate the gastrointestinal tract, thereby eliminating the negative effect on the gastric mucosa. Injections allow you to provide the body with useful elements in increased quantities, which is often impossible to achieve using other methods of application.

The pharmaceutical industry today offers oral non-hormonal anti-inflammatory drugs. They are available in the form of tablets.

Precautionary measures

In order for the non-steroidal anti-inflammatory drugs used to bring relief to the patient and at the same time harm from them was minimized, they must be used strictly in accordance with the doctor's recommendations. When visiting a specialist, the patient must receive a prescription that he must follow. The desire to overdose the drug to hasten recovery will not be beneficial. On the contrary, it can cause a number of complications that can be very severe, sometimes even fatal.

It is extremely careful to use the means of the category of patients who suffer from diseases of the gastrointestinal tract, kidneys, have pronounced allergies, cirrhosis of the liver, heart and vascular diseases. It should also be noted that non-steroidal anti-inflammatory drugs contain special components that can make other drugs less effective when used together. This requires the patient to correctly combine drugs. Therefore, before starting a course of treatment with one or another drug, it is necessary to discuss this issue with a specialist.

Treatment of joints with non-steroidal anti-inflammatory drugs is a rather lengthy process. The desired therapeutic effect can be achieved after the entire course has been completed, which includes approximately 15 injections or 7 intra-articular injections. The exact number of sessions is determined taking into account the stage of the disease and the body's response to the drug.

Some Important Facts

Based on medical practice, there are many cases when prescribed NSAIDs brought relief to the patient, relieving him of pain, and after that he refused to continue treatment. However, the absence of symptoms is not a sign that arthrosis or arthritis has been cured. Having removed the symptoms, the patient must throw all his strength into the treatment of the underlying disease. You can solve this problem using the following methods:

• proper nutrition;
• taking chondroprotectors;
• massage;
• swimming;
• gymnastics;
• folk methods;
• stay in medical sanatoriums.

With a long course of treatment with NSAIDs, cartilage tissue is no longer able to synthesize new cells, this function stops. One of the main signs of arthrosis is the destruction of cartilage. Therefore, when taking these drugs, you can accelerate the process of deformation. As a result of their intake, the production of proteoglycans worsens, and this leads to water loss. Thus, with prolonged use of NSAIDs, it is necessary to constantly be observed by a specialist. The patient should have an idea of ​​which ointments he is allowed to use in his case in order to minimize possible harm.

Side effects, contraindications

Few cases are known when non-steroidal anti-inflammatory drugs were harmful, worsening the patient's condition. But at the same time, one must not forget that these drugs have a number of side effects:

• Negatively affect the functioning of the kidneys;
• Have a negative impact on the activity of the gastrointestinal tract;
• With prolonged use, conditions may arise for the development of diseases of the heart or blood vessels;
• May cause symptoms such as rash, nausea, and diarrhea;
• When taken by women during pregnancy up to 20 weeks, there is a chance of miscarriage.

An unconditional contraindication to the use of these drugs is the presence of bronchial asthma.

It's important to know

Statistics show that, unlike steroid drugs, non-steroidal anti-inflammatory drugs can quickly achieve a stable remission. However, there are important points to keep in mind:

• It is forbidden to take drugs for patients diagnosed with stomach ulcers, asthma, hypertension, as well as severe forms of kidney, liver and heart diseases.
• In the case of taking these drugs, there is a possibility of bleeding in the gastrointestinal tract. To avoid this, the patient should be regularly tested to avoid such complications.
• Regardless of the form in which nonsteroidal drugs are taken, there is a risk of blood clots, stroke or heart attack. With these drugs, you need to be careful for people with diseases of the cardiovascular system.
• Patients who have recently undergone coronary bypass surgery should not take non-steroidal anti-inflammatory drugs.

Rules of use

While taking non-steroidal anti-inflammatory drugs, as in the treatment of steroid drugs, the patient must follow certain rules exactly.

1. Medicines can only be used as directed in the instructions.
2. When taking the drug in the form of a capsule or tablet, it is washed down with a full glass of water. This can help the stomach avoid significant irritation.
3. During the course of treatment with nonsteroidal drugs, it is unacceptable to take alcohol. In this case, there is a possibility of developing pathology of the stomach.
4. It is strongly recommended that women stop taking non-steroidal drugs during pregnancy.
5. After drinking the drug in the form of a capsule or tablet, you must wait 30 minutes, and then you can lie down. When a person is in an upright position, this accelerates the passage of the drug through the esophagus due to the effect of gravity.
6. Patients who are being treated with anti-inflammatory ointments for the joints need to choose separate days for the use of non-steroidal drugs. The combination of drugs will lead to the fact that the side effects will increase, and this will not bring much benefit.
7. Sometimes when taking certain drugs, it is difficult to achieve the desired effect. In this case, it is necessary to reconsider the dosage. It is not worth making changes to the treatment regimen on your own. Be sure to get permission from your doctor. It is possible that you may need to change your medication.

Ibuprofen

This anti-inflammatory non-steroidal drug is offered in the form of tablets and can reduce fever, as well as relieve headaches. It must be taken, like all steroid drugs, strictly in accordance with the instructions, which contain certain nuances of use. It is indicated for use in increased doses for the treatment of diseases of the joints and spine.

Take this drug strictly in accordance with the instructions of the instructions, since non-compliance with them will lead to the manifestation of side effects:

• Problems with the gastrointestinal tract;
• Dizziness;
• Headache;
• High blood pressure;
• Sleep disturbance.

This drug also has other side effects. Therefore, before you start taking the medicine, you must carefully study them in order to avoid complications. It is advisable to consult a specialist on this issue before starting treatment and follow his instructions exactly.

diclofenac

Doctors often prescribe diclofenac ointment to relieve symptoms. This is a very affordable drug that quickly relieves pain. The medicine has proven itself in the treatment of joints and back.

But this drug also has its drawbacks - adverse reactions that occur with prolonged use. Failure to follow this recommendation can lead to unpleasant symptoms such as dizziness, headaches, and tinnitus. At the same time, there are problems with the functioning of the liver. It should also be avoided in people with asthma, during pregnancy and breastfeeding.

Diseases of the musculoskeletal system, ligaments and joints are in the ranking of the most popular diseases after diseases of the cardiovascular system and neurological abnormalities. The age threshold of patients has also been reduced: an increasing number of people under the age of forty turn to orthopedists with complaints about and ligaments. After contacting a doctor and determining the diagnosis, treatment is prescribed, including non-steroidal anti-inflammatory drugs.

General information

Non-steroidal anti-inflammatory drugs - such a pharmaceutical group of drugs that is used in the treatment and prevention of inflammation:

1. Large and small joints.
2. Ligaments.

The main action of NSAIDs is aimed at removing:

• pain;
• inflammation;
• heat.

The development of this group of drugs was preceded by the discovery of salicylic acid, obtained from the bark of the willow in 1829. Since then, nonsteroidal drugs have been an indispensable group of drugs. The meaning of the treatment of joints and ligaments with non-steroidal anti-inflammatory drugs is based on the suppression of the production of prostaglandins due to cyclooxygenase.

According to the chemical structure, nonsteroidal drugs are divided into 2 large groups:

1. Acidic - the most common group containing at its core acid (salicylic acid), the directed action of which effectively relieves fever and anesthetizes. These drugs include Ibuprofen, Meloxicam.
2. Non-acid - anti-inflammatory drugs that direct their action to suppress inflammation and pain. These drugs include Ketoprofen and them.

Dr. Epifanov explains the mechanism of action:

Side effects and contraindications

In medicine, there are no other ways to treat joints and ligaments, except for the appointment of non-steroidal anti-inflammatory drugs. NSAIDs, despite their powerful effect in relieving inflammation, have a long list of side effects. The most common are:

• indigestion;
• nausea and vomiting;
• loss of vision and hearing;
• dry mouth;
• cardiopalmus;
• violation of hematopoiesis;
• allergies;
• blurred vision and tinnitus;
• pain in various organs;
• drowsiness.

Due to serious side effects, non-steroidal drugs are contraindicated in persons with:

1. Ulcerative colitis.
2. Gastritis, erosion, stomach ulcers.
3. Children's age up to 12 years.
4. Pregnancy, lactation period.
5. Hypersensitivity to the components of the drug.
6. Liver or kidney failure.

Non-steroidal anti-inflammatory drugs come in various forms. There are certain advantages of one form over another. Sometimes the appointment of a specific form for the treatment of joints and ligaments is fundamentally important. Non-steroidal anti-inflammatory drugs for the treatment of joints have the following forms of release:

1. (gels, creams).
2. Plasters.
3. Suppositories.
4. Suspensions.
5. Capsules.

Advantages and disadvantages

Each release form has its own advantages and disadvantages. Depending on the type of disease, its severity, time of course and form, the type of drug, its specific form, is prescribed. Sometimes several forms can be prescribed for treatment at once. For example, injections (shots) and tablets at the same time or tablets, ointments and gels.

Injections (shots) are prescribed by a doctor for the treatment of joints and ligaments, if the disease is in an acute stage, and inflammation, pain must be removed quickly in order to alleviate the patient's suffering and prevent the disease from hitting new foci. Injections can be administered intravenously or intramuscularly (more often), a course of 7 to 10 days twice a day. Injections are the first in the list in terms of the frequency of prescription for patients with pain in the joints and ligaments.

Advantages of injections:

• speed of action;
• minimal risk of damage to the gastric mucosa;
• no time is required for the absorption of the drug into the walls of the stomach.

Disadvantages of injections:

1. Painful insertion.
2. Inconvenience (it is impossible to self-administer the drug).

Ibuprofen is an acid derivative drug with antipyretic, analgesic effect. This is one of the few drugs that is allowed:

1. Children over 3 months old.
2. Pregnant women.
3. Nursing mothers.

Release forms:

• suspension;
• tablets;
• ointments;
• gels.

Indomethacin, a drug widely used to relieve inflammation and pain, belongs to the group of non-acid derivatives. Its release form:

1. Tablets.
2. Ointment.
3. Candles.
4. Gel.
5. Capsules.

Painkillers of the indomethacin group are also prescribed for adults and children.

Nimesulide is a relatively recently developed drug prescribed for the treatment of degenerative processes in joints and tissues. The advantages of nimesulide are in a small list of contraindications. Available in the form:

• tablets;
• injections;
• ointments;
• candles.

Ketoprofen is one of the most powerful anti-inflammatory nonsteroidal drugs with analgesic effects. Widely applicable by orthopedists for the treatment of diseases:

1. joints.
2. Backs.
3. Ligaments.

Release forms:

• tablets;
• injections;
• gels.

Conclusion

Medicines prescribed for the treatment of pathologies of the musculoskeletal system, in particular, joints and ligaments, have analgesic, antipyretic, anti-inflammatory effects.

Non-steroidal drugs are mandatory in the treatment of diseases of the musculoskeletal system. Each pharmacological form of release (tablets, injections, gels, ointments, creams, suppositories, patches, suspensions) has its own advantages and disadvantages. The choice of a specific form depends on the patient's age, type of disease, general health.

They direct their action to suppress the production of prostaglandins that affect the occurrence of inflammation.

Diseases of the joints and ligaments are a frequent occurrence that causes a large number of troubles. The disease requires an immediate visit to the doctor for a full treatment, after which you will have to change your lifestyle completely in order to avoid a relapse of the disease.