How different orthopedists approach the treatment of coxarthrosis

Summary.

Osteoarthritis (OA) is the most common joint disease and is one of the leading reasons for visiting a general practitioner. According to statistics, OA affects 20% of the population, and the incidence is steadily increasing. The predominant age is 40–60 years. Today, structure-modifying slow-acting drugs, or chondroprotectors, are widely used in the treatment of OA. The author assessed the effectiveness of a new European chondroprotector in the combination therapy of stage I–II osteoarthritis of various localizations. The study included 358 patients with OA of the knee and hip joints, as well as polyosteoarthrosis. According to the study, all patients experienced a decrease in pain severity, a decrease in the need for painkillers, and an increase in functional activity and quality of life. The drug was well tolerated and patients demonstrated high adherence to treatment.

Keywords:

Osteoarthrosis, polyosteoarthrosis, articular cartilage, chondroprotectors, hydrolyzed type II collagen, chondroitin sulfate, glucosamine sulfate, hyaluronic acid, ginger root extract.

Experience of applying a new European chondroprotector in patients with stage 1–2 osteoarthritis in general medical practice.

Kargaeva Tatyana Nikolaevna, kmn, rheumatologist Polyclinic No. 218 Moscow

Summary.

Osteoarthritis (OA) is the most common joint disease and occupies one of the leading places among the reasons for visiting a general practitioner. According to statistical data, 10 to 20% of the population suffer with OA, while the incidence is steadily increasing. To date, in the treatment of OA, structurally modifying delayed-action drugs or chondroprotectors are widely used. The author estimated the effectiveness of the new European chondroprotector in combined therapy in the 1–2 stages of osteoarthrosis of different localization. The study included 358 patients with knee and hip joint OA, as well as polyosteoarthrosis. According to the study, all patients experienced a decrease in the severity of pain, a decrease in need for analgesics, an increase in functional activity and improvement in the quality of life. The drug is well tolerated, and patients demonstrated high adherence to treatment.

Key words:

osteoarthritis, polyarthritis, articular cartilage, chondroprotectors, hydrolyzed type II collagen, chondroitin sulfate, glucosamine sulfate, hyaluronic acid, ginger root extract.

Osteoarthritis (OA) is a heterogeneous group of diseases of various etiologies with similar biological, morphological, clinical manifestations and outcome [1]. Damage to cartilage, subchondral bone, synovial membrane, capsule, ligaments and periarticular muscles is the basis of this pathology (2). In the English-language literature, the name of the disease is usually used - osteoarthritis, which emphasizes the role of inflammation in the development of the disease [3].

Osteoarthritis is the most common joint disease. OA accounts for 60–70% of all joint diseases; arthrosis affects 10–20% of the population (4). At the same time, the proportion of patients with OA is steadily growing; it is expected that by 2021 osteoarthritis will become the fourth cause of disability [5]. Osteoarthritis represents a serious socio-economic problem, as it significantly worsens the quality of life of patients. OA is one of the main causes of premature disability, second only to ischemic heart disease.

In OA, the resistance of articular cartilage to mechanical load is impaired. The balance of cartilage tissue metabolism shifts towards increased catabolic processes. Changes in articular cartilage contribute to the deterioration of its biomechanical properties, which negatively affects the underlying bone tissue, causing metabolic disorders, increased intraosseous pressure, and the development of subchondral sclerosis and osteophytosis. Depolymerization of hyaluronic acid (HA) is associated with deterioration of the viscoelastic properties of synovial fluid in OA [6].

According to the modern classification of drugs used in the treatment of OA [7], they are divided into the following groups:

• Symptom: rapid-acting drug-modifying drugs (NSAIDs, acetaminophen, opioid analgesics, corticosteroids, muscle relaxants, etc.). These drugs relieve the main clinical symptoms, such as pain and inflammation.
• Structurally - time-modifying drugs, or chondroprotectors.

These drugs have a chondromodifying effect. They are able to influence inflammation and metabolic processes in cartilage tissue, and thus prevent the degradation of articular cartilage.

Among the structure-modifying drugs used to treat OA, the largest evidence base is for chondroitin sulfate (CS) and glucosamine sulfate, level of evidence (1A). [8].

Another substance with a proven chondroprotective effect is hyaluronic acid (HA). It plays a number of key roles in the trophism of cartilage and, by improving the properties of synovial fluid, facilitates the sliding of articular surfaces [1,9].

It is also known that taking type II collagen increases joint mobility and reduces the severity of pain in patients with osteoarthritis [10].

In this regard, it seems interesting to study the effectiveness of chondroprotective drugs containing collagen II, chondroitin, glucosamine and hyaluronic acid for OA of various localizations in the initial stages of the disease. Such a drug recently appeared on the Russian pharmaceutical market and is called Flexinovo.

Flexinovo is a European-made chondroprotector that contains a combination of structure-modifying slow-acting components, whose effectiveness has been confirmed from the standpoint of evidence-based medicine. Active ingredients: hydrolyzed collagen type II - 300.0; chondroitin sulfate (including 200 mg from shark) - 240.0; glucosamine sulfate from crustaceans (D-glucosamine sulfate 2KCl) - 105.0; L-ascorbic acid (vitamin C) - 40.0; hyaluronic acid (Nutrihyl) - 24.0; ginger root extract (Zingiber officinalis) - 10.0.

Research objectives:

• To evaluate the effectiveness of treatment of osteoarthritis of various localization stages I - II with the chondroprotector Flexinovo.
• To evaluate the safety and tolerability of Flexinovo therapy in patients with stage I–II osteoarthritis of various localizations.

Purpose of the study:

studying the possibilities of therapy with chondroprotectors for patients suffering from osteoarthritis of various localizations, stages I - II.

Causes of deforming coxarthrosis

The disease is caused by pathologies of the spine and joints:

• congenital hip dislocation;
• aseptic necrosis of the femoral head;
• hip dysplasia;
• injuries, dislocations;
• inflammation of the hip joint, Perthes disease;
• scoliosis, kyphosis, flat feet.

Coxarthrosis occurs against the background of circulatory disorders, metabolism, overload of the hip joint, hormonal changes and prolonged stress.

Athletes, elderly and overweight people, relatives of patients with coxarthrosis and people who move little are susceptible to coxarthrosis. If you are at risk or are familiar with problems with the hip joint, take measures to prevent coxarthrosis. We'll talk about it a little later.

The key to successful treatment is finding the cause

The treatment regimen depends on what caused the coxarthrosis, whether it is primary or secondary, and whether the patient has concomitant pathologies. There is no universal drug that can relieve pain and restore joint mobility. The set of therapeutic measures includes various measures and medications, the set of which is determined individually after diagnosis. Why is it so important to determine the cause?

• for injuries or an active lifestyle of the patient, treatment will be the same;
• with passive pastime, against the background of which stagnant processes develop, - others;
• if coxarthrosis was a consequence of arthritis - third;
• if it was caused by hormonal disorders, for example diabetes, the fourth, etc.

Orthopedists carefully study the patient’s medical history to rule out the primary nature of the pathology and determine the root cause of the secondary one. Knowing it, you can prevent re-damage to cartilage in the future, since otherwise the treatment of osteoarthritis will not give the desired results.

Without knowing the cause, there is no point in treating coxarthrosis

How the disease develops

The bones of the hip joint are covered with a layer of elastic and durable articular cartilage. Cartilage ensures soft sliding of bones relative to each other and helps distribute the load when walking. It is covered with a layer of joint fluid, which provides protection and nutrition to the cartilage.

Osteoarthritis of the hip joint changes the properties of the joint fluid; it becomes viscous, thick and does not properly lubricate the cartilage. As a result, the cartilage dries out, becomes cracked and becomes thinner. The bones of the joint are exposed, the pressure on them increases, and they begin to deform.

What therapeutic methods are used at stages 1 and 2 of coxarthrosis?

The earlier treatment is started, the higher the patient's chances of taking control of the disease and maintaining freedom of movement. There are many methods, but not all of them are suitable for every patient. It is important not to overdo it, follow the specialist’s recommendations and not postpone therapy until later.

The diagram includes several points:

• short-course non-steroidal anti-inflammatory drugs, since medications have side effects on the gastrointestinal tract and cardiovascular system;
• vasodilators to improve blood circulation (after administration, the ability of cartilage to self-heal increases);
• muscle relaxants - drugs to relieve spasm of the thigh and leg muscles, to improve blood circulation in the joints;
• chondroprotectors to restore cartilage tissue and stop its deformation;
• intra-articular injections of a synovial fluid prosthesis, for example Noltrex, which restores the functionality of the hip joint for 12-18 months;
• hormonal drugs are relevant if the disease is accompanied by severe pain, as well as if muscles and tendons are inflamed;
• ointments and compresses are a method with low efficiency, since the product must overcome the skin, fat and muscle tissue (the effect of ointments is rather to massage the thigh, as a result of which blood circulation is activated and pain is reduced);
• physiotherapy - UHF therapy, laser, magnetic, cryotherapy, phototherapy (physiotherapy in combination with massage is especially effective);
• manual therapy;
• Exercise therapy to strengthen muscles and improve blood circulation.

It is very useful for patients with coxarthrosis to swim in sea water

Why is coxarthrosis dangerous?

The disease is constantly progressing. Without timely treatment, it can cause the following complications:

• constant pain in the leg that bothers you even at night;
• deterioration of posture, development of spinal osteochondrosis;
• the sore leg becomes shorter;
• in an advanced state of the disease, a person cannot walk without a cane.

Alternative Treatments

coxarthrosis have appeared . As experts say, the meaning of new unconventional technologies that the Internet is replete with is sometimes there, but very often it is a waste of money and time

If you have 2nd or 3rd degree coxarthrosis, then this is your joint.

There is no need to expect a cure after using “miracle” medicines; they cannot in any way affect the deformed parts of the joint. In principle, one can rely on a symptomatic result, but only at the initial stage of development of coxarthrosis. In the later stages, when the clinical symptoms are persistent and pronounced, which is explained by the high degree of destruction, their benefit is practically zero.

Plasmolifting - will PRP therapy cure arthrosis?

Its essence is the introduction into the cavity of the hip joint of plasma saturated with platelets, which is isolated from the patient’s own blood. The procedure promises activation of restoration processes in the lesion area and regeneration of hyaline cartilage due to the “switching on” of the self-renewal mechanism in the cartilaginous structures.

In the first two stages, it is possible, but not guaranteed, that the cartilaginous covers, devoid of nerve endings and the circulatory system, will improve to a normal state. But the procedure will not cure advanced pathogenesis! There is only a tiny fraction of the chance that remission will be achieved. It is worth considering that many scientists have already agreed that such autohemotherapy can cause the development of cancerous tumors, since it stimulates the production of stem cells in large quantities, the effect of which on the body has not been fully studied.

On the left is the smooth head of a healthy hip joint, and on the right is grade 3 coxarthrosis. Imagine how difficult it is to rotate in the acetabulum.

Degrees of coxarthrosis

There are three stages of the disease:

1. Coxarthrosis of the hip joint, grade 1, is characterized by mild pain in the hip area. It appears periodically and goes away after rest. The person walks freely, his gait does not change.
2. With coxarthrosis of the 2nd degree, the pain intensifies, is felt even at rest, and can radiate to the groin or knee area. The man begins to limp.
3. Coxarthrosis grade 3 is the most serious stage of the disease. The pain becomes constant and does not go away even at night. The patient has difficulty walking and is forced to rely on a cane.

Some experts also identify grade 4, the most severe, when the pain is especially intense, a person almost cannot walk, it hurts even to sit. Non-surgical treatment in this case is almost impossible.

What therapeutic methods do most orthopedists prefer?

Orthopedists in different countries, with different experience and qualifications, make choices depending on the clinical picture of each patient. But there are also “favorite” treatment methods that are preferred in most cases. To quickly relieve pain, non-steroidal anti-inflammatory drugs are mainly used in a short course. Among chondroprotectors, the latest generation of drugs are in particular demand.

As a basic treatment method, orthopedists most often choose intra-articular injections of synovial fluid prosthesis. In the older age group, this is sometimes the only possible option, since the cardiovascular system in old age is not ready for general anesthesia, and not everyone agrees to undergo long-term rehabilitation. It is much easier, faster and safer to take a course of 2-4 injections - and get rid of pain for a year - than to undergo surgery.

Whatever therapeutic method the orthopedist chooses, he will always recommend reviewing the diet, as well as adding the right, complex carbohydrates to it, which will provide the body with energy. In the fight against chronic joint disease, it will never be superfluous!

Dysplastic coxarthrosis

Dysplastic coxarthrosis develops against the background of hip dysplasia. Dysplastic arthrosis of the hip joint deforms the joint components and, without treatment, can lead to disability.

Most often, dysplastic coxarthrosis of the hip joint develops at the age of 25 years. The disease usually begins after stopping sports, during pregnancy, menopause, after childbirth, or after a joint injury.

Symptoms of dysplastic coxarthrosis include pain in the hip joint, difficulty abducting the hip to the side and turning.

Material and methods

The study included 358 patients with stage I–II OA of various locations.

Inclusion criteria:

1. Presence of one of the following symptoms:

• pain and crepitus in the knee joints,
• morning stiffness ≤ 30 min.

2. Presence of pain syndrome requiring drug therapy

• (40 mm or more on the visual analogue scale (VAS)).

3. The duration of the articular syndrome is no more than 10 years.

Exclusion criteria:

• High inflammatory activity,
• Reliable signs of another rheumatic disease,
• The presence of an ulcer of the gastric or duodenal mucosa in the acute stage,
• Severe concomitant pathology.

Taking into account the above criteria, 358 patients were included in the study. Of these, OA of the knee joints - 210 (59%) patients, polyosteoarthrosis - 97 (27%) patients, and OA of the hip joints - 51 (14%) patients (Fig. 1).

Rice. 1 Distribution of the sample of study patients by type of disease.

The average age of the patients was 54.5±2.02 years. The duration of the disease was on average 6.7±1.24 years.

The diagnosis of OA was established according to the criteria of Altman (1991). To determine the radiological stage of arthrosis, the classification of Kellgren and Laursen (1957) was used.

All 358 patients received complex therapy, including symptom-modifying fast-acting drugs (paracetamol/NSAIDs). As a structure-modifying slow-acting drug, patients received Flexinovo 1 tablet per day for 3 months. The effectiveness of therapy was assessed by the dynamics of joint pain using the Visual Analogue Scale and the Lequesne functional severity index over 3 months. Additionally, the number of patients who completely stopped taking painkillers was assessed.

Bilateral coxarthrosis

Bilateral coxarthrosis affects both hip joints. This form of the disease is quite rare. The disease is accompanied by “tied” legs syndrome.

Pain with bilateral coxarthrosis is felt in both hip joints. Painful sensations appear during physical activity and at rest. Other symptoms include limping, stiffness in movement, and muscle weakness.

Treatment of bilateral coxarthrosis should begin as early as possible. In advanced cases of the disease, a person loses the ability to move.

conclusions

• The use of Flexinovo, 1 tablet once a day for 3 months, in complex therapy of patients with OA of the knee joints, OA of the hip joints and polyosteoartosis reduces the severity of pain and the need for painkillers. Increases functional activity and quality of life of patients.
• Flexinovo is well tolerated. The use of Flexinovo, 1 tablet once a day for three months, is safe in terms of the development of side effects.

Thus, the data obtained confirm the effectiveness of Flexinovo in the complex therapy of OA of large joints and the feasibility of its use in general medical practice.

Literature:

1. Rheumatology: national guide / Ed. E. L. Nasonova, V. A. Nasonova. M.: GEOTAR-Media, 2008; 573–588.
2. 2.Peat G., McCarney R., Croft P. Knee pain and osteoarthritis in older adults: a review of community burden and current use of primary health care. Ann Rheum Dis 2001;60;91–7.
3. Khitrov N. A. Diversity and comorbidity of osteoarthritis: ways of treatment // Medical Council. - 2014. - No. 10. - p. 3 - 6.
4. Svetlova M. S. Approaches to the treatment of osteoarthritis of the knee joints in the early stages of the disease // Medical Council. - 2012. - No. 2. - p. 3 - 9.
5. Galushko E.A., Bolshakova T.Yu., Vinogradova I.B. and others. The structure of rheumatic diseases among the adult population of Russia according to epidemiological research. Nauch praktich rhevmat 2009;1:11–7.
6. Ananyeva L P Symptomatic treatment of pain in rheumatic diseases // Consiliummedicum-2002 - T 4 - N 8 - P 416–425.
7. Chichasova N.V. Treatment of pain in patients with osteoarthritis of various localizations // Attending physician. - 2014. - No. 7. p. 2 - 7.
8. Jordan KM, Arden NK, Doherty M. EULAR recommendations 2003: an evidence based approach to the management of knee osteoarthritis: report of a task force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT) // Ann Rheum Dis. 2003; 62:1145–1155.
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Treatment according to Bubnovsky

Nationally recognized doctor Sergei Bubnovsky is known as the creator of a unique technique belonging to kinesitherapy. Its main task is to restore lost ability to work and relieve pain in sore joints. Without medications or surgeries, the honored doctor helps you expand your range of physical activity and say goodbye to unbearable pain. Recovery occurs through a specially designed set of physical exercises.

Mr. Bubnovsky.

As the doctor notes, the bones cannot hurt, it is the muscles that hurt, which, when sick, stop working normally, weaken and atrophy. It is impossible not to emphasize that the classes successfully train, increase endurance and increase the range of movements not only in the problematic segment of the musculoskeletal system, but also in other parts of the musculoskeletal system. Moreover, they help strengthen the body as a whole.

BUT, if it is not the bones that hurt, but the muscles that atrophy during the disease, then the question arises - why do they atrophy if nothing hurts? And that’s why they atrophy because the pain is so strong that the person begins to limp and unload the limb. And when there is no load, the leg “dries out.” That's all the explanation. He got sick, he limped, his leg atrophied, and then the other one got sick. If gymnastics helped, then more than a million operations a year would not be performed in the world.

The expected therapeutic effect is as follows:

• restoration of mobility;
• improvement of blood circulation in the periarticular tissues;
• saturation of muscle, cartilage and bone structures with nutrients;
• elimination of pain syndrome.

But there is also a positive side to the work of a respected doctor, if he treats it as a way of preparing for surgery in the form of increasing the muscle strength of the legs.

The popular treatment according to the Bubnovsky method, unlike the Evdokimenko method, does not involve the use of drugs from the pharmacy. According to the country's leading rehabilitation specialist, it is enough to apply cold compresses to the sore area and systematically perform the exercises he suggests. By regularly training at home, the muscle complex will return to normal, and the pain will completely subside, while the quality of life will significantly increase.