Post-traumatic arthrosis of the elbow joint: symptoms, treatment. Bobyr Clinic

Elbow bursitis

INSTRUCTIONS

on the use of a medicinal product for medical use

Nise®

Registration number: P N012824/03

Trade name of the drug : Nise®

International nonproprietary name of the drug: nimesulide.

Dosage form: tablets

Compound

Each tablet contains:

Active ingredient: nimesulide 100 mg.

Excipients: calcium hydrogen phosphate, microcrystalline cellulose (type 114), corn starch, sodium carboxymethyl starch, magnesium stearate, colloidal silicon dioxide, talc.

Description

White with a yellowish tint, round biconvex tablets with a smooth surface.

Pharmacotherapeutic group: non-steroidal anti-inflammatory drug (NSAID).

ATX code: M01AX17.

Pharmacological properties

Pharmacodynamics

Non-steroidal anti-inflammatory drug (NSAID) from the sulfonanilide class. Is

a selective competitive inhibitor of cyclooxygenase-2 (COX-2), inhibits the synthesis of prostaglandins at the site of inflammation. The inhibitory effect on COX-1 is less pronounced (less likely to cause side effects associated with inhibition of prostaglandin synthesis in healthy tissues). Has anti-inflammatory, analgesic and pronounced antipyretic

action.

Pharmacokinetics

Absorption when taken orally is high (food intake reduces the rate of absorption without affecting its degree). Time to reach maximum concentration (TCmax) - 1.5-2.5 hours. Communication with plasma proteins - 95%, with erythrocytes - 2%, with lipoproteins - 1%, with acidic alpha1-glycoproteins - 1%. Changing the dose does not affect the degree of binding. The maximum concentration value (Cmax) is 3.5-6.5 mg/l. Volume of distribution – 0.19-0.35 l/kg. Penetrates into the tissues of the female genital organs, where after a single dose its concentration is about 40% of the concentration in plasma. Penetrates well into the acidic environment of the inflammation site (40%) and synovial fluid (43%). Easily penetrates histohematic barriers.

Metabolized in the liver by tissue monooxygenases. The main metabolite - 4 - hydroxynimesulide (25%), has similar pharmacological activity, but due to a decrease in the size of the molecules, it is able to quickly diffuse through the hydrophobic channel COX - 2 to the active binding site of the methyl group. 4 - hydroxynimesulide is a water-soluble compound, the elimination of which does not require glutathione and conjugation reactions of phase II metabolism (sulfation, glucuronidation, etc.).

The half-life (T1/2) of nimesulide is 1.56-4.95 hours, 4 - hydroxynimesulide - 2.89-4.78 hours.

4—Hydroxynimesulide is excreted by the kidneys (65%) and bile (35%) and undergoes enterohepatic recirculation.

In patients with renal failure (creatinine clearance 1.8-4.8 l/h or 30-80 ml/min), as well as in children and the elderly, the pharmacokinetic profile of nimesulide does not change significantly.

Indications for use

rheumatoid arthritis;
articular syndrome during exacerbation of gout;
psoriatic arthritis;
ankylosing spondylitis;
osteochondrosis with radicular syndrome;
osteoarthritis;
myalgia of rheumatic and non-rheumatic origin;
inflammation of ligaments, tendons, bursitis, including post-traumatic inflammation of soft tissues;
pain syndrome of various origins (including in the postoperative period, with injuries, algodismenorrhea, toothache, headache, arthralgia, lumbar ischialgia).

The drug is intended for symptomatic therapy, reducing pain and inflammation at the time of use, and does not affect the progression of the disease.

Contraindications

Hypersensitivity to the active substance or auxiliary components; complete or incomplete combination of bronchial asthma, recurrent polyposis of the nose or paranasal sinuses and intolerance to acetylsalicylic acid and other NSAIDs (including a history); erosive and ulcerative changes in the mucous membrane of the stomach and duodenum (duodenum), active gastrointestinal bleeding, cerebrovascular or other bleeding; inflammatory bowel diseases (Crohn's disease, ulcerative colitis) in the acute phase; hemophilia and other bleeding disorders; decompensated heart failure; liver failure or any active liver disease; anamnestic data on the development of hepatotoxic reactions when using nimesulide preparations; concomitant use of potentially hepatotoxic substances; alcoholism, drug addiction; severe renal failure (creatinine clearance less than 30 ml/min), progressive kidney disease, confirmed hyperkalemia; period after coronary artery bypass surgery; pregnancy, lactation period; children under 12 years of age (for this dosage form, see the “Special Instructions” section).

Carefully

Coronary heart disease, cerebrovascular disease, congestive heart failure, dyslipidemia/hyperlipidemia, diabetes mellitus, peripheral arterial disease, smoking, creatinine clearance less than 60 ml/min. Anamnestic data on the development of ulcerative lesions of the gastrointestinal tract, the presence of Helicobacter pylori infection, old age, long-term use of NSAIDs, frequent alcohol consumption, severe somatic diseases, concomitant therapy with anticoagulants (for example, warfarin), antiplatelet agents (for example, acetylsalicylic acid, clopidogrel), oral glucocorticosteroids ( for example, prednisolone), selective serotonin reuptake inhibitors (for example, citalopram, fluoxetine, paroxetine, sertraline).

Directions for use and doses

The minimum effective dose should be used for the shortest possible short course. The tablets are taken with enough water, preferably after meals.

Adults and children over 12 years old - 1 tablet orally 2 times a day. If you have diseases of the gastrointestinal tract, it is advisable to take the drug at the end of a meal or after a meal. The maximum daily dose for adults is 200 mg.

Patients with chronic renal failure require a reduction in the daily dose to 100 mg.

Side effect

The frequency of side effects is classified depending on the frequency of occurrence: often (1-10%), sometimes (0.1-1%), rarely (0.01-0.1%), very rarely (less than 0.01%) , including individual messages.

Allergic reactions: rarely – hypersensitivity reactions; very rarely - anaphylactoid reactions.

From the central nervous system: infrequently – dizziness; rarely - a feeling of fear, nervousness, nightmares; very rarely - headache, drowsiness, encephalopathy (Reye's syndrome).

From the skin: infrequently – itching, rash, increased sweating; rarely: erythema, dermatitis; very rare: urticaria, angioedema, facial swelling, erythema multiforme, including Stevens-Johnson syndrome, toxic epidermal necrolysis (Lyell's syndrome).

From the urinary system: infrequently - swelling; rarely - dysuria, hematuria, urinary retention, hyperkalemia; very rarely - renal failure, oliguria, interstitial nephritis.

From the gastrointestinal tract: often – diarrhea, nausea, vomiting; infrequently – constipation, flatulence, gastritis; very rarely - abdominal pain, stomatitis, tarry stools, gastrointestinal bleeding, ulcer and/or perforation of the stomach or duodenum.

From the liver and biliary system: often - increased “liver” transaminases; very rarely - hepatitis, fulminant hepatitis, jaundice, cholestasis.

From the hematopoietic organs: rarely – anemia, eosinophilia; very rarely - thrombocytopenia, pancytopenia, purpura, prolonged bleeding time.

From the respiratory system: infrequently – shortness of breath; very rarely - exacerbation of bronchial asthma, bronchospasm.

From the senses: rarely – blurred vision.

From the cardiovascular system: infrequently – arterial hypertension; rarely – tachycardia, hemorrhages, “hot flashes”.

Other: rarely – general weakness; very rarely - hypothermia.

Overdose

Symptoms: apathy, drowsiness, nausea, vomiting. Gastrointestinal bleeding, increased blood pressure, acute renal failure, and respiratory depression may occur.

Treatment: The patient requires symptomatic treatment and supportive care. There is no specific antidote. If an overdose has occurred within the last 4 hours, it is necessary to induce vomiting, take activated carbon (60–100 g per adult), and osmotic laxatives. Forced diuresis and hemodialysis are ineffective due to the high binding of the drug to proteins.

Interaction with other drugs

The effect of medications that reduce blood clotting is enhanced when used simultaneously with nimesulide.

Nimesulide may reduce the effect of furosemide. Nimesulide may increase the possibility of side effects while taking methotrexate.

Plasma lithium levels increase when lithium and nimesulide are taken simultaneously.

Nimesulide may enhance the effect of cyclosporine on the kidneys.

Use with glucocorticosteroids and serotonin reuptake inhibitors increases the risk of gastrointestinal bleeding.

special instructions

Since Nise® is partially excreted by the kidneys, its dose should be reduced in patients with impaired renal function, depending on creatinine clearance.

Causes of elbow pain

Type of pain	What disease causes	Symptoms of the disease
Pain above and below the elbow	Thoracic and cervical osteochondrosis, disc herniation in the thoracic or cervical region, disc protrusion in the thoracic or cervical region	The pain is felt not only in the elbow. It comes from the neck, shoulder blades, and “pierces” the arm. The arm in the elbow hurts during movement and rest. Externally, the elbow does not change. As the disease develops, the person has difficulty bending the elbow and almost does not feel touch on the forearm.
Burning pain in the elbow	Gouty arthritis or gout	The pain usually appears at night and is accompanied by fever. The joint in the elbow area swells, the skin around the joint turns red. A person becomes nauseous and loses his appetite.
Elbows have moderate to severe pain	Arthritis, polyarthritis, rheumatoid arthritis	The skin in the elbow area swells and turns red. The pain is accompanied by an increase in temperature and is also felt at rest. The person can rotate the elbow, but has difficulty bending the arm. Elbow joints hurt.
Dislocation	The injury occurs after a fall on the elbow, arm, or a car accident. The skin over the damaged joint turns red, the joint swells and swells.
Mild pain in the elbow when bending	Arthrosis	The pain is not as severe as with arthritis. It gets worse when you try to bend your arm. Movements of the elbow are accompanied by a crunching sound, and the arm may not fully extend.
Pain in the arm and elbow	Tendon rupture	The tendon ruptures due to injury, lifting weights exceeding 60 kg. A person cannot move his arm freely and bend it; the biceps is damaged. The hand is swelling.
Severe pain in the elbow of the right or left hand	Broken arm	At the moment of fracture, a crunching sound is heard. It hurts a person to move his hand, or it becomes immobile. Bruising occurs due to rupture of blood vessels.
Elbow and knee pain	Chondrocalcinosis - deposits of calcium salts in articular cartilage	The elbow becomes swollen and swollen, and the person has difficulty bending his arm. The disease affects one or more joints.
Acute pain in the elbow	Osteophytes - bone growths	Osteophytes occur due to heavy physical activity or calcium metabolism disorders. The growths damage surrounding tissue when moving and cause severe pain.
Aching pain in the elbow	Ulnar nerve neuritis	The ulnar nerve becomes inflamed, causing aching pain, often the fingers become numb and lose sensitivity. The person moves his hand worse.
Tumor of the elbow joint	The first signs of a tumor: weakness, weight loss, fatigue. At first, the pain in the elbow is not very noticeable. Over time, it becomes constant and intensifies at night. The pain does not go away after painkillers.
Elbow pain	Tendinitis - inflammation of the tendon	Elbow pain intensifies with movement and goes away with rest. Pain occurs when the damaged tendon is felt, the skin over the joint turns red, and the temperature rises. The elbow swells and crunches when moving.
Pain in left elbow	Myocardial infarction	The disease is accompanied by severe pain behind the sternum and under the left shoulder blade. The pain radiates to the neck, stomach, shoulder blade and left arm up to the elbow. A person experiences shortness of breath, cold sweat, and dizziness.