In the treatment of arthritis of various etiologies, one of the most important components is medicament preparations. Tablets from arthritis are divided into several different groups:
NSAIDs and glucocorticoids.
Inhibitors of COX-2.
Basic preparations that are used to treat rheumatic diseases.
Indications of the arthritis pills
Among the indications for the use of tablets:
Violations of ODA inflammatory-degenerative nature (osteoarthritis, rheumatoid and rheumatoid arthritis).
Articular syndrome, which develops in the exacerbation of psoriatic arthritis in psoriasis.
Shark pellets include shark cartilage and other natural components that allow the cartilage surface of joints and bones to be restored naturally. Accelerate the effect of the drug allows a combination of plant elements and 2 chondroprotectors. It should be noted that the anti-inflammatory effect of Shark cartilage does not have those side effects that are inherent in NSAIDs.
Tablets Stop arthritis is a drug used as a prophylactic for rheumatic diseases. Since it affects the cartilage of the joints, their (as well as the spine) soreness and stiffness decreases. The drug prevents the subsequent destruction of the cartilage, and also positively affects the recovery process.
Methotrexate is a cytostatic drug that is part of a group of antimetabolites that act as antagonists of folic acid. The drug has a pronounced immunosuppressive effect in small dosages.
Tablets from rheumatoid arthritis
For the treatment of rheumatoid arthritis, basic drugs are mainly used. Usually in such cases, drugs are used that can be divided into 5 main groups:
as well as the salt of gold.
Standard drugs used for the therapy of arthritis, can prevent the destruction of articular joint surfaces, and in addition they are used as a means of treating associated autoimmune diseases, such as systemic lupus erythematosus, Bechterew's disease and Sjogren's syndrome. The drugs included in this drug group interfere with the development of arthritis, but do not eliminate its manifestations (in this they are different from NSAIDs).
Basic medicines have a long-lasting effect - from the start of therapy and until the first shifts to the side of improvement can take 3-6 months. Usually, these drugs are prescribed together with NSAIDs and glucocorticosteroids.
To select the necessary basic drugs, it takes some time - to test the effectiveness of several groups of drugs, which helps achieve maximum effect. If the medications are well tolerated, you should undergo a full-fledged treatment course, after waiting for the initial stage of therapy, which has not seen any obvious symptoms of improvement.
If the drugs are chosen well, and the treatment gives the result - the basic medicines are used for many years.
Immunomodulating agents are usually used in case of neglected, severe forms of the disease, when other drugs do not give the desired effect. But you need to understand that using these drugs to achieve the desired result requires complex treatment in combination with other medicines.
Arava is a basic medicine with antirheumatic action. The drug has anti-inflammatory, immunomodulating, as well as antiproliferative effect. It is used in the therapy of adult patients suffering from rheumatoid arthritis in active form. The medicine helps to reduce the strength of manifestations of the symptoms of the disease, and also prevents the destruction of the structure of articular surfaces of the joints.
Plakvenil has immunosuppressive, as well as anti-inflammatory effect on the body with rheumatoid arthritis (chronic and acute forms). The active substance of the drug - hydroxychloroquine - has a cumulative activity. The effect of taking medication can only appear after a few weeks, but side effects can occur much earlier. To achieve the desired result, you need to take the medicine for several months. If objective improvement is not observed during the half-year of Plaquenil's administration, it should be stopped.
Neural is an immunosuppressive drug, polymyxin, which includes 11 amino acids. Used for the treatment of rheumatoid arthritis (with active flow in severe form, when standard anti-rheumatic drugs of long-term effect do not have the desired effect or when they can not be used).
In the treatment of rheumatoid arthritis, the preparation Imuran has a strong therapeutic effect without combination with corticosteroids. The medicine has an immunosuppressive effect.
Cytoxan is an antitumor drug with an alkylating effect, besides it also has an immunosuppressive effect. It is used for psoriatic and rheumatoid arthritis.
Anesthetics for arthritis
Analgesics help reduce pain, but they can not relieve the inflammatory process in the joints - this distinguishes them from NSAIDs. Painkillers are usually prescribed for the treatment of severe forms of arthritis with severe pain symptoms, such as osteoarthritis. These drugs can contain substances such as paracetamol, as well as codeine or aspirin, or other similar substances in combination.
In the treatment of arthritis, diclofenac is usually prescribed. The use of aspirin is sometimes accompanied by side effects from the gastrointestinal tract in the form of pain symptoms and unpleasant sensations in the abdomen, so do not take it with peptic ulcer, gastritis or fasting. It is desirable to drink these medicines with milk. Codeine can cause constipation or nausea. In general, any medicine should be prescribed by the attending physician after a thorough examination of the patient in order to assess the appropriateness of using certain medications in view of the presence of concomitant diseases that he has besides arthritis.
Therapy of osteoarthritis usually begins with the use of aspirin. Although this drug is successfully used for many medical purposes, it is not effective enough to treat arthritis and arthrosis. Often it is replaced by other medicines.
It should be borne in mind that aspirin should be administered with caution in the event that the patient has blood diseases, because this drug reduces its coagulability.
Anti-inflammatory tablets for arthritis
NSAIDs (among these drugs, indomethacin, ketoprofen, diclofenac, as well as piroxicam, ibuprofen and butadion are among the most known) are prescribed to eliminate the inflammatory process and pain in the joints, and in addition their swelling. These drugs are the most famous and most commonly used group of drugs used in arthritis. They successfully cope with the main manifestations of the disease, but can not resist the destruction of joints, and therefore can not affect the development and course of the disease.
NSAIDs interfere with the production of hormone-like elements, as well as prostaglandins, which are the cause of the development of the inflammatory process and the appearance of pain. These drugs should be used with caution, as they can lead to erosive and ulcerative complications from the stomach. Sometimes they are prescribed in combination with other drugs that reduce the effect of non-steroidal anti-inflammatory drugs on the digestive tract.
Diclofenac is one of the most popular and known NSAIDs. This drug helps in the treatment of arthrosis. It combines effective anti-inflammatory properties, as well as a strong analgesic effect.
Ibuprofen is used in the treatment of joint diseases. It is less effective than indomethacin, if we talk about its analgesic and anti-inflammatory properties, but it is much better tolerated by patients without causing strong adverse reactions.
Indomethacin has a highly effective anti-inflammatory properties, and also has a strong analgesic effect. The drug is produced in tablets of 25 mg. Although it is considered one of the most effective means for arthrosis or arthritis, it should be borne in mind that this medication has an extensive list of side effects.
Ketoprofen is an NVS, a derivative of aryl carboxylic acid. The medicine has antipyretic, analgesic, and anti-inflammatory properties. It helps to reduce pain in the joints both at rest and during movement, reduces their swelling and stiffness in the morning, and also increases the amount of movement performed by the joints.
Movalis is one of the most famous drugs, the active ingredient of which is meloxicam. The main advantage of this medication is that it can be consumed by long courses (several months or even years), but only under the supervision of the attending physician. The drug is produced in the form of tablets. This form of manufacture allows the medicine to act for a long time, so it is enough to take only 1 tablet a day. You can take it either in the morning or at bedtime after a meal.
Celecoxib has powerful analgesic and anti-inflammatory properties, helping to get rid of pain in arthrosis and arthritis, and at the same time almost does not cause an adverse reaction from the gastric mucosa and the gastrointestinal tract as a whole. This drug is available in capsules with a dosage of 200 or 100 mg.
Nimesulide has a powerful anti-inflammatory and analgesic effect, helping to eliminate the main symptoms in arthrosis. It also has antioxidant properties and helps to reduce the activity of elements destructively affecting cartilage tissue, proteoglycans, and collagen fibers.
Etorikoksib is available in tablets under the trade name "Arkoksia". When taking drugs at low dosages (not more than 150 mg / day), it does not cause serious side effects and does not affect the gastric mucosa (as well as other drugs from the drug group COX-2). During the treatment of arthrosis, the drug is prescribed in a dosage of 30-60 mg / day.
Since the drug of this group is able to negatively affect the organs of the cardiovascular system, at the initial stage of reception it is necessary to perform regular checks of the BP index.
Corticosteroid preparations for arthritis
Corticosteroids are drugs that have the properties of the hormonal substance cortisol. In the body, it is produced by the adrenal cortex. Cortisol affects various systems in the body, among others also on the immune system.
Corticosteroids reduce the levels of prostaglandins, and also affect T and B lymphocytes, which are involved in immune reactions. In this way, there is an effect on the processes of inflammation in the joints.
These drugs are high-speed, they are often used for arthritis and other diseases of the musculoskeletal system. When compared with NSAIDs, corticosteroids have anti-inflammatory properties more powerful, and they also effectively cope with autoimmune diseases, in which it is necessary to prevent the development of autoimmune aggression against the body's own tissues. But it should be borne in mind that because of immunosuppression, the vulnerability of the organism to any infections is increasing - this is the main drawback of this group of drugs.
The active component of the drug is betamethasone - a synthetic systemic glucocorticoid. Since betamethasone acts as a synthetic derivative of prednisolone, it has powerful anti-allergic, anti-inflammatory, and anti-rheumatic properties. Celeston has increased SCS activity, as well as a weak mineralocorticoid effect.
Prednisolone is a synthetic substance that can have similar characteristics of the hormones produced by the adrenal glands of hydrocortisone, as well as cortisone. When administered orally, this component is 4-5 times more active than cortisone and 3-4 times hydrocortisone. In addition, the difference between prednisolone and these substances is that it does not cause a noticeable delay in water and sodium, and rarely causes hyperkalemia. The drug also has powerful anti-inflammatory properties.
Diprospan is a medicine from the group of glucocorticoids, which has an immunosuppressive, anti-allergic and anti-inflammatory effect on the body. This drug is used to treat autoimmune diseases of connective tissue, as well as the musculoskeletal system (such as osteoarthritis or rheumatoid arthritis).
A synthetic-type glucocorticoid drug used to treat rheumatoid arthritis (in addition to Bechterew's disease and juvenile rheumatoid arthritis).
Metipred inhibits the development of tissue reaction to various agents (mechanical and thermal, chemical and immunological, as well as infectious). This allows glucocorticoids to affect the symptoms of the disease, reducing its manifestations, but without affecting the very cause of its appearance. Methylprednisolone has strong anti-inflammatory properties, which are at least 5 times higher than the similar properties of hydrocortisone.
The main element of the mechanism of the NSAID operation is the suppression of the synthesis of PG (prostaglandins) from so-called arachidonic acid by slowing down the PG synthetase enzyme.
GHGs have versatile bioactivity:
They act as mediators in the development of an inflammatory response: they have local vasodilator effect, swelling, exudation, leukocyte movement, and other effects (most often PG-E2 and PG-I2);
Increase the sensitivity of nerve endings to painful conductors (histamine, as well as bradykinin) and mechanical influence, thereby reducing the pain threshold;
Increase the sensitivity of hypothalamic thermoregulatory centers to the action of internal pyrogens (such as interleukin-1, etc.), which are formed in the body as a result of exposure to various viruses, as well as bacterial agents or toxins (most often PG-E2).
Recently, it has been found that there are at least 2 COX isoenzymes inhibited by NSAID drugs. The first of these is COX-1, which controls the synthesis of PG and regulates the integrity of the gastrointestinal mucosa, blood circulation in the kidneys, and the functioning of platelets. The second - COX-2, is induced by the inflammation process. It should be taken into account that COX-2 is absent under natural conditions, being formed only under the influence of individual tissue factors that provoke the appearance of an inflammatory reaction (these can be cytokines, growth factors, etc.). As a consequence, it is believed that the anti-inflammatory properties of NSAID drugs appear due to a delay in COX-2, and adverse reactions occur as a result of the slowing down of COX-1.
The indicator of the proportions of the activity of NSAID drugs when blocking substances COX-1 / COX-2 makes it possible to determine the possible level of their toxicity. The lower it is, the higher the selectivity level of the drug to COX-2, and with it, respectively, the toxicity index is lower.
Pharmacodynamics of glucocorticoids
After passing through the cell membrane, they bind in the cytoplasm with a special steroid receptor, resulting in the activation of an integrated complex that passes inside the cell nucleus, binds to DNA and further promotes the process of formation of information RNA. Subsequently, various regulatory proteins begin to be synthesized on the ribosomes. Among them, one of the most important is lipocortin, which inhibits the enzymatic substance phospholipase-A2. As a result of this action, suppression of the synthesis of leukotrienes and PG occurs, which are the main reasons for the development of the inflammation process.
Therefore, in order for the full-fledged effect of glucocorticoids to appear, they should take several hours after they are taken. The maximum pharmacological activity of these substances reach when the peak of their saturation in the blood plasma has already been passed.
All drugs from the category of NSAIDs are well absorbed in the digestive tract. They almost completely connect to plasma albumins, instead of displacing some other substances. For example, in newborns they displace bilirubin, which can further cause bilirubin encephalopathy. The most dangerous in these cases are phenylbutazone, as well as salicylates. Most NSAID drugs are perfectly absorbed into the joint synovial fluid. Metabolism of NSAIDs is carried out in the liver, and excretion occurs through the kidneys.
After internal administration of glucocorticoids rather quickly and at the same time almost completely absorbed in the upper parts of the small intestine. The maximum saturation in the blood they reach in 0.5-1.5 hours. When taken together with food, their suction rate decreases slightly, but the degree of activity remains the same.
Use of the arthritis pills during pregnancy
Glucocorticoids are able to penetrate the placental barrier. Non-fluorinated natural medicines do not lead to the development of a child in the womb of Cushing's syndrome, as well as suppression of the hypothalamic-pituitary adrenal system, and therefore are safe for the fetus. But the long-term use of fluorinated glucocorticoids can adversely affect the fetus, for example, triggering its congenital malformation.
Contraindications for the use of drugs from the group of glucocorticoids are conditional, so they are taken into account only in the case of prolonged treatment. The following are the diseases in which the intake of glucocorticoids can be prohibited:
Diabetes mellitus (in this case, the most dangerous are fluorinated glucocorticoids);
Diseases of the psyche, as well as epilepsy;
Gastric ulcer or duodenal ulcer;
The expressed form of an osteoporosis;
Hypertensive illness in severe form;
Severe form of heart failure.
Medicines NSAIDs can be banned in erosive and ulcerative gastrointestinal pathologies (especially at the stage of exacerbation), expressed kidney or liver disease, individual hypersensitivity, cytopenia, and during pregnancy. It is not allowed to prescribe phenylbutazone or indomethacin to patients who require increased concentration due to professional activity.
Side effects of the arthritis pills
When NSAIDs are used, an adverse reaction is most often destruction of the gastrointestinal mucosa. 30-40% of patients taking this group of medicines suffer from dyspeptic disorders, 10-20% from ulcers or erosion of the duodenum and stomach, and 2-5% from perforation or bleeding.
Adverse reactions of the body when using drugs from the category of glucocorticoids:
The musculoskeletal region - osteoporosis, muscle pains, compression fractures in the vertebral column and pathological fractures, as well as the anatomical head of the femur;
Gastrointestinal tract - perforation and bleeding, steroid ulcerative lesions of the intestine and stomach, dyspepsia and esophagitis, as well as pancreatitis;
Skin - acne, hemorrhages, stretch marks and atrophic thinning of the skin;
Organs of the endocrine system - secondary amenorrhea, delay in sexual development, problems with GGNS, the appearance of symptoms of diabetes mellitus, which previously occurred latent, and steroid diabetes;
The process of electrolyte-water metabolism - hypokalemia, fluid and sodium retention, swelling, hyperglycaemic coma;
The organs of vision are the posterior cup-like cataract, exophthalmos and glaucoma;
The immune system is a sharp activation of infectious diseases (tuberculosis);
Metabolism - increased appetite, negative nitrogen balance, hyperlipidemia and hyperglycemia, as well as hypercorticoid syndrome;
Violation of the process of wound healing.
Dosing and administration
If tablets from arthritis from the NSAID group (any drug) are new to the patient, they should first be prescribed at the lowest dosage. If it turns out that the medicine is well tolerated, after 2-3 days the daily dosage is increased. Therapeutic doses of NSAID drugs have a fairly wide range, and recently there has been a tendency to increase one-time and daily doses of drugs that are well tolerated by patients (this is ibuprofen and naproxen). But for the maximum dosage of drugs such as phenylbutazone, indomethacin, as well as piroxicam and aspirin, restrictions remain. But it should be understood that the therapeutic effect in individual patients can be achieved only if very high dosages are used.
In rheumatology, tablets from the category of NSAIDs are prescribed by a long curative course - in this case it is recommended to take the medicine after eating food. Although, to get an early antipyretic or analgesic effect, it is preferable to drink tablets half an hour before meals or 2 hours after it (to drink 0.5-1 cup of water). It is desirable after the use of the drug for 15 minutes not to lie down - it is necessary as a preventive measure of the development of esophagitis.
The moment of drug use can be selected in accordance with the time when signs of the disease (a feeling of stiffness and pain in the joints) are manifested as brightly as possible - that is, taking into account the chronopharmacology of drugs. It is also allowed to depart from the standard regimen (2-3 r./day) and to use NSAIDs at any time of the day - this way, an increase in the effectiveness of the drug is achieved, and the daily dosage is thereby reduced.
In case of an overdose, the following symptoms may occur: vomiting with nausea, pain in the abdomen, a state of depression, drowsiness and retardation. Metabolic acidosis, lowering blood pressure, tinnitus, the development of renal insufficiency (in acute form), stopping of breathing, the appearance of headache, tachycardia and bradycardia, and also the state of shock or coma and atrial fibrillation are possible. The appearance of an overdose can also be dizziness, frustration, a sense of dyspnea, pain in the epigastric region, increased blood pressure and bleeding in the gastrointestinal tract. Children may experience bleeding and myoclonic cramps, a disorder of renal or hepatic function, and abdominal pain.
Interactions with other drugs
NSAIDs can enhance the effectiveness of oral hypoglycemic drugs, as well as indirect anticoagulants. In doing so, they also reduce the effectiveness of antihypertensive drugs, enhance the toxic properties of digoxin, antibiotics-aminoglycosides and some other drugs - this plays a significant role in prescribing drugs.
It is recommended to avoid the combined use of diuretics and tablets from arthritis from the NSAID group, because, firstly, in this case, the diuretic effect decreases, and secondly, this can lead to the appearance of renal failure. The most dangerous combination of triamterene and indomethacin.
There are also medicines that, when combined with NSAIDs, can have a different effect on their effectiveness:
Aluminum-containing antacids (such as maalox or almagel, etc.), as well as cholestyramine, reduce the absorption of NSAIDs in the digestive tract. Because of this, with the additional appointment of these antacids, it is necessary to increase the dosage of NSAIDs, and when using them together with cholestyramine, you need to take a break between receptions for at least 4 hours;
sodium bicarbonate on the contrary increases the absorption of NSAIDs in the digestive tract;
anti-inflammatory properties of NSAIDs are increased when combined with glucocorticoid and basic drugs (aminoquinolines and gold preparations);
analgesic properties of NSAIDs become stronger when combined with sedatives and narcotic analgesics.
Tablets from arthritis are stored in standard conditions - at a temperature of no more than 25 degrees Celsius, in a place that is closed from sunlight.
Tablets from arthritis are recommended to be used within 2-3 years from the date of manufacture.
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Medical expert editor
Portnov Alexey Alexandrovich
Education: Kiev National Medical University. A.A. Bogomolets, Specialty - "General Medicine"
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To simplify the perception of information, this instruction for use of the drug "Arthritis tablets" translated and presented in a special form on the basis of the official instructions for medical use of the drug. Before use read the annotation that came directly to medicines.
Description provided for informational purposes and is not a guide to self-healing. The need for this drug, the purpose of the treatment regimen, methods and dose of the drug is determined solely by the attending physician. Self-medication is dangerous for your health.
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