Local treatment of osteoarthritis

Application therapy (local treatment) is a simple and painless method of treating patients with osteoarthritis, complementing drugs prescribed systemically (paracetamol, NSAIDs, etc.). The advantages of application therapy are:

• direct impact on the main lesion - the target organ, namely the joint;
• achieving the optimal therapeutic concentration of the drug in the affected organ, which reduces the need for systemically prescribed pharmacological agents, while reducing the toxic effects of drugs.

According to modern requirements, a drug for local use should not cause local toxic and allergic reactions; should reach the target organ; the concentration of the drug in the blood serum should not reach a level at which dose-dependent side effects occur; the metabolism and excretion of the drug should be the same as with systemic use. When using applications, it is assumed that a therapeutic concentration of the drug is created in the tissues at the site of application, while only an insignificant amount of the substance enters the general bloodstream, which allows for a virtual minimization of systemic side effects.

Ointments with a warming and distracting effect, containing both synthetic active substances and those prepared on the basis of bee and snake venom, have found wide application in osteoarthritis application therapy. In the treatment of muscle and joint pain, ointments containing the following are traditionally used:

• menthol as a pain reliever;
• salicylates, which have analgesic and anti-inflammatory properties;
• turpentine - a component that has a local irritant and analgesic effect;
• nicotinic acid esters, which promote vasodilation.

An ointment containing a combination of two active vasodilator components for topical use - nonivamide (nonylic acid vanillylamide) and nicoboxil (nicotinic acid butoxyethyl ester) has a local vasodilator and warming effect, and has a distracting effect. Warming and distracting effects, improved blood flow have a positive effect on osteoarthritis.

Capsaicin is an alkaloid derived from plants of the nightshade family that stimulates the release of the neuropeptide substance P from the endings of peripheral nerves and prevents their reuptake. Local application of capsaicin leads to a decrease in the content of substance P in the neuron as a whole, including its branches that innervate deeper tissues, such as joints. In controlled clinical trials, capsaicin caused a decrease in joint pain in patients with gonarthrosis and osteoarthrosis of the hand joints. The maximum effect is achieved after 3-4 weeks of treatment.

The use of NSAIDs in the form of applications - ibuprofen, piroxicam, diclofenac - is pathogenetically determined. To obtain a clinical effect when using ointments containing NSAIDs, it is necessary to use them for a sufficiently long time, observe the frequency of applications, and apply a sufficient amount of the drug to the skin. NSAIDs for local use are effective in acute and chronic pain and are often used in osteoarthritis as drugs that do not cause side effects from the digestive tract.

Among NSAID-containing products used for applications, Dolgit-cream, the active substance of which is ibuprofen, has proven itself well. Its use in various diseases accompanied by joint syndrome, including osteoarthrosis, gives a pronounced analgesic effect. In addition, Dolgit-cream has proven itself as a means of enhancing the effect of physiotherapy procedures - its use is promising as a contact drug environment in ultraphonophoresis. The use of Dolgit-cream in massage ensures its higher effectiveness in pain syndromes.

Dimethyl sulfoxide has proven itself in the treatment of patients with osteoarthrosis. Its 50% aqueous solution in the form of applications to the affected joint has an anti-inflammatory and analgesic effect. In addition, dimethyl sulfoxide, as a good solvent, is a conductor for the penetration of other drugs (procaine, metamizole sodium, drotaverine, hydrocortisone) into soft tissues. This agent is used both in application therapy of osteoarthrosis and to improve the introduction of drugs during electrophoresis using the electroreging method.

The disadvantages of application therapy include the low concentration of the drug penetrating into tissues (on average up to 5% of the amount used). The drug is resorbed into soft tissues through the excretory ducts of sweat and sebaceous glands, hair follicles, and intercellular spaces. The degree of drug penetration depends on its lipophilicity and the degree of hydration of the stratum corneum of the epidermis. The penetration of the drug into the tissue depths is hindered by the barrier functions of the skin, including the difference in pH gradients.

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