Local treatment of osteoarthritis
Last reviewed: 23.04.2024
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Applicative therapy (local treatment) is a simple and painless method for treating patients with osteoarthritis, supplementing drugs prescribed systemically (paracetamol, NSAIDs, etc.). Advantages of the 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, the drug for topical application should not cause local toxic and allergic reactions; must reach the target organ; the concentration of the drug in the blood serum should not reach the level at which dose-related side effects occur; metabolism and excretion of the drug should be the same as in systemic application. When applying applications, it is proposed to create a therapeutic concentration of the drug in the tissues at the site of application, while only a small amount of substance enters the total blood flow, which allows to practically minimize systemic side effects.
Widespread in the application therapy of osteoarthritis found ointments with a warming and distracting effect, containing both synthetic active substances, and prepared on the basis of bee and snake venom. In the treatment of muscle and joint pain, ointments containing:
- menthol as an analgesic;
- salicylates, which possess analgesic and anti-inflammatory properties;
- turpentine - a component that exerts a local irritant and analgesic effect;
- esters of nicotinic acid, promoting the expansion of blood vessels.
Ointment containing a combination of two active vasodilating components for topical application - nonivamide (vanillamide vanillamide) and nicoboxyl (butoxyethyl nicotinic acid ester), has local vasodilating and warming effects, has a distraction effect. The warming and distracting effects, improved blood flow have a positive effect in osteoarthritis.
Capsaicin is an alkaloid derived from the plants of the Solanaceae family, which stimulates the release of the neuropeptide of substance P from the peripheral nerve endings and prevents their re-entrapment. Local application of capsaicin leads to a decrease in the content of substance P in the neuron as a whole, including in its branches innervating deeper tissues, for example, the joint. In controlled clinical trials, capsaicin caused a reduction in joint pain in patients with gonarthrosis and osteoarthrosis of the joints of the hands. The maximum effect is achieved after 3-4 weeks of treatment.
The use of drugs containing NSAIDs in the form of applications - ibuprofen, piroxicam, diclofenac - is pathogenetic. To obtain a clinical effect when using ointments containing NSAIDs, it is necessary to apply them long enough, observe the frequency of applications, apply a sufficient amount of the drug to the skin. NSAIDs for topical application 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 the NSAID-containing agents used for applications, Dolgit-cream, an active ingredient of which is ibuprofen, has proved itself well. Its use in various diseases accompanied by articular syndrome, including osteoarthritis, gives a pronounced analgesic effect. In addition, Dolgit-cream has established itself as a means to enhance the action of physiotherapy procedures - its use is promising as a contact medication medium under ultraphonophoresis. The use of Dolgite cream with massage provides its higher effectiveness in case of pain syndromes.
Dimethyl sulfoxide is well established in the treatment of patients with osteoarthritis. Its 50% aqueous solution in the form of applications to the affected joint has anti-inflammatory and analgesic effect. In addition, dimethyl sulfoxide as a good solvent is a conductor for penetration into soft tissues of other drugs (procaine, metamizole sodium, drotaverine, hydrocortisone). This agent is used both in the application therapy of osteoarthritis, and to improve the administration of drugs in electrophoresis by the method of electroregistration.
The disadvantages of the application therapy include a low concentration of the drug penetrating the tissues (an average of 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 penetration of the drug depends on its lipophilicity and the degree of hydration of the stratum corneum of the epidermis. It is difficult to penetrate the medicine into the tissues of the barrier functions of the skin, including the gradient of pH gradients.
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