Health resort treatment of osteoarthritis

Patients with osteoarthrosis of I-III radiographic stage according to Kellgren and Lawrence without synovitis or with its mild exacerbation are referred to spa treatment. Resorts are indicated that use therapeutic mud, as well as with chloride, sodium and other mineral waters (in Ukraine - Berdyansk, Evpatoria, Odessa, Saki), with hydrogen sulphide waters, with radon waters (in Ukraine - Khmelnik), with nitrogenous weakly mineralized siliceous thermal waters. Patients with osteoarthrosis of stage IV with a sharp exacerbation of synovitis and the presence of contraindications to spa treatment are not referred to spa treatment.

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Osteoarthritis treatment regimen proposed by the Ukrainian Association of Rheumatologists

1. Anti-inflammatory and analgesic treatment of osteoarthritis.

NSAIDs - non-selective COX inhibitors:

• diclofenac;
• ibuprofenidr.

NSAIDs - selective COX-2 inhibitors:

• meloxicam 7.5-15 mg once a day;
• nimesulide 100 mg 2 times a day;
• celecoxib 100-200 mg/day.

IL-1 receptor antagonists:

• diacerein - 50 mg orally 2 times a day during meals for at least 3 months;

SET preparations:

• Phlogenzym 2 tablets 3 times a day for 3 weeks,
• Wobenzym 3-5 tablets 3 times a day for 3 weeks,

Glucocorticosteroid hormones intra-articularly (if other anti-inflammatory drugs are ineffective) no more than 4 injections per year:

• methylprednisolone (20-40 mg depending on the size of the joint),
• hydrocortisone (50-125 mg depending on the size of the joint),
• triamcinolone (20-40 mg depending on joint size).

2. Chondroprotectors:

• glucosamine 1500 mg once a day for 2-3 months with NSAIDs,
• chondroitin sulfate 750 mg 2 times a day for 3 weeks, then 500 mg 2 times a day long-term;
• hyaluronic acid 20 mg intra-articularly once a week for 2 weeks, 3 cycles every 3 weeks,
• Alflutop - if several joints are affected, 1 ml once a day intramuscularly for 20 days, after 3 months the course can be repeated; if large joints are involved, intra-articularly or intramuscularly according to the following scheme: 2 ml in each affected joint once every 3 days for 18 days (6 injections), followed by intramuscular injection of 1 ml (up to 20 injections).

3. Local application of ointment and gel forms of NSAIDs:

• ibuprofen,
• piroxicam,
• diclofenac preparations, etc.

4. Antioxidant therapy:

• a-tocopherol acetate (vitamin E) 0.1-0.2 g per day orally for 1 month or 1-2 ml of 10% solution once a day for 20 days.

5. Preparations that improve microcirculation:

• pentoxifylline 100 mg 3 times a day,
• dipyridamole 75 mg/day.

6. Orthopedic treatment.
7. Physiotherapy exercises.
8. Physiotherapy procedures.
9. Sanatorium and resort treatment.