Database of diseases - Pain treatment clinic

bones, joints, ligaments, tendons and muscles. After all, they are constantly exposed to injuries and micro-injuries. Inflammation can be caused by overloading and micro-injuries lasting for many months and years, for example due to defects in posture, overweight, degenerative joint and spine changes, or streptococcus infection. It is worth noting that the pathogenic effect of long-acting damaging factors is statistically, much stronger than the violent injuries.


Pain is the result of the body's defensive reaction

Pain and other symptoms are caused by the body's defensive reaction to damaging factors. Sometimes, however, this reaction is excessive in relation to the active stimulus, which leads to secondary tissue damage and exacerbation of symptoms.



Excessive immune response can damage the joints ...

One of the reasons for this excessive reaction is the action of specific pathogenic microorganisms (e.g. streptococci) and autoimmune reactions consisting in the production of antibodies that destroy their own tissues. These antibodies and immune complexes are deposited within the motor system, triggering inflammatory processes.


Harmful mediators of inflammation and proinflammatory cytokines

Painful and long-lasting symptoms of arthritis and periarticular inflammation are caused by specific irritants produced by the body, called mediators of inflammation (prostaglandins, histamine, etc.) and pro-inflammatory cytokines (various interleukins, etc.). They are produced and released by special immune cells (immune) as well as by bone tissue cells. All drugs with anti-inflammatory activity, and thus stopping the development of the disease, work by reducing production, inhibiting release or antagonism to already isolated inflammation mediators.


Local or general treatment?

Movement rehabilitation is necessary in all described states, without which the joint degenerates. Paradoxically, it is the movement, although it is painful, that stops the rheumatic disease. Its lack adversely affects the nutrition of the articular cartilage and the production of a special fluid through the synovium, whose function is to reduce the friction between the elements forming the joint.


To be able to rehabilitate and "cure movement" it is necessary to get rid of the paralyzing pain.

Local therapy with the use of anti-inflammatory, analgesic and anti-swelling products may be helpful in this. It is beneficial due to the action of the drug closely at the site of the ongoing disease process. Sometimes it is enough as the only form of treatment, it can also be carried out in parallel with oral pharmacotherapy. It is usually used in minor ailments, but when the pains become more severe or persist despite local treatment, a doctor's advice is always necessary.




 
 
    
 

How to treat rheumatic pains?

If a cold and rainy day we feel the morning stiffness of the joints - for example, fingers, toes, knees or elbows, and strong pain during each movement test - it will most likely be a rheumatic attack. Although the disease runs in very different ways and concerns not only joints, but periarticular tissues and even muscles - its characteristic feature is motion pain. Usually the pain is accompanied by: limitation of joint mobility, inflammatory changes, inflammation of periarticular tissues, and edema, distortion and redness.


It hurts from the so-called inflammation of periarticular tissues

The common cause of rheumatic diseases is inflammation of affected tissues. This is usually caused by damage to these tissues - i.e.

How do we treat the most common rheumatic diseases?

The most common rheumatic diseases include rheumatoid arthritis (RA), ankylosing spondylitis (ZZSK); osteoarthritis and degenerative disease of the spine. The treatment of individual disease entities is slightly different. In the therapy of these diseases, whose common denominator is the release of the painful mediators of inflammation mentioned above, the so-called first-line drugs are usually used. Non-steroidal anti-inflammatory drugs (NSAIDs).



The role of non-steroidal anti-inflammatory drugs (NSAIDs)

These drugs are very important in the treatment of rheumatic diseases, because they inhibit the production of inflammation and cytokine mediators. Their anti-inflammatory and analgesic action is rapid and strong enough to allow the patient to retain the necessary motor skills enabling rehabilitation. The effects of other drugs - for example on the effect of a drug that modifies the course of inflammation - should often be expected several months.

The analgesic effectiveness of NSAIDs

The analgesic effectiveness of NSAIDs used in a given treatment should be assessed after 5 days and anti-inflammatory after 3 weeks. Two NSAIDs should not be used in parallel, as this may reduce the effect of any of them and aggravate side effects such as abdominal pain, nausea, vomiting. It is important that NSAIDs stay briefly in the body after cessation of treatment, which is beneficial to health. However, a full procedure for the treatment of severe cases presupposes the use of a wider range of drugs.

Treatment of rheumatoid arthritis

For example, in the treatment of rheumatoid arthritis, the following groups of medications are used:
1. The so-called medicines first line, from which we start treatment: non-steroidal anti-inflammatory drugs (NSAIDs: ketoprofen, acetylsalicylic acid, diclofenac, ibuprofen, naproxen and others), and glucocorticoids. These drugs alleviate the symptoms of the disease, but do not affect its course and do not lead to cure.
2. Second-line drugs - so-called modifying the course of the disease. These include gold salts, penicillamine, sulfasalazine and leflunomide. These drugs, used in more severe cases, are able to stop the progression of the disease for some time, and in some patients even forever (damage to the joints remains, but the disease no longer progresses).
3. Third-line drugs - cytostatics; these drugs work more strongly than the previous ones, but at the price of much more serious side effects.

Treatment of ankylosing arthritis

In ankylosing spondylitis we use a similar set of drugs plus additions that relax the striated muscles.

Treatment of degenerative joint diseases

The essence of osteoarthritis is the progressive destruction of joint cartilage. On the other hand, degenerative disease of the spine concerns the intervertebral discs (discopathy), joints between the vertebrae and joints between the vertebrae in the cervical spine. This is manifested in X-ray narrowing of the joint cavity and the presence of osteophytes, i.e. bone growth. The pain occurs depending on the location of the degenerative process or the presence of secondary inflammation.

Treatment of degenerative disease of the musculoskeletal system involves the use of:

1. unloading the joint (using the ball, losing weight, in the case of back pain relieving lying down)

2. physical therapy (analgesic, relaxing muscles, improving blood circulation)

3. kinesiotherapy (to maintain mobility of the joint and the mass of appropriate muscles),

4. balneology (the impact of natural resources on the musculoskeletal system and the inflammatory process),

5. NSAID (analgesic effect - the strongest shows ketoprofen - and anti-inflammatory enabling joint activation),

6. chondroprotective drugs (regenerating the cartilage of joints - still under investigation). In addition to conservative treatment, surgical procedures are also applied.




Disadvantages of treatment of rheumatic pain with Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

Commonly used in rheumatic diseases, non-steroidal anti-inflammatory drugs (NSAIDs) inhibit the physiological activity of an important enzyme - cyclooxygenase, called COX in short. We know two forms of this enzyme; COX-1 and COX-2. The main difference between the name is that COX-1 is involved mainly in the production of prostaglandins, which have nothing to do with inflammatory mediators mentioned above, but are useful for health, because, for example, they protect the stomach from digestive digestive juice.Inhibition of this enzyme strain may result in damage to the gastric mucosa, erosions, and also impaired renal function. Therefore, it is beneficial for health to avoid inhibition of the COX-1 enzyme, while blocking the action of the COX-2 enzyme, which is responsible for the synthesis of prostaglandins causing inflammation of the joints and their acute pain.




What's new in the treatment of joint pain?

NSAIDs inhibit the action of both enzymes, which explains both their anti-inflammatory and analgesic effects as well as their side effects on mucous membranes of the digestive system. Therefore, the most important progress in the treatment of rheumatic diseases is the latest generation of NSAIDs that inhibit selectively only the COX-2 enzyme. It arouses the interest of leflunomide - the latest generation of drug.

New generation preparations - COX-2 inhibitors

In people at risk of peptic ulcer disease, so-called selective COX-2 inhibitors. The use of these drugs should also be considered in patients prone to bleeding due to reduced blood clotting or active bleeding, and alcohol abusers. The troublesome flaw of the drugs in this group is their high price, often weaker than other therapeutic NSAIDs. Recently, under close observation of international and national agencies, evaluation and registration of medicines is the negative impact of this drug group on the cardiovascular system. It is enough to mention that for these reasons one of the flagship drugs in this group was withdrawn from the market in 2004 (VIOOX). The risk of using selective COX-2 inhibitors in patients with congestive heart failure, cirrhosis, hypertension or kidney disease has not yet been fully established. However, right now - in 2005, the EU Medicinal Agency (EMEA) issued a statement on COX-2 inhibitors, which states that the use of all drugs in this group may increase the risk of cardiovascular side effects. vascular. (A similar analysis is now being carried out by the US Food and Drug Administration.) New contraindications for all COX-2 inhibitors have already been added in Europe: - ischemic heart disease or stroke. In addition, uncontrolled hypertension was added as contraindication for etoricoxib. Warnings are cautioned when prescribing COX-2 inhibitors to patients with cardiovascular risk factors such as hypertension, hyperlipidemia, diabetes and smoking, and in patients with peripheral vascular disease. One should bear this in mind when choosing between classic NSLPZ and a selective COX-2 inhibitor and another treatment method.

New generation preparations - leflunomide

The already mentioned drug is leflunomide, a preparation that modifies the course of RA, that is, reduces the frequency of relapses or even completely prevents them. Leflunomide significantly improves the efficiency and quality of life of patients, and in addition, its therapeutic effect persists in many patients also a long time after treatment. In the case of this preparation, however, you must be very careful about contraindications and side effects. The feature of this drug is the possibility of occurrence of severe adverse reactions, including significant toxicity to the liver and kidneys. Therefore, the positive feature of the drug - extremely long stay in the body - in the case of side effects turns into a negative trait. In the case of worsening side effects, you should implement a procedure aimed at accelerating the elimination of drug residues in the body. Otherwise, serious liver poisoning may occur.


ed. Edward Ozga Michalski, MA
The instructions and published texts of med med Piotr Tederko were used