How to Choose NSAIDs for Joint Treatment?

2023 Author: Alfred Shackley | [email protected]. Last modified: 2023-05-21 13:14

Non-steroidal anti-inflammatory drugs - tablets, gels, creams, ointments, injections - form the basis of drug treatment for most ailments of the musculoskeletal system.

With their help, the inflammatory process stops quickly enough and the swelling of the joints is removed, which brings significant relief from pain.

Such funds, as a rule, also have antipyretic effects. This explains why non-steroidal anti-inflammatory drugs are often used for osteochondrosis and its manifestations, for the treatment of joints, for arthrosis and arthritis. Often, the anti-inflammatory and analgesic effects are considered separately.

Systematization of non-steroidal anti-inflammatory drugs

NSAIDs are divided into acids and non-acidic derivatives. It should be noted that medications based on non-acidic derivatives have not yet become widespread.

Acids:

• pyrazolidines (phenylbutazone is the most striking example of this group);
• salicipates (for example, aspirin);
• indoleacetic acid and its derivatives (one of the most effective drugs of this type is Indomethacin);
• phenylacetic acid and its derivatives (Diclofenac is the most worthy competitor of Indomethacin in all respects);
• derivatives of prolionic acid (ketoprofen is also one of the serious competitors of Diclofenac, only its main advantage is pain relief in the joints, and as an anti-inflammatory agent it is not so effective. This group includes Ibuprofen, which is still very popular today);
• oxicams (Meloxicam, Piroxicam).

Studies of the effectiveness of NSAIDs for the treatment of diseased joints have shown that indomethacin, diclofenac sodium, flurbiprofen and ketoprofen (including those used in the form of an ointment) hold the lead in this regard.

These drugs are "basic": they make the vast majority of NSAIDs sold in pharmacies.

Side effects

This is the most problematic NSAID parameter. Due to their very wide distribution, we had to pay serious attention to their side effects. In cases where nonsteroidal anti-inflammatory drugs are used to treat joints, the list of possible side effects is quite large, but the kidneys and the digestive tract are most often affected.

The consequences of treating joints with these agents are quite serious and depend significantly on the doses taken. Most often, the minimum effective dose is prescribed. Sometimes such a minimum dose is not effective enough, and the doctor is forced to look for the optimal balance of harm and benefit: he either increases the dose, or "stretches" the period of treatment with the medication, or switches to the use of NSAIDs in the form of an ointment.

With osteochondrosis and joint diseases, the use of NSAIDs is quite long, which often causes damage to the mucous membrane of the stomach or duodenum, which are accompanied by the appearance of ulcers and bleeding that are difficult to treat. Therefore, they become an unambiguous indication for the abolition of anti-inflammatory drugs. This led to the search and development of a new generation of NSAIDs.

A new generation of NSAIDs

The first non-steroidal anti-inflammatory drugs suppressed the production of both isoforms of the enzyme cyclooxygenase (COX) in the body, which was the main problem. The essence of which is that COX-1 can be conditionally called a protection enzyme. COX-2 also acts as an enzyme of inflammation. When all classic NSAIDs are taken, COX-1 is suppressed, which leads to the fact that, for example, the protection of the gastric mucosa is significantly reduced.

In addition, COX-1 suppression is almost always more frequent than COX-2. And ideally, it is necessary to suppress COX-2 - after all, this is what determines the effectiveness of the drug.

New non-steroidal anti-inflammatory drugs have been developed by Austrian scientists. The most popular of them today is Movalis.

It acts much more selectively, significantly inhibiting COX-2 without suppressing COX-1.

The disadvantage of the new generation of these medicines can be called only their high price, due to which, in cases where long-term treatment of NSAIDs is not necessary, drugs of the old generation are used.

Oxicams are also representatives of the new generation of these drugs. It was on their basis that new generation tools were created. This group is characterized by an increased half-life, which significantly prolongs the effect of the drug. For example, Tenoctil is a joint medicine based on tenoxicam.

Its half-life is approximately 60 -75 hours, and after 10 days from the start of use, the level of concentration of the active substance in the blood becomes so stable that it is used once a day.

The main disadvantage of the representatives of the new generation of the oxicam group, as well as of the rest of the new generation, is the relatively high price. But even in spite of this, they are becoming more widespread.

NSAIDs are used internally, externally as an ointment or gel, or intramuscularly.

When taken orally, they are well absorbed in the gastrointestinal tract, their bioavailability is 70-100%. The highest content of the active substance in the blood is observed several hours after taking the drug. When administered intramuscularly, NSAIDs form functionally active complexes, binding by 90-99% to blood proteins.

The drugs penetrate deep enough into organs and tissues, in particular, into the focus of inflammation in the joint cavity. NSAIDs are excreted in the urine. The elimination half-life varies considerably depending on the drug.

Gels and ointments are applied to the area of the affected joints. The frequency of application is 3-4 times a day. There are many anti-inflammatory medications in the form of an ointment or gel.

Dolaren Gel is one of the most popular topical NSAIDs for painful joints. It contains components that perfectly potentiate each other's action.

The gel should be applied to painful areas every 7-8 hours.

Ointments and gels are popular due to the lack of side effects associated with oral NSAIDs. But whatever remedy you choose - pills, injections, ointments - be sure to consult your doctor first.

When treating joints with any NSAIDs, carefully read the instructions and try to adhere to its prescriptions. And if one of the drugs did not have the desired effect, change it, preferably with a new generation of anti-inflammatory drugs. This will increase the likelihood of reaching the desired action as soon as possible.