Why do my joints hurt?
Arthralgia can have a number of causes, such as:
- toxic syndrome in acute infectious processes;
- acute or recurrent arthritis of various etiologies;
- progressive degenerative-dystrophic changes in cartilage, damage to the synovial membranes;
- residual effects after an inflammatory process or injury;
- pseudoarthralgia (psychosomatic simulation of joint pain - Ed.).
If one joint hurts, first of all we can assume an injury, an infectious process or the deposition of salt crystals in the joint (microcrystalline arthritis). For young people, arthralgia is most likely to be associated with injury, infection, or a primary inflammatory disease (eg, rheumatoid arthritis). At the same time, in older people, the most likely causes are osteoarthritis or microcrystalline arthritis.
When it comes to arthropathy involving multiple joints, the most common causes are systemic inflammatory diseases, as well as microcrystalline arthritis, osteoarthritis and infections.
Rare causes of arthralgia include synovitis of various etiologies, hemorrhages into the joint cavity due to blood clotting disorders, tumor processes, and side effects after taking medications (for example, angiotensin-converting enzyme inhibitors or proton pump inhibitors).
It is important to remember that the appearance of pain can be associated with damage to the periarticular tissues - bursitis, tendinitis, fasciitis, epicondylitis and tenosynovitis. Sometimes joint pain is a consequence of disorders of the musculoskeletal system (for example, flat feet) or neuralgia and myalgia of other origins.
“Difficult” client – see a doctor!
Joint pain that persists for a long time or is accompanied by unusual symptoms is a reason to consult a doctor. There are alarming symptoms (“red flags”) that require special attention:
- redness in the joint area, swelling, increased temperature in the joint area, decreased range of motion;
- combination of acute arthralgia and fever;
- joint pain in combination with skin damage and signs of inflammation of adipose tissue;
- indications of a history of bleeding disorders or use of anticoagulants;
- the presence of extra-articular or systemic manifestations (weakness, weight loss, sweating);
- night pain, awakening due to pain;
- previous trips to tropical countries.
In each such case, therapy should be determined only by the attending physician.
How do they do it?
Blood is taken from the patient from the cubital vein. He then waits for 20 minutes for the intra-articular injection. During this time, the drug is prepared. Centrifugation is used. It can be one- or two-stage. In the first case, it is possible to better preserve the integrity of platelets, in the second, their higher concentration is obtained.
After preparing PRP, the resulting plasma is administered intra-articularly. The injection site is numbed with an anesthetic. Therefore, the patient does not feel significant pain during the procedure. In terms of tolerability, it can be compared to an intramuscular injection - unpleasant, but quite tolerable.
Some patients feel a feeling of fullness inside the joint. Especially in cases where a large volume of plasma is administered. After the injection, the doctor asks the patient to perform flexion and extension movements in the knee joint so that the plasma is better distributed in the joint cavity. After 10 minutes the patient goes home. He does not require hospitalization or additional observation.
Plasma can be used in courses of varying durations. Most often, PRP is administered once a week. A total of 3 to 7 injections are required. The treatment regimen is selected individually. The doctor forms it based on the clinical situation and the purposes of using platelet-rich plasma.
We are locals ourselves
Often patients suffering from joint pain prefer topical medications for treatment. The pharmaceutical industry offers several basic dosage forms - ointments, gels, creams, solutions for topical application (including in the form of sprays), as well as patches.
First of all, let us recall the method of application common to this entire group of drugs.
A small amount of the product is applied to dry and clean skin, gently rubbed in with clean hands, which should be washed after applying the product. Avoid contact of the product with mucous membranes and damaged areas of the skin. In general, the use of local agents under sealed occlusive dressings, which promote enhanced absorption of components, is not recommended.
What is this?
PRP is platelet-rich plasma. The patient's own plasma is used during the treatment process. It is prepared from autologous blood immediately before injection into the knee.
Platelets are the formed elements of blood that perform the function of forming a blood clot. By gluing, they initially form a “plug” in damaged vessels. This happens immediately after the injury. Then platelets provide their surface for the formation of the main reactions of plasma blood coagulation.
Not long ago, another important function of platelets was established. It turned out that they secrete a large number of growth factors and take part in regenerative processes.
Normally, the concentration of platelets in the blood ranges from 180 to 360 thousand cells per μl. Even this amount is enough to somewhat speed up the regenerative processes. But they occur faster and more intensely if a lot of platelets are injected into the joint. Therefore, the plasma is pre-prepared. Other formed elements of blood are removed from it. The platelet concentration increases 5 or more times.
It has been established that the maximum regenerative potential of tissues is achieved when they are exposed to plasma containing at least 1 million platelets per 1 μl. Further increases do not provide significant benefits. If the platelet count exceeds 1.8 million, inflammatory reactions may be enhanced. Therefore, too high a concentration of these cells is not recommended for use for intra-articular administration.
Classification of drugs
Let's consider the main groups of local remedies for joint pain:
Non-steroidal anti-inflammatory drugs (NSAIDs) for topical use: Phenylbutazone, Etofenamate, Piroxicam, Ketoprofen, Ibuprofen, Diclofenac, Indomethacin, Meloxicam and Nimesulide.
Local agents with irritating effects:
a) Capsaicin and similar agents:
Capsaicin is fat-soluble, therefore, if necessary, products containing this drug can be removed from the skin or mucous membranes using petroleum jelly or vegetable oil.
- Capsicum fruit tincture;
- Capsicum fruit tincture + Camphor;
- Capsicum fruit extract;
- Capsaicin + Ethylnicotinate;
- Camphor;
- Carnation flowers oil + Camphor + Chinese cinnamon bark oil + Peppermint leaves oil + Eucalyptus leaves oil + Levomenthol;
- Camphor + Gum turpentine + Eucalyptus leaf oil + Levomenthol;
- Camphor + Salicylic acid + Gum turpentine + Viper venom;
- Camphor + Peppermint leaves oil / Levomenthol + Eucalyptus rodentum leaves oil;
- Camphor + Salicylic acid + Gum turpentine + Viper poison;
- Pepper patch.
b) Propyl nicotinate (salicylic acid derivatives in combinations):
- Methyl salicylate + Racementol;
- Methyl salicylate + Cobra venom;
- Methyl salicylate + Bee venom;
- Methyl salicylate + Levomenthol + Eucalyptus oil + Turpentine oil.
Preparations containing dimethyl sulfoxide:
- Sodium heparin + Dexpanthenol + Dimethyl sulfoxide;
- Dimethyl sulfoxide + Camphor + Turpentine oil + Benzyl nicotinate + Nonivamide.
Other drugs
- Nicoboxil + Nonivamide;
- Benzocaine + Procaine + Racementol;
- Glucosamine + Chondroitin sulfate;
- Formic alcohol;
- Titanium glycerosolvate aquacomplex;
- Menthol + Novocaine + Anestezin.
Anti-inflammatory drugs
Nonsteroidal anti-inflammatory drugs (NSAIDs) suppress inflammation and reduce pain and swelling. Drugs in this group are generally well tolerated, but are not recommended in cases of hypersensitivity to NSAIDs (including bronchial asthma), erosive lesions of the gastrointestinal tract, as well as during pregnancy and breastfeeding (a number of drugs can penetrate the placental barrier) . In addition, the use of NSAIDs is associated with the risk of local and systemic allergic reactions, the possible development of increased sensitivity to light (photosensitivity), especially when used together with cosmetics containing octocrylene sunscreen. Therefore, topical use of NSAIDs on areas with damaged skin, as well as use without protection from direct sunlight, is not recommended. If necessary, these products can be removed from the skin with plenty of water.
Salicylic acid derivatives (for example, methyl salicylate), which are included in various combinations of medicinal substances, have similar effects.
Irritants
A fundamentally different group of drugs from non-steroidal ones are painkillers with a local irritant effect, often used for joint pain. Products based on capsicum extract containing capsaicin are widely used. This alkaloid irritates and warms the skin and increases local blood flow in the area of application. In addition, it affects pain receptors, which leads to a local analgesic effect. Products containing capsaicin should also not be used for damaged skin. The question of use in pregnant and lactating women should be decided by a doctor. We should not forget about the possibility of developing allergic reactions.
Other substances of plant origin act in a similar way, for example, mustard oil and its derivatives (allyl isothiocyanate), camphor, menthol (which also has a “cooling” effect), extracts of cloves, eucalyptus, peppermint, and gum turpentine. The use of these products may also cause allergic reactions.
Keep away from children!
It is important to avoid accidental ingestion of any topical medications, which is especially important for families with young children.
If this does happen, then in the case of NSAIDs you should rinse the stomach. If locally irritating drugs are ingested, vomiting should not be caused due to the risk of inhalation. For example, inhalation of camphor followed by laryngospasm can lead to death. Instead, you need to take enveloping antacids and/or sorbents, and consult a doctor. There is a synthetic analogue of capsaicin with an identical mechanism of action - nonivamide. Nonivamide is usually used in combination with nicoboxil, a substance with vasodilating activity ( expands the lumen of blood vessels - Ed.).
). The application of these drugs to areas of skin with increased permeability, to the neck, lower abdomen and inner thighs is contraindicated.
Another representative of this group, propyl nicotinate, also has an irritating effect. When applied, propyl nicotinate is broken down to form nicotinic acid, which increases local blood flow and blocks nerve endings, which leads to the development of local anesthesia and hyperthermia. This painkiller can be used for joint pain only if it is non-inflammatory in origin, for example due to injury. Using a large amount of the drug over a large area can lead to a decrease in blood pressure and bradycardia, and the entry of propyl nicotinate into the oral cavity is fraught with respiratory failure, increased blood pressure, and the development of cardiovascular failure.
It is also not recommended to use propyl nicotinate simultaneously with other locally irritating agents (local medications, warming physiotherapy) due to the risk of skin irritation and lowering blood pressure. Benzyl nicotinate works similarly.
Poisons
Often, topical products contain venoms of hymenoptera and reptiles. Bee venom has an analgesic and anti-inflammatory effect, and may also have an antibacterial effect. The venoms of snakes - vipers, vipers, cobras - act similarly. If such products are used, allergic reactions may develop.
Dimethyl sulfoxide
An important component of many compounds used for arthralgia is dimethyl sulfoxide. It improves the penetration of medicinal substances into tissues by increasing the permeability of cell membranes, and also has its own local anti-inflammatory and analgesic effect. Dimethyl sulfoxide, with long-term use, improves the absorption of ethanol from the gastrointestinal tract, can enhance the effect of insulin, and increases sensitivity to anesthesia drugs. The drug should not be used if you are hypersensitive to it, pregnant or lactating women, or children under 12 years of age. An additional limitation on its use may be a specific odor reminiscent of garlic.
Other
Metal compounds can also be used in the treatment of joint pain. Thus, there are preparations based on titanium compounds, for which anti-inflammatory and antimicrobial effects, anti-edematous and local analgesic effects are described.
Another option is the use of local anesthetics, for example, novocaine and anesthesin in combination with menthol, which provides both an analgesic effect and a cooling sensation in the sore joint.
Many of the listed drugs are included in various combination drugs and enhance each other’s effect.
