Among rheumatic diseases osteoarthritis takes 85%. Leading symptom of osteoarthritis - chronic pain. It becomes the cause and treatment of the patient to the doctor, and the factor of progression of the disease, and an important clinical test. Six months after the diagnosis of osteoarthritis of the knee sstavov more than half of patients in need of painkillers and anti-inflammatory medications. Therefore, nonsteroidal anti-inflammatory agents (NSAIDs) is the basis of current guidelines for the treatment of osteoarthritis.
In the treatment of rheumatic diseases and essential B vitamins They have a beneficial effect on inflammatory and degenerative lesions not just nerves, but the muscles, joints, bones that occur in patients with rheumatic diseases. But the use of NSAIDs is associated with the risk of gastrointestinal and other complications are usually dose-related. Therefore, rheumatologists are trying to reduce the complications of NSAIDs, such as assigning these medications exactly as required, reducing the duration of the course taking, adding auxiliary agents.
A promising approach to the treatment of OA is a combination of non-selective NSAIDs diclofenac with vitamins B1, B6 and B12. These vitamins enhance the analgesic effect of diclofenac, and therefore it is possible to reduce the dose. In 2011, on the basis of the Yaroslavl State Medical Academy I.G.Krasivina and her colleagues conducted a clinical trial. Its purpose was to assess the analgesic and anti-inflammatory activity of the fixed combination of diclofenac sodium in vitamins B 1, 6 and 12 (drug Neurodiclovit) in osteoarthritis of the knee. 30 women with this disease within a month received Neurodiclovit "on demand", depending on the severity of pain in doses of 50-150 mg per day.
After a month of treatment to reduce the pain in the joints at 25-59%, improved joint function by 29%. The concentration of C-reactive protein, as a sign of inflammation, decreased by 54%. Overall assessment of the effectiveness of drug treatment was "good" in 69% of patients. The use of Neyrodiklovita in "on-demand '' is well transferred 87% of the patients, the therapy provided a stable and pronounced analgesic and anti-inflammatory effects. The frequency of adverse events in the stomach and intestines Neyrodiklovitom the treatment was significantly lower than the values obtained in clinical trials for the treatment of OA which diclofenac was applied in similar dosages in monotherapy. It is noteworthy that the vast majority of patients took Neurodiclovit a maximum dose of 150 mg only in the first week of the study, patients were selected and then a dose of 100 and 50 mg per day.
The results of this study involving patients with rheumatologic and actually correspond to confirm the results of other studies that have proven that the treatment of pain of other origin (radiculopathy, diabetic polyneuropathy, etc.) Becomes much more successful if applied sequential therapy, on the principle of step-up. The intensity of the treatment is first amplified to achieve significant clinical results. Such start-therapy is a combination of NSAIDs and neurotropic vitamins.
Then the treatment continues on the principle of step-down, that is, its intensity gradually decreases . When reducing the symptoms and especially the intensity of pain dosage of NSAIDs initially decreases, then these drugs altogether canceled . But certainly it continues the second stage of therapy neurotropic vitamins, which have their own analgesic effect, a beneficial effect on the entire nervous system as a whole and calm "irritable" nerves, which increases the effectiveness of therapy . In the above two-step treatment regimen as a starting Neurodiclovit drug is prescribed with a subsequent transition to maintenance therapy until remission other complex drug Neyromultivitom It contains only vitamins B1, B6 and B12 . Application step regimens reduced the time of treatment of patients with rheumatic diseases, prolong remission, reduce the number of complications typical of NSAIDs by reducing doses of these drugs and the duration of use . Finally, due to receiving fewer pills increases patients' adherence to treatment and reduces the cost of it .
Dmitry Serov, traumatologist orthopedist, doctor of the highest category, clinics Asteri honey.
Treatment and prevention
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