How to choose a treatment for knee osteoarthritis❓❓❓

Knee osteoarthritis can be painful and inconvenient for patients. The first symptom of knee osteoarthritis is pain. Pain initially occurs when going up and down stairs, squatting down, or sitting and then standing up. Later, the movement of the knee joint is further restricted, and eventually the patient may not be able to walk a single step. Knee osteoarthritis patients with mild initial symptoms can generally be relieved by non-drug treatment. However, patients with mid-stage knee osteoarthritis generally experience pain. They need medication to relieve the pain. This article will describe how to choose a drug to treat knee osteoarthritis.

Systemic analgesics.

Analgesics for knee osteoarthritis are not just for pain relief, they also have anti-inflammatory effects. Knee pain is caused by inflammation. Inflammation must be eliminated in order to eliminate pain in patients. The inflammatory cause of knee osteoarthritis is not caused by a bacterial or viral infection, so antibiotics or antiviral drugs are not used to treat it. Analgesic and anti-inflammatory drugs can eliminate the inflammation of knee osteoarthritis. Pain relief for knee osteoarthritis can be divided into three levels. Different levels of pain medication are used to treat different levels of pain. In clinical practice, drugs should be selected according to the individual situation of patients and the efficacy of drugs, so as to achieve the purpose of individualized medication.

First-level: Acetaminophen.

Acetaminophen is a drug that has been used for many years. It can be used short-term for mild pain and it has relatively low damage to the gastrointestinal tract, liver and kidneys. However, its anti-inflammatory effect is relatively weak, so it can only be used for mild pain. The total daily dose of acetaminophen should not exceed 4 g. Although its damage to the liver is relatively low, liver damage is still its main side effect, especially when taking the drug, patients should avoid drinking alcohol.

Second-level: Non-steroidal anti-inflammatory analgesics (NSAIDs).

For moderate pain, the most commonly used analgesics are NSAIDs. It can be divided into the following categories: acetic acid derivatives (such as diclofenac, indomethacin), propionic acid derivatives (such as ibuprofen, naproxen, ketobufen), fenamic acid esters (such as methyl chloride sulfonate), enolic acid derivatives (eg, piroxicam), and selective cyclooxygenase-2 inhibitors (eg, celecoxib). The most common side effects of these drugs are increased cardiovascular adverse events, gastrointestinal bleeding, liver and kidney damage.

Third-level: Weak opioids.

Weak opioids such as codeine or tramadol may be considered for patients with severe pain and poor response to first- and second-level drugs. The initial dose of these drugs should be low and then slowly and gradually increased to reduce side effects.

Joint topical medication.

Emulsions, ointments and patches of topical pain relievers such as NSAIDs or capsaicin. They can be used outside the body for pain relief. Topical topical analgesics are simply and directly applied to or rubbed on the painful area. Their active ingredients penetrate quickly into the skin and effectively relieve pain. Topical application avoids their irritation of the gastrointestinal tract, reduces side effects and is convenient to use. The following points should be paid attention to when using:

• Adequate amount of use: The dosage of topical drugs must be sufficient to achieve the best pain relief and anti-inflammatory effect.
• The location of the medication should be correct: Anti-inflammatory and analgesic external medicines are used in the acute inflammatory attack period, and the skin will appear red, swollen, hot and painful. Infrared hyperthermia topical medicine is used for chronic injury. There was no redness, swelling and pain at this time. In addition, opioid patches are absorbed through the skin and can be applied to any painful area. Therefore, they should be attached to the shoulders, the upper edge of the chest and the outside of the forearm, and try not to attach to other places.
• Use for less than 12 hours: Most topical analgesics should be used for less than 12 hours. If they are used for more than 12 hours, they may cause adverse effects on the skin.

Intra-articular injection of drugs.

Glucocorticoids: It provides temporary pain relief for patients. However, if high-dose glucocorticoids are used for a long time, patients will experience many adverse reactions such as hypertension, renal impairment, and lower extremity edema. Although the dose of intra-articular glucocorticoid injection is small and generally does not cause the above-mentioned adverse reactions, long-term application will still cause damage to the bones and joints. The bone and cartilage of the joints are damaged by prolonged use of glucocorticoids. This in turn worsens the patient's condition. Therefore, it is recommended that it should not be applied more than 4 times a year.

Sodium Hyaluronate: It is a component of the joint fluid in the joint cavity, which can repair the joints. In patients with knee osteoarthritis, the synovial fluid contains less sodium hyaluronate and becomes thinner. Intra-articular injection of sodium hyaluronate can supplement the lack of sodium hyaluronate in synovial fluid. This increases joint fluid viscosity and reduces joint friction. This can help relieve symptoms and slow the progression of the disease. It is effective in relieving mild to moderate knee osteoarthritis, but it is not very effective in severe advanced knee osteoarthritis. It is generally recommended to use it once a week, with 4 to 6 weeks as a course of treatment.

Disease-modifying drugs and chondroprotective agents.

In patients with knee osteoarthritis, the articular surface cartilage is damaged. These drugs can protect the cartilage and improve the condition. Commonly used drugs are glucosamine and chondroitin sulfate. They are the two major nutrients for articular cartilage.

• Glucosamine: Although it has been widely used in the prevention and treatment of osteoarthritis, its efficacy has been controversial. Osteoarthritis patients with mild or moderate abrasion of articular cartilage are best candidates for glucosamine therapy. It does not work well for people with osteoarthritis who have severely abrasion of articular cartilage. Glucosamine needs to be continuously taken at 1500mg daily for more than 8 weeks to have a certain effect. Taking it for more than one year will have a more stable effect.
• Chondroitin Sulfate: It provides nutrients to cartilage, absorbs and retains water in cartilage. This can help repair articular cartilage. 

Studies have pointed out that the simultaneous application of glucosamine and chondroitin sulfate can obtain a more precise effect.