Pharmacological tests for steroidal anti-inflammatory drugs. Steroid and non-steroidal anti-inflammatory drugs

Today, the treatment of most skin diseases cannot be accomplished without the use of external medications containing steroids. Many people are interested in choosing the optimal hormonal ointment with high efficiency and low risk of serious complications.

List of steroid ointments

All external agents that contain glucocorticosteroids have anti-inflammatory, antiallergic and antipruritic effects. On the pharmaceutical market, drugs from this group are presented in quite a wide range. List of some modern steroid ointments:

• Laticord.
• Lokasalen.
• Belosalik.
• Beloderm.
• Diprogent.
• Prednisolone.
• Dermovate.
• Elokom.
• Flucinar.
• Fluorocort.
• Triderm.
• Locacorten.
• Cutivate et al.

It is strictly not recommended to use steroid ointments, gels, creams or lotions on your own without the approval of your attending physician.

Generations of steroid ointments

In dermatological practice, four generations of steroid ointments are used, which differ from each other in the severity of their action. They are appointed for local therapy skin diseases. The first generation includes hydrocortisone and prednisolone ointments and creams with a low concentration of active substances that have a weak effect. They can be used to treat children. Also treat your face without fear of the formation of “steroid skin”. The following drugs of domestic and foreign production, which are classified as the first generation, are considered the most popular:

• Laticort.
• Lokoid.
• Prednisolone ointment 0.5% (from Nizhpharm, Polfa and Gedeon Richter).

The group of second-generation drugs is represented by fluorinated glucocorticosteroids, which are characterized by moderate severity therapeutic action(Fluorocort, Polcortolon, Sikorten, etc.). Potent fluorinated glucocorticosteroids make up the third generation (Celestoderm B, Dermovate). The fourth group of drugs are glucocorticosteroids, which are derivatives of prednisolone, which contain 2 fluorine atoms. These include:

• Flucinar.
• Sinalar.
• Sinaflan.
• Locacorten.

A qualified medical specialist knows that when choosing a steroid ointment, gel or cream, it is necessary to take into account the clinical form of dermatosis, as well as the localization, prevalence and severity of the pathological process. We list some features of the choice of external corticosteroids:

• Steroids of moderate action are indicated for the exudative form of psoriasis (for example, Fluorocort or Polcortolone).
• Severe and resistant forms of psoriasis are treated with strong corticosteroids such as Celestoderm or Dermovate.
• Regardless of the stage and form of eczema, it is recommended to start therapy with hydrocortisone and prednisolone in the form of an ointment. If there is no therapeutic effect, switch to Fluorocort or Dermovate.
• Itchy dermatoses, complicated by infection, are an indication for the prescription of combination drugs containing steroids and antibiotics. Currently popular combination medications are Corticomycetin, Gixison, Oxycort, etc.
• In the case of allergic dermatosis and secondary infection, the use of steroid ointments that also contain an antiseptic component is indicated. In pharmacies you can find several such medications (Cortonitol, Trimistin, Sibicort, Sikorten Plus, etc.).
• If dermatosis and disruption of the keratinization process of the epidermis are observed, then combined ointments with steroids and keratolytics should be used. Most often, the role of a keratolytic is either salicylic acid, or urea (Diprosalik, Betasalik, Lorinden A).

When the first signs appear adverse reactions from the use of steroid ointments, you must consult your doctor as soon as possible.

Lokoid

One of the representatives of the first generation of external glucocorticosteroids is Lokoid. It contains the active substance hydrocortisone in a concentration of 0.1%. At local application has the following effects:

• Relieves inflammation on the skin.
• Reduces swelling.
• Relieves the feeling of itching.

It is worth noting that the use of this drug in a therapeutic dosage does not cause hormonal imbalance. Small amounts of hydrocortisone can be absorbed into the blood, but this does not have a significant effect on the body. Lokoid is indicated for the treatment of various dermatitis, eczema and psoriasis. However, it cannot be used for:

The affected areas of the skin are treated up to three times a day. The medicine should be applied in a thin layer. If positive dynamics are noted, the course is reduced to 2–4 times a week. Using massaging movements when applying the drug, you can improve the penetration of the active substance into the skin. Over the many years of using Lokoid, no cases of overdose have been recorded.

The ointment is not recommended for use for lesions located on the head or acute inflammatory process. To treat the face, genitals and scalp, it is better to use the drug in the form of a cream. If you treat too large areas of the skin, the likelihood of developing various adverse reactions significantly increases. Prescription in pediatric practice is allowed, but only for patients older than 6 months. Lokoid steroid cream or ointment can be purchased at a pharmacy for about 300 rubles.

Fluorocort

The second generation of external glucocorticosteroids includes Fluorocort. The active substance is triamcinolone. It has pharmacological actions characteristic of steroid drugs:

• Anti-inflammatory.
• Anti-allergic.
• Anti-edematous.
• Antipruritic.

The range of skin pathologies for which the use of Fluorocort is indicated is quite wide. This medicine may be prescribed to treat:

• Various types of dermatitis (atopic, contact, etc.).
• Psoriasis.
• Depriving the red flat.
• Erythema.
• Urticaria.
• Sunburn.
• Granuloma annulare.
• Photosensitivity, etc.

The affected areas of the skin are treated with a small amount of ointment up to three times a day. The maximum daily dosage when treating patients over 18 years of age should not exceed 15 grams. A sealed bandage is not an obstacle to the use of Fluorocort. The course of treatment for pediatric patients is no more than 5 days. Elderly patients are prescribed with extreme caution. The cost of Ftorokort ointment for external use, which is produced by the Hungarian pharmaceutical company Gedeon Richter, ranges from 240 rubles.

When prescribing a steroid ointment, gel or cream, it is necessary to take into account the form, stage and course of the skin disease, including the localization and extent of the pathological process.

Dermovate

Dermovate is considered a representative of the fourth generation of external glucocorticosteroids. The active substance of this drug is Clobetasol. Available as ointment and cream. When applied topically, it can eliminate swelling, redness, itching and reduce the inflammatory process on the skin. Under what pathological conditions and diseases is it recommended to switch to Dermovate:

• Most forms of psoriasis.
• Chronic eczema.
• Lichen planus.
• Discoid lupus erythematosus.
• Other skin diseases, treatment of which with weaker glucocorticosteroids was ineffective.

Women who are pregnant or breastfeeding should consult their doctor before use about the advisability of external hormone therapy. We list the main contraindications:

• Acne disease.
• Perioral dermatitis.
• An infectious process on the skin, regardless of the type of pathogen.
• Skin lesions in young patients who are not yet one year old.

If Dermovate is used for a sufficiently long time, atrophic changes in the skin, the appearance of warts and dilation of small blood vessels, and a decrease in the protective function of the skin are noted. The affected areas should be treated up to twice a day. The therapeutic course should not exceed 4 weeks. In the event of a resumption of exacerbation of the disease, the use of short short courses is allowed, but with a transition to weaker hormonal drugs.

If a positive effect is not observed within 14–20 days, stop therapy and contact a specialist.

In childhood, external corticosteroids are used with caution and under the supervision of a pediatrician. Pathological lesions on the face can be treated with Dermovate ointment or cream for no more than 5 days. In this case, an occlusive (sealed) dressing is not used. If infection is suspected, local treatment with steroids is stopped and antibiotic therapy is switched to. It is also necessary to carefully avoid getting Dermovate into the eyes, since the risk of developing glaucoma is high. The price of this drug (ointment or cream) is approximately 430 rubles.

Flucinar

Among the fourth generation external steroids, Flucinar is the most popular. The pharmacological action of the drug is realized by the active substance fluocinolone acetonide. For what skin pathologies is it recommended to use Flucinar:

• Atopic and seborrheic dermatitis.
• Simple chronic lichen.
• Severe itching.
• Various forms of psoriasis.
• Lichen planus.
• Erythema.
• Sunburn.
• Discoid lupus erythematosus.

Some patients may experience local adverse reactions in the form of a burning sensation, itching, acne, vascular purpura, atrophic skin changes, the appearance spider veins, stretch marks, hair growth disorders, pigmentation, etc. Systemic disorders that seriously affect the functioning of many internal organs arise as a result of unjustifiably long-term use Flucinar or when treating large areas, which significantly increases the dosage of the drug.

Steroid ointments, gels or creams are contraindicated for use in case of allergies to the components of the drug, skin infections, wounds, neoplasms, trophic ulcers. Also, they cannot be prescribed if the patient suffers from psoriatic plaques and acne. During pregnancy, the doctor decides how appropriate it is to use Flucinar for a particular skin pathology. At the same time, it takes into account possible risks for the woman and baby.

It can be combined with antibacterial drugs for external use. During therapy, it is recommended to refrain from vaccination and immunization. Flucinar is prescribed in short courses. To avoid development side effects Only small areas of affected skin can be treated. In pediatric practice, it is used with extreme caution. Due to the high risk of adverse reactions, many experts do not recommend using Flucinar for the treatment of skin diseases on the face. However, they can resort to it only in very severe cases. Ointment or gel sells for 250–280 rubles.

Belosalik

One of the frequently prescribed combination steroid drugs for external use is Belosalik. Contains two active substances: betamethasone and salicylic acid. Used to treat various forms of dermatoses, which, among other things, are accompanied by problems with keratinization of the epidermis (hyperkeratosis). For example, for psoriasis, eczema, neurodermatitis, ichthyosis, lichen planus, etc. A contraindication to the use of Belosalik is the presence of:

• Allergies to betamethasone or salicylic acid.
• Tuberculosis process on the skin.
• Wounds and ulcers.
• Any infections on the skin.
• Acne disease.

During pregnancy and breastfeeding Belosalik cannot be used without the approval of the attending physician. If the child is not yet six months old, this drug is not even considered for the treatment of any skin pathology. Use in older children should be strictly according to indications and in compliance with all recommendations and prescriptions of a specialist.

Try not to let the ointment get into your eyes or mucous membranes. Not used for the treatment of skin diseases, the pathological foci of which are located in the anus, perineum and genitals. When a fungal or bacterial infection occurs, appropriate agents, in particular antifungal and antimicrobial agents, are included in the therapeutic course. The combined use of drugs for external use should be previously agreed with your doctor. According to the established rules, no prescription is required to purchase Belosalik ointment, which costs approximately 300 rubles.

Oxycort

Another representative of combined external glucocorticosteroids is Oxycort. It contains hydrocortisone and oxytetracycline, which determine the pharmacological properties of the drug:

• Reduce local inflammatory process.
• Kill pathogenic microflora on the skin.
• Coping with allergies.
• Relieves itching sensation.

Currently, Oxycort is very actively used in dermatological practice. The main indications for prescribing this drug include:

• Chronic pyoderma, which is caused by staphylococci, streptococci or mixed pathogenic microflora.
• Various dermatoses that are complicated by infection (allergic, contact, seborrheic, etc.).

However, Oxycort is contraindicated in case of allergies to the active substances of the drug, herpes, chicken pox, tuberculosis, fungal infection and tumors on the skin. Side effects may include atrophic changes, burning, itching, rashes, dryness, stretch marks, increased hair growth or, conversely, baldness, problems with skin pigmentation, etc. If you notice such undesirable effects, you should stop treatment and consult a specialist . The absence of a positive effect within a week is also an indication for stopping local hormonal therapy.

When using steroid ointments, creams and gels, follow the regimen and frequency of application recommended by a specialist doctor.

One of the common pathological processes in the body is inflammation. The inflammatory response is not just a response human body for infection or injury. This is protection and damage at the same time.

Inflammation

With mechanical, chemical, thermal or infectious damage to any organ, inflammation develops in it. What is it?

The inflammatory process is primarily an increase in local blood circulation and the production of special substances designed to fight the damaging agent. Thanks to this reaction, the body is able to restore its integrity and eliminate the effect of external factors. However, the results of the inflammatory process do not occur unnoticed by humans. Accelerated blood flow and the release of inflammatory mediators leads to the following symptoms:

• edema;
• deformation;
• redness;
• local increase in temperature;
• pain.

Together they lead to dysfunction. The most obvious manifestation of the inflammatory process is in the joint area. It often forces the patient to see a doctor.

Arthritis and arthrosis

If one joint is affected, this pathology is called monoarthritis; if there is multiple inflammation, it is called polyarthritis. There is also an intermediate state when only one or two joints are involved in the process. Then it will be an oligoarthritis variant of the disease.

Inflamed joints are usually treated special doctors– rheumatologists. Sometimes they can observe the patient together with other specialists - cardiologists, endocrinologists, dermatovenerologists. The causes of inflammatory processes in the joints are very diverse and the list of diseases that cause arthritis is quite large.

Do joint inflammation need to be treated? Or is it better to let the body fight infection or injury on its own?

It is certainly necessary to treat arthritis. First of all, in inflammatory processes in the joints, it is quite pronounced pain syndrome. It limits his motor function. In addition, the joint will work worse due to the developing swelling. Repeated inflammatory processes in the joints subsequently lead to the development of a degenerative disease - arthrosis.

The same thing happens with untreated arthritis. In severe cases, these two diseases occur simultaneously, and without treatment the patient will experience great suffering.

Are there any effective methods treatment of joint diseases?

Treatment

As can be seen from the mechanism of development of the pathological process in the joint, treatment should be primarily aimed at reducing inflammation. This will have the following effects:

1. Inhibition of the inflammatory, and therefore destructive reaction in the joint. Inflammatory mediators can destroy not only a foreign agent, but also worsen the condition of their own organs.
2. Reducing swelling. Edema is a localized accumulation of fluid due to increased blood flow. One of the clearest manifestations of inflammation.
3. Reducing pain intensity. Both the work of inflammatory agents and compression of edematous tissues lead to the development of pain. Elimination of these pathological processes significantly alleviates the patient's condition.
4. Restoring range of motion in the joint. This becomes possible when local swelling is eliminated and pain subsides.

To treat arthritis and arthrosis, there is a class of medications called anti-inflammatory drugs. According to their structure, they are steroidal (hormones) and non-steroidal (NSAIDs).

NSAIDs

Nonsteroidal anti-inflammatory drugs, or NSAIDs, can suppress any inflammation - regardless of the cause that caused it. In addition, the most important property of NSAIDs is the absence of drug dependence.

The list of non-steroidal anti-inflammatory drugs is huge. It includes more than eighty medications, on the basis of which about a thousand different dosage forms have been created.

Nonsteroidal anti-inflammatory drugs are most often used as individual drugs, but can sometimes be included in combination forms.

Every year, about 300 million people use NSAIDs, most of them purchasing over-the-counter medications. In Russia, nonsteroidal anti-inflammatory drugs occupy about 30–35% of the total pharmaceutical market. Every fifth patient in the therapeutic department receives a prescription for NSAIDs.

A third of the world's population has used an anti-inflammatory drug at least once in their lives.

How do non-steroidal anti-inflammatory drugs work?

Operating principle

The mechanism of action of NSAIDs is quite complex. There are three main actions in their work:

• anti-inflammatory;
• pain reliever;
• antipyretic.

Any of the non-steroidal anti-inflammatory drugs has these effects, but they can be expressed in to varying degrees. So, Aspirin perfectly reduces fever, Analgin relieves pain, and Diclofenac eliminates inflammation. But if necessary, it is quite possible to use Diclofenac for fever, and Analgin to relieve the inflammatory process. All NSAIDs are interchangeable, but when selecting therapy, it is highly advisable to take into account their most pronounced effect. What happens when you take anti-inflammatory drugs?

Anti-inflammatory effect

The anti-inflammatory effect of drugs is nonspecific. This means that they are equally effective in combating any inflammatory reaction.

Non-steroidal anti-inflammatory drugs suppress two phases of the pathological process - alterative, or damaging, and exudative (edematous). In addition, most of these drugs, in their chemical composition, belong to organic acids, therefore, will accumulate in the acidic environment of the inflammatory focus and directly affect the processes occurring in it. Increased permeability of small vessels - capillaries - during inflammation also helps the medicine reach the source of the disease.

An important mechanism of the anti-inflammatory effect of NSAIDs is their effect on cyclooxygenase (COX). At the beginning of the pathological process, special substances - prostaglandins - begin to be released into the blood. They contribute to the progression of inflammation - both acute and chronic. The regulator of their production is the enzyme COX. By suppressing its activity, drugs significantly inhibit the pathological process. This is how the anti-inflammatory effect of NSAIDs is realized.

Analgesic effect

The analgesic effect of NSAIDs is also associated with inhibition of prostaglandin production. In addition, the reduction of inflammatory edema when using them is also of certain importance. Compression of tissue by liquid can cause significant pain.

Non-steroidal anti-inflammatory drugs are significantly inferior in their analgesic effect to morphine derivatives - narcotic analgesics. However, unlike the latter, they do not cause addiction, euphoria or withdrawal symptoms. NSAIDs do not inhibit respiratory center, like morphine.

The analgesic and anti-inflammatory effect of NSAIDs has found use in various colics, arthrosis, arthritis, myositis, and neuralgia.

Antipyretic effect

All NSAIDs have the property of lowering body temperature. However, they work only in conditions of fever - in infectious diseases, poisoning, malignant tumors. Unlike, for example, antipsychotics, NSAIDs do not reduce normal body temperature.

The antipyretic effect is associated with blocking cyclooxygenase, inhibition of prostaglandin production and an effect on the thermoregulation center in the hypothalamus.

Effectiveness of temperature reduction different drugs may differ significantly.

Classification

Given the huge number of NSAIDs, for ease of use they are divided into groups according to structure, strength of anti-inflammatory action, and duration of effect.

The classification of anti-inflammatory drugs by chemical structure distinguishes several groups. These are derivatives of the following acids:

1. Salicylic acid and anthranilic acid. Most famous medicinal substances in this group - acetylsalicylic acid, sodium salicylate, niflumic and mefenamic acids. One of the first drugs in this group is Aspirin.
2. Arilalkanovs. These include diclofenac, ketorolac, ketoprofen, naproxen, ibuprofen. In pharmacies, these products are known under the names Diklak, Dikloberl, Voltaren, Ketanov, Fastum, Ibuprom.
3. Enolikova. These are pyrazolidinediones (phenylbutazone) and oxicams (meloxicam, piroxicam). Trade names of drugs in this group are Movalis, Melbek, Revmoxicam.
4. In addition, non-acid derivatives are isolated - colchicine, proquazone, epirazole, and combination drugs - Arthrotec. Arthrotec is diclofenac with misoprostol. The latter protects the gastric lining from the irritating effects of NSAIDs.

However, the classification of NSAIDs by intensity of action is of great practical interest. There are high activity anti-inflammatory drugs:

• Salicylates (well-known acetylsalicylic acid).
• Pyrazolidines - phenylbutazone, or Butadione, is often used.
• Indoleacetic acid. Its main representative is Indomethacin.
• The phenylacetic acid group and the gold standard in rheumatology is diclofenac.
• Oxicams – meloxicam and piroxicam.
• Medicines based on propionic acid - dexketoprofen, ketoprofen, and ibuprofen.
• Sulfonamide and its derivatives. These are nimesulide (Nimesil), celecoxib.

Highly active NSAIDs are widely used to treat rheumatological diseases. However, drugs with mild anti-inflammatory effects have also found their niche. They are used as a pain reliever - non-narcotic analgesics.

Low anti-inflammatory activity is observed in the following drugs:

• Mefenamic acid.
• Ketorolac (Ketanov, Ketolong).
• Paracetamol (Panadol).
• Metamizole, or Analgin.

Another classification of NSAIDs is also widely used - by time of action. Drugs can be divided into 3 groups:

1. Medicines with short period actions - diclofenac and ibuprofen, ketoprofen, indomethacin.
2. Medium duration - naproxen and sulindac.
3. Long-acting medications are phenylbutazone and a group of oxicams.

The duration of action of the drug is important in the ongoing treatment of arthrosis or other rheumatological diseases. It is much more convenient to take one tablet per day than 2-3.

Despite the huge number of existing anti-inflammatory drugs, new medications are constantly being developed - with minimal side effects and maximum effectiveness. Today, new generation non-steroidal anti-inflammatory drugs are very popular among rheumatologists. What medications are they, and what makes them different from other NSAIDs?

Modern generation of NSAIDs

Why is the synthesis and research of new anti-inflammatory drugs necessary if the existing ones cope with their tasks perfectly? Moreover, unlike narcotic analgesics addiction does not develop to them.

The difficulty of long-term use of NSAIDs is associated with their side effects. The most severe complications that can threaten the patient are the formation of stomach ulcers and bleeding. Since the treatment of arthrosis is usually long-term, the high frequency of such complications imposes significant restrictions on the use of such medications. That is why in recent years not only stronger but also safer drugs have been actively developed in medicine. New generation NSAIDs include oxicams and coxibs.

Oxycams

Oxycams appeared on the pharmaceutical market not so long ago, but are widely used in the treatment of many diseases. Most often they are used in rheumatology to treat joints.

Oxycams are represented by the following medicinal substances:

• piroxicam;
• meloxicam;
• lornoxicam.

Piroxicam is known commercially as Pirocam or Erazon. Its anti-inflammatory effect is very strong, although it develops quite slowly. A pronounced effect is observed only at the end of the second week of continuous use. Piroxicam reaches its peak effect after 3–4 weeks.

In addition to anti-inflammatory, the drug also has a strong analgesic effect, which occurs quickly, especially with intramuscular injection. However, Piroxicam is a rather toxic drug; it has a negative effect on the gastrointestinal tract (GIT).

Meloxicam is a bright representative of the latest generation of anti-inflammatory drugs. It selectively inhibits a subtype of the cyclooxygenase enzyme, COX-2, so its side effects are minimal. Meloxicam is significantly less toxic to the gastrointestinal tract and kidneys than piroxicam or diclofenac. In the pharmaceutical market it is known under the names Movalis, Melbek, Revmoxicam.

Lornoxicam, unlike other drugs in this group, has the most pronounced analgesic effect. In terms of the strength of its analgesic effect, it can be compared with morphine derivatives. It is commercially known as Xefocam and is available in the form of injections and tablets.

Coxibs

Coxibs belong to the modern generation of NSAIDs. They, like oxicams, selectively inhibit the action of COX-2. Coxibs have pronounced anti-inflammatory activity. In addition, they are also used as non-narcotic analgesics. Due to their selective action, they side effects appear much less frequently. When using coxibs, damage to the digestive, urinary, or blood coagulation systems is infrequently observed.

However, some studies have shown that long-term use of coxibs can worsen the condition of the cardiovascular system, and therefore the advisability of using these drugs remains debatable. In pharmacies, this generation is represented by celecoxib - Celebrex.

And yet, despite greater safety, even the new generation of NSAIDs is characterized by the same side effects as long-known drugs.

Side effects

All anti-inflammatory drugs have an ulcerogenic effect - they affect the mucous membranes with the formation of erosions or ulcers. Long-term use of NSAIDs is fraught with the development of gastric ulcers and duodenum. The same happens in case of drug overdose. Aspirin is especially dangerous for the digestive system. Aspirin ulcers are not uncommon when treated with this drug. Also highly toxic to gastrointestinal tract are piroxicam and indomethacin.

In addition to the ulcerogenic effect, NSAIDs can affect the coagulation system - thin the blood. This property is used in the treatment of cardiovascular diseases, for the prevention of heart attack and stroke. However, for heart diseases, NSAIDs - aspirin - are prescribed in small doses.

If the medicine is used for anti-inflammatory purposes, in the usual dosage, it can cause bleeding - gastric, intestinal or hemorrhoidal. This happens especially often when NSAIDs are abused – for example, in case of severe pain.

Many anti-inflammatory medications have a negative effect on the kidneys and exhibit nephrotoxicity. A serious complication of taking them can be damage to the renal parenchyma - interstitial nephritis. Even harmless paracetamol, which is approved for use in pregnant women and children, is dangerous in this regard. Nephrotoxicity of NSAIDs should be considered when treating elderly patients and those with heart disease.

Sometimes anti-inflammatory drugs also have side effects on the respiratory system. There is even a separate disease - aspirin asthma.

Certain drugs can inhibit the formation of new blood cells. Depending on which hematopoietic germ they affect, aplastic anemia or agranulocytosis develops. Such complications are characteristic of treatment with Analgin.

Various allergic reactions are also not uncommon - from urticaria during treatment with tablets to Quincke's edema during an injection.

The risk of side effects can be reduced by correct selection of dosage and optimal dosage form.

Release forms

NSAIDs are available in various forms. This is done not only for the convenience of patients, but also for the correct distribution of the drug, quick access to the lesion, and reducing the risk of complications. The list of forms of anti-inflammatory drugs is quite large:

• pills;
• capsules;
• powders;
• ointments;
• gels;
• cream;
• lotions;
• solutions for injections;
• candles;
• plasters.

The advantages of tablets are obvious. They are easy to take and do not require special training or any medical skills.

The tablets can be taken on the go and taken at any time. But this form is not suitable for all patients. Some tablets simply dissolve in the acidic environment of the stomach. Others cause a person discomfort after reception. The effect of the medication taken in this form does not occur immediately.

Unlike pills, injections act very quickly. But they also have their drawbacks - pain, inconvenience, and not everyone has the skills to perform injections.

NSAIDs in suppositories act quickly enough and do not irritate the stomach. Capsules are less susceptible to gastric acid than tablets. Powders are characterized by a rapid onset of effects, but may cause a feeling of discomfort in the gastrointestinal tract.

An excellent dosage form for NSAIDs is the patch. It does not require frequent changes, is highly effective, and free of irritation. But not all drugs can boast of this form of release.

Local remedies - creams, lotions, gels and ointments - can only be used for mild forms of arthrosis and arthritis. Their effectiveness is significantly inferior to tablets and injections. But, at the same time, the risk of complications when using them is very low.

Steroid drugs

Like NSAIDs, steroid drugs have found widespread use in rheumatology. They are used to treat degenerative and inflammatory joint diseases. What are steroid drugs?

By their structure, they are hormonal substances and are characterized by all the properties of hormones. Steroids have the following effects:

1. Inhibits inflammation.
2. Stop the growth connective tissue at the site of damage.
3. Eliminate swelling and, as a result, pain.

Steroid hormones are stronger and longer acting than NSAIDs. Sometimes one injection is enough to stop an exacerbation. They are often prescribed for chronic joint damage. But in this situation, tablets become the preferred form of release.

However, steroids also have many more side effects. They also lead to the development of ulcers and bleeding, but in addition they can cause diabetes, obesity and adrenal dysfunction. Steroids should only be used under the close supervision of a physician.

Popular hormonal drugs in rheumatology are Kenalog, Diprospan, Polcortolone and tablet forms of prednisolone - Metipred.

Anti-inflammatory nonsteroidal and steroidal drugs are the main therapy for joint diseases in modern medicine. However, it can only be carried out under the supervision of a doctor and according to his recommendations. Self-treatment NSAIDs and hormones are unacceptable.

Steroid drugs are the most powerful anti-inflammatory drugs available today. This is a group of drugs based on cortisol, a hormone produced by the human adrenal glands. Medicines containing steroid hormones include the following:

• Steroid drug in the form of an ointment;
• New generation steroidal anti-inflammatory drugs;
• Steroid anti-inflammatory drugs for the treatment of joints

Mechanism of action

Steroid medications reduce inflammation by suppressing the functions of the immune system. They reduce the production of leukocytes and anti-inflammatory enzymes, thereby stopping tissue erosion at the site of the affected area.

List of indications

• A malfunction occurred in the immune system, which led to skin allergies.
• The inflammatory process in the joint has a destructive effect on surrounding tissues and causes severe pain(rheumatoid arthritis).
• With systemic inflammation of blood vessels (vasculitis).
• With systemic muscle inflammation (myositis).
• For inflammation of internal organs and tissues.
• Hepatitis.
• Shock states.

Watch a useful video on this topic

Contraindications

• Tissue damage is caused by infection.
• The body is exposed to bacterial diseases.
• With the potential for bleeding.
• When taking blood thinning medications.
• With extensive erosion of tissues and joints.
• In case 3 injections of steroid drugs have already been made this month.
• Immunodeficiency of the body.
• Pregnancy and lactation.

Side effects

The study showed that the use of steroid drugs may be accompanied by the following symptoms:

• Hypertension.
• Increased blood clotting.
• Low immunity.
• Peptic ulcer of the digestive system.
• Osteoporosis.
• Masculinization of the female body (acquiring masculine properties).

Withdrawal syndrome

The hormone cortisol is involved in the body's energy metabolism. It helps break down proteins. When the level of this hormone increases in the body, and then when it sharp decline, problems with metabolism arise. Muscles may become more flabby, and the percentage of fatty tissue in the body increases.

Popular steroid drugs

Available in the form of a solution for injection. It is used in cases requiring immediate administration of an anti-inflammatory drug, as well as in shock conditions.

Available in the form of a suspension. Used orally or intramuscularly to relieve pain in acute rheumatoid arthritis.

Clear gel, cream or ointment. It is used externally for psoriasis, priororal dermatitis and other itchy skin lesions.

Ointment for external use. Used for itchy skin inflammation and skin allergies.

White or transparent gel. Apply to the surface of the skin for allergic reactions and itchy inflammation.

New generation anabolic drugs

Available in the form of tablets or ampoules for injection. Should be taken in cases of dermatitis, allergic conjunctivitis and for other inflammations of internal organs.

Produced in tablet form. Used for acute stressful situations, syndrome multiple sclerosis and growth retardation in children.

It is produced in the form of ampoules or a bottle for the preparation of a solution for injection. Accepted in shock situations.

Ointment or cream white. Used as an antipruritic and anti-inflammatory agent.

Available in tablet form. Used for asthma, acute rhinitis and allergic reactions.

Anti-inflammatory drugs for joints based on steroid hormones

Powder for preparing a solution for infections. It is used for inflammation of the joints and in surgical practice.

Tablets or solution for injection. Used for allergic reactions, inflammatory or shock conditions.

Solution for injection. It is used for pinching of the lumbosacral region, allergies and dermatitis.

Solution for intramuscular and intravenous administration. Used for acute shock or allergic conditions and inflammatory reactions.

Sold in the form of double ampoules with solution. Used intramuscularly as an anti-inflammatory agent for acute pain in the joints.

Steroid ointments

Steroid ointments can come in the form of a cream, ointment, or gel. Each patient can individually choose a form that is convenient for themselves.

Steroid ointment, cream or gel. Used for skin dermatitis and eczema.

A cream distinguished by its softening properties. Used for itchy and flaky dermatitis and eczema.

Cream used for dermatitis.

Ointment used for seborrhea, psoriasis and dermatitis.

Frequently Asked Questions

What is the difference between hormonal and steroid drugs?

Steroid drugs are a type hormonal drugs. In addition to adrenal hormones, there are drugs that can replace pituitary hormones, sex hormones, anabolic hormones, pancreatic hormones, thyroid and parathyroid hormones.

How is treatment carried out with both steroid and non-steroidal drugs?

Many diseases are recommended to be treated with steroidal and nonsteroidal (NSAID or NSAID) drugs simultaneously. Anabolic steroid drugs help reduce inflammation and tissue swelling, and non-steroidal drugs act on the cause of inflammation. When taking steroid drugs, be sure to take into account that they can provoke an allergic reaction to the medications and vitamins that you take at the same time. Only a highly qualified attending physician can draw up the correct dosage plan and combination of steroid hormones.

What is the best way to use such drugs for osteochondrosis?

Steroid drugs relieve pain well and relieve tissue swelling in osteochondrosis of the joints. Ambene is a fairly popular drug. This is a medicine that consists of two solutions for infections. This drug relieves tissue swelling well, relieves pain, reduces temperature and has a calming effect on the nervous system.

What are new generation steroidal anti-inflammatory drugs?

Recently, a new generation of anabolic steroid anti-inflammatory drugs have begun to be produced, which have fewer side effects. The use of such drugs is more preferable, but their anti-inflammatory effect is lower than that of traditional drugs.

How are anti-inflammatory drugs with a steroid structure produced?

Anabolic steroid drugs are obtained through a series of chemical and biological transformations and deep purification of the resulting raw materials. Special immobilized microbial cells participate in these transformations.

Steroid and non-steroidal drugs. What's the difference?

The difference between steroidal and non-steroidal drugs lies in their effect on the body. The effect of steroid drugs is that they inhibit immune system person. Non-steroidal non-narcotic painkillers have an analgesic effect on the body. They slow down the enzyme reaction in the membranes of nerve cells. Both medications have significant negative effects on the body, so they should not be used regularly.

The modern pharmaceutical market offers the use of steroid drugs that help avoid large quantity problems associated with allergic reactions of the body or exacerbation of inflammatory processes.

Medicines for gout: tablets, ointments, injections, full list of drugs

Gout is a complex joint disease that will have to be treated medications. The joint is affected due to excessive amounts of uric acid and its salts. Medicine for gout is selected based on examination of the patient, determining the causes of the pathology. Treatment must be carried out immediately.

Causes and symptoms of pathology

So, gout is most often localized on the big toes. The cause of the development of the disease may be too strong physical activity, poor nutrition, disruption of metabolic processes in the body.

Gout is an insidious disease. It may not appear for a long time. During an exacerbation, it has the following symptoms: swelling of the affected area, increased local temperature, severe pain, which appears most often at night. The joint becomes very sensitive to any touch.

Features of treatment of gout during exacerbation

So, it is advisable to carry out treatment inpatiently. At this stage of treatment, it is important to eliminate severe pain, eliminate or reduce the intensity of the inflammation process, and restore normal mobility of the joint. During the period of exacerbation, the attack is stopped with the help of the following drugs:

Nonsteroidal anti-inflammatory drugs

"Butadion". This is an anti-inflammatory ointment that can relieve pain and high temperature. In addition, this drug is considered a good antirheumatic agent. Apply the ointment in a thin layer around the affected area. There is no need to rub it in.

"Indomethacin". This tablet drug is considered one of the most effective non-steroidal anti-inflammatory drugs. It is prescribed for the treatment of gout in the legs in most cases. The main advantage of the medicine is the ability to quickly relieve pain during exacerbation. It is necessary to take tablets three times a day, 0.05 g.

"Ibuprofen." This medicine is also used in tablet form. Most often, Ibuprofen is used during the period when the exacerbation attack has reached its peak, that is, when the symptoms are most pronounced. The daily dose can range from 1200 to 2400 mg.

Steroid hormonal drugs

These drugs cannot always be taken for treatment, since they have a strong effect, but a large number of adverse reactions. If they are prescribed, it is only in extreme cases, and the period of their use is significantly limited. The most commonly used steroidal anti-inflammatory drugs for treatment are:

• "Betamethasone." This is a pain reliever that is used to reduce inflammation. This hormonal drug can be used systemically or topically;
• "Methylprednisolone." This is an anti-inflammatory drug that is used in the form of ointments, tablets, and injections (shots);
• "Ketasone". It eliminates the inflammatory process well. You can drink it in the form of dragees or tablets. You need to take medicine for gout twice a day.

You can take steroid medications only with the permission of your doctor. Independent use of such products can be fraught with various health problems.

More details

One of the most effective medications against gout on the legs is Colchicine. This drug is made from plant based. It is almost completely safe, so it has no restrictions for patients, except renal failure and allergies. Colchicine not only helps relieve severe pain and other symptoms of gout. In addition, the medicine stops the formation of uric acid salts. Therefore, this remedy relieves gout attacks well, as it has analgesic properties.

Colchicine ensures the removal of uric acid from the blood. However, the effectiveness of the drug depends on when the patient starts taking it. The fact is that Colchicine must be taken on the first day of inflammation. At the same time, you should take these gout tablets every hour (no more than 10 pieces per day).

Colchicine has good reviews patients who note that with the help of the drug it is possible to reduce the level of uric acid in the blood plasma. The medication is completed after the intensity of the symptoms decreases and the signs of the disease disappear.

Medicines for basic treatment of gout

After an acute attack of gout has been stopped, it is necessary to switch to basic treatment, which involves reducing the level of uric acid in the blood, as well as removing salts from the body. The drugs in this case are non-steroidal and practically do not serve to relieve pain or other symptoms of the disease. There are two groups of these drugs:

Uricodepressants (suppress uric acid synthesis)

"Allopurinol." It should be taken once a day at a dosage of 300 mg or 3 times a day. 100 mg each. It is advisable to take the tablet after meals. "Allopurinol" ensures the removal of uric acid from the blood plasma. In addition, this remedy prevents complications of the disease. While taking Allopurinol, the patient is required to monitor the level of uric acid in the blood monthly. The use of the medicine must be agreed with the doctor. The fact is that Allopurinol can aggravate the condition of the body in the presence of concomitant diseases. An analogue of the presented drug is Thiopurinol.

Uricosuric medications (remove salts from joints and cleanse the blood)

• "Benemid." These tablets can speed up the removal of salts from the body several times. The presented medicine is quite well tolerated by patients;
• "Anturan". These tablets are more effective than the previous remedy. However, the drug cannot be taken together with Aspirin, which blocks the action of Anturan;
• "Amplivix". Treatment with this remedy helps speed up the removal of uric acid salts from the body. However, you will have to take it from several weeks to a couple of months;
• "Flexen". The medicine presented is sold in capsules, tablets, ampoules and suppositories. This medicine is used if it is necessary to stop an acute attack, as well as other symptoms of gout.

All non-steroidal drugs presented are prescribed by a doctor, depending on the nature of the attack. In addition, the age of the patient must be taken into account, as well as the ability of the liver and kidneys to perform their functions well.

Compresses

The most used medicine for lotions is Dimexide. It is applied as additional remedy for the treatment of gout. You need to use it correctly:

• the product must be mixed with water in equal quantities;
• Next, a piece of gauze is soaked in the mixture, applied to the affected joint and covered with film;
• Additionally, the compress must be wrapped in cotton cloth and a woolen scarf;
• it must be removed after half an hour.

The course of treatment can last 10-90 days. Reviews about this medicine are quite good. However, it should not be used during an acute attack.

Treatment of joints Read more >>

Analgesics

During an acute attack of gout, it is vital to take medications that relieve pain. Among them, the most effective are:

1. "Diclofenac". This remedy works very quickly. It can be used in the form of tablets or ointment (the latter is used most often). The treatment course can last about 1.5 months.
2. "Movalis injections." Treatment with this remedy allows you to get a quick, short-term effect. The drug is administered intramuscularly. Injecting the medicine into a vein is strictly prohibited, as this can lead to kidney failure.
3. "Voltaren." It is used for severe pain. Here you need to use both tablets and ointment at the same time.
4. "Blemaren." This drug promotes the rapid removal of uric acid, as well as its alkalization. The advantage of the product is its complete safety for the kidneys and liver.

It is strictly forbidden to self-medicate gout.

New drugs for the treatment of gout

Diseases support system organism significantly complicates a person’s life. Gout is an insidious pathology that brings great suffering. Therefore, it is necessary to fight it thoroughly. Pathology can be treated using modern, new generation means:

• "Arcoxia". It is used to treat pain and other symptoms of gout. However, Arcoxia is not for everyone. This medicine can cause a large number of side effects. Although, if Arcoxia is used correctly, side effects are isolated and infrequent. The drug is sold in tablet form with film-coated. Arcoxia is more often used as an analgesic and anti-inflammatory drug.
• Febuxostat. This product is non-purine in nature and is used to treat high uric acid levels in gout. Febuxostat should not be used during exacerbation of the disease. The fact is that it first increases the acid level. Taking Febuxostat can be long-term. If an exacerbation develops after the drug was prescribed, then you should not stop using it. Febuxostat is a fairly effective remedy, but it should be used only for its intended purpose.

All modern medications for gout are effective. However, which of them is better in each individual case will be determined by the doctor. Be healthy!

The health of every person is largely in his hands. As a rule, it is the lifestyle one leads and whether timely therapy is carried out that determines how high the quality of life will be. Medicines also relate to this topic. Today it has become a matter of duty to be able to understand medications. At least in those prescribed for a particular case.

And so today we will talk about one of the groups of medicines. They are called steroidal anti-inflammatory drugs.

Thanks to further information, you can most accurately understand why these funds are needed, to whom they are indicated and what effect they have on the human body.

Types of drugs

First, it’s worth understanding what anti-inflammatory steroid drugs are. So, this name refers to glucocorticoids that are produced in the human adrenal gland. All anti-inflammatory steroid drugs are divided into natural (hydrocortisone and cortisone) and synthetic. The latter, in turn, are divided into halogenated (betamethasone, dexamethasone and triamcinolone) and non-halogenated (methylprednisolone and prednisolone).

These substances have an effect at the intracellular level, while binding to human DNA. They can have a strong influence on many processes in the body. These include carbohydrate, fat, protein metabolism, as well as some other processes, such as water-salt metabolism.

Anti-inflammatory steroid drugs have antiallergic, anti-inflammatory and antipruritic effects. Drugs in this group are used in the treatment of various dermatological diseases. These include psoriasis, eczema, dermatitis, lichen, neurodermatitis and some other serious diseases. For these purposes, glucocorticoids are usually available in the form of ointments, creams, and gels. You need to know that their use without a doctor’s prescription is impossible and can even become dangerous. Side effects such as atrophy, acne and some others are possible.

The effect of using steroid drugs

In addition, glucocorticoids are actively used in ophthalmology for the treatment of advanced forms of conjunctivitis, iritis, iridocyclitis, keratitis, uveitis and some others. However, glucocorticoids are contraindicated in acute infectious eye diseases.

Another area of ​​application is otorhinolaryngology. Treat diseases such as acute otitis media(both external and internal), eczema of the ear canal, vasomotor rhinitis.

In addition to all of the above, glucocorticoids are used as immunoregulatory, antishock drugs, as well as for some other indications.

Thus, the spectrum of use of anti-inflammatory steroid drugs is quite wide. But at the same time, they have their own narrow territory of influence in terms of the functions they perform. Recently, new generation drugs have begun to be produced that act more loyally, but are no less effective. Let today's knowledge and new experience be useful for an accurate understanding of what steroid drugs are and why they are sometimes needed by the human body. Knowledge is strength and health. Good luck!

The mechanism of their action is based on blocking certain enzymes (COX, cyclooxygenase), they are responsible for the production of prostaglandins - chemicals, which contribute to inflammation, fever, pain.

The word “non-steroidal”, which is contained in the name of the group of drugs, emphasizes the fact that the drugs in this group are not synthetic analogues of steroid hormones - powerful hormonal anti-inflammatory drugs.

The most famous representatives of NSAIDs: aspirin, ibuprofen, diclofenac.

How do NSAIDs work?

While analgesics directly combat pain, NSAIDs reduce both of the most unpleasant symptoms of the disease: pain and inflammation. Most drugs in this group are non-selective inhibitors of the cyclooxygenase enzyme, suppressing the action of both of its isoforms (varieties) - COX-1 and COX-2.

Cyclooxygenase is responsible for the production of prostaglandins and thromboxane from arachidonic acid, which in turn is obtained from cell membrane phospholipids by the enzyme phospholipase A2. Prostaglandins, among other functions, are mediators and regulators in the development of inflammation. This mechanism was discovered by John Wayne, who later received Nobel Prize for his discovery.

When are these drugs prescribed?

Typically, NSAIDs are used to treat acute or chronic inflammation accompanied by pain. Non-steroidal anti-inflammatory drugs have gained particular popularity for the treatment of joints.

We list the diseases for which these drugs are prescribed:

• acute gout;
• dysmenorrhea (menstrual pain);
• bone pain caused by metastases;
• postoperative pain;
• fever (increased body temperature);
• intestinal obstruction;
• renal colic;
• moderate pain due to inflammation or soft tissue injury;
• osteochondrosis;
• lower back pain;
• headache;
• migraine;
• arthrosis;
• rheumatoid arthritis;
• pain in Parkinson's disease.

NSAIDs are contraindicated for erosive and ulcerative lesions of the gastrointestinal tract, especially in the acute stage, severe liver and kidney dysfunction, cytopenias, individual intolerance, and pregnancy. Should be prescribed with caution to patients with bronchial asthma, as well as to persons who have previously experienced adverse reactions when taking any other NSAIDs.

List of common NSAIDs for treating joints

We list the most well-known and effective NSAIDs that are used to treat joints and other diseases when anti-inflammatory and antipyretic effects are necessary:

Some medications are weaker and not so aggressive, others are designed for acute arthrosis, when urgent intervention is required to stop dangerous processes in the body.

What are the advantages of new generation NSAIDs?

Adverse reactions are observed with long-term use of NSAIDs (for example, in the treatment of osteochondrosis) and consist of damage to the mucous membrane of the stomach and duodenum with the formation of ulcers and bleeding. This disadvantage of non-selective NSAIDs has led to the development of a new generation of drugs that block only COX-2 (an inflammatory enzyme) and do not affect the functioning of COX-1 (a defense enzyme).

Thus, new generation drugs are practically free of ulcerogenic side effects (damage to the mucous membrane of organs digestive tract) associated with long-term use of non-selective NSAIDs, but increase the risk of thrombotic complications

Among the disadvantages of the new generation of drugs, only their high price, which makes it inaccessible to many people.

New generation NSAIDs: list and prices

What is it? New generation non-steroidal anti-inflammatory drugs act much more selectively; they inhibit COX-2 to a greater extent, while COX-1 remains practically untouched. This explains the rather high effectiveness of the drug, which is combined with a minimal number of side effects.

List of popular and effective new generation non-steroidal anti-inflammatory drugs:

1. Movalis. It has antipyretic, pronounced analgesic and anti-inflammatory effects. The main advantage of this remedy is that with regular medical supervision it can be taken for a fairly long period of time. Meloxicam is available in the form of a solution for intramuscular injection, in tablets, suppositories and ointments. Meloxicam (Movalis) tablets are very convenient because they are long-acting and it is enough to take one tablet throughout the day. Movalis, which contains 20 tablets of 15 mg each, costs RUB.
2. Xefocam. A drug based on Lornoxicam. Its distinctive feature is the fact that it has a high ability to relieve pain. In this parameter, it corresponds to morphine, but is not addictive and does not have an opiate-like effect on the central nervous system. Xefocam, which contains 30 tablets of 4 mg, costs rubles.
3. Celecoxib. This drug significantly alleviates the patient’s condition with osteochondrosis, arthrosis and other diseases, relieves pain well and effectively fights inflammation. Side effects celecoxib has minimal or no effect on the digestive system. Price rub.
4. Nimesulide. It is used with great success to treat vertebrogenic back pain, arthritis, etc. Removes inflammation, hyperemia, normalizes temperature. The use of nimesulide quickly reduces pain and improves mobility. It is also used as an ointment to apply to the problem area. Nimesulide, which contains 20 tablets of 100 mg, costs rub.

Therefore, in cases where long-term use of non-steroidal anti-inflammatory drugs is not required, older generation drugs are used. However, in some cases this is simply a forced situation, since few people can afford a course of treatment with such a drug.

Classification

How are NSAIDs classified and what are they? Based on their chemical origin, these drugs come in acidic and non-acidic derivatives.

1. Oxicams – piroxicam, meloxicam;
2. NSAIDs based on indoacetic acid - indomethacin, etodolac, sulindac;
3. Based on propionic acid – ketoprofen, ibuprofen;
4. Salicipates (based on salicylic acid) – aspirin, diflunisal;
5. Phenylacetic acid derivatives – diclofenac, aceclofenac;
6. Pyrazolidines (pyrazolonic acid) – analgin, metamizole sodium, phenylbutazone.

Also, non-steroidal drugs differ in type and intensity of effect - analgesic, anti-inflammatory, combined.

Effectiveness of average doses

Based on the strength of the anti-inflammatory effect of average doses of NSAIDs, they can be arranged in the following sequence (the strongest at the top):

According to the analgesic effect of average doses, NSAIDs can be arranged in the following sequence:

As a rule, the above medications are used for acute and chronic diseases accompanied by pain and inflammation. Most often, non-steroidal anti-inflammatory drugs are prescribed for pain relief and treatment of joints: arthritis, arthrosis, injuries, etc.

NSAIDs are often used for pain relief for headaches and migraines, dysmenorrhea, postoperative pain, renal colic etc. Due to their inhibitory effect on the synthesis of prostaglandins, these drugs also have an antipyretic effect.

What dosage should I choose?

Any drug new to a given patient must be prescribed first in the lowest dose. If well tolerated, the daily dose is increased after 2-3 days.

Therapeutic doses of NSAIDs are in a wide range, and in recent years there has been a tendency to increase single and daily doses of drugs characterized by the best tolerance (naproxen, ibuprofen), while maintaining restrictions on the maximum doses of aspirin, indomethacin, phenylbutazone, piroxicam. In some patients, the therapeutic effect is achieved only when using very high doses of NSAIDs.

Side effects

Long-term use of anti-inflammatory drugs in high doses can cause:

1. Disruption of the nervous system - mood changes, disorientation, dizziness, apathy, tinnitus, headache, visual impairment;
2. Changes in the functioning of the heart and blood vessels - heartbeat, increase blood pressure, swelling.
3. Gastritis, ulcers, perforation, gastrointestinal bleeding, dyspeptic disorders, changes in liver function with increased activity of liver enzymes;
4. Allergic reactions – angioedema, erythema, urticaria, bullous dermatitis, bronchial asthma, anaphylactic shock;
5. Kidney failure, urinary disorders.

Treatment with NSAIDs should be carried out for the minimum permissible time and in the minimum effective doses.

Use during pregnancy

It is not recommended to use NSAIDs during pregnancy, especially in the third trimester. Although no direct teratogenic effects have been identified, it is believed that NSAIDs may cause premature closure of the ductus arteriosus and renal complications in the fetus. There is also information about premature births. Despite this, aspirin in combination with heparin has been successfully used in pregnant women with antiphospholipid syndrome.

According to the latest data from Canadian researchers, the use of NSAIDs before 20 weeks of pregnancy was associated with an increased risk of miscarriage. According to the results of the study, the risk of miscarriage increased by 2.4 times, regardless of the dose of the drug taken.

Movalis

The leader among non-steroidal anti-inflammatory drugs can be called Movalis, which has an extended period of action and is approved for long-term use.

It has a pronounced anti-inflammatory effect, which makes it possible to take it for osteoarthritis, ankylosing spondylitis, and rheumatoid arthritis. It has analgesic and antipyretic properties, and protects cartilage tissue. Used for toothache and headache.

Determining the dosage and method of administration (tablets, injections, suppositories) depends on the severity and type of disease.

Celecoxib

A specific inhibitor of COX-2, which has a pronounced anti-inflammatory and analgesic effect. When used in therapeutic doses negative impact It has practically no effect on the mucous membrane of the gastrointestinal tract, since it has a very low degree of affinity for COX-1, therefore, it does not cause disruption in the synthesis of constitutional prostaglandins.

As a rule, celecoxib is taken in a dosage of mg per day in 1-2 doses. The maximum daily dose is 400 mg.

Indomethacin

Refers to the most effective means non-hormonal action. For arthritis, indomethacin relieves pain, reduces joint swelling and has a strong anti-inflammatory effect.

The price of the drug, regardless of the form of release (tablets, ointments, gels, rectal suppositories) is quite low, the maximum cost of tablets is 50 rubles per package. When using the drug you must be careful, as it has a considerable list of side effects.

In pharmacology, indomethacin is produced under the names Indovazin, Indovis EC, Metindol, Indotard, Indocollir.

Ibuprofen

Ibuprofen combines relative safety and the ability to effectively reduce fever and pain, so drugs based on it are sold without a prescription. Ibuprofen is also used as an antipyretic for newborns. It has been proven to reduce fever better than other non-steroidal anti-inflammatory drugs.

Additionally, ibuprofen is one of the most popular over-the-counter analgesics. It is not often prescribed as an anti-inflammatory drug, however, the drug is quite popular in rheumatology: it is used to treat rheumatoid arthritis, osteoarthritis and other joint diseases.

The most popular brand names for ibuprofen include Ibuprom, Nurofen, MIG 200 and MIG 400.

Diclofenac

Perhaps one of the most popular NSAIDs, created back in the 60s. Release form: tablets, capsules, injection solution, suppositories, gel. This joint treatment product combines both high anti-pain activity and high anti-inflammatory properties.

It is produced under the names Voltaren, Naklofen, Ortofen, Diclak, Diclonac P, Vurdon, Olfen, Dolex, Dikloberl, Clodifen and others.

Ketoprofen

In addition to the drugs listed above, the group of drugs of the first type, non-selective NSAIDs, i.e. COX-1, includes a drug such as ketoprofen. In terms of the strength of its action, it is close to ibuprofen, and is available in the form of tablets, gel, aerosol, cream, solutions for external use and for injection, rectal suppositories (suppositories).

You can buy this product under the trade names Artrum, Febrofid, Ketonal, OKI, Artrosilen, Fastum, Bystrum, Flamax, Flexen and others.

Aspirin

Acetylsalicylic acid reduces the ability of blood cells to stick together and form blood clots. When taking Aspirin, the blood thins and the blood vessels dilate, which leads to relief from headaches and intracranial pressure. The action of the drug reduces the energy supply at the site of inflammation and leads to the attenuation of this process.4

Aspirin is contraindicated for children under 15 years of age, as a possible complication in the form of extremely severe Reye's syndrome, in which 80% of patients die. The remaining 20% ​​of surviving babies may be susceptible to epilepsy and mental retardation.

Alternative drugs: chondroprotectors

Quite often, chondroprotectors are prescribed for the treatment of joints. People often do not understand the difference between NSAIDs and chondroprotectors. NSAIDs quickly relieve pain, but they also have a lot of side effects. And chondroprotectors protect cartilage tissue, but they need to be taken in courses.

The most effective chondroprotectors include 2 substances - glucosamine and chondroitin.

Clinical and pharmacological characteristics of anti-inflammatory drugs (nonsteroidal and steroidal)

Anti-inflammatory (non-steroidal - NSAIDs and steroidal - GCS) drugs occupy one of the first places in the frequency of clinical use. This is due to their multifaceted pharmacodynamic effects.

NSAIDs are a group of drugs, many of which can be purchased without a prescription. More than thirty million people worldwide take NSAIDs daily, with 40% of these patients over 60 years of age. About 20% of inpatients receive NSAIDs, which have a polysyndromic effect.

In recent years, the arsenal of NSAIDs has been replenished with a significant number of new drugs, and the search is being conducted in the direction of creating drugs that combine high efficiency with improved tolerability.

If there is no effect from the use of NSAIDs, there is a need to use glucocorticosteroids. The therapeutic potential of GCS has led to their widespread use. Although the benefits of corticosteroids can be significant, there are numerous adverse effects, including serious metabolic disturbances and suppression of the hypothalamic-pituitary-adrenal axis.

The topic being studied allows students to effectively use the knowledge and skills acquired at various clinical departments, form clinical thinking and use them in practical activities. Students get the opportunity to master diverse pathologies, develop skills in managing pathological processes, and understand the body as a whole.

Non-steroidal anti-inflammatory drugs.

Non-steroidal anti-inflammatory drugs (non-steroidal anti-inflammatory drugs/agents, NSAIDs, NSAIDs, NSAIDs, NSAIDs, NSAIDs) are a group of drugs that have analgesic, antipyretic and anti-inflammatory effects that reduce pain, fever and inflammation. The use of the term “nonsteroidal” in the name emphasizes their difference from glucocorticoids, which have not only an anti-inflammatory effect, but also other, sometimes undesirable, properties of steroids.

NSAIDs are the first-line drugs for treatment inflammatory diseases musculoskeletal system. These drugs are taken by every seventh patient suffering from rheumatic diseases, and every fifth by other pathological conditions associated with pain, inflammation and fever. However, despite their undoubted clinical effectiveness, anti-inflammatory drugs belong to a group of drugs that are characterized by so-called “pharmacological scissors,” i.e., in addition to their therapeutic effect, they have serious side effects. Even short-term use of these drugs in small doses in some cases can lead to the development of side effects, which occur in approximately 25% of cases, and in 5% of patients can pose a serious threat to life. The risk of side effects is especially high in the elderly, who make up more than 60% of NSAID users. It should also be noted that for many diseases there is a need for long-term use of NSAIDs. Therefore, every doctor faces the problem of rational choice of drug and adequate treatment regimen, taking into account the effectiveness and safety of the anti-inflammatory drug used.

NSAIDs are classified depending on the severity of their anti-inflammatory activity and chemical structure. The first group includes drugs with a pronounced anti-inflammatory effect. NSAIDs of the second group, which have a weak anti-inflammatory effect, are often referred to as “non-narcotic analgesics” or “analgesics-antipyretics”.

From a practical point of view, it is important that drugs belonging to the same group and even close in chemical structure, differ somewhat both in the strength of the effect and in the frequency of development and nature of adverse reactions. Thus, among NSAIDs of the first group, indomethacin and diclofenac have the most powerful anti-inflammatory activity, and ibuprofen has the least. Indomethacin, which is a derivative of indoleacetic acid, is more gastrotoxic than etodolac, which also belongs to this chemical group. The clinical effectiveness of the drug may depend on the type and characteristics of the disease in a particular patient, as well as on his individual reaction.

Classification of NSAIDs by activity and chemical structure

NSAIDs with pronounced anti-inflammatory activity

Acetylsalicylic Acid (Asc) - (Aspirin);

Lysine monoacetylsalicylate (Aspizol, Laspal);

Indoleacetic acid derivatives

Phenylacetic acid derivatives

Diclofenac Sodium (Ortofen, Voltaren);

Diclofenac Potassium (Voltaren – Rapid);

Lonazalac Calcium (Irriten).

Propionic acid derivatives

Ibuprofen (Brufen, Nurofen, Solpaflex);

Naproxen Sodium Salt (Apranax);

Ketoprofen (Knavon, Profenid, Oruvel);

Tiaprofenic Acid (Surgam).

NSAIDs with weak anti-inflammatory activity

Anthranilic acid derivatives

Mefenamic Acid (Pomstal);

Meclofenamic Acid (Meclomet);

Niflumic Acid (Donalgin, Nifluril);

Tolfenamic Acid (Clotam).

Heteroarylacetic acid derivatives

CLASSIFICATION OF NSAIDs (by duration of action)

1. Short-acting (T1/2 = 2-8 hours):

2. Average duration of action (T1/2 = 10-20 hours):

3. Long-term action (T1/2 = 24 hours or more):

Classification of NSAIDs by selectivity towards various forms of cyclooxygenase

Selective COX-1 blockers

Low doses of acetylsalicylic acid Aspirin, Aspecard, Aspirin cardio, Cardiomagnyl, etc.

Non-selective blockers of COX-1 and COX-2

Ketoprofen, Diclofenac, Ibuprofen, Indomethacin, etc., Ketonal, Voltaren, Naklofen, Olfen, Diclobrew, Dicloberl, Solpaflex, Nurofen, etc.

Predominant COX-2 blockers

Meloxicam, Movalis, Melox, Revmoxicam, Nimesil, Nise, Nimegesic, Aponil, Nimesulide

Selective COX-2 blockers

Celecoxib, Rofecoxib, Celebrex, Rancelex, Zycel, Revmoxib, Flogoxib, Rofica, Denebol, Rofnik.

Classification of NSAIDs according to their effect on biosynthesis processes in cartilage tissue.

Suppressing inflammation and neutral to arthrosis - Piroxicam, diclofenac, sulindac, solpaflex;

Suppressing inflammation and increasing arthrosis - Acetylsalicylic acid, indomethacin, fenoprofen, phenylbutazone;

Suppressing inflammation and promoting the normalization of metabolic processes in cartilage tissue - Benoxaprofen, tiaprofenic acid (surgam), paracetamol.

Despite their widespread use, the mechanism of action of NSAIDs for a long time remained unexplored. It was believed that acetylsalicylic acid disrupts oxidative phosphorylation and inhibits the synthesis of a number of enzymes involved in protein biosynthesis. However, these effects manifested themselves at drug concentrations much higher than therapeutic and were not associated with its anti-inflammatory, analgesic and antipyretic effects. The most important mechanism of NSAIDs is associated with inhibition of the synthesis of cyclooxygenase (COX) and lipoxygenase (LOX), key enzymes in the metabolism of arachidonic acid. Arachidonic acid is part of membrane phospholipids and is released under the influence of the enzyme phospholipase A 2. COX and LOX catalyze further conversion of arachidonic acid. The products of their metabolism include cyclic endoperoxides, prostaglandins (PG), thromboxane (TXA 2), leukotrienes (LT), etc. PGs are produced by many cells and are among the most important paracrine and autocrine mediators.

PGs have versatile biological activity:

a) are mediators of the inflammatory response: cause local vasodilation, edema, exudation, migration of leukocytes and other effects (mainly PG-E 2 and PG-I 2);

b) catalyze the release of other inflammatory mediators (histamine, serotonin, bradykinin, etc.). The pro-inflammatory effects of PG are potentiated by the action of free radicals formed during the enzymatic oxidation of arachidonic acid. Activation of free radical oxidation (FRO) promotes the release of lysosomal enzymes, which leads to further destruction cell membranes, sensitize receptors to pain mediators (histamine, bradykinin) and mechanical influences, lowering the threshold of pain sensitivity;

c) increase the sensitivity of the hypothalamic thermoregulation centers to the action of endogenous pyrogens (interleukin-1 and others) formed in the body under the influence of microbes, viruses, toxins (mainly PG-E 2).

Thromboxane is a platelet aggregation factor that constricts blood vessels. Prostacyclin, formed from the damaged vascular wall, reduces platelet aggregation and adhesion, dilates blood vessels.

The existence of two main isoforms of COX is known: COX-1 and COX-2.

COX-1 is a structural enzyme, synthesized in most cells healthy body(excluding erythrocytes) and catalyzes the formation of physiological PGs, thromboxane and prostacyclin, which occupy an important place in the regulation of a number of physiological processes in the body, such as protecting the gastrointestinal mucosa, ensuring renal blood flow, regulation of vascular tone, blood coagulation, bone metabolism, growth of nervous tissue, pregnancy, regeneration and apoptosis processes.

COX-2 – is involved in the synthesis of prostaglandins during inflammation. Moreover, COX-2 in normal conditions is absent, but is formed under the influence of certain tissue factors that initiate the inflammatory response (cytokines and others). In this regard, it is assumed that the anti-inflammatory effect of NSAIDs is due to inhibition of COX-2, and their undesirable reactions are due to inhibition of COX-1 (damage to the gastrointestinal tract, disturbances of renal blood flow and platelet aggregation, etc.). The ratio of the activity of NSAIDs in terms of blocking COX-1/COX-2 allows us to judge their potential toxicity. The lower this value, the more selective the drug is for COX-2 and, thus, the less toxic. For example, for meloxicam it is 0.33, diclofenac – 2.2, tenoxicam – 15, piroxicam – 33, indomethacin – 107.

The existence of another COX isoform, COX-3, is also assumed. The putative COX-3 is expressed in the brain, also influences PG synthesis and plays a role in the development of pain and fever. However, unlike other isoforms, it does not affect the development of inflammation.

Various representatives of NSAIDs differ not only in their chemical structure and pharmacodynamics, but also in the degree of influence on various COX isoforms. For example, acetylsalicylic acid, indomethacin, and ibuprofen inhibit COX-1 to a greater extent than COX-2. The most widely used NSAID, diclofenac, inhibits both isoenzymes to the same extent. Selective or selective COX-2 inhibitors include nimesulide, meloxicam, nabumetone. however, it must be taken into account that with increasing dose their selectivity is significantly weakened. Highly selective or specific inhibitors of COX-2 are coxibs: celecoxib, rofecoxib, valdecoxib, parecoxib, lumiracoxib, etoricocosib, etc. The activity of COX-3 is inhibited by acetaminophen (paracetamol), which has a weak effect on COX-1 and COX-2.

Other mechanisms of action of NSAIDs

The anti-inflammatory effect may be associated with inhibition of lipid peroxidation, stabilization of lysosome membranes (both of these mechanisms prevent damage cellular structures), a decrease in the formation of ATP (the energy supply of the inflammatory reaction is reduced), inhibition of neutrophil aggregation (the release of inflammatory mediators from them is impaired), inhibition of the production of rheumatoid factor in patients with rheumatoid arthritis. The analgesic effect is to a certain extent associated with disruption of the conduction of pain impulses in spinal cord(metamizole).

Some NSAIDs relieve pain and inflammation of the articular cartilage, but they are seriously harmful metabolic processes inside the joint, and eventually destruction of the articular cartilage occurs. Among these drugs, acetylsalicylic acid and indomethacin, widely used in rheumatology, should be put in first place. These drugs, from the point of view of their effect on metabolic processes in articular cartilage, should be used sparingly.

The next group of drugs are drugs that are indifferent to the metabolic processes in the cartilage itself, relieve pain and inflammation, but do not disrupt the metabolism of articular cartilage. These are drugs based on piroxicam, diclofenac, as well as sulindac and ibuprofen.

The third group of drugs that relieve pain and inflammation to varying degrees, but not only do not disrupt the metabolism of articular cartilage, but also stimulate synthetic processes in articular cartilage. These are benoxaprofen, tiaprofenic acid and paracetamol.

The above example illustrates the complexity and inconsistency of the requirements for modern NSAIDs.

It should be noted that COX-independent aspects of the mechanism of action of NSAIDs currently exist and are being widely studied, which will significantly expand the range of their use. Thus, there is evidence that a number of NSAIDs are capable, to a certain extent, of stimulating the proliferative response of T lymphocytes and the synthesis of interleukin-2. The latter is associated with an increase in the level of intracellular calcium, inhibition of chemotaxis, increased neutrophil aggregation, and the formation of hypochlorous acid and superoxide oxygen radicals. The ability of salicylates to inhibit the activation of transcription factors in T lymphocytes is known.

It is also believed that NSAIDs can change physical and chemical properties cellular biomembranes. NSAIDs, as anionic lipophilic molecules, are able to penetrate the leukocyte bilayer and reduce the permeability of biomembranes by interrupting signaling at the level of guanosine triphosphate binding protein, which prevents cellular activation of leukocytes under the influence of chemotactic stimuli in the early stages of inflammation.

There are results on the effect of NSAIDs on the central mechanisms of pain that are not associated with COX inhibition. The antinociceptive effect of NSAIDs is believed to be due in part to the release of endogenous opioid peptides.

The antiproliferative effect of NSAIDs can also be mediated by various mechanisms: both through increased activity of natural killer cells when inhibiting PG synthesis, and COX-2 dependent regulation of cell apoptosis. It has been established that the production of COX-2 precedes the apoptosis of neuronal cells, therefore selective COX-2 inhibitors have a certain neuroprotective activity. Their use will help optimize the treatment of Alzheimer's disease, since one of the characteristic features Brain pathology in this disease is an inflammatory reaction, characterized by activation of glial cells, an increase in the level of pro-inflammatory cytokines, and activation of complement. Metabolites of COX-2 also promote the growth of tumor cells, so the ability to inhibit COX-2 will allow the use of NSAIDs in oncology in the treatment of a number of cancers.

Further study of the role of COX in the human body is very important for determining the mechanisms of pathogenesis and developing new approaches to the treatment of a number of diseases.

REQUIREMENTS FOR MODERN NSAIDs

Predominant inhibitory effect on COX-2

Chondroprotective effect or no effect on the metabolism of articular cartilage; improving the composition of synovial fluid

Steroid and non-steroidal drugs - what they eat with and why they are needed

Steroids

Glucocorticosteroids (hormones of the adrenal cortex) began to be used for the treatment of joints more than 50 years ago, when their positive effect on the severity of joint syndrome and the duration of morning stiffness became known.

The most popular drugs from the group of steroids in rheumatology are:

• Prednisolone (Medopred);
• Triamcinolone (Kenacort, Kenalog, Polcortolone, Triamsinolol);
• Dexamethasone;
• Methylprednisolone (Metypred);
• Betamethasone (Celeston, Diprospan, Flosteron).

It is worth noting that non-steroidal hormones are not used in the treatment of joint diseases.

Mechanism of action

The pronounced anti-inflammatory effect of drugs with a steroid structure is achieved in several ways:

• an obstacle to the movement of neutrophils (the main inflammatory cells) from the vessels into the tissue, to the affected area;
• decreased permeability of biological membranes, which inhibits the release of proteolytic enzymes;
• suppression of cytokine formation;
• influence on epithelial cells;
• stimulation of lipocortin formation.

This mechanism of action, which slows down all phases of the inflammatory response, leads to rapid relief of symptoms and improvement in the condition of patients.

Indications

All anti-inflammatory steroid drugs have a strict list of indications for use. This is due to the fact that hormones have a large number of side effects. Therefore, they are a reserve group in the treatment of joint diseases.

Steroid drugs are prescribed for conditions such as:

1. High disease activity.
2. Systemic manifestations of pathology.
3. Weak effectiveness of non-steroidal anti-inflammatory drugs.
4. The presence of contraindications to the prescription of NSAIDs that prevent their use.

Side effects

Like any other drugs, steroid hormones have a number of unwanted effects. These include:

• dyspepsia (feeling of nausea, abdominal pain, vomiting, bloating, hiccups, loss of appetite, perversion of taste);
• increased pH of gastric contents;
• development of myocardial insufficiency, if present - aggravation of the condition;
• increased blood pressure numbers;
• liver enlargement;
• blood clot formation;
• obesity;
• increased excretion of potassium and calcium, retention of sodium ions;
• osteoporosis;
• muscle weakness;
• skin rashes;
• increased sweating;
• weakness;
• depressive states;
• allergic local and systemic reactions;
• weakened immunity, decreased body resistance to infections, exacerbation of chronic diseases;
• increased blood sugar levels;
• impaired wound healing;
• violations menstrual cycle etc.

Almost all steroids have these side effects to a greater or lesser extent. Their quantity and strength depend on the method of administration of the drug, dosage and duration of use.

Contraindications

Anti-inflammatory steroid drugs should be prescribed with caution in the following conditions:

The listed contraindications do not mean that steroid drugs cannot be used. However, concomitant pathologies should always be taken into account when prescribing medications.

Main characteristics of NSAIDs

Medicines from the group of non-steroidal anti-inflammatory drugs are first-line drugs for the treatment of joint diseases. They are used to treat rheumatoid arthritis, reactive systemic arthritis, psoriatic arthritis, ankylosing spondylitis, gout, osteoarthritis of any localization, osteochondropathy, osteochondrosis, and other systemic pathologies.

The history of the creation of non-steroidal drugs goes back to ancient times. Our ancestors also knew that when the temperature rises, it is necessary to make a decoction from willow tree branches. It was later discovered that willow bark contains the substance salicyl, from which sodium salicylate was later created. It was only in the 19th century that salicylic acid, or aspirin, was synthesized from it. It was this medicine that became the first non-steroidal remedy for inflammation.

Pathogenetic mechanism, effects

Nonsteroidal anti-inflammatory drugs can inhibit the synthesis of prostaglandins (the main mediators of inflammation) from arachidonic acid. This is possible by blocking the action of the enzyme cyclooxygenase (COX).

It was found that non-steroidal drugs act on 2 types of enzyme: COX-1 and COX-2. The first affects platelet activity, the integrity of the gastrointestinal tract, prostaglandins, and renal blood flow. COX-2 primarily acts on the inflammatory process.

Nonsteroidal drugs that inhibit COX-1 have a large number of undesirable properties, so the use of selective NSAIDs is more preferable.

For therapeutic purposes in traditional medicine the following properties of non-steroidal anti-inflammatory drugs are used:

1. Analgesic: the drugs effectively relieve pain of mild to moderate intensity, which is localized in ligaments, articular surfaces, and skeletal muscle fibers.
2. Antipyretic: acute stages Inflammatory joint diseases are often accompanied by an increase in general body temperature. NSAIDs do a good job of reducing it without affecting normal temperature readings.
3. Anti-inflammatory: The difference between NSAIDs and steroids is the strength of the effect. The latter have a different mechanism of action and a more powerful effect on the pathological focus. For the treatment of joint manifestations, Phenylbutazone, Diclofenac, and Indomethacin are most often used.
4. Antiplatelet: more typical for aspirin. It is used not only to treat joint diseases, but also for concomitant pathology in the form of coronary heart disease.
5. Immunosuppressive: Non-steroidal anti-inflammatory drugs slightly suppress the immune system. This occurs due to a decrease in capillary permeability and a decrease in the possibility of interaction of antigens with antibodies of foreign proteins.

Indications

Unlike steroid drugs, NSAIDs for the treatment of joints are prescribed in the following cases:

• the need for long-term medication;
• elderly and senile patients (over 65 years);
• severe somatic pathologies;
• the occurrence of side effects from taking hormonal medications;
• peptic ulcer (only for COX-2 inhibitors).

Treatment of almost all joint diseases is associated with the use of non-steroidal anti-inflammatory drugs. Therapeutic courses differ in duration, dosage, and method of drug administration.

It is important to remember that NSAIDs do not affect the pathogenesis rheumatic diseases. The drugs significantly alleviate the condition of patients, relieving pain and stiffness. But they are not able to stop the pathological process, prevent joint deformation or cause remission.

Side effects

The main negative symptoms observed when using non-steroidal medications are gastrointestinal disorders. They manifest themselves in the form of dyspeptic disorders, the development of erosive-ulcerative disorders and perforation of the mucous membranes of the stomach and duodenum. Side effects are most common for COX-1 inhibitors (Aspirin, Ketoprofen, Indomethacin, Ibuprofen, Diclofenac). Other undesirable effects include the following:

• renal blood flow depletion and renal failure;
• analgesic nephropathy;
• development of anemia;
• bleeding from damaged surfaces of the skin and mucous membranes;
• hepatitis;
• allergic reactions;
• spasm of the bronchial muscles;
• weakening labor activity and prolongation of pregnancy.

These side effects of non-steroidal drugs should be taken into account when choosing a treatment regimen for patients with joint diseases.

Contraindications

NSAIDs should not be prescribed to patients with concomitant pathologies such as:

1. Ulcers of the gastrointestinal tract, especially in the acute stage of the disease.
2. Significant decrease in the functional capacity of the kidneys and liver.
3. Pregnancy.
4. Cytopenic conditions (anemia, thrombocytopenia).
5. The presence of an allergic reaction to the components of the drugs.

Non-steroidal drugs should be used with caution in patients with bronchial asthma. arterial hypertension. Elderly patients should be prescribed individual short courses.

Differences between steroid and non-steroid drugs, their comparative characteristics

The main differences between the two groups of drugs in the treatment of joint diseases are the following:

1. Pathogenetic mechanism of action. Unlike NSAIDs, steroid medications have not only local but also systemic effects. Their influence is stronger and multi-component.
2. Application in the treatment of joints. The range of use of non-steroidal medications is wider; they are used not only in the treatment of inflammatory pathologies (arthritis), but also for pain syndrome associated with osteochondrosis of any localization.
3. Side effect. The range of adverse effects is much wider for steroid hormonal drugs. This is due to the fact that drugs have an affinity for endogenous compounds in the body.
4. Contraindications. Steroids affect almost every system of the human body. It is impossible to achieve selectivity of action using adrenal hormones. Therefore, many conditions exclude the use of this group of medications. Selective NSAIDs (COX-2 inhibitors), on the contrary, can only affect the inflammatory component, which significantly expands the therapeutic possibilities of this group of drugs. On the other hand, steroid drugs have a weaker negative effect on the mucous membrane of the stomach and intestines. It is this factor that is often decisive when choosing a medicine.
5. Features of treatment courses. As a rule, NSAIDs are the first-line drugs for the treatment of articular syndrome. If the product is chosen correctly, it can be used for a long time. Only in case of insufficient effectiveness are steroid medications prescribed. They are not used for a long time; they always try to resume taking NSAIDs. It is important to remember that withdrawal from steroids can have a detrimental effect on the body’s condition; withdrawal syndrome occurs. Non-steroidal drugs do not have this quality.
6. Release forms. Steroid and non-steroidal drugs are available in the form of ointments, solutions for intramuscular, intravenous, intra-articular administration, gels, suppositories, and tablets for oral administration. This allows you to avoid local reactions and select the required form for maximum impact on the inflammatory focus.

Steroid and non-steroidal drugs are necessary to carry out the most effective course of treatment for rheumatic diseases. You cannot use them yourself without first consulting a specialist. Only strict adherence to the proposed treatment regimen can provide lasting relief from articular manifestations and avoid unwanted effects.

To date. This is a group of drugs based on cortisol, a hormone produced by the human adrenal glands. Medicines containing steroid hormones include the following:

• steroid drugs in the form of ointment;
• new generation steroidal anti-inflammatory drugs;
• steroidal anti-inflammatory drugs for the treatment of joints.

Mechanism of action

Steroid medications reduce inflammation by suppressing the functions of the immune system. They reduce the production of leukocytes and anti-inflammatory enzymes and thereby stop tissue erosion at the site of the affected area.

However, the causes of the disease do not disappear.

List of indications

• There was a malfunction in the immune system, which led to skin allergies.
• The inflammatory process in the joint has a destructive effect on the surrounding tissues and causes severe pain (rheumatoid arthritis).
• Systemic inflammation of blood vessels (vasculitis).
• Systemic muscle inflammation (myositis).
• Inflammation of internal organs and tissues.
• Hepatitis.
• Shock states.

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Contraindications

• Tissue damage is caused by infection.
• The body is exposed to bacterial diseases.
• With the potential for bleeding.
• When taking blood thinning medications.
• With extensive erosion of tissues and joints.
• In case 3 injections of steroid drugs have already been made this month.
• Immunodeficiency of the body.
• Pregnancy and lactation.

Side effects

The study showed that taking steroid drugs may be accompanied by the following symptoms:

• Hypertension.
• Increased blood clotting.
• Low immunity.
• Peptic ulcer of the digestive system.
• Masculinization of the female body (acquiring masculine properties).

Withdrawal syndrome

The hormone cortisol is involved in the body's energy metabolism. It helps break down proteins. When the level of this hormone in the body increases, and then when it sharply decreases, problems with metabolism arise. Muscles may become more flabby and the percentage of body fat may increase.

Therefore, drugs containing cortisol should be used only in courses.

Popular steroid drugs

Cortisol

Price - from 426 rubles. Available in the form of a suspension. Used orally or intramuscularly to relieve pain in acute rheumatoid arthritis.

Sinalar

Price - from 183 rubles. Clear gel, cream or ointment. It is used externally for psoriasis, perioral dermatitis and other itchy skin lesions.

Sinaflan

Price - from 28 rubles. Ointment for external use. Used for itchy skin inflammation and skin allergies.

Betamethasone

Price - from 108 rubles. White or transparent gel. Apply to the surface of the skin for allergic reactions and itchy inflammation.

New generation anabolic drugs

Celeston

Price - from 128 rubles. Available in the form of tablets or ampoules for injection. It should be taken in cases of dermatitis, allergic conjunctivitis and other inflammations of internal organs.

Medrol

Price - from 663 rubles. Produced in tablet form. It is used for acute stressful situations, multiple sclerosis syndrome and growth retardation in children.

Urbanzon

Price - from 28 rubles. It is produced in the form of ampoules or a bottle for the preparation of a solution for injection. Accepted in shock situations.

Momat

Price - from 209 rubles. White ointment or cream. Used as an antipruritic and anti-inflammatory agent.

Berlicourt

Price - from 208 rubles. Available in tablet form. Used for asthma, acute rhinitis and allergic reactions.

Anti-inflammatory drugs for joints based on steroid hormones

Cyanocobalamin

Price - from 32 rubles. Solution for injection. It is used for pinching of the lumbosacral region, allergies and dermatitis.

Dexamethasone

Price - from 188 rubles. Solution for intramuscular and intravenous administration. Used for acute shock or allergic conditions and inflammatory reactions.

Steroid ointments

Steroid ointments can come in the form of a cream, ointment, or gel. Each patient can individually choose a form that is convenient for themselves.

Triderm

Price - from 774 rubles. Steroid ointment, cream or gel. Used for skin dermatitis and eczema.

Akriderm

Price - from 102 rubles. A cream distinguished by its softening properties. Used for itchy and flaky dermatitis and eczema.

Diprolene

Price - from 160 rubles. Cream used for dermatitis.

Elokom

Price - from 217 rubles. Ointment used for seborrhea, psoriasis and dermatitis.

Frequently Asked Questions

What is the difference between hormonal and steroid drugs?

Steroid medications are a type of hormonal medication. In addition to the adrenal hormone, there are drugs that can replace pituitary hormones, sex hormones, anabolic hormones, pancreatic hormones, thyroid and parathyroid hormones.

How is treatment carried out with both steroid and non-steroidal drugs?

Many diseases are recommended to be treated with steroid and non-steroidal drugs at the same time. Anabolic steroid drugs help reduce inflammation and swelling of tissues, and non-steroidal drugs act on the cause of inflammation. When taking steroid drugs, it is necessary to take into account that they can provoke an allergic reaction to drugs medications and vitamins that you take at the same time. Only a highly qualified doctor can draw up the correct plan for taking steroid hormones.

What is the best way to use such drugs for osteochondrosis?

Steroid drugs relieve pain well and relieve tissue swelling in osteochondrosis. Ambene is a fairly popular drug. This is a medicine that consists of two injection solutions. This drug relieves tissue swelling well, relieves pain, reduces temperature and has a calming effect on the nervous system.

What are new generation steroidal anti-inflammatory drugs?

Recently, a new generation of anabolic steroid anti-inflammatory drugs have begun to be produced, which have fewer side effects. The use of such drugs is more preferable, but their anti-inflammatory effect is lower than that of traditional drugs.

How are steroidal anti-inflammatory drugs made?

Anabolic steroid drugs are obtained through a series of chemical and biological transformations and deep purification of the resulting raw materials. Special immobilized microbial cells participate in these transformations.

Steroid and non-steroidal drugs. What's the difference?

The difference between steroidal and non-steroidal drugs lies in their effect on the body. The effect of steroid drugs is that they suppress the human immune system. Non-steroidal non-narcotic painkillers have an analgesic effect on the body. They slow down the enzyme reaction in the membranes of nerve cells. Both medications have significant negative effects on the body, so they should not be used regularly.

The modern pharmaceutical market offers the use of steroid drugs that help avoid a large number of problems associated with allergic reactions or exacerbation of inflammatory processes.