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Russian
00:00:02
[music]00:00:11
dimexide gel modern form00:00:14
proven medicine with00:00:17
analgesic and anti-inflammatory00:00:18
effective now in new packaging00:00:22
dimexide gel is used in complex00:00:24
therapy of arthritis and arthrosis00:00:27
radiculitis thrombophlebitis bruises and00:00:29
sprains00:00:31
dimexide gel penetrates deeply and quickly00:00:34
in tissue and increases skin permeability00:00:37
for other drugs00:00:39
enhances and accelerates the action of external00:00:42
forms of non-steroidal anti-inflammatory drugs00:00:45
heparin and venotonics00:00:47
low toxicity no side effects00:00:50
effects on the gastrointestinal tract00:00:52
is a safe alternative00:00:55
NSAIDs in patients with chronic disease00:00:57
kidney and diseases00:00:59
gastrointestinal tract dimexide gel00:01:03
quick relief for pain and inflammation00:01:06
[music]00:01:26
[music]00:01:35
[music]00:01:55
exacerbation of inflammatory diseases00:01:57
joints causes excruciating pain00:01:59
makes it impossible to work with does not subside in00:02:02
peace of mind bothers me even at night how to help00:02:05
to the patient if the usual means have become00:02:07
insufficiently effective exchange of minds between couples00:02:10
and roll relief of pain and inflammation00:02:12
single injection single injection00:02:15
exchange mind far in tirol provides00:02:17
rapid and long-term pain relief and00:02:20
inflammation exchange mind parente roll00:02:22
indicated for inflammatory and00:02:24
degenerative diseases00:02:25
musculoskeletal system00:02:27
inflammatory pain in the spine00:02:29
exacerbation of arthritis with gout method00:02:32
application of arbeiten by renderings00:02:33
intramuscular injection of 2 Lydians00:02:35
solution exchange umpo render.ru00:02:37
effective control of acute pain00:02:43
good evening dear colleagues today00:02:46
we will discuss the problem from 10000:02:49
arthritis is a new name for an old one00:02:52
disease arthrosis00:02:56
why are we talking about boost arthritis?00:02:59
that 100 arthritis belongs to the group00:03:01
diseases of the musculoskeletal system and00:03:03
indeed in patients with articular00:03:06
syndrome00:03:07
the maximum proportion are patients00:03:11
suffering from arthritis of the mouth therefore00:03:14
patients with joint pain00:03:16
who consult a primary care physician00:03:19
links are most often patients00:03:22
suffering from mouth arthritis00:03:25
talking about00:03:27
epidemiology of stu arthritis I must say00:03:30
that the disease is enough00:03:31
widespread00:03:33
is00:03:35
major cause of disability00:03:37
so look at the proportion of disabled people00:03:40
among musculoskeletal diseases00:03:42
device in Russia on average is00:03:46
about seven more than seven percent of them00:03:50
38 percent disability is determined by00:03:54
about osteoarthritis 3 400:03:56
stages00:03:58
primary general morbidity with that00:04:00
arthritis is directly related to age00:04:02
increasing life expectancy and00:04:05
unfortunately expected in the future00:04:06
further increase in the number of patients00:04:09
suffering from osteoarthritis00:04:11
according to official statistics00:04:15
prevalence of stu arthritis00:04:17
significantly lower than this figure00:04:19
which is obtained as a result00:04:22
epidemiological studies one of00:04:24
such research is the last in Russia00:04:26
was carried out in the first decade of the 21st century and00:04:31
I showed that the prevalence of justu00:04:33
arthritis in Russia account for 13 percent00:04:37
and more and this00:04:39
matches prevalence data00:04:42
mouth arthritis in other countries of the world00:04:45
are currently talking about00:04:48
fifteen percent prevalence00:04:50
mouth with arthritis and00:04:52
in one of the latest studies00:04:55
which was published in twenty00:04:57
first year00:05:00
showing that00:05:04
1994 to 2018 indeed00:05:09
occurs00:05:10
growth 100 arthritis according to official data00:05:13
statistics as primary morbidity00:05:15
it grows and so does me00:05:19
the prevalence of star before growing and00:05:21
look00:05:23
northwestern district00:05:25
ahead00:05:28
is ahead of these indicators on average00:05:32
Russia00:05:33
and if we take the increase in percentage asth00:05:36
arthritis for 1 out of 5 years here00:05:40
2013-2017 is the average for Russia00:05:43
this percentage was 37 and under00:05:46
some regions see00:05:48
Northwestern Federal District00:05:50
eleven and a half and Ural00:05:53
Federal District is the 13th half00:05:55
percent gives an increase in arthritis in the morning00:05:58
it’s unclear why the carts are mink physicists00:06:01
around and even negative dynamics00:06:05
hardly there at all00:06:08
this is the case00:06:10
the issue with that arthritis is better than throughout00:06:13
country but the statistics are as follows00:06:15
really mouth disease00:06:18
arthritis depends on age than left00:06:20
age, the higher the indicators00:06:23
morbidity and associated with many00:06:26
reasons in particular with the increase00:06:28
comorbidity and00:06:30
development of systemic inflammation in00:06:32
patients with metabolic syndrome with00:06:36
changes in posture and gait with disturbance00:06:38
adequate load on the joint, that is,00:06:41
violation of biomechanics00:06:43
belief due to various reasons related to00:06:45
age00:06:46
physical inactivity with impairment00:06:48
microcirculation in the periarticular00:06:50
region and with age associated00:06:53
changes in proteoglycans and00:06:56
research results show that00:06:59
persons over 65 years old post arthrosis00:07:02
determined in 50 percent of cases00:07:05
and it is known and this has been proven too00:07:09
many environments, in particular one of00:07:11
research by the so-called Fleming00:07:13
ska and american study which00:07:16
assessed the prevalence00:07:19
X-ray and Vastu symptom00:07:21
arthritis concluded that among00:07:24
persons aged 50 years and older00:07:26
Almost 20 percent of people have00:07:29
X-ray signs of mouth arthritis00:07:31
hip joint but here is a symptom on00:07:34
This disease only appears in00:07:37
a little over four percent of these individuals00:07:41
what about 100 hip arthritis00:07:44
joints, men are more likely to suffer at the time00:07:47
like bones with arthritis00:07:48
Women are more likely to suffer from knee joint problems00:07:52
and so what are we currently00:07:55
understand the sole of the foot arthritis growth arthritis00:07:57
this is a disease of the joints00:08:00
characterized by cellular stress and00:08:03
degradation of the extra ciliary matrix00:08:07
arising from McCoy we micro00:08:09
damage and is activated00:08:12
abnormal pay attention00:08:14
abnormal adaptive00:08:16
restorative answers including pro00:08:18
inflammatory pathways of the immune system00:08:21
there is in the definition it sounds that at the core00:08:23
The symptoms of arthritis are inflammatory00:08:26
answers including you water about burn on00:08:30
pathways of the immune system and initially00:08:33
changes occur at the molecular level00:08:34
level with subsequent anatomical and00:08:37
physiological disorders such as00:08:40
cartilage degradation00:08:42
bone remodeling abutment formation00:08:45
hits inflammation loss of normal00:08:48
joint functions that lead to00:08:50
development of clinical manifestations00:08:52
diseases00:08:53
according to ICD-1000:08:55
various options us top 300:08:57
are considered under the heading m15 m1900:09:04
Class 13 musculoskeletal disease00:09:07
systems but we already have to since January 2200:09:12
years to work the breakdown would be 15 so here it is00:09:15
catch b15 me mouth arthritis00:09:20
located in the disease section00:09:22
musculoskeletal system and00:09:23
connective tissue is chapter 1500:09:26
arthropathy section and you already see it sounds00:09:31
get sick name of the disease00:09:33
growing arthritis, well, under these codes00:09:36
you can find different mouth options00:09:40
arthritis in icd 1100:09:43
to imagine a little better00:09:46
what happens in the joints I a little00:09:50
I want to remind you of the building diagram00:09:52
connective tissue00:09:54
connective tissue like any tissue00:09:56
consists of cells and intercellular00:09:57
substances and secrete various types00:10:01
connective tissue which are all00:10:03
present in joints but in particular00:10:07
fibrous connective tissue00:10:09
presented00:10:11
interweaving different fibers with00:10:14
small inclusion of cells and00:10:17
fibrous connective tissue dense00:10:19
present in the joint capsule and ligaments00:10:23
periarticular00:10:25
cartilage tissue is also represented00:10:28
hagra cells flowers blues blasts00:10:31
chondrocytes00:10:33
located in groups in gaps in00:10:36
intercellular substance00:10:38
between fibers fibers presented00:10:42
type 2 collagen fibers00:10:45
cartilage tissue00:10:48
blues blasts are located above the predator00:10:51
and blues blasts have the ability to00:10:54
division and collagen production as well00:10:59
like chondrocytes have the ability00:11:01
develop00:11:03
collagen and produce components00:11:06
intercellular substance00:11:09
bone tissue is represented by me too00:11:12
connective tissue but rigidity00:11:14
connective tissue where the cells00:11:16
located concentrically00:11:19
around00:11:21
channels in the channels are behind the fibers00:11:25
nerve fibers, vessels, cells have00:11:29
plasma processes are connected to each other00:11:32
friend and in00:11:35
intercellular substance are deposited00:11:38
calcium that is, it is dense00:11:40
connective tissue and00:11:44
specialized connectors fabric00:11:46
adipose tissue is also found in00:11:49
joint in periarticular tissues and me00:11:53
are also represented by intercellular00:11:56
substance00:11:57
quite loose in which they are located00:11:59
adipocyte cells and currently00:12:02
adipose tissue appears as00:12:05
independent endocrine don who00:12:07
capable of producing00:12:09
various00:12:12
hormones00:12:14
enzymes and pro-inflammatory00:12:18
substances that can support00:12:22
inflammation that occurs when00:12:25
osteoarthritis00:12:26
speaking about the intercellular substance I want you00:12:30
present its main components00:12:32
this is Agrico's new complex00:12:35
peptidoglycan, which is00:12:40
glycosaminoglycans strung on00:12:43
the main protein which with the help00:12:46
binding proteins attach and00:12:48
hyaluronic acid which is also00:12:51
is00:12:52
the most important component of the intercellular00:12:55
substances00:12:57
hyaluronic acid is hydrophilic and00:13:01
water holding capacity00:13:04
a certain environment is created in00:13:07
intercellular substance thus everything00:13:11
types of connective tissue present00:13:14
joints and now we will see00:13:17
how it happens00:13:18
inflammation00:13:21
low levels in the joints because00:13:25
currently no one has00:13:27
raises doubts that the basis00:13:29
pathogenesis of mouth arthritis and fluid00:13:31
chronic00:13:32
low intensity so-called low00:13:35
grade inflammation that appears in00:13:38
the role of the most important development factor and00:13:40
progression of osteoarthritis00:13:43
the diagram may seem a little bit00:13:47
a little complicated but that's why it's00:13:50
this inflammation occurs00:13:53
Now the matter is explained that in00:13:57
life process constantly00:13:59
is happening00:14:01
mechanical stress in joints and00:14:05
When00:14:07
mechanical load or static00:14:10
the load occurs on the joint and in00:14:12
life process00:14:14
biological wear occurs00:14:17
components00:14:18
joints and are damaged as00:14:20
specialized cells chondrocytes00:14:26
fibroblasts similar to since then aviation00:14:28
thick cycle 100 blaster is damaged00:14:32
This is how the components get damaged00:14:34
intercellular matrix00:14:36
these00:14:37
damaged components represent00:14:40
constitute the so-called dumps complex00:14:44
There is00:14:45
biological complexes that00:14:47
associated with damage are these00:14:50
these are the complexes00:14:52
[music]00:14:55
annoying00:14:57
irritate resident macrophages which00:15:00
located on00:15:03
in the synovial membrane on the synovial00:15:06
from within the synovial membrane and through00:15:10
stimulation of this receptor is transmitted00:15:12
the signal into the cell is the result00:15:16
this signaling is activated00:15:20
in the core of the so-called well batter nova00:15:23
boot factor which is responsible for00:15:25
gene expression00:15:28
responsible for synthesis00:15:30
pro-inflammatory cytokines and such00:15:32
way it starts low level00:15:35
inflammation whose purpose is00:15:38
liquidation of these damaged00:15:42
components of joint tissue because00:15:45
damaged damage must be left behind00:15:50
give00:15:52
give a signal for reparation but reparation00:15:56
can only happen when the field00:15:59
it will be clean and this is it00:16:01
physiological catabolic00:16:03
inflammation is aimed at removing00:16:06
remnants of destroyed biological00:16:09
material as soon as the process begins00:16:12
and the cleansing process starts immediately00:16:15
reparation The process of reparation is00:16:19
is that00:16:20
the pool of macrophages changes, these are the macrophages00:16:26
the first type that launch00:16:29
the inflammatory process is replaced00:16:31
type 2 macrophages that play00:16:34
they function as cleaners00:16:37
start quoting the phage00:16:40
leftovers00:16:42
damaged biological material00:16:44
cells00:16:46
inflammation loses its activity00:16:49
inflammatory cytokines stop00:16:51
be produced in addition activated00:16:54
substances that are the strongest00:16:58
inhibitors of proinflammatory cytokines00:17:00
the so-called rizal guilt is happening00:17:03
cleansing00:17:04
sites for reparation if00:17:09
mechanical stress is adequate00:17:11
the body's capabilities from the settings00:17:14
reparations then everything happens like this00:17:18
thus the damage processes are replaced00:17:22
reparation processes and everything remains in00:17:25
normal but worsening arthritis unfortunately00:17:27
this doesn't happen, the thing is that00:17:33
molecules00:17:35
associated with damage during00:17:37
osteoarthritis in the joint environment inside00:17:41
joints appear constantly because00:17:45
for osteoarthritis during treatment00:17:48
inflammatory ones would prevail over00:17:51
processes00:17:53
anti-inflammatory that is, power00:17:56
anti-inflammatory mechanisms00:17:58
arthritis lacks this happens because00:18:01
What00:18:03
there are risk factors00:18:05
mechanical stress is more00:18:09
active than00:18:12
he has opportunities00:18:14
joint restoration this can lead to this00:18:18
cause trauma that changes00:18:20
the biomechanics of the joint may contribute to this00:18:22
give genetic characteristics when00:18:25
genetic disorder already inherent00:18:28
cartilage repair in addition to this00:18:31
contribute to various systemic incentives00:18:34
in particular in patients with metabolic00:18:37
obesity syndrome occurs00:18:40
increased activity00:18:42
adipocytes to produce pro-inflammatory00:18:46
components because in obesity00:18:49
adipose tissue is in hypoxia and00:18:53
apoptosis of adipose tissue cells occurs00:18:57
and this leads to gene activation00:19:00
responsible for00:19:04
not angiogenesis which supports00:19:07
inflammatory process and those substances00:19:10
inflammatory drugs that are produced in00:19:12
adipose tissue they enter through00:19:17
bloodstream00:19:19
through vessels in the systemic circulation such00:19:23
how the system is supported00:19:25
inflammation that is, this is it00:19:27
low-intensity inflammation with a-star 300:19:31
unfortunately does not fade away if I somehow00:19:35
we will not be able to help our patients00:19:38
reduce the activity of this inflammatory00:19:41
process, well, here it is again, it’s like this00:19:44
what circuit is activated except simply00:19:46
beneficial cytokines activated by metal00:19:49
protein for collagen hyaluronidase for00:19:52
greek she is for which they destroy not00:19:54
intercellular matrix also here00:19:57
pro-inflammatory drugs are produced00:19:58
cytokines, the most important of which is00:20:01
Internet at 1pt00:20:03
transforming factor00:20:05
growth alpha and00:20:08
this is inflammation00:20:11
continues as a result develops00:20:14
mismatch between mechanical axial00:20:17
joint load and ability00:20:19
structural elements of joints00:20:21
withstand this load which00:20:23
manifests itself with just the same signs00:20:26
growth art river well, this table00:20:29
indicating how much00:20:32
various slept through the mud00:20:34
cytokines and chemokines are involved in the00:20:38
agenesis00:20:39
low-intensity inflammation with00:20:41
osteoarthritis00:20:43
I must say that this is it00:20:46
low-intensity inflammation which is00:20:48
openly recently has led to00:20:51
that an interesting hypothesis was created in00:20:55
flamingos and nfl amazing these are age00:20:58
diseases caused by inflammation00:21:00
and leading to aging of the body00:21:02
is the basis of aging of the body00:21:05
this is low-intensity inflammation and00:21:08
look at the basis of which ones00:21:10
conditions associated with age are not00:21:14
lies this low-intensity inflammation00:21:16
except for the mouth, arthritis and sharp sail and00:21:19
obesity alzheimer's disease and disease00:21:21
Parkinson's00:21:22
note iraq and scattered00:21:25
sclerosis and lateral places of the choir sarco00:21:28
get drunk shark to generate increase00:21:30
morbidity and mortality in the end00:21:33
what if we can influence this00:21:36
inflammation targeting mouth arthritis00:21:39
then we can improve the quality of life and00:21:43
slow down overcome00:21:45
the occurrence of other diseases00:21:47
associated with age but among00:21:50
risk factors for guest arthritis in visible00:21:52
a large group of system factors00:21:54
age gender times hormonal status00:21:56
remember that this woman has arthritis00:22:01
begins to appear in00:22:02
postmenopausal period clinically during00:22:04
anyway to genetic factors00:22:07
connective tissue features00:22:09
birth bone mineral density00:22:12
tissues that are formed at 30 years of age and00:22:14
not the one who will have saved more by the age of 3000:22:18
mineral density in those00:22:21
better status of the musculoskeletal system00:22:24
nutrition factors vitamin d vitamin c if00:22:28
there is a drawback, then of course it will be00:22:30
promote the development of stu arthritis00:22:32
has been of great importance lately00:22:34
given to the gut microbiome00:22:37
Well, local factors, we already have them00:22:39
touched it could be an injury before00:22:42
previous muscle weakness incorrect00:22:46
I'm tired as a result of Lior's injury00:22:48
congenital hypermobility of the joint and00:22:51
external factors such as obesity00:22:53
the most important factor is the specific load00:22:55
joints during sports activities with00:22:58
some professional loads00:23:01
which are related to00:23:03
load on certain joints but also00:23:06
natural biochemical factor00:23:09
increased production00:23:10
Internet on 1, that is, they overslept00:23:13
tina cytokines with new accents and00:23:15
products from depp cinema in adipose tissue00:23:18
all this leads to00:23:21
the bush's susceptibility to arthritis and its00:23:24
Let's touch on progression a little00:23:26
gut microbiome as risk factors00:23:29
vastu arthritis microbiome is a collection00:23:32
all human microflora are cavities00:23:36
mouth and intestines and skin and hair and and00:23:38
respiratory tract and genitourinary system and00:23:41
note that the microbiome00:23:44
outnumbers host cells00:23:47
that is, this is what all the cells are made of00:23:50
a man is both skin and00:23:53
muscles and all other tissues and so on00:23:57
microbiome outnumbers cells00:24:00
host 10 times the gut microbiome00:24:03
makes up 29 percent of all microflora00:24:06
person and this is represented by more than00:24:10
100 trillion microbes and about 150000:24:14
species of these microbes and it is known that00:24:17
every person has a unique00:24:19
composition of the microbiome that acts00:24:21
like the fingerprint of each individual00:24:24
subject00:24:25
Please note that Ilyich Mechnikov is still00:24:28
V00:24:29
In 1866 he put forward the hypothesis that00:24:33
the disease is a struggle between those admitted00:24:36
from the outside by microbes and phagocytes of the00:24:39
body00:24:40
the disease is a struggle between those admitted00:24:44
sorry microbes and phagocytes themselves00:24:46
organism and in 2010 arose00:24:50
hypothesis that it is premature00:24:53
old age is the result00:24:55
permanent poisoning of the body00:24:57
toxins released by microbes00:25:00
living in large intestines and in 201000:25:05
a new direction in science has arisen00:25:08
this dynamic and00:25:10
this dynamics is a section of molecular00:25:13
genetics in which it is studied00:25:15
genetic material of the human body00:25:17
which contains the genome of the host cells and00:25:21
the genome of the microorganisms inhabiting it00:25:24
please note that only 1000:25:27
percent of the human genome00:25:29
are his own00:25:32
the rest belongs to bacteria00:25:35
inhabiting the human body and00:25:38
interaction between the owner and00:25:40
microbes especially in the intestines00:25:43
promotes the development of immunity and00:25:45
formation of a stable complex00:25:47
microbial community00:25:49
called fireplace sebaceous microbiota00:25:52
there is this, this is stable and microbial00:25:55
community00:25:56
which a person has before is called k00:26:00
mental microbiota and and00:26:05
microbilon is a target for00:26:08
modulation of aging diseases because00:26:11
The gut microbiome is the source00:26:13
pay attention to a number of key vitamins00:26:15
attention to which ones are necessary for00:26:18
musculoskeletal health00:26:21
It is known that the diversity of the microbiome00:26:24
participate in the pathogenesis of age-related00:26:26
disorders, including stu00:26:29
arthritis because it affects00:26:32
metabolic potential of its host00:26:34
innate adaptive immune system00:26:37
we know what happens with age00:26:39
changes in the intestinal microbiome and this00:26:42
leads to an increase00:26:44
translocation associated with microbes00:26:46
molecular pattern of through the endothelium00:26:49
intestines into the systemic circulation, that is,00:26:52
microbiome change leads00:26:54
really leads to intoxication of the body00:26:59
products of this modified one00:27:03
community00:27:05
bacteria that live in the intestines and here00:27:11
microbial molecular pattern and such00:27:13
how do lipopolysaccharides go far and00:27:16
bacterial dna00:27:18
talk about inflammatory pathways00:27:21
stimulate immune receptors00:27:23
resident immune cells you know on00:27:26
that there are resident cells that00:27:28
are found in all organs and systems and00:27:31
for disorder in a certain area which00:27:35
they guard00:27:36
immediately starts their activation00:27:39
send signals and activate cells00:27:44
inflammation that should restore00:27:46
that's the order00:27:49
stimulate immune receptors00:27:51
resident immune cells of bone cartilage00:27:54
and synovial membrane in this way00:27:57
supports the inflammation that00:28:00
triggered by mechanical stress in00:28:03
musculoskeletal system00:28:06
gut microbiome00:28:09
ios that arthritis even allowed00:28:13
currently00:28:15
such00:28:18
definition to work out as the axis of the gut00:28:21
joint it is known that the main types00:28:25
gut microbiome 90 percent00:28:27
represented by bacteria of the firma type00:28:30
cootes here they are Perry listed and00:28:33
type bacteroidetes from the mouth of arthritis00:28:37
heaviness is associated with increased00:28:40
the ratio of the types of the company cootes and00:28:43
dts bacteria by reducing00:28:46
populations such as bacteria before that especially00:28:49
genera of bacteria bacteria and prevotella00:28:54
that is00:28:55
knowing that00:28:58
we can restore00:29:02
this ratio is up to we can thereby00:29:07
reduce the inflammatory process which00:29:09
triggered by waste products00:29:11
of these pathogens in osteoarthritis00:29:15
the composition of the cootes company was characterized by a decrease00:29:19
lactobacillus species and increase00:29:22
squad class 3des high performance00:29:25
more arthritis on a scale in poppy and00:29:28
high level of functional00:29:30
joint insufficiency correlates with00:29:33
an increase in the proportion of streptococcal species to00:29:36
20 percent among lactobacillus that is00:29:40
knowing these features00:29:43
functioning00:29:45
intestinal microflora we can00:29:48
purposefully restore it and00:29:53
thereby reducing mouth symptoms00:29:56
Arthritis isn't really a thing yet00:29:59
very developed but only in 201000:30:02
see new new science has appeared but00:30:06
work is currently underway00:30:11
now everything I said is very00:30:16
understandable when it comes to supporting support00:30:19
joints to the knee joint00:30:21
hip joint when00:30:23
really happens00:30:24
mechanical stress and here's why00:30:28
acute arthritis of the joints of the hands develops00:30:31
so it turns out that00:30:35
dysbiosis associated with nutrition00:30:40
just capable of00:30:44
capable run maintain 10000:30:47
arthritis of the hands is considered wrong00:30:50
nutrition over time leads to00:30:54
obesity00:30:55
and here are lipopolysaccharides and products00:31:00
vital activity00:31:02
microbes00:31:04
enter the systemic circulation00:31:07
thereby causing intoxication00:31:11
inflammatory process and00:31:13
poor diet leads to obesity00:31:16
adipose tissue also begins to produce00:31:20
slept through the mud of cytokines in this way00:31:22
arthritis starts in the bush00:31:25
joints of hands and mouth arthritis of joints00:31:28
brushes, you know, also make things worse00:31:31
quality of life of our patients with one00:31:33
on the other hand unfortunately00:31:35
this is the localization of osteoarthritis00:31:38
very difficult to treat00:31:40
Now00:31:42
touching directly on clinical00:31:45
manifestations of mouth in arthritis it must be said00:31:47
that all components are involved in the process00:31:49
joint and cartilage and subchondral bone and00:31:53
synovial membrane and joint capsules00:31:56
and periarticular soft tissues of the ligament and00:31:58
periarticular muscles and and in the process00:32:02
disease development occurs00:32:04
thinning camber window not I articular00:32:06
cartilage narrowing of the joint space with00:32:10
long ongoing process00:32:12
arises00:32:14
bone venous stasis inside the modular00:32:17
hypertension which can give00:32:19
severe severe pain syndrome00:32:22
cysts in periarticular bones00:32:25
rebecca larn and micro are developing00:32:27
fractures according to acute type according to different00:32:31
subchondral sclerosis fractures00:32:33
consequences develop abutments are formed00:32:36
fit and tendon ligaments are affected and this00:32:39
leads00:32:40
clinical manifestation00:32:42
joint instability00:32:44
but if we talk about the stage00:32:46
progression of stu arthritis here00:32:48
it's all shown clearly00:32:51
gradually00:32:54
deepens deepens00:32:57
joint damage first books then00:33:00
cracking and then exposure00:33:03
bones occurs and here is the fourth stage00:33:06
when already00:33:07
and virtually no cartilage tissue remains00:33:09
on the surface and if I look at00:33:13
arthroscopy it will be like this00:33:15
an unsightly picture from the normal00:33:18
hyaline cartilage that's what00:33:20
is turning00:33:21
cartilage and in general00:33:24
joint structures as they progress00:33:28
diseases00:33:30
classification of oral arthritis00:33:34
quite simple, isolate the primary00:33:37
oysters idiopathic and two forms00:33:40
local when the process is involved from00:33:43
one to two joints is the hand and00:33:46
foot or knees and or you assure and00:33:48
we know the spine or generalized00:33:52
form when three are already involved in the process00:33:54
and more joints or groups of joints but00:33:57
and the largest group is secondary00:34:00
100 arthritis is most often post-traumatic00:34:03
have mouth arthritis associated with00:34:06
congenital and acquired and00:34:08
endemic and diseases with00:34:11
metabolic diseases but also with00:34:13
various endocrine diseases00:34:15
there is a group of secondary mouth arthritis and00:34:18
also quite big if you look00:34:20
ICD-10 then here it is00:34:24
classification of such00:34:26
but there is also a so-called00:34:29
phenotypic classification of height00:34:31
arthritis00:34:33
approaches to phenotypic classification00:34:37
start then today is very00:34:39
there are many different ones up to 8 probably00:34:42
options for approaches in phenotypic00:34:45
classification but one of the first00:34:47
classification of such this classification according to00:34:50
number of affected joints00:34:53
osteoarthritis of the knee joints and00:34:56
generalized start here00:34:59
knees can be hips, any00:35:02
to the joint and generalized mouth00:35:05
arthritis and by the presence of comorbidity, growth00:35:09
arthritis without comorbidity iost uart ritsko00:35:11
morbidity, with moderate00:35:15
mosquito is at risk00:35:18
elderly age00:35:19
obesity type 2 diabetes00:35:22
arterial hypertension00:35:24
and other cardiovascular00:35:25
diseases of erosion and ulcers00:35:28
history of gastrointestinal tract and00:35:31
second option high mosquito low risk00:35:34
where a complete heart attack has already been determined00:35:37
myocardium or00:35:40
acute brain disorder00:35:41
history of blood circulation00:35:44
chronic very and hepatic00:35:46
deficiency chronic disease00:35:49
kidney and gastrointestinal bleeding00:35:53
how do these affect me?00:35:56
comorbid conditions on a100 arthritis00:36:00
so it turns out there is comorbidity with growth00:36:04
arthritis00:36:06
on cardiovascular diseases00:36:09
type 2 diabetes mellitus00:36:10
chronic obstructive pulmonary disease00:36:14
persons with these diseases in00:36:17
eighty percent of cases have00:36:19
joint pain in 50 nine percent00:36:23
cases have radiological00:36:25
symptoms of vastu arthritis clinical00:36:28
screening demonstrates that almost everyone00:36:30
the second patient from internal pathology00:36:32
organs00:36:33
has growing arthritis, that is, quite and00:36:36
high association on the other hand00:36:39
patients with osteoarthritis00:36:40
pathology of internal organs is detected00:36:43
arterial hypertension00:36:45
more than half of patients have diabetes00:36:47
diabetes in more than a quarter of patients00:36:50
diseases of the gastrointestinal tract00:36:52
more than 60 percent of patients00:36:55
obesity in about 15 percent of patients00:36:59
I see chemical heart disease around 1500:37:01
percent of patients and these00:37:03
comorbid conditions00:37:05
ios that arthritis they affect each other00:37:08
note00:37:10
it has been shown that a high mass index00:37:13
body increases the risk of mouth arthritis and00:37:16
13 percent and chronic pain by 4000:37:19
percent00:37:20
arterial hypertension increases00:37:22
the risk of mouth arthritis is 20 percent00:37:25
risk of chronic pain by 96 percent and00:37:28
so on tarot sclerosis risk of arthrosis00:37:32
increases the risk of chronic pain by 3000:37:35
90 percent00:37:36
diabetes mellitus risk00:37:38
increases by 20 and chronic pain by00:37:42
70 percent and osteoporosis with complications00:37:45
increases the risk of acute00:37:47
arthritis by 80 percent and the risk00:37:51
chronic pain increases by 9700:37:54
percent that is00:37:56
comorbidity with host arthritis is very00:37:59
urgent problem and it is necessary naturally00:38:03
treat comorbid conditions then00:38:06
manifestations of oral arthritis will decrease with00:38:08
one side on the other side treatment00:38:10
mouth in arthritis will help00:38:12
reduction of comorbid conditions00:38:15
And00:38:16
here is one of the most one of the most00:38:20
relevant00:38:22
phenotypic classification 100 of arthritis00:38:24
presented here means growing arthritis00:38:28
post-traumatic but it’s clear what it is00:38:31
synovitis then mechanoreceptors signaling then00:38:35
this is exactly what we were talking about00:38:38
chronic pain syndrome00:38:41
aberrant inflammation of pain that is00:38:43
abnormal inflammation pain when00:38:46
available00:38:48
really and00:38:50
pathological pain perception00:38:53
genetically determined growth00:38:56
arthritis and hereditary00:38:58
volume clearing rate of progression00:39:00
mouth 3010 hyper mobile various00:39:04
condition that is genetic00:39:05
conditioned imperfection00:39:07
connective tissue age dependent00:39:11
ost have arthritis but that's what we're talking about00:39:14
today they talked about how old they are00:39:16
a person becomes the more he has00:39:20
comorbid conditions accumulate and in00:39:24
including changes in the intestinal microbiome00:39:27
You and I are estrogen addicts too00:39:30
they said that postmenopausal women00:39:35
arthritis debuts clinically, but here it is00:39:38
interesting 200:39:40
we are with you a little more now00:39:43
let's talk about metabolic fatigue arthritis00:39:46
which supports low level00:39:48
inflammation and crystalline variant and00:39:52
phenotype of asth arthritis00:39:56
metabolic phenotype of arthritis00:39:59
low-level inflammation even led to00:40:03
because a new term arose00:40:06
called meta inflammation of the mind00:40:09
inflammation is an ost in arthritis which00:40:13
associated with components00:40:14
metabolic syndrome00:40:16
known clinical studies00:40:19
showed that metabolic syndrome is more common00:40:22
occurs at about 100r 3 than without it00:40:25
that rice bush arthritis regardless00:40:28
localization in patients with metabolic00:40:29
syndrome is higher than those without it in patients with00:40:34
obese people have an increased risk of00:40:36
arthritis of the hands and knees00:40:40
components of metabolic syndrome00:40:42
associated with total arthroplasty00:40:45
knee joints regardless of index00:40:47
body weight please note yes and00:40:51
studies have been conducted that the more00:40:53
components of metabolic syndrome00:40:55
present in patients, the higher the risk00:40:58
their total endoprosthetics00:41:01
further rice to the bush of arthritis of colleagues' knees00:41:04
joints and bones are increased in patients with00:41:07
arterial hypertension and00:41:09
atherosclerosis, which confirms the hypothesis00:41:11
about impaired perfusion of the subchondral00:41:14
bones are a consequence of widespread00:41:16
atherosclerosis00:41:17
From this it follows that treatment00:41:20
metabolic phenotype of the mouth in arthritis00:41:23
should include the correction of all00:41:25
components of metabolic syndrome00:41:28
weight loss glycemic control00:41:31
blood pressure lipids and00:41:35
adequate physical activity00:41:37
but here it is schematically presented00:41:40
dual role of obesity in pathogenesis00:41:42
a-star three different joints obesity00:41:46
it's really a mechanical factor00:41:48
overload obesity leads to increased00:41:50
body weight to increased load on axial00:41:55
joints supporting joints and this leads00:41:59
here to the activation of immune cells and00:42:01
formation of the start of the knee00:42:04
joint, but meta-inflammation first00:42:07
queue depends on00:42:09
excess nutrients to00:42:12
metabolic tissues are00:42:15
sources of cytokines including00:42:18
adipose tissue from metabolic tissue and this00:42:21
so-called cold inflammation00:42:23
which leads to the development of o start rita00:42:26
joints of the hand because de patina00:42:29
among which such as leptin resisting00:42:33
free and more increase00:42:35
catabolic processes in cartilage00:42:37
increase the synthesis of pro-inflammatory00:42:39
mediators of joint tissue and support00:42:42
this is it00:42:45
cold is not inflammation00:42:49
crystal phenotype 100 arthritis is00:42:52
osta arthritis which is associated with00:42:58
violation00:43:01
disruption of crystals in the body but00:43:03
most often of course it is00:43:07
sodium urate crystals are uric acid00:43:10
acid is00:43:14
violation is associated with such00:43:16
disease like gout and currently00:43:19
time has shown that I will warm up the stool arthritis00:43:21
may be risk factors for each other00:43:23
growth arthritis and gout occur due to00:43:26
common risk factors such as obesity00:43:30
age and gender the older the check00:43:33
becomes00:43:34
the higher it is00:43:37
weight, the higher the risk of developing gout and mouth00:43:43
have arthritis but also suffer more often00:43:46
growing men, arthritis and gout often00:43:49
affect the same joints, distal00:43:52
interphalangeal joints of the metatarsophalangeal00:43:54
joint of the first toe and knee00:43:57
joints00:43:58
it is now known that the joints that were00:44:01
site of gout attacks00:44:03
please note it's seven eight00:44:05
times higher chances of developing a mouth00:44:08
arthritis compared to joints in00:44:11
who did not have gout attacks00:44:13
in addition, the joints that have00:44:16
signs of mine crystal deposition00:44:18
guy's sodium mannoroth00:44:23
double00:44:25
computed tomography spirit00:44:28
energy computer00:44:30
tomography look like crystals00:44:33
Munawara looks like a three because of this00:44:38
this research method is the first00:44:41
metatarsophalangeal joint so accumulated00:44:43
here and here look throughout00:44:46
foot crystal to him on the gate of sodium00:44:49
accumulated so here are the joints that00:44:51
have signs of crystal deposition00:44:53
manowar to sodium are 5-10 times more likely to have00:44:57
X-ray signs of start rhitis00:45:00
including us to feed and subchondral00:45:03
sclerosis and narrowing of the joint space, that is,00:45:06
signs that are not typical for gout00:45:09
as such in one study00:45:11
which included paying attention00:45:14
more than 39 thousand patients for the first time00:45:17
resulting gout and the same amount00:45:20
patients from the control group showed00:45:22
that compared to the control group00:45:24
the risk of oral arthritis was higher00:45:27
in patients with gout and subjects with00:45:30
gout on the other hand, more often than not, Emily00:45:33
previous diagnosis of oral arthritis00:45:36
compared to the control group00:45:38
In addition, it is known that osteoarthritis00:45:42
associated with inter river response genes to 100:45:44
beta I told you about this today00:45:47
repeatedly which has the potential00:45:50
and attitude towards gout because00:45:52
interleukin 1 beta is central00:45:55
also a gouty mediator00:45:57
inflammatory response has been proven00:45:59
many studies and even approaches00:46:02
to treatment and00:46:04
It is known that sodium aurate moons are00:46:08
one of the molecules associated with00:46:10
damage that leads to assembly and00:46:14
nfl amazon and00:46:16
subsequent activation of inflammatory00:46:18
paths, that is, such an association00:46:21
ost in arthritis and gout00:46:25
led to it being singled out separately00:46:28
crystalline phenotype of gost arthritis00:46:31
if I delve a little deeper into00:46:35
this problem, here are the common risk factors00:46:38
d leads to what can happen00:46:41
ost arthritis with osteoarthritis you remember00:46:44
chondrocytes are destroyed from chondrocytes00:46:47
which died in articular cartilage00:46:51
the crystal is displayed on his gate at 300:46:54
increase city in joint products00:46:57
decay acute paste arthritis cartilage00:47:01
synovial fluid is what we00:47:02
discussed with you in pathogenesis00:47:04
chondroitin sulfate collagen and others00:47:07
activates the deposition of urate crystals in00:47:10
cartilage and00:47:12
high concentration of urate in synovial00:47:14
fluid promotes deposition00:47:16
cry crystals and00:47:19
inflammatory firming mechanisms00:47:21
damage to chondrocytes and cartilage00:47:23
contributes to the progression of asthma00:47:26
arthritis on the other hand crystallization00:47:29
urates around dead chondrocytes00:47:32
activation of neighboring rhocytes and others00:47:35
resident cells induced00:47:37
Arata crystals produce interleukin00:47:40
one Internet for 18 others00:47:43
pro-inflammatory components including00:47:46
the number of metal proteinases leads again00:47:50
death of chondrocytes and again00:47:52
progression of arthritis growth if with00:47:56
sides00:47:57
don't gout, let's take it00:48:00
asymptomatic hyperuricemia contributes to00:48:03
an increase in urate in the joint and also00:48:05
starts this process again and00:48:08
asymptomatic hyperuricemia at the end00:48:11
can ultimately transform into00:48:13
gout and gout can contribute00:48:16
damage prevents damage00:48:20
cartilage and progression 100 arthritis or00:48:22
the onset of arthritis and00:48:24
it turns out to be a vicious circle, that is,00:48:28
microcrystalline company00:48:31
microcrystalline phenotype start rita00:48:33
may be associated with crystals00:48:37
uric acid but there is one more00:48:40
a disease that is also associated with00:48:43
this variant of mouth arthritis is00:48:46
crystal phenotype conditional00:48:48
crystal deposition disease and00:48:50
calcium phosphate or hunter calcification or00:48:55
it's called pseudo gout00:48:57
disease00:48:58
prevalence of the disease which00:49:00
associated with deposition of calcium crystals00:49:03
increases with age and00:49:05
up to 15 percent in patients00:49:10
60 50 75 years and reaches 40 percent in00:49:15
persons over 80 years of age feather phosphate crystals00:49:18
calcium induces the production00:49:20
pro-inflammatory and catabolic00:49:22
mediators in primary chondrocytes00:49:26
aviation is so human and can00:49:28
promote the degradation of cartilage and hay00:49:31
type of arthritis growth from crystal pen00:49:34
calcium phosphate can be seen00:49:36
synovial fluid they look like00:49:38
such diamonds but you can see it00:49:41
only polarizing microscope00:49:44
I must say that clinically I just have arthritis00:49:48
with calcium phosphate crystals00:49:50
characterized00:49:52
spectrum of clinical phenotypes from00:49:55
asymptomatic to acute acute forms00:49:58
that is, it became the first calcium phosphate00:50:01
putting it in the cartilage gives us this one here00:50:05
hunter symptom of calcification when in00:50:09
region00:50:10
in the area of cartilage we have something like this00:50:15
Here00:50:16
double circuit is honda calcification and00:50:20
check can00:50:22
live and have absolutely nothing to say about it00:50:25
know it might just be like this00:50:26
X-ray finding but in some00:50:29
patients may be acute acute form00:50:32
which she pin resembles gout and00:50:36
that's why my disease is called00:50:38
pseudo gout because never00:50:40
the uric acid levels of these patients00:50:42
does not increase but there is a chronic00:50:45
form with moderate and00:50:47
such or high laboratory00:50:49
activity00:50:51
diagnostics00:50:52
carried out using radiography00:50:56
when we see00:50:57
feather phosphate crystal deposits00:50:59
calcium per00:51:02
radiographs or detected in00:51:05
synovial fluid crystals fir00:51:06
calcium phosphate00:51:10
speaking about the clinical picture of the mouth00:51:13
arthritis we should know of course00:51:16
the main symptom that causes00:51:18
in general, the patient should think about what00:51:21
something is not very good with his joints00:51:22
this is pain in the joints and surrounding them00:51:26
mechanical places00:51:27
the so-called starting pain, that is00:51:30
pain that is not present when the patient is at rest00:51:32
worries but when changing body position00:51:34
this pain appears00:51:37
crepitus with active movement00:51:40
there may be morning stiffness in the joints00:51:42
but this morning stiffness is less than 3000:51:45
minutes but usually it’s a few minutes00:51:48
patients note00:51:49
morning stiffness only if00:51:51
what is formed in them00:51:54
secondary hay type is often knee00:51:57
joints may not be in the area of others00:52:00
joints, particularly in the area of the joints00:52:02
brushes also with progression00:52:06
the disease is formed by deformities and00:52:08
increased volume of joint protection00:52:11
exudative in the future due to00:52:14
proliferative phenomena00:52:16
there is a restriction of functional00:52:19
joint capabilities but patients00:52:22
note that they cannot bend there and00:52:25
fully extend00:52:29
joints in comparison with a healthy sieve with00:52:33
healthy joint conditions further00:52:37
typical for us top 3 is gradual00:52:40
the onset of pain first is the pain that occurs in00:52:44
for several days a year00:52:48
certain physical activities afterwards00:52:50
it is a pain00:52:52
gradually intensifies lengthens in that00:52:55
add joint stiffness and00:52:58
the process of progression is already in process00:53:01
soft tissues around the joints are involved00:53:04
atrophy of surrounding muscles00:53:06
pain is really the most important thing00:53:09
characteristics of the mouth in arthritis again00:53:11
I say that it is mechanical in nature00:53:13
pain occurs when changing position00:53:17
body that is00:53:18
at night a man sleeps with nothing00:53:21
worries him in the morning when he wakes up nothing00:53:24
doesn't bother but as soon as he starts00:53:25
get up the affected joints make themselves known00:53:28
know either the person is sitting with him nothing00:53:30
it doesn't hurt as soon as it starts00:53:32
when he gets up it hurts like this00:53:34
starting mechanical fight is a pain00:53:37
worsens at the end of the day and during physical activity00:53:39
load but subsides at rest culture so00:53:42
that patients should not wake up at night00:53:45
Is there any pain at night from this pain?00:53:47
whether this arises or is already far advanced00:53:50
case there venous stasis occurs in00:53:53
bone tissue or is the pain associated with00:53:57
media and again body position when00:54:00
the man turned over from one side to00:54:03
another00:54:05
groundwork in motion00:54:08
sore joint affected yes but when00:54:11
takes a comfortable position then I'm more00:54:13
this goes away in the presence of inflammatory00:54:17
component when there is and in appearance it can00:54:20
occur suddenly and increase in pain or00:54:23
like I already said, pain at night00:54:25
time there may be morning stiffness00:54:27
which however cannot last more than 3000:54:30
minutes swelling of the joint patients can00:54:33
note but also the doctor accordingly to00:54:35
Unfortunately, in some patients and00:54:37
aromatic beads appear00:54:39
component is pain which00:54:44
still most often occurs in00:54:46
patients with joint damage00:54:48
spine and00:54:50
pain may be dysfunctional00:54:53
When00:54:54
the person is impaired00:54:57
the perception is more that there is no reason for00:55:02
pain but man00:55:05
perceives00:55:09
perceives00:55:11
there is more reason for this00:55:14
no pain here00:55:17
but 30 at the most is the main pain when00:55:20
activated00:55:21
nociceptors during injury inflammation scheme00:55:25
swelling inflammation muscle spasm arthralgia00:55:28
burns, that is, this is what we have00:55:30
chronic inflammation prius cake 300:55:34
neuropathic result of the lesion00:55:36
somatosensory nervous system and00:55:39
dysfunctional when there is no inflammation00:55:41
no defeat00:55:43
somatosensory nervous system but there is00:55:45
mental disorder and drug addiction00:55:48
pain has its own specific00:55:51
characteristics00:55:52
it's no less than a tingling itch00:55:55
crawling00:55:57
electric shock, if there are any00:56:00
characteristics hurts and we have to think00:56:03
that there are energy components00:56:06
then in the treatment complex we must00:56:08
include, of course, central drugs00:56:11
actions00:56:12
drugs00:56:16
having here00:56:18
the ability to influence this world and00:56:20
tical component for the algorithm00:56:22
diagnostics, a 3s approach is proposed00:56:26
listen watch correlate that is00:56:28
listen to what the patient says watch what00:56:31
there are actually rates and correlate00:56:34
patient complaints so that we objectively00:56:37
we see from the joints the reasons00:56:42
Anything could be more likely to cause arthritis00:56:45
components of the joint yes it is synnov00:56:48
inflammation venous stasis bone spasms pcs00:56:52
involvement of the meniscus ligaments and the mountain00:56:56
the system is already with you about this00:56:58
we talked00:57:00
I must say that the pain is about 100r 300:57:04
it is recommended to evaluate by00:57:06
visually on the tax scale00:57:12
digital rating scale and00:57:14
vertebral rating scale here they are00:57:16
all three are presented here00:57:22
Sorry00:57:26
this scale represents00:57:30
ten centimeter ruler00:57:39
the patient is offered00:57:41
estimate how much00:57:44
he feels the severity of this pain00:57:49
Well, you see that up to three centimeters00:57:53
mild pain intensity from four to00:57:57
six average pain intensity and from 700:58:00
up to 10 centimeters severe pain is necessary00:58:03
say that00:58:04
patients with osteoarthritis with such obvious00:58:07
pronounced clinical but usually pain00:58:10
is located in this segment from four00:58:14
up to six centimeters with this pain00:58:17
patients rarely go to doctors, but00:58:20
some patients00:58:22
already in such an advanced case the pain00:58:26
can be so intense00:58:29
that patients even within five00:58:32
minutes they can’t walk around the room, that is00:58:35
the pain can be very severe so00:58:38
of course00:58:39
reduce the volitional component during treatment00:58:44
patients we must but among00:58:47
most commonly affected joint legally00:58:50
Certainly00:58:51
knees come first00:58:54
joints come second00:58:56
hip joints in third place00:58:59
Here are the small joints of the hands and what you need00:59:02
remember that when00:59:03
osteoarthritis primarily affects00:59:07
you will remove the phalanx and joints and00:59:09
proximal interphalangeal joints00:59:11
reserve for the 5th joint and interphalangeal joint00:59:16
first finger00:59:18
brushes00:59:20
extremely rarely can they be involved in the process00:59:23
metacarpophalangeal joints 1 2 fingers00:59:27
brushes but this is very rare and00:59:30
1 metatarsophalangeal and foot joint too00:59:33
quite often involved in the process00:59:36
talking about diagnosing vastu arthritis00:59:41
Let's touch on laboratory research in00:59:43
principle to confirm vastu arthritis00:59:46
and no laboratory tests00:59:48
needed because there are no signs00:59:52
who could confirm to us about the00:59:54
arthritis laboratory but still00:59:57
laboratory tests of blood and urine01:00:00
sometimes synovial fluid is necessary01:00:03
to exclude inflammatory01:00:04
joint diseases and exclusion01:00:07
contraindications for treatment01:00:09
medicines in particular01:00:11
non-steroidal anti-inflammatory01:00:12
drugs01:00:13
And01:00:15
rule out infectious arthritis01:00:17
sometimes synovial fluid is required01:00:20
for osteoarthritis to exclude01:00:22
infectious arthritis she says that01:00:24
infectious arthritis clinic01:00:26
significantly different from an oral clinic01:00:29
arthritis but sometimes you have to01:00:32
metabolic arthritis from gout01:00:35
disease deposited pen crystals01:00:37
calcium phosphate for the diagnosis of which01:00:40
in general in clinical recommendations01:00:42
it is recommended to examine the synovial01:00:45
liquid to identify these01:00:47
crystals01:00:49
so if we take the clinical01:00:52
blood c reactive protein and see what01:00:55
there are no signs of inflammation then01:00:58
and clinic corresponding mechanical01:01:01
pain localization corresponding then we01:01:04
we can safely no longer assume that01:01:07
patient and has severe arthritis01:01:09
among instrumental methods01:01:12
research01:01:13
first of all it is x-ray01:01:16
radiography developed and01:01:18
X-ray stages of arthritis growth01:01:22
by kinguin lawrence zero stage when01:01:27
no radiological signs01:01:29
mouth arthritis is the first stage when they have01:01:33
place I cyst prominent bone reconstruction01:01:35
structures linear about 100 sclerosis but here01:01:38
There's a little bit of subchondral here x01:01:40
affairs and the appearance of small regional01:01:43
there are osteophytes right here, yes01:01:46
second01:01:48
stage when more joins01:01:52
pronounced u100 sclerosis and narrowing01:01:54
joint space more pronounced normal01:01:57
here are the medial sections if we talk about01:02:00
knee joint more pronounced01:02:03
narrowing of the joint space, the third stage is01:02:06
already expressed 100 sclerosis you can here01:02:09
see here yes so emphasized01:02:12
joint boundaries01:02:14
large marginal osteophytes01:02:16
visible here and01:02:19
significant pronounced narrowing01:02:21
look at the joint space01:02:25
the fourth stage is rough massive01:02:28
abutment fit and joint space01:02:29
can be traced with difficulty of the epiphysis of bones01:02:33
forming a joint deformed risk01:02:35
compacted but it is considered that the prius is the same01:02:38
arthritis never develops01:02:41
ankylosis here for tired 3 tanks lust not01:02:45
characteristic01:02:46
which is typical for01:02:49
rheumatoid arthritis01:02:52
But01:02:54
it is clear that with osteoarthritis we must01:02:57
identify narrowing of the joint space01:02:59
subchondral sclerosis marginal osteophytes01:03:01
subchondral cyst in osteoarthritis01:03:05
knee joints in order to01:03:07
100% objectify the walls01:03:10
conditions necessary front and rear01:03:13
lateral projections in a standing position01:03:17
study of a teacher and lo-fi moral01:03:20
100 arthritis and lateral projection with01:03:23
bending but above saying that these are01:03:27
conditions are not always met in real life01:03:29
clinical practice and if there is a suspicion of01:03:32
us top 3 hip joints01:03:34
radiography is performed01:03:36
gripping both hip joints01:03:40
talking about exploring brushes01:03:45
radiography of the hands and what we do01:03:49
we can see here in the first stock on01:03:52
sand joint are often noted01:03:55
radial subluxation of the metacarpal bone01:03:58
we can see erosions in the distal01:04:01
interphalangeal joints and01:04:03
for severe and severe arthritis01:04:08
so-called deformation develops01:04:10
like a gull wing, you see the body of a seagull01:04:15
and on the sides there are gull wings in the area01:04:19
wrists may also be open01:04:22
productive changes with the formation01:04:25
the foundation of the Sith and maybe the blues01:04:28
calcinosis, pay attention here01:04:30
here is the blues calcification here is the deposit01:04:34
where there should be cartilage there we see01:04:37
seal01:04:39
similar to bone density yes this is it01:04:42
just deposits of pyrophosphate crystals01:04:45
calcium but01:04:47
here in the area of the joints of the hands01:04:51
they write that there may be ankylosis but01:04:54
ankylosis is extremely rare in large01:04:57
There is no ankylosis in joints with arthrosis01:05:02
but radiography is of course a good method01:05:05
but it does not give a complete picture01:05:09
what is the best method01:05:12
non-invasive and01:05:14
allowing for early stage01:05:17
diagnosis is a magnetic resonance imaging method01:05:19
tomography to its features and01:05:22
benefits include but not01:05:24
invasiveness absence on the believer01:05:27
radiation good resolution01:05:29
ability and opportunity to obtain01:05:32
three-dimensional image like here and01:05:34
can reveal minimal quantities01:05:36
fluid in the joint cavity area of edema01:05:40
bone marrow and initial signs01:05:42
acute necrosis see what mri01:05:46
allows you to identify joint damage01:05:48
cartilage with a 90 percent probability and01:05:53
very low hypo level or01:05:56
overdiagnosis that is01:05:58
magnetic resonance imaging on01:06:00
today is considered one of01:06:02
the best01:06:03
joint imaging methods01:06:07
ultrasound diagnostics01:06:09
also a very good method, also not01:06:12
invasive accessible simple and01:06:14
economical01:06:15
you can also see the image layer by layer01:06:19
joint is used for me to evaluate in01:06:23
primarily to assess non-synovitis and01:06:27
for rate01:06:31
to estimate thickness01:06:34
cartilage01:06:36
hyaline cartilage thickness reduction01:06:39
hyaline cartilage with ultrasound01:06:41
obvious and it's very so good01:06:45
way to diagnose mouth arthritis and01:06:48
early stages when radiography01:06:51
there is practically no visible complaint yet01:06:53
there are patients01:06:56
further01:06:58
computed tomogram computer01:07:00
tomography but quite rare01:07:02
used for oral diagnostics01:07:04
arthritis are mainly used for01:07:07
suspicion of some traumatic01:07:09
damage is a very method01:07:13
detects various injuries well and01:07:18
quickly if mri 30 40 minutes needed01:07:23
one patient per location then01:07:27
multi spiral computer01:07:28
tomography has already been there for several01:07:30
minutes he can give us results01:07:33
research01:07:34
arthroscopy is sometimes used, but this01:07:37
after all, the method is so invasive and01:07:42
although arthroscopy can01:07:45
very give us great information about01:07:49
joint condition of articular cartilage01:07:53
still diagnostic arthroscopy01:07:55
it is performed rarely and more often01:07:58
wears one like this01:08:01
therapeutic and diagnostic character when01:08:04
identifying intra-articular bone fragments01:08:07
and cartilage and they must be removed01:08:14
criteria01:08:15
diagnostic criteria mouth criteria01:08:18
arthritis of the joints of the hands developed01:08:21
American colleagues of rheumatologists before01:08:24
present time01:08:25
well they count01:08:28
workers01:08:30
includes signs of pain la mata01:08:33
or stiffness in the hand and01:08:35
plus three out of four signs of increase01:08:40
solid in density of two or more of01:08:43
ten receiving attention01:08:45
joints, but there are just these01:08:49
nodules01:08:50
hypertension and bouchard and increased solid01:08:53
by the density of two or more distal01:08:55
interphalangeal joints nodules cyberdyne01:08:59
here's a bushard and this01:09:03
proximal interphalangeal distal01:09:06
these are hiberti nodules on the swelling group01:09:09
less than three metacarpophalangeal joints and01:09:12
deformities of at least one in ten01:09:15
joints taken into account01:09:18
the attention taken is the second and01:09:20
third distal interphalangeal 2 301:09:23
proximal interphalangeal joints and01:09:26
1 entry for the 5th joint of both hands01:09:31
cox arthritis01:09:34
signs criteria pain in the area01:09:37
hip joint not less than01:09:40
over the past two weeks plus how01:09:43
at least two of the following three signs01:09:46
soybeans are within normal limits despite01:09:49
severe pain to01:09:50
radiologically detectable osteophytes01:09:53
femoral head01:09:56
or the acetabulum here01:09:59
diagram shown shown and01:10:01
X-ray reveals a and narrowing01:10:04
joint space01:10:06
superior axial and or medial01:10:09
department01:10:13
Features of pain in the hip joint01:10:15
with osteoarthritis are such that it is most01:10:18
expressed in the groin area01:10:20
may radiate to the buttock along01:10:24
anterior lateral surface of the thigh01:10:27
knee or more01:10:29
it’s clear that it’s not on the back surface01:10:33
as with radiculopathy and in the anterior01:10:37
lateral surface of the thigh radiates to01:10:39
knee or lower leg and expressed in the inguinal01:10:42
region01:10:43
referred hip pain01:10:46
please note may be localized01:10:48
only in the knee area and01:10:52
this is the so-called referred pain01:10:54
pain along the lateral surface01:10:56
hip joint which intensifies in01:10:59
lying on this side01:11:01
accompanied by pain01:11:03
palpation of the greater trochanter01:11:05
indicate a secondary tetra course01:11:08
hunter this indicates01:11:10
significant severity01:11:11
inflammatory process I'm in this01:11:14
region01:11:15
what other signs for acute arthritis and01:11:19
hip joint restriction01:11:22
internal rotation with a flexed joint01:11:24
you determine when patients01:11:27
put him on the couch and check with him01:11:30
internal rotation with a flexed joint01:11:33
considered to be the earliest most sensitive01:11:35
sign of osteoarthritis and hip01:11:39
joints, other movements can also be01:11:41
limited and painful further01:11:44
pain on palpation of the inguinal01:11:46
areas and lateral pulsations01:11:48
femoral artery further fixed01:11:51
flexion and or external rotation of the joint01:11:54
shortening of the legs over a long period of time01:11:57
diseases, muscle atrophy appears01:11:59
thighs and gluteal muscles are very noticeable01:12:02
happens to patients01:12:04
limb accepts forced01:12:05
position01:12:07
slight flexion at the hip01:12:08
joint with impaired abduction rotation01:12:12
the emergence of combinatorial01:12:14
compensatory lumbar lordosis01:12:17
pelvic tilt towards the affected side01:12:19
joint and scoliosis this leads to the appearance01:12:23
I have pain in the spine area01:12:25
in the back area and changes in gait01:12:29
temple you and if both are amazed01:12:31
hip joints it appears like this01:12:33
called duck walk like this01:12:36
here the patient comes and this is of course very01:12:39
it's hard but there's no escape01:12:43
speaking about the diagnosis of arthritis, that is01:12:48
arthrosis to the father of the knee joints01:12:51
also pain in the knee joint no less01:12:54
two episodes within 10 days01:12:56
last year at standard01:12:59
radiography01:13:01
can only be at the counter, that is01:13:03
first second stage can be at all01:13:06
no radiological signs01:13:08
plus one of the following criteria but here01:13:11
or signs are arthroscopic or by01:13:14
Martin we have to say that when two01:13:18
episode within 10 days of the past01:13:22
year01:13:23
the patient is rarely approached in reality01:13:25
see a doctor about this because for now they01:13:28
they're going to come, they've got it all01:13:30
passes and look at the diagnostic methods01:13:33
enough01:13:36
expensive and arthroscopy in general01:13:40
invasive therefore in the early stages01:13:44
we almost never make a diagnosis01:13:47
As a rule, when a patient with arthritis comes to us01:13:50
contact already at the stage when we01:13:54
we can easily make a diagnosis using01:13:57
ordinary radiography but also earned01:14:00
criteria gunnar 3 you are also clinical01:14:03
laboratory and clinical and01:14:04
X-ray01:14:05
if you take clinical laboratory tests then01:14:10
knee pain plus 5 criteria01:14:13
out of 9 age over 50 years stiffness01:14:16
less than 30 minutes bone crepitus01:14:19
pain on palpation bone01:14:21
proliferation01:14:22
absence of hyperthermia upon palpation01:14:24
own norm rheumatoid factor norm and01:14:27
synovial fluid01:14:29
Arthritis characteristic of the mouth is01:14:32
low viscosity face tos well that is pain01:14:35
no signs of inflammation01:14:38
people over 50 years of age and01:14:42
if there01:14:46
stiffness lasts for a short time if you take it01:14:50
clinical and radiological01:14:51
criteria then pain plus one of three01:14:54
criteria again age more than 50 years01:14:56
speed less than 30 minutes crepitus and01:14:59
the presence of tired hits, but if you take it01:15:04
European league recommendations against01:15:06
rheumatism, pain on exertion often01:15:10
intensifying at the end of the day passing into01:15:13
rest, that is, the boule of the mechanical01:15:14
character01:15:15
feeling of dangling legs that is01:15:18
instability of the knee joint about this01:15:20
patients often speak very moderately01:15:23
morning stiffness or stiffness01:15:25
disturbance after being at rest01:15:27
functions with more pronounced stu01:15:30
arthritis may present pain in01:15:32
rest night fight and usually mouth symptoms01:15:35
arthritis is episodic and does not change over time01:15:38
heaviness and01:15:40
change slowly01:15:41
but among the additional symptoms is01:15:45
already far advanced cases when we01:15:48
we have a fixed joint deformity01:15:52
flexion or varus and valgus and01:15:56
varus deformity v-shaped or01:15:58
sleep foil i x shaped deformation01:16:01
possible periarticular tenderness01:16:04
especially pain in the so-called area01:16:07
on the sarin bundle below01:16:10
joint space and pain when pressing01:16:12
on the patella area this01:16:15
additional symptoms of knee arthritis01:16:17
the joint and the outcome of the bridge of supporting arthritis01:16:20
joints is clear is changes sisu01:16:23
functional has become pronounced01:16:25
deficiency and01:16:27
as a result of endoprosthetics01:16:30
joints and disabilities01:16:32
talking about boosting arthritis during a pandemic, after all01:16:36
19 then I must say that at 19 often01:16:42
arise here01:16:45
up to 50 90 percent of patients note01:16:49
muscle and joint pain and01:16:52
post to prominent syndrome in nine01:16:55
percent, pain is usually noted in01:16:57
joints and01:16:59
I must say that very often these more01:17:02
are not caused by the growth of arthritis or its01:17:05
progression or its debut in01:17:07
post to a prominent period it must be said that in01:17:12
mostly researchers01:17:15
from interested in problems01:17:19
inflammatory arthropathy in costo01:17:22
wine period but here is an analysis of the symptoms01:17:26
hole of one type in one of the studies01:17:28
that's more than four and a half thousand01:17:31
patients noted that back pain01:17:34
you see fifteen percent remains01:17:37
muscle pain 12 percent back pain 1201:17:41
percent and arthralgia are practically but01:17:45
9 10 percent and all researchers01:17:47
stop at the fact that 9 10 among01:17:50
a large group of these patients are01:17:52
patients with asthma and arthritis and indeed01:17:57
knockdown increased risk factor01:18:00
progression of mouth arthritis is01:18:02
restriction of physical activity01:18:04
changes in the rhythm of eating decreased01:18:07
muscle tone, alarming and01:18:09
depressive disorders01:18:10
this led to an increase in body weight in01:18:13
patients increased occurrence of01:18:16
more mechanical nature of the legs and01:18:19
decreased quality of life01:18:22
including until stabilization of comorbidities01:18:25
states01:18:26
research conducted01:18:29
in patients with osteoarthritis showed that01:18:33
covid infections are more common in patients with01:18:36
osteoarthritis than without it and01:18:38
Vastu arthritis symptoms after period01:18:42
quarantine I have patients with severe01:18:46
manifestations of 34 stadium start01:18:49
intensified even after the quarantine was lifted01:18:52
How can we treat growth arthritis?01:18:56
you see the prevalence is high01:19:00
quality of life is bad what we should01:19:03
keep in mind what the goals are, the goals of treatment then01:19:06
decrease more improvement01:19:08
functional state of joints01:19:10
prevention of deformation disability01:19:12
patient but also as a result of improvement01:19:15
quality of life of patients and I slowing down01:19:18
progression01:19:19
diseases it must be said that01:19:21
recommendations for the treatment of 100 arthritis01:19:25
since '9501:19:28
are being developed by many01:19:30
international organizations including01:19:33
Russian Association of Rheumatologists01:19:35
Russia now Russian traumatologists and01:19:39
all these recommendations have something in common01:19:43
recommendations but there are some differences01:19:46
latest latest clinical01:19:49
recommendations01:19:50
Russian ones came out in 2021 for treatment01:19:55
coxarthrosis and gonarthrosis under the auspices of the day01:19:58
association of traumatologists and associations01:20:01
rheumatologists of Russia and01:20:03
these recommendations indicate that due to01:20:06
variety of options01:20:09
pathogenetic chains which01:20:11
leads to manifestation of oral symptoms01:20:13
arthritis and until now actually01:20:16
no medications found01:20:18
capable of guaranteed stopping01:20:20
progression of the disease in all01:20:23
clinical situations but nevertheless01:20:25
there must be a treatment plan01:20:28
individualized what we have01:20:31
these are clinical opportunities01:20:34
recommendations01:20:36
almost completely coincide with01:20:38
international recommendations01:20:41
which are particularly developed01:20:44
save01:20:48
European Economic Community01:20:51
issues related to arthritis and osteoporosis01:20:55
are presented in this table very01:20:58
they are convenient01:21:00
present step-by-step treatment01:21:03
osteoarthritis but like not all01:21:07
recommendations including Russian ones first01:21:10
it is noted that the treatment of the mouth01:21:13
arthritis should be01:21:14
a combination of non-dime, non-medicinal and01:21:18
pharmacological methods basic set01:21:20
education weight loss and therapeutic01:21:23
physical education is recommended at the first step01:21:27
reduce pain due to01:21:30
using less than three grams of paracetamol01:21:33
in short courses but precisely for this reason01:21:35
question01:21:36
there are differences with Russian01:21:39
recommendations in Russian01:21:42
recommendations indicate that large doses01:21:45
paracetamol01:21:46
for a long time01:21:47
lead to a large number01:21:51
adverse events that are expressed01:21:54
no less than when using non-steroidal01:21:57
anti-inflammatory drugs for01:21:59
This is the effectiveness of paracetamol01:22:01
the rule is almost two times lower than01:22:04
non-steroidal anti-inflammatory01:22:05
drugs therefore our recommendations are already01:22:10
at the first stage it is recommended to use01:22:13
use of non-steroidal01:22:14
anti-inflammatory drugs for01:22:17
relief of pain in01:22:19
combination with basic therapy which01:22:23
applies to application01:22:26
drugs that we used to call01:22:28
counter protectors, well, as you understand01:22:32
Asth's arthritis is not today01:22:34
only lesions of articular cartilage01:22:37
that's why they are called01:22:39
symptomatic and medicinal01:22:41
by means of delayed action or01:22:44
abbreviation01:22:46
English words and si gardens and to these01:22:50
drugs include chondroitin sulfate01:22:52
glucosamine sulfate dio cyren and01:22:55
unsaponifiable compounds of avocado draws and01:22:58
at the first stage it is also recommended01:23:01
Let's consider using local tools01:23:08
non-drug methods but this is understandable01:23:10
that reducing the load on the joint01:23:13
performing weight loss exercises01:23:16
general health activities and01:23:19
physiotherapeutic measures01:23:23
talking about01:23:25
weight correction level must be pointed out01:23:28
that weight loss is ten percent in01:23:31
combined with regular exercise01:23:33
reduces pain in knee joints by 5001:23:36
percent look here shown01:23:39
what when and exercise01:23:42
weight loss then knee pain01:23:45
joints really decreases01:23:46
much better than just01:23:49
weight loss or just exercise01:23:53
Various mortise and insoles are used01:23:56
as non-drug methods01:23:58
treatment various methods of physiotherapy01:24:02
attraction vastu arthritis all this I bring01:24:05
according to clinical01:24:07
our recommendations which are here in 202101:24:11
released here you see and massage01:24:15
personal hardware physiotherapy and01:24:18
electrophoresis of various drugs01:24:21
products and various baths and01:24:25
cryotherapy as one of the methods that01:24:28
no longer has the right to01:24:31
for life01:24:33
the building was recently completed01:24:35
impact comparison study01:24:38
various methods of pain therapy01:24:41
osteoarthritis and it turned out to reverse01:24:43
attention that the biggest impact on01:24:46
pain has an effect on pain reduction01:24:50
exercise exercise01:24:53
so even more than the bottom is difficult01:24:56
anti-inflammatory drugs01:24:58
therefore there is no therapy01:25:01
medicines won't help us01:25:04
to our patients01:25:06
as far as all these methods can01:25:10
help in combination with01:25:12
adequate exercises when talking about01:25:16
use of non-steroidal01:25:18
anti-inflammatory drugs01:25:20
this is 2 this is the train and the first stage01:25:25
our recommendations01:25:27
it is necessary to prescribe non-steroidal01:25:29
anti-inflammatory drugs taking into account01:25:32
their beans have the potential for side effects01:25:35
this must be taken into account and01:25:38
there you know it's non-selective01:25:42
inhibitor cycle oxygenase 2 selective01:25:44
cycle x inhibitors and oxygenase 2 any01:25:47
drugs can be used taking into account01:25:49
risk of complications if risk of complications01:25:55
in the gastrointestinal tract is low01:25:58
any NSAIDs in moderation are mandatory in01:26:01
combination with proton pump inhibitors01:26:02
high then we must apply the day01:26:05
selective cox-2 inhibitors combinations with01:26:08
proton pump inhibitors if there is a risk01:26:11
moderate cardiovascular complications01:26:14
or high then we must apply and01:26:16
drugs with low cardio01:26:19
you01:26:20
cardiovascular risk this drug01:26:23
naproxen and low dose ibuprofen01:26:27
low doses less than 1200 milligrams01:26:29
day01:26:31
or naproxen with proton inhibitors01:26:35
pumps or celecoxib and01:26:37
if you notice very high01:26:40
cardiovascular risk01:26:42
risks, then in general any NSAIDs should not be prescribed01:26:48
recommended so01:26:50
the first stage of NSAIDs to reduce pain and01:26:55
basic drugs from the group01:26:59
symptomatic medications01:27:01
delayed action to the main ones01:27:03
drugs include01:27:05
glucosamine and01:27:08
chondroitin sulfate01:27:14
these two components01:27:19
have01:27:21
energy not action and even01:27:23
they have no additive effect01:27:26
don't they interfere with each other?01:27:29
act because chondroitin01:27:32
sulfate is absorbed it's time it's time goal01:27:35
learn this is not intercellular in a cell01:27:38
penetrates but its bioavailability01:27:41
is 22 percent and as a result01:27:44
experimental studies shown01:27:47
that it accumulates in the cartilage of the knee01:27:50
forty-five percent of the dose of glucosamine01:27:54
absorbed via a conveyor01:27:57
glucose and penetrates into cells01:28:00
chondrocytes synovitis 100 region east01:28:03
fins its bioavailability is 25 percent and01:28:07
It is believed that01:28:09
when01:28:13
induced arthritis is in01:28:15
experiment01:28:16
joint penetration increases by four01:28:19
times, that is, when patients have01:28:22
usb uart pic there is inflammation there01:28:25
penetration of glucosamine into the cell01:28:28
joint01:28:29
increases significantly, that is, four01:28:32
times than but simply without availability01:28:36
inflammatory process01:28:37
I must say that moping in sulfate01:28:40
glucosamine affects all components01:28:43
pathogenic for asthma and arthritis01:28:46
as a result of which they contribute01:28:48
suppression of inflammation prevention for01:28:51
cartilage generation01:28:53
prevent pathological angiogenesis01:28:55
of the formation of bone erosions and01:28:59
prevent chondrocyte apoptosis01:29:01
That's why01:29:03
these drugs are widely used01:29:07
are considered basic for the treatment of oral01:29:09
arthritis shown comparative01:29:11
research that these two components01:29:13
basic therapy for mouth arthritis are01:29:17
excellent safe means01:29:20
that is, they generally have practically01:29:23
don't give any side effects01:29:26
with the exception of individual01:29:27
intolerance what can happen in01:29:30
basically with any drugs01:29:35
it has been shown that combined use01:29:38
glucosamine with chondroitin sulfate01:29:42
Quite a lot of research has been done01:29:45
here is 1 one from a meta-analysis from 15 years ago01:29:49
showed that the combination of chondroitin and01:29:52
glucosamine01:29:53
statistically significantly reduces01:29:55
severity of pain and one01:29:59
Besides01:30:03
It has been shown that glucosamine and chondroitin01:30:05
reduce01:30:07
Sorry, I checked and it looks like no01:30:10
everything is correct that they reduce not only01:30:15
have an effect only on joints01:30:18
it turned out that these drugs01:30:21
have many more positive01:30:24
there were such effects in a number of studies01:30:27
it is shown that glucosamine and chondroitin01:30:29
reduce the risk of colorectal cancer01:30:33
and01:30:35
combined use of these01:30:37
drugs reduces the risk of developing01:30:40
better than using each01:30:44
components separately in addition01:30:48
glucosamine and chondroitin positive01:30:51
influence the intestinal microbiome, this too01:30:54
has been confirmed in clinical01:30:57
research and that’s exactly what happened01:31:00
shown, that01:31:02
the number is increasing01:31:06
positive01:31:07
[music]01:31:10
microbes and the number decreases01:31:13
negatively affecting the child's moment01:31:17
pathogens therefore01:31:20
influencing the composition of the intestinal microbiome01:31:23
these drugs may01:31:26
improve gastrointestinal function01:31:28
tract that as you understand01:31:31
the current has a beneficial effect on me01:31:35
mouth arthritis and decline01:31:37
inflammatory process which01:31:39
microbiome is also supported01:31:43
An interesting study was conducted in01:31:46
United States of America which01:31:49
showed that01:31:50
use of glucosamine with chondroitin01:31:53
was associated with a decrease01:31:55
mortality from all causes by 3901:31:58
percent and from cardiovascular01:32:01
diseases by 65 percent01:32:05
that is, unique is unique, not only that01:32:10
that we reduce symptoms from01:32:12
mouth arthritis mortality rate decreases01:32:15
What01:32:17
please treat our patients well01:32:20
and you will help them01:32:23
not only from the side of growth arthritis is one thing01:32:27
from recent studies that01:32:29
has proven the effectiveness of the combined01:32:31
use of chondroitin sulfate and01:32:34
glucosamine01:32:36
at the same time this research01:32:38
held here in Russia under the auspices01:32:40
Institute of Rheumatology and Valentin01:32:43
Alexandrova Nasonova01:32:45
the study was conducted using01:32:47
the drug teraflex01:32:49
patients took the drug 1 capsule01:32:53
3 times a day and01:32:56
see quite a large number01:32:58
patients was increased this process01:33:01
1102 patients 51 research01:33:04
center and01:33:06
in the twentieth year study01:33:08
ended as a result of this01:33:10
research has shown that01:33:12
teraflex01:33:14
revealed high efficiency and01:33:17
long-term therapeutic effects in01:33:19
patients with knee arthritis01:33:21
joints and hip joints01:33:23
teraflex also provided a reduction01:33:25
number of patients with constant01:33:27
daily pain five times01:33:30
reduced the need for constant admission01:33:32
non-jet anti-inflammatory pro01:33:35
devices are 89 percent colossal01:33:38
effect and provided significant01:33:41
reduction of all oral arthritis symptoms01:33:43
already by the second visit and their progressive01:33:46
declines throughout the entire period01:33:47
observations observed 15 patients01:33:51
months and more than 70 percent01:33:54
patients took Teraflex for more than 601:33:57
months but it's very lovely01:34:01
the result shown in01:34:02
result of this study01:34:05
but let's remember that01:34:07
glucosamine and chondroitin sulfate and01:34:10
the drug teraflex which is just the same01:34:13
contains these two components it01:34:15
drugs that belong to the group01:34:18
delayed action, that is, the effect of01:34:21
taking these medications01:34:22
develops through01:34:26
8-12 weeks from the start of treatment but01:34:30
someone before and the patient comes to you01:34:32
for an appointment today and wants to01:34:34
you prescribed him a drug today01:34:37
tomorrow he will be accepted and he will feel better01:34:40
such a combined one was created01:34:42
a drug that contains other than01:34:44
glucosamine and chondroitin sulfate01:34:47
contains non-steroidal01:34:48
short term anti-inflammatory drug01:34:50
actions01:34:51
non-selective drug ibuprofen01:34:54
why did you choose ibuprofen it seemed that01:34:57
ibuprofen combination look like goats to us01:35:01
gives01:35:03
enhanced analgesic effect due to01:35:06
because glucosamine potentiates01:35:08
energy tricks for ibuprofen what01:35:12
allows you to reduce the effective dose01:35:14
ibuprofen 24 times possible due to01:35:17
influence of glucosamine on education01:35:19
active racemic form of ibuprofen01:35:22
and the concentration of ibuprofen in plasma01:35:25
the blood does not change and so01:35:30
ibuprofen in a small dose we are with you01:35:32
have already said that even with high risks01:35:37
cardiovascular with01:35:40
cardiovascular unwanted01:35:42
phenomena from NPP low doses of ibuprofen01:35:45
as one of the drugs of choice01:35:47
therefore recommended01:35:51
drug in01:35:54
as part of teraflex advance and prefab01:35:59
The drug is called Teraflex Advance01:36:01
low dose ibuprofen provides01:36:05
short01:36:06
cardiovascular risk and low doses01:36:09
ibuprofen turns out01:36:11
associated with relatively low01:36:15
gastrointestinal risk01:36:17
thus, at the onset of pain01:36:22
syndrome against the background of Vastu arthritis with01:36:24
in case of exacerbation of vastu arthritis it is recommended01:36:27
start therapy with teraflex01:36:29
advance01:36:30
1 capsule of which contains and01:36:33
glucosamine sulfate 250 milligrams01:36:36
chondroitin sulfate 200 milligrams01:36:38
ibuprofen 100 milligrams I must say01:36:42
what is the daily therapeutic dose01:36:44
glucosamine sulfate 1500 mi gram a01:36:48
mope in sulfates 1200 milligrams01:36:51
so that you can get your daily allowance01:36:53
dose of chondroprotectors teraflex advance01:36:56
should be taken in a daily dose of 201:37:00
capsules 3 times a day please note01:37:04
what is the daily dose of ibuprofen in this01:37:06
case will be only 60001:37:09
milligram that is at least minimum with01:37:13
excellent analgesic effect and01:37:15
minimal unwanted01:37:17
reactions01:37:19
teraflex advance01:37:23
accepted01:37:24
two to three weeks if necessary01:37:27
add proton pump inhibitors if01:37:30
some undesirable names will appear with01:37:32
sides of the gastrointestinal tract01:37:35
and then we switch to receiving teraflex a01:37:37
you ruffled contains 500 in one capsule01:37:41
look at milligrams of glucosamine01:37:43
double dose of Teraflex Advance Ada01:37:46
daily dose of 1500 chondroitin sulfate01:37:50
one capsule contains four hundred01:37:52
milligram daily dose 1200 milligrams01:37:55
thus the daily dose of teraflex a01:37:59
will be three capsules01:38:01
course duration from three to six01:38:03
months this is the first time and in the future01:38:08
You can change the duration of the course, but the most01:38:13
small01:38:14
activity is three months for someone01:38:18
after three for someone after four for someone01:38:20
after six months the effect occurs01:38:22
you can take breaks afterwards01:38:25
up to two three months but I must say that01:38:29
use of these drugs01:38:32
in such short courses it leads to01:38:36
reduction of symptoms but all studies01:38:38
who confirmed that01:38:41
combination01:38:43
glucosamine and chondroitin sulfate and01:38:48
leads to slowdown01:38:51
growing arthritis and only if01:38:53
duration of treatment is not less than two01:38:57
year, that is, if we want not only01:38:59
reduce symptoms but also01:39:02
[applause]01:39:04
prevent progression of the process01:39:06
we need to use these drugs more01:39:09
it’s been a long time, so here we go01:39:11
wash flex advance and switch to herbs01:39:14
rex and also local locals01:39:17
medications if you notice01:39:20
there are recommendations, yes there are01:39:21
the teraflex blues cream is also wonderful01:39:24
cream for the which contains01:39:26
chondroitin sulfate01:39:27
meloxicam and01:39:30
dimexide which promotes01:39:32
drug penetration01:39:34
in the tissue and helps reduce01:39:38
pain and improved function01:39:41
joints01:39:43
but there are others01:39:46
drugs01:39:48
related symptomatically slowly01:39:51
active slow-acting drug01:39:54
effects of the drug tsyren from01:39:57
aloe juice has the ability too01:40:01
suppress internet synthesis by one01:40:04
Internet on 6 tumor necrosis factors01:40:06
alpha and01:40:09
this drug01:40:11
good effect on01:40:13
diabetes mellitus can reduce01:40:17
blood sugar levels and promote01:40:20
weight loss another drug from01:40:23
forest this is not a walk and the connection is oil01:40:26
avocado and soy also enjoy01:40:28
ability to suppress01:40:30
inflammatory cytokines and do not suppress01:40:33
this is the inflammation that lies in01:40:35
basis01:40:37
at the heart of mouth arthritis01:40:40
important note again that for01:40:43
achieving the effect of medication01:40:45
therapy for arthritis we must01:40:47
apply therapeutic doses of drugs01:40:49
Andrey then sulfate not less than thousand 20001:40:52
milligram per day glucosamine not less01:40:55
1500 milligrams per day and tsyren 50 10001:40:59
milligram per day not but my land and we and01:41:02
compound of avocado oils I draw 30001:41:04
milligram per day and the first course of at least 301:41:07
6 months courses repeated twice a year01:41:10
And01:41:11
I must say that there is more about01:41:14
natural csa yes01:41:17
they are divided into those whose main01:41:20
the active ingredient is01:41:22
chondroitin sulfate is the drug01:41:25
which01:41:26
as an active ingredient01:41:28
contains glucosamine preparations01:41:31
apply01:41:35
intramuscularly for a course of treatment 10 2001:41:38
injections and can be combined01:41:40
drugs orally are not specific01:41:43
effects of federal drugs including01:41:46
that the effect occurs faster than from01:41:48
taking medications orally, that is, it is possible01:41:50
simultaneously start both inside and01:41:53
parenterally and even finish already01:41:57
take medications internally for a long time01:41:59
can also be used naturally01:42:02
medications between courses01:42:08
hyundai protectors inside that is, they01:42:11
enhance each other's effect01:42:14
but here is confirmation that01:42:16
local medications are also recommended01:42:19
apply and they are effective and01:42:23
at the second stage if we still don’t01:42:25
the achieved effect is still possible01:42:28
such an option as the use of hyaluronic01:42:31
intra-articular acids and01:42:35
intra-articular corticosteroids are01:42:37
extremely rare only in the presence of synovitis01:42:40
and no more than 2 times01:42:46
Well, no more than once every three months01:42:49
same composition but better overall01:42:51
do without corticosteroids because01:42:54
that unfortunately there are often side effects01:42:58
effects and man-made01:43:00
aseptic necrosis hyaluronic01:43:03
acid is an excellent substitute for natural01:43:06
synovial fluid in joints01:43:07
person and01:43:09
intra-articular injection of hyaluronic acid01:43:12
acids can actually reduce01:43:14
vastu arthritis symptoms01:43:16
within 6-24 weeks for some01:43:20
patients longer there up to 9 months after01:43:24
injections and01:43:26
delays the stages of endoprosthetics but01:43:29
if we fail to achieve effect01:43:32
good, it is recommended that they be short01:43:35
courses of weak opioids or du lac citan01:43:39
but then surgical methods01:43:42
total endoprosthetics or01:43:44
endoprosthetics of individual parts01:43:46
joint and if this is not possible then01:43:51
already recommends opioid analgesics but01:43:54
Needless to say, here are the recommendations for01:43:56
opioid drug in our country in01:44:00
in general, somehow they didn’t find such a response in01:44:04
real clinical practice and no01:44:07
probably not a single doctor who would01:44:09
prescribed opioids to the patient for treatment01:44:12
start then taking into account01:44:15
taking into account the design but here are examples01:44:20
joint replacement replacement01:44:22
arthritis is not always good results01:44:26
they think that after receiving an endoprosthesis they01:44:29
will become the same full-fledged joints01:44:33
will become as full-fledged as in01:44:35
unfortunately there is no youth and therefore until01:44:38
50 percent of patients do not01:44:42
satisfied with the results01:44:45
endoprosthetics of this body I tell you01:44:47
By01:44:48
according to data from orthopedists01:44:54
regarding the management of patients01:44:58
no arthritis during the pandemic01:45:00
no special features need to be treated01:45:03
according to modern recommendations for01:45:05
management of patients with osteoarthritis01:45:08
have physical activity01:45:09
discordant anti-inflammatory drugs01:45:12
And01:45:14
symptomatic drugs01:45:19
delayed action01:45:21
well of course01:45:22
anti-inflammatory diet vitamin d and01:45:27
let's hope we can help01:45:31
to our patients if they comply01:45:35
our recommendations01:45:40
proof that01:45:45
that physical therapy is beneficial01:45:48
affects01:45:50
muscular skeletal symptoms in patients01:45:53
in a post to a prominent period this proves01:45:57
this is a study and if you01:45:59
look at that01:46:01
the effect of exercise is favorable01:46:05
affects almost all systems01:46:08
who are involved in the process01:46:10
pathologically preserved01:46:13
manifestations during the start-up period01:46:17
so pretty01:46:20
modern research in twenty01:46:23
first year in May '21 published01:46:25
that is, physical therapy is one of01:46:28
the most important factors01:46:30
treating patients is empty to a prominent period01:46:34
wonka view and including patients with01:46:37
osteoarthritis01:46:41
currently even we have released01:46:44
remember methodological recommendations01:46:47
features of the course and treatment01:46:50
patients during the Ilonka period01:46:55
all this is reflected there, including01:46:59
guest of arthritis01:47:02
Now, if you take extracts from these01:47:07
symptomatic slow-acting medication01:47:09
look at the actions01:47:11
continue all all all medications01:47:14
continue and continue NSAIDs if available01:47:19
contraindications01:47:26
talking about the prospects for oral treatment01:47:29
arthritis but there are many different approaches01:47:33
the drug is being studied but let us at least01:47:36
let's use what we have now01:47:38
absolutely accessible and01:47:40
we will help our patients01:47:43
All01:47:55
Thank you01:48:16
[music]01:48:25
[music]01:48:45
exacerbation of inflammatory diseases01:48:47
joints causes excruciating pain01:48:50
makes it impossible to work does not subside in01:48:52
peace of mind bothers me even at night how to help01:48:55
to the patient if the usual means have become01:48:57
insufficiently effective mind sharing01:49:00
printers relief of pain and inflammation01:49:02
single injection single injection am by01:49:05
no umpo renders provide fast and01:49:08
long-term relief of pain and inflammation01:49:10
exchange of mind couples enterol is indicated for01:49:13
inflammatory and degenerative01:49:14
diseases of the musculoskeletal01:49:16
inflammatory pain apparatus01:49:18
spine exacerbation of arthritis with01:49:21
gout how to use the body01:49:23
palindrome intramuscular injection 2 or01:49:25
liters of solution combine parental01:49:27
effective control of acute pain01:49:31
dimexide gel modern form01:49:34
proven medicine with01:49:36
analgesic and anti-inflammatory01:49:38
action01:49:40
now in new packaging dimexide gel01:49:43
used in complex therapy01:49:44
arthritis and arthrosis01:49:46
radiculitis thrombophlebitis bruises and01:49:49
sprains01:49:50
dimexide gel penetrates deeply and quickly01:49:54
in tissue and increases skin permeability01:49:56
for other drugs01:49:59
enhances and accelerates the action of external01:50:02
forms of non-steroidal anti-inflammatory drugs01:50:04
heparin and venotonics01:50:07
low toxicity no side effects01:50:09
effects on the gastrointestinal tract01:50:12
is a safe alternative to NSAIDs01:50:15
patients with chronic kidney disease and01:50:18
diseases of the gastrointestinal tract01:50:21
dimexide gel quick relief for pain and01:50:24
inflammation01:50:25
[music]Description:
Видеозапись онлайн-семинара "Остеартрит (остеоартроз)" О лекции: Остеоартрит (остеоартроз) — наиболее частая патология суставов, её распространенность в общей популяции достигает 13%. В ходе онлайн-семинара будут рассмотрены современные представления о патогенезе остеоартрита, классификация, клинические проявления заболевания, диагностика и алгоритм лечения. Дата проведения: 16.02.22 в 20:00 мск Организатор: Образовательный центр Фармамед.РФ - один из крупнейших образовательных порталов в России. Бесплатные онлайн-семинары в программе НМО. Докладчик: Ольга Александровна Смульская Доцент кафедры общей врачебной практики Первого Санкт-Петербургского государственного медицинского университета им. акад. И.П. Павлова, врач-ревматолог СПб ГБУЗ «Клиническая ревматологическая больница № 25», кандидат медицинских наук Ссылки: Ссылка на видео: https://www.youtube.com/watch?v=KuW26DaxcAc Канал Образовательного центра Фармамед.РФ: https://www.youtube.com/channel/UCJTFAPBD3dZ3PugMTcB5xqg Уважаемые коллеги! Создайте Личный кабинет на сайте Образовательного центра Фармамед, чтобы: 1. Получать баллы программы НМО за участие в прямых трансляциях онлайн-семинаров 2. Иметь доступ к видео-архиву онлайн-семинаров 3. Видеть программу предстоящих трансляций
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