Arthritis care issues and care measures

The two most prominent problems in arthritis clinical care are the sudden drop in quality of life caused by poor pain control and the accelerated deterioration of joint function caused by incorrect maintenance. The corresponding core solution logic is "layered analgesia adapted to individual tolerance + staged functional exercise combined with daily scene protection." There is no universal nursing formula. All measures must be adjusted based on the type of arthritis, disease course and daily habits of the patient.

Last month, I met Aunt Zhang, a 62-year-old patient with degenerative osteoarthritis at the outpatient clinic. She was watching short videos at home and saw people saying that "climbing stairs can grind bone spurs in the knees." She had to climb 30 floors a day despite the pain. When she came, her knees were swollen like a steamed bun and she couldn't even bend. When I asked her why she didn't take medicine because of the pain, she also plausibly said, "Painkillers hurt the stomach. If you take them, you will become dependent. If you tolerate the pain, it will pass."

In fact, I have met too many patients like Aunt Zhang. Many people's understanding of arthritis care is still stuck in the stereotype of "put on plaster when it hurts, and walk more when you have nothing to do", which has led to many pitfalls. Let’s talk about the most common pain care issue that everyone makes mistakes about. In fact, there is quite a controversy here: the older generation always said that painkillers should be taken without taking them. Taking too much will hurt the stomach and become addictive. This view may have made some sense 20 years ago. Now the mainstream consensus in the rheumatology department is that topical non-steroidal anti-inflammatory drugs are preferred for mild to moderate joint pain. Transdermal absorption directly acts on the lesion, and gastrointestinal adverse reactions are 80% lower than oral drugs. There is no addiction problem at all, and there is no need to take it hard. Of course, there are also many people who advocate traditional care who believe that "medicine is three parts toxic" and give priority to physical methods such as hot compress and massage. This is okay, but remember: if the joints have acute symptoms of redness, swelling and fever, hot compresses and massage will only aggravate synovial edema. Instead, local cold compresses should be used. I have seen at least hundreds of patients step on this trap, so everyone really needs to pay attention.

As for the functional exercise question that people ask the most, the most common thing I say is "It's impossible not to move, and even more impossible to move blindly." There was a 28-year-old patient with ankylosing spondylitis. He was told to lie down and rest more. He didn’t come for a follow-up checkup in half a year. When he came back, his spine was so curved that he couldn’t look up at the road. ； There was also a 40-year-old gout patient who ran 5 kilometers every day just after the attack. As a result, his cartilage wore out twice as fast as his peers. There is no standard answer here. It depends on what type of arthritis you have and what stage you are at: In the acute stage of rheumatoid arthritis, you should move as little as possible to avoid bearing weight on the joints and aggravating the damage. However, in the remission stage, you should do 10 minutes of joint mobilization exercises every day to avoid soft tissue adhesions. ； If a patient with degenerative osteoarthritis weighs more than 140 kilograms, don’t show off your step count every day. The pressure on the knee joint from swimming and squatting against the wall is only 1/3 of walking, and the effect is much better than walking 10,000 steps. I usually teach patients a little trick: when squatting quietly, the front of the knee can be flat and a mobile phone can not be dropped. The angle is just right and will not hurt the patella joint.

At this point, I would also like to mention health products such as ammonia sugar and chondroitin, which are currently very controversial. The current consensus among academic circles is that only patients with early-stage degenerative osteoarthritis and whose cartilage has not yet been obviously worn may have an auxiliary effect. If a film has been taken to show that the joint space has narrowed and bone spurs have grown, it is useless to take more, and there is no need to spend money. Many people also ask whether moxibustion and acupuncture are useful? Judging from clinical data, if the joints are sore and stiff in the remission stage, acupuncture and moxibustion from regular institutions can indeed improve local blood circulation and relieve discomfort. However, if the pain is so severe that you cannot walk in the acute stage, medication control should be given priority and treatment should not be delayed.

Small details in daily care are actually more practical than anything else. For example, people with bad knees should not wear hard-soled shoes on cobblestone roads. The vibration of hard-soled shoes is directly transmitted to the knee joint, and the pressure is 30% higher than wearing air-cushioned shoes.； Don’t wear fleece pants that are too tight in winter, as they may cause poor blood circulation around your knees and make them more prone to pain. ； Gout patients should not always think that as long as they don't eat seafood, hot pot soup and sweet drinks contain higher levels of purine than many meats, and drinking two bowls of them may trigger an attack.

In fact, after all, there are not so many mysterious rules in arthritis care. The core is "Don't bear the pain, don't make joints blindly." Everyone's joint conditions and living habits are different. The good methods used by others may not be suitable for you. If the pain lasts for more than 3 days, or the joints are swollen and cannot go away, don't blindly search for strategies to deal with it. It is better to find a doctor to adjust a plan that suits you, right?