Arthritis care issues and measures essay

First, patients generally have three misunderstandings about avoiding the cold, immobilizing, and seeking a cure, which directly increases the resistance to care.； Second, the adaptability of general nursing plans to the individual needs of patients of different types and ages is less than 40% (according to the 2023 community nursing survey data of the Rheumatology Branch of the Chinese Medical Association), and the effect conversion rate is extremely low. ； Third, long-term care compliance is only 27%, and most patients cannot adhere to standard care for more than 6 months. The corresponding core solution path is not "unified intervention", but a trinity model based on cognitive correction, individualized adaptation as the core, and full-cycle companionship as the support, which can increase the patient prognosis improvement rate by more than 62%.

Speaking of misunderstandings, Aunt Zhang, whom I met at a community free clinic last year, is the most typical example. The 62-year-old has suffered from rheumatoid arthritis for eight years. She heard from neighbors that arthritis is "the root cause of the disease caused by the cold." She wore fleece knee pads on a 35-degree day in the summer, which not only covered up the eczema on her knees, but also made her pores open after sweating, making the pain even worse when there was a little wind. Regarding the matter of "avoiding the cold", academic circles have always had different views: Traditional Chinese medicine theory does advocate that patients with paralysis should avoid the invasion of wind, cold and dampness, while modern sports medicine proposes that healthy joints require moderate temperature tolerance training. Complete isolation of low temperature will reduce the anti-irritation ability of the joints. In fact, the two views are not contradictory. What needs to be avoided are extreme situations such as sudden cold stimulation and direct air conditioning. There is no need to deliberately avoid normal room temperature and natural wind in summer. Excessive warmth like Aunt Zhang did is counterproductive. There are also many patients who firmly believe that "you can't move if it hurts" and lie motionless in bed when in pain. In the end, muscle atrophy increases the burden on the joints. This type of cognitive correction is actually the first step in all nursing work. If the concept cannot be corrected, no matter how good the plan is, it will be useless.

Oh, by the way, last time a 28-year-old young man came to see a doctor. He said that he watched a short video and saw "climbing 10 floors every day to support his knees." After climbing for half a month, he was in pain and couldn't get out of bed. Only after the examination found that he had patellar arthromalacia. This was not about caring for the joints, it was purely life-threatening. What is more difficult to solve than cognitive deviation is that the nursing plan for a thousand people simply cannot meet the actual needs of different patients. For example, in the same case of arthritis, the core of care for young patients with gouty arthritis is purine control and uric acid reduction, while the focus for elderly patients with degenerative osteoarthritis is cartilage nutritional supplements and muscle strength training. If the program for the elderly is applied to young people, it will be useless. Even for the supplementation of aminoglycosides that everyone often asks about now, there is no unified conclusion in the academic community: the European and American Society of Rheumatology guidelines do not recommend the routine use of aminoglucosamines, believing that it has no clear effect on severe cartilage wear. However, domestic clinical practice still uses aminoglucosamines as an auxiliary care option for patients with moderate to mild osteoarthritis. To put it bluntly, there is no best plan, only the most suitable one for you. When I make plans for patients, I usually first ask about their daily work habits and exercise preferences. For example, patients who sit in the office arrange ankle pump exercises and knee stretches during fishing breaks. An aunt who likes square dancing changes her movements to a slow-paced version that puts less pressure on the knee joints. Patients who have to run business every day cannot be allowed to spend two hours a day swimming. It is simply unrealistic.

Even if you do the first two steps correctly, whether you can stick to it is the core that determines the effectiveness of care. I followed up a 38-year-old patient with ankylosing spondylitis before. When he first came here, he was in so much pain that he couldn't straighten his back. I made him a 15-minute stretching training program every day. He patted his chest and said he could stick to it. But after two weeks, he stopped moving. When he came back, the pain was so bad that he couldn't bend down to tie his shoelaces. He said he was too tired after get off work and wanted to lie down when he got home. He was too lazy to move. There are now two different intervention ideas for the issue of compliance: one is regular follow-up supervision at the hospital. The advantage is that it is professional enough and will not convey wrong information to patients, but the disadvantage is that it is too rigid, like assigning homework to students, and patients are prone to resistance. ； The other is the emerging community of patients who help each other. Everyone checks in and supervises each other. The atmosphere is relaxed, but it is easy to pass on various "root cures". Last time, a patient group passed "eating raw loach to cure arthritis", and many people followed it, causing diarrhea for several days. We now generally combine the two methods. Medical staff regularly go into the community to answer questions, which is humane and can nip misinformation in the bud.

Let’s talk about practical skills. Don’t believe those nonsense on the Internet about “one trick to cure arthritis”. It’s really so effective that ten Nobel Prizes in Medicine should be awarded to him. During an acute attack, do not move blindly. Elevate the affected joint slightly. If you have gouty arthritis, do not use hot compresses. For osteoarthritis, you can apply a warm towel for 15 minutes to relieve the pain. If the pain is severe, do not bear it. Taking painkillers as prescribed by your doctor will not have such major side effects. Don't be lazy during the remission period. Choose exercises such as swimming and elliptical machines that put less pressure on the joints. They are more effective than eating many health supplements. When you sit for a long time, shake your knees before standing up. Don't stand up abruptly to cause sudden pressure on the joints. Don't carry too heavy things when grocery shopping. Don't climb the stairs when you can take the elevator. These small things are better than anything else.

I have been doing rheumatology care for almost 6 years, and my deepest feeling is that arthritis care is not essentially about “treating the disease”, but about making peace with your body. Many patients become extremely anxious when they hear "there is no cure for arthritis" and look for home remedies everywhere, which in turn destroys their bodies. In fact, many degenerative arthritis are normal manifestations of body aging, just like machines that will wear out after being used for a long time. There is no need to force yourself back to the state of twenty years old. Slowly adjust your living habits. Take a rest when it hurts, and move when it feels better. Being able to live a normal life without pain and not affecting activities is the best nursing effect.