Arthritis care routine

Prioritize analgesia and anti-inflammation during the acute attack period, focus on reducing joint load during the remission period, and long-term care must take into account individual tolerance and quality of life. There is no uniform standard that applies to all patients, and all nursing measures must be based on the premise of "not aggravating additional joint damage."

Believe it or not, last week we just received a 62-year-old Aunt Zhang from the outpatient clinic with grade 2 degenerative knee arthritis. I heard the sisters from the square dance team in the neighborhood said, "Joint pain is caused by inactivity, just grind it out." She had to climb 20 floors every day to practice her legs. Within two weeks, she was in so much pain that she couldn't get out of bed. When she came, her knees were swollen like a steamed bun, and more than 20 milliliters of fluid were extracted from the joint cavity.

At this point, I have to mention that the current views of orthopedics and sports rehabilitation departments on acute care are slightly different: most orthopedic surgeons advocate that when redness, swelling, heat and pain are obvious in the acute phase, you should try to brake and move as little as possible to avoid joint friction and aggravation of inflammation.； Rehabilitation doctors often recommend doing some muscle isometric contraction training within the pain tolerance range to avoid rapid muscle atrophy and greater burden on the joints. In fact, both statements are correct. It all depends on your current state: if it hurts so much that you can't touch it or can't even stand, then just rest and don't practice forcefully. ； If it only hurts a little when you move and you don’t feel it when you lie still, then you can get better faster by hooking your feet and stretching your thighs while lying down.

Many people are confused about whether to apply cold compress or hot compress when they feel pain in the acute stage. This has been controversial for many years. In fact, there is no need to stick to the guide, just touch your own joints: if the skin temperature is higher than other places and the redness is obvious, then apply cold compresses for about 15 minutes each time. Put a thin towel on the skin and do not directly ice the skin. Constricting blood vessels can quickly reduce edema. ； If it is just a cold pain, no redness or swelling, and the joints become stiff due to the usual breeze, then use hot compresses if you feel comfortable, such as hot water bottles or moxibustion patches. They can promote circulation and relieve muscle tension at the same time. You can feel comfortable as long as you like.

Oh, by the way, don’t bear the pain without taking medicine. Many people think that “painkillers hurt the stomach and are addictive.” They would rather be in pain and unable to sleep without taking medicine. In fact, it is completely unnecessary. COX-2 inhibitors such as celecoxib and etoricoxib, which are commonly used now, can be used for a short period of three to five days as directed by the doctor. The side effects are much less than if you force your joints to continue to be eroded by inflammation, and they are not addictive at all. Don’t just buy miracle medicines and plasters that “can cure arthritis” in WeChat Moments and live broadcast rooms. I have seen too many patients take the so-called “ancestral secret recipe” for half a month, but the pain is gone. After checking for osteoporosis and gastric mucosal bleeding, most of them have illegally added hormones and analgesics, which is not worth the gain.

After the acute phase has passed and the patient enters the remission phase, the most important thing is to "reduce the load" on the joints. Don’t underestimate the impact of weight. Research data shows that for every 1 kilogram of weight loss, the pressure on the knee joint can be reduced by 3 kilograms when walking, and it can be reduced to 5-7 kilograms when running and jumping. I used to have a 180 kilogram patient. After losing 20 kilograms, he used to have pain two or three times a week. Now he has not had an attack for two months, and the effect is more obvious than taking ammonia sugar for more than half a year.

There is also the common saying of keeping joints warm. In Western medicine, there is actually no saying that "cold directly causes arthritis." However, catching cold will slow down local blood circulation and prevent inflammatory metabolites from being discharged, which can easily induce pain. So don’t be obsessed with “is there any scientific basis for it?” If your joints hurt when blowing the air conditioner, wear a thin knee pad instead of forcefully carrying it. However, don’t choose knee pads that are tight and extremely supportive. You can only wear them when it’s cold or in pain. Wear them as little as possible during daily activities. If you wear them for a long time, your muscles will become “lazy” and will easily atrophy due to disuse.

As for which sport to choose, there is really no standard answer. Some people say that swimming is the best. The buoyancy of water can offset most of the joint pressure. I have a patient with level 3 degenerative arthritis. It used to be so painful when walking 1,000 meters. I insist on swimming breaststroke three times a week, 40 minutes each time. After half a year, the joint space has not narrowed anymore, and I don’t have much pain when going up and down stairs. However, some patients say that the water in the swimming pool is too cold and their joints become stiff after swimming. They can also choose an elliptical machine or walk slowly on the ground. Some people also ask whether they can practice Tai Chi. Previous studies in the rehabilitation community have shown that standardized Tai Chi movements can improve knee arthritis better than regular exercise. However, the problem is that many middle-aged and elderly people squat too low when doing Tai Chi, and their knees are higher than their toes, which will cause excessive wear on the cartilage. To put it bluntly, there is only one criterion: Do your joints hurt when you do this action? As long as it hurts, no matter what others say about how good this exercise is for health, don’t do it forcefully.

The small details in daily life are actually the key to reducing attacks. For example, don’t squat for long periods of time. If you are squatting on the toilet, it is best to install a commode chair at home. I once had a patient in a rural area who squatted on the toilet for 20 minutes to check his phone every time. His arthritis kept getting worse. Later, my son bought a commode chair worth tens of yuan, and the frequency of attacks was reduced by half. Also, wear shoes. Don’t wear high heels or old cloth shoes with paper-thin soles. Choose sports shoes with elastic soles and supportive arches. They can cushion a lot of impact when your feet hit the ground, naturally reducing the pressure on your knees.

Finally, I would like to say my sincere words after having been doing joint care for more than ten years: There is never a 100% correct "care routine". No matter how good other people's experience is, it is not as reliable as your own physical experience. Some people can walk 10,000 steps a day without any problems, while some people can feel pain after walking 5,000 steps. There is no need to compare the amount of exercise with others, and there is no need to set any rigid standards. The ultimate goal of nursing is never to let you live like the template in the guide, but to have less pain and live your life comfortably.