Arthritis Care Plan and Measures

There is currently no clinical plan for a complete cure for arthritis. The optimal nursing goals are always to control pain, preserve joint mobility, and reduce the probability of long-term disability. The complete nursing system covers three modules: daily home maintenance, clinical standard intervention, and emergency emergency treatment. However, the nursing focus of different types of arthritis (osseous, rheumatoid, and gout) is very different, so it is forbidden to directly copy the general plan on the Internet.

Last week, I met a 42-year-old brother at a community free clinic. He has a history of gouty arthritis for 5 years. His feet swelled like steamed buns during an attack. When he limped over, he said, "I read on the Internet that people with arthritis need to soak their feet more to activate blood circulation. I soaked for three days and the pain was so bad that I couldn't even put on slippers." In fact, this is also the most common pitfall for many people. Regarding the choice of hot and cold compresses, different academic schools do have different opinions: Traditional Chinese orthopedic schools usually recommend the use of warm compresses and moxibustion during the chronic remission period to promote local circulation and loosen adhering soft tissues, which is very effective in improving morning stiffness and soreness. ； However, modern sports medicine clearly requires that cold compresses must be applied in the acute phase (within 72 hours of onset, when joints show obvious redness, swelling, heat and pain) to reduce inflammatory exudation by constricting blood vessels. At this time, hot compresses will only dilate blood vessels and aggravate swelling. There is nothing wrong with both options, but the applicable scenarios are completely different.

Oh, by the way, some people also asked whether to take ammonia sugar. This topic has been debated in academic circles for almost ten years. In the past few years, European and American orthopedic guidelines directly classified glucosamine into the category of "ineffective supplements." The updated guidelines in the past two years have adjusted their statement: For patients with osteoarthritis with mild to moderate cartilage wear, long-term supplementation of glucosamine may have a certain cartilage repair effect and relieve dull pain. ； But if the cartilage has reached the third degree of wear and the joint space is significantly narrowed, taking ammonia sugar has basically no effect, and there is no need to spend money.

Many people's first impression of arthritis care is "take care of yourself and move less." When I first joined the industry, I followed out outpatient clinics, and the old director always told uncles and aunts to "climb stairs less, squat less, and use joints more sparingly." Now, young doctors in the rehabilitation department will proactively prescribe exercises to patients, such as squatting against the wall and straight-leg raises. In fact, the two statements are not contradictory. If there is obvious cartilage wear and meniscus damage, you should do less activities such as climbing stairs and squatting that require joint weight and pressure. However, the quadriceps are the "natural knee protectors" of the knee joint. If the muscle strength is not enough, the joint stability will be poor, and the cartilage wear rate will be doubled or tripled when walking. I have a 62-year-old patient with knee arthritis. When he first started practicing static squats, his legs shook like sieves and he could only hold them for 10 seconds at a time. After following the plan for two months, walking up and down stairs now hardly hurts. I used to rely on painkillers to go to the vegetable market, but now I can go shopping for two hours without any problem. Of course, don’t practice blindly. When squatting silently, your knees should not exceed your toes, and the knee bend angle should not exceed 90 degrees. Stop immediately if it hurts. Carrying it hard will only aggravate the injury.

Different types of arthritis have very different care priorities, so don’t get confused. Rheumatoid arthritis is an autoimmune disease, and it is useless to just take care of it. You must strictly follow the doctor's instructions and take immune modulators. Don't stop taking the medicine on your own when the pain subsides. I have seen several patients who stopped taking the medicine privately. When they relapsed, their joints deformed so quickly that they couldn't even hold chopsticks. The core of gouty arthritis is to control uric acid. Don't touch high-purine foods such as soups, seafood, and beer. Even if you are practicing muscle strength every day, if uric acid floats above 500 μmol/L for a long time, an attack will still occur. Don't leave it to chance.

There is also the issue of knee pads. Many people wrap their knee pads tightly in the summer, saying they are afraid of the cold, but it is actually unnecessary. It’s okay to wear knee pads for warmth and support when the temperature is low and the wind is strong. Don’t wear them all the time at home or when you have no symptoms. Otherwise, the muscles will gradually atrophy without exerting force for a long time, which will make the joints less stable and fall into an endless cycle of “the more you wear them, the weaker they become, and the weaker they become, the more you need to wear them.”

If there is a sudden acute attack and the pain is severe, don't just rub it or apply plasters. First check to see if there is any redness, swelling, heat and pain. If so, wrap an ice pack in a towel and apply it for 15 minutes. Apply it every two hours. Take a non-steroidal anti-inflammatory drug such as ibuprofen as needed. If the pain is not relieved after two or three days of medication, go to the hospital to take a X-ray to find out the cause. Don’t do acupuncture, bloodletting or apply folk remedies at home. I once treated a patient who had an infection by bloodletting himself. The arthritis was not cured, and the soft tissue infection had to be treated first. The gain outweighed the gain.

In fact, after doing rehabilitation for so long, I found that the problem for most arthritis patients is not that they can't find a solution, but that they can't persist. If you feel tired after doing the training exercises for three days, you will throw them aside and look for "Yitieling" or "radical cure". In fact, arthritis care is like oiling an old bicycle. You can't expect to ride it for a lifetime. You have to maintain it regularly. Everyone's joint wear and tear and physical foundation are different. Don't just copy what your neighbor says is good. It's better to ask a doctor to take a picture first to clarify your arthritis type and degree of disease, and then customize a plan that suits you. It's more reliable than anything else.

Oh yes, a final reminder, if you have already experienced joint deformation or limited movement, don’t force yourself to do it. Seek a professional rehabilitation therapist to loosen the joints. You can easily get injured if you practice blindly on your own.