Arthritis care issues and care measures

At present, the three most common common problems in arthritis care are irregular pain management, polarized awareness of joint protection, and poor adaptability of rehabilitation training.； The corresponding core solution directions are layered analgesia, individualized joint load management, and staged rehabilitation intervention. There is no universal care plan. All measures must be adjusted based on the type of arthritis, disease stage, and patient's physical condition.

I met a 62-year-old Zhou when I was doing a free clinic in the community a while ago. He had osteoarthritis in his knees for three years. I heard the old man say, "The pain comes from not practicing enough." He climbed 10 floors every day to wear down his joints. In the end, he was in so much pain that he couldn't get out of bed. When he came here, he was on crutches, and his knees were swollen like steamed buns. I come across dozens of similar cases every year. Either they are in so much pain that they do not take any medicine, or they are unable to move at all and their muscles have atrophied. The pitfalls are almost all concentrated in the problems just mentioned.

Let’s first talk about the pain problem that troubles patients the most. When it comes to pain relief, the industry has actually been quarreling for almost two decades: Conservatives believe that anti-inflammatory painkillers such as ibuprofen and celecoxib have gastrointestinal side effects, so just take them if you can, and just rely on baking lamps and plasters to get through them. ； The modern pain management school believes that if the pain score exceeds 4 points (probably the level of pain that is so painful that you cannot sleep or walk normally), it will induce pain sensitization and cause pain at the slightest stimulation in the future, which will accelerate joint degeneration. Now our clinical practice generally adopts the middle plan: if the pain does not affect eating and sleeping, priority is given to local analgesia such as warm water packs and topical flurbiprofen gel patches to avoid the side effects of systemic medication. ； If the pain is so severe that you can't even walk, don't bear it. Take anti-inflammatory drugs for about a week as directed by your doctor. The benefits far outweigh the risks. Oh, and by the way, there is also the acute attack stage of gouty arthritis. Don’t rub it or apply hot compress. First apply cold compress to relieve pain, and take colchicine together, otherwise the swelling will become worse.

After talking about pain relief, let’s talk about joint protection, which is the area where everyone has the biggest misconception. Two extremes are particularly common nowadays: one is the "work hard" school, which feels that the joints will become stronger with more use. Even if it hurts, they have to climb mountains, do Tai Chi and squat horse steps. ； The other type is the "completely nourished" type, who rarely get out of bed except for eating and going to the bathroom, for fear of wearing out their joints. In fact, we often say in clinical practice: joints should be used sparingly, but not left unused. For example, when the swelling is severe in the acute stage of osteoarthritis, you should take less stairs and squat less. When carrying heavy things, squat down first and then get up. Do not bend down and pull directly to avoid putting extra burden on the joints. ； Once the swelling subsides and the pain subsides, you have to move, otherwise the thigh muscles will atrophy and become unable to hold the knees, causing them to wear out faster. Patients with rheumatoid arthritis should also pay more attention to the protection of small joints. When carrying bags, do not hook them with your fingers, but hold them with your palms. When opening the door, try to push it instead of twisting it with a key to avoid deformation of your fingers. There is also a question that people ask a lot, "Is arthritis caused by freezing?" Cold itself will not directly cause arthritis, but it will constrict the blood vessels around the joints, prevent inflammatory metabolites from being discharged, and make the pain worse. Therefore, it is okay to wear knee pads in cold weather, but don't wear the kind that are too tight to tighten your legs. On the contrary, they will jam the joints and put more pressure on them. You don't need to wear them all year round. Just wear them when it hurts. If you wear them for a long time, your muscles will become lazy.

Another key point that is easily overlooked is the adaptability of rehabilitation training. There was a rheumatoid patient who read online that squatting against the wall was good. He squatted for 20 minutes a day. After half a month of squatting, his knees swelled and he went to the hospital. In fact, the appropriate training for different conditions is completely different: when the swelling has just subsided in the acute stage, practice static contraction first, then do straight leg raises while lying down, so that you can practice muscle strength without moving the joints. ； When the strength is up, do silent squats against the wall, slowly increasing from 1 minute to 1 minute. Don’t let your knees go past your toes, and don’t squat too deep. ； Swimming is recognized as a joint-friendly exercise, but don’t swim if the water temperature is lower than 26 degrees, otherwise it will cause pain if you catch a cold. Swimming can also help lower uric acid during the remission period of gout patients, and is much friendlier than running or skipping. I would also like to mention a new point of view here: I used to think that patients with arthritis could not do strength training, but now the latest guidelines recommend doing light-weight lower limb strength training twice a week. As muscle mass increases, the burden on the joints can be reduced by more than 30%, as long as you don't add weight blindly.

In fact, there is no one-size-fits-all standard answer to arthritis care. Some people are allergic to plasters, some have gastrointestinal problems and cannot take painkillers, and some live in unavoidable high-rise buildings and have to take stairs. The final plan must be adjusted according to your own living habits. Don't blindly believe in the "7 days to cure arthritis" folk remedies on the Internet, and don't practice blindly on your own. Regularly consult a rehabilitation practitioner or orthopedic surgeon to adjust the plan, which is more reliable than anything else.