Osteoarthritis deformans is the most common joint disease, which is based on premature aging and degeneration of articular cartilage associated with impaired metabolism. Elderly and senile people get sick more often.
Predisposing factors for the development of osteoarthritis are structural defects of the musculoskeletal system (scoliosis), obesity, intoxication, occupational hazards, and hereditary predisposition. Arthrosis mainly affects the hip joints and professionally overloaded joints (milkmaids, typists, pianists, dancers, and loaders are affected).
The hip, knee and hand joints are predominantly affected. Minor pain in the evening is a concern; it is characterized by slowly developing deformation of the joints due to bone changes in the absence of inflammatory changes in the joint tissues (swelling, effusion). Joint movements remain in full range (with the exception of arthrosis of the hip joints). The “starting” pain that occurs at the moment of starting movement may be disturbing, and the cracking of the joints may also be disturbing. When a piece of necrotic cartilage is pinched between the articular surfaces, a symptom of “blockade” or “joint mouse” may occur - acute sudden pain and inability to move in the joint, which then disappears.
Arthrosis of the hip joint (coxarthrosis) is the most common and severe form of deforming arthrosis. Early lameness occurs, pain in the groin area, radiating to the knee. Atrophy of the muscles of the thigh and buttock develops, the limb shortens, and the gait changes with bilateral damage (“duck” gait). Arthrosis is constantly progressing and can lead to loss of ability to work.
Body temperature and blood counts are normal. A characteristic feature of osteoarthritis is the long-term preservation of joint function, despite its severe deformation.
Secondary osteoarthritis is the outcome of various joint diseases (arthritis, trauma, especially with an intra-articular fracture), and also develops with congenital pathology of the joints that violate the correct ratio of the articular surfaces and lead to cartilage degeneration at the site of greatest load. It develops at a younger age and quickly leads to significant deformation of the joint and a decrease in its mobility.
Intervertebral osteochondrosis is degeneration of the intervertebral disc with the proliferation of marginal osteophytes. It occurs when there is mechanical overload of the spine, when it is constantly traumatized due to unfavorable working and living conditions (for loaders, athletes, drivers, etc.), when there is curvature of the spine (kyphosis, scoliosis).
Degeneration, decay of the intervertebral disc, as well as the proliferation of marginal osteophytes leads to a decrease in the intervertebral foramina, to compression of the vessels and nerve roots passing through them, and radiculitis (lumbago) occurs. The cervical and lumbar spine are most often affected, but widespread osteochondrosis may also occur. Men aged 40-60 years are more likely to get sick.
Clinical picture. I am concerned about pain and stiffness in the corresponding part of the spine, and rapid fatigue of the back muscles. With cervical radiculitis, you are bothered by sharp pain in the neck, radiating to the back of the head and arms, intensifying with movement, cooling, and exercise. With thoracic radiculitis, pain encircles the chest, intensifying with deep breathing and movement. The pain can be so intense that it is necessary to carry out differential diagnosis with an attack of angina pectoris, myocardial infarction, for this purpose an ECG is recorded. With lumbosacral radiculitis, pain occurs in the lumbar region, sacrum, pain radiates to the buttock and thigh. The pain intensifies with movement. Body temperature and blood test are normal. A Schmorl's hernia may develop; this is a local unevenness of the disc surface of the vertebrae due to the penetration of disc substance into it. The diagnosis is made on the basis of pain in the spine and a characteristic x-ray picture.
During an exacerbation, treatment is outpatient or inpatient. Bed rest is prescribed with a shield under the mattress to unload the spine. Anti-inflammatory and painkillers are prescribed: analgin with diphenhydramine, reopirin, voltaren, brufen, for severe pain - novocaine blockade, administration of kenologist. B vitamins, nicotinic acid. Prescribed drugs that improve cartilage metabolism and microcirculation in bone tissue (rumalon, arteporon, riboxin, chimes). When the pain subsides, therapeutic exercises, massage, and stretching of the spine are performed to decompress the roots, preferably water. Physiotherapy is prescribed - ultrasound, electrophoresis with novocaine, ultraviolet irradiation. Spa treatment has a good therapeutic effect: hydrogen sulfide, radon baths, mud. For severe pain that is not amenable to conservative therapy, surgical treatment is performed (removal of a cartilaginous hernia).
Problems of patients with joint diseases: joint pain, limited mobility, limited mobility, swelling of the joints, stiffness of the joints, cracking in the joints, increased body temperature, muscle atrophy, disability, fear of disability, etc.
Primary prevention consists of timely treatment of joint injuries and systematic exercise. People over 40 years old need to normalize their body weight and avoid heavy physical activity.
Date added: 2015-01-29; views: 182; Copyright infringement
Deforming osteoarthritis is a chronic degenerative disease of the joints, leading to their deformation.
Excessive physical stress on articular cartilage, hereditary predisposition.
Predisposing factors: nutritional imbalance, occupational hazards and other intoxications, alcohol abuse, previous viral infections, excess body weight, endocrine diseases, other diseases of the musculoskeletal system (flat feet, scoliosis), previous joint injuries.
Joint pain that appears and intensifies with exercise, decreases and disappears at night, and at rest.
Characteristic joint pain occurs at the beginning of movement and then disappears.
“Wedging” of the joint due to wedging between the articular surfaces of pieces of necrotic cartilage. Otherwise, the limitation of mobility in the joints is mild.
Crunching when moving the joints. Deformation (change in configuration) of the joint.
Secondary synovitis, hemarthrosis, osteonecrosis.
2. Biochemical blood test.
3. X-ray of joints.
4. Biopsy of the synovial membrane, examination of synovial fluid.
More often, women over 50 years old suffer from deforming osteoarthritis. With this pathological condition, the hip joints are usually affected, and less commonly, the knees, elbows, shoulders, and small joints of the hand.
1. Treatment regimen.
2. Balanced nutrition.
3. Drug therapy: chondroprotectors, proteolytic enzyme inhibitors, metabolic therapy, non-steroidal anti-inflammatory drugs, multivitamins, antioxidants.
6. Surgical treatment (orthopedic).
7. Sanatorium-resort treatment.
1. Normalization of body weight.
2. Active lifestyle.
3. Timely treatment of injuries and joint diseases.
1. Since the main etiological factor in the development of the disease is excessive stress on the joints, one of the components of treatment is unloading the affected joints. The patient is contraindicated for prolonged walking, going up and down stairs, standing for long periods of time, and carrying heavy objects. When walking, the patient should use a walking stick or crutches and rest every 10 minutes. If the patient’s work is associated with the above loads, it must be changed.
2. Another way to relieve joint stress is to reduce body weight (fight obesity). For this purpose, it is advised to adhere to table No. 8 (see Obesity). The patient needs to regularly arrange fasting days (cottage cheese, kefir, apple, rice-compote, meat, vegetable, etc.).
3. Exercise therapy. General strengthening exercises for undamaged joints are prescribed. Exercises for the affected joint are performed while lying on your side, back, sitting, or doing exercise therapy in the pool. Swing exercises (to increase range of motion) and resistance exercises (to increase muscle strength) are indicated for the affected joint. Active exercises are alternated with relaxation exercises for muscle groups with increased tone. All of them must be performed systematically (preferably daily). If the joints of the lower extremities and spine are affected, dosed walking is recommended; if the joints of the upper extremities are affected, light forms of labor are recommended. Swimming and cycling are useful for all forms of the disease.
4. Therapeutic massage. A relaxing massage is performed for muscles with increased tone and a tonic massage for hypotrophied, weakened muscles.
Osteoarthritis Osteoarthritis is a disease in which degenerative changes occur in the articular cartilage. Unlike arthritis, inflammation in the joint is intermittent and mild. There are primary and secondary osteoarthritis (with joint dysplasia and
Primary deforming osteoarthritis This disease belongs to the group of metabolic-dystrophic lesions of the joints. It is based on degeneration and destruction of articular cartilage, the function of which to a certain extent depends on the condition of the endocrine glands.
Deforming osteoarthritis Deforming osteoarthritis is a chronic degenerative disease of the joints, leading to their deformation. Etiology Excessive physical stress on articular cartilage, hereditary predisposition. Predisposing factors:
Osteoarthrosis Osteoarthrosis is chronic, slowly progressive destructive and degenerative changes in the joints. They can be more simply defined as wear and tear on joints. Over the years, the cartilage on the articular surfaces of bones wears away. Normally they are intended for
Osteoarthritis deformans A disease of the joints of the extremities, which is based on dystrophic changes in the cartilaginous cover with its gradual destruction and the development of joint deformation. Osteoarthritis is a chronic progressive disease of the joints,
Rheumatoid arthritis is a systemic inflammatory disease of connective tissue, characterized by progressive polyarthritis, deformities and ankylosis of the joints.
This disease belongs to the group of collagenoses, and the joints are mainly affected (knee, ankle, elbow, wrist, interphalangeal), the joint capsule and articular cartilage thicken, and therefore the function of the joint (mobility) is impaired.
E t i o l o g i .
The following are important in the development of this disease:
· disorders of the immunocompetent system
· infectious agents: retroviruses, rubella viruses, herpes, mycoplasma, cytomegalovirus, etc.
CLINICAL CARD.
· begins gradually or acutely (less often)
Characterized by multiple lesions of small and medium-sized joints of the extremities
· joints are deformed, their functions are impaired
Gradually more and more joints are affected
Pain in affected joints when moving
body temperature rises
weakness and sweating develop
· the range of movements in them is limited
Subsequently, complete immobility occurs (ankylosis)
Damage to the joints of the hand leads to deviation of the fingers towards the ulna.
This shape of the hand resembles a “walrus fin” (ulnar deviation), then a “swan neck” deformation of the fingers develops.
On the foot, deformities of the 2nd, 3rd, 4th toes cause a hammertoe appearance with subluxations in the metatarsophalangeal joints (“boutonniere symptom”). When a boutonniere finger is strained, the tendons at the top of the finger are torn or stretched. This creates a gap that resembles a buttonhole (or boutonniere in French). The joint bends the finger backward. The tendons on the top of the finger are flat and thin. They are highly prone to injury. If the thumb becomes deformed, it affects the metacarpophalangeal joints.
Over time, signs of systematicity appear in the clinical picture:
Muscles are affected (atrophy of the muscles of the hand, forearm, thigh, buttocks)
skin (subcutaneous hemorrhages, necrosis)
Gastrointestinal tract (chronic gastritis, colitis, enteritis)
liver, lungs and pleura (pleuritis)
heart (pericarditis, myocarditis, endocarditis)
The disease becomes chronic with frequent exacerbations and progressive deterioration (almost complete impairment of joint mobility).
Diagnostics.
· CBC - signs of anemia, leukocytosis, increased ESR
BAC - dysproteinemia, increased fibrinogen levels
· AI (immunological study) - the presence of rheumatoid factor, a decrease in the number of T-lymphocytes, CIC (circulating immune complexes) are detected
X -ray of joints - epiphyseal osteoporosis, narrowing of the joint space, marginal erosion
· Radioisotonic study with technetium
· Study of synovial fluid (rheumatoid factor)
· Synovial biopsy
Outcome: loss of ability to work and disability.
Principles of treatment: treatment must be comprehensive
1. Basic funds:
aminocoline drugs: delagil, planquenil (prescribed for a long time, for years)
· cytostatics: azothiaprine, metatrexate, vincristine (side effects - leukopenia, thrombocytopenia, anemia)
corticosteroids: prednisolone, metipred (taken after meals)
gold salts: crizanol, tauredon
Non-steroidal anti-inflammatory drugs: diclofenac, ketanol, voltaren (after meals)
· vascular drugs: pentoxifylline, trental
3. Additional methods:
physical therapy, massage
Extracorporeal treatment methods: hemosorption, plasmapheresis
4. Surgical treatment: prosthetics
5. Sanatorium-resort treatment: Staraya Russa, Khilovo, Sestroretsky resort, Kislovodsk.
Violation of needs satisfaction:
Maintain body temperature
joint pain in the morning and when moving
Stiffness in joint movements in the morning
Impaired ability to self-care
chills or feeling hot (increased body temperature)
· Diet recommendations: foods rich in proteins.
· During an exacerbation: ensure the optimal position in bed for the affected joints: systematically alternating flexion and extension of the affected joints throughout the day. For maximum extension of the knee joints, use sandbags.
· Recommendations for using an orthopedic mattress (do not sleep on a soft or very hard surface of the bed) and wearing orthopedic shoes
· Assess the patient's ability to self-care.
· Train the patient and his relatives in the use of various devices for self-care and care (cane, walkers, crutches, spoon holders, pens, toothbrushes, etc.).
· Teach the patient how to apply a compress with dimexide to the affected joints
Monitoring body temperature, blood pressure, pulse rate,
· Monitoring the timely implementation of therapeutic exercises.
· Monitoring the timely and correct intake of medications prescribed by a doctor.
Deforming osteoarthritis is a chronic, progressive, non-inflammatory disease of the joints, characterized by damage to the articular cartilage, which becomes less resistant to normal physical stress, which leads to its thinning and destruction.
heredity, excess weight
· injuries, sports overload
· professional loads, age over 50 years
Changes in joints: with DOA, the cartilage becomes “dry”, loses its elasticity, microcracks appear on its surface, the cartilage becomes thinner and destroyed. Outgrowths called “osteophytes” appear on the articular surface of the bone. Reactive inflammation develops in the joint, affecting the ligaments and tendons (periarthritis).
joint pain during exercise
“jamming” of the joint, crunching, swelling in the joints
limitation of movement, joint deformation
· Chondroprotectors - activate restoration processes in cartilage: structum (chondroitin sulfate), dona, teraflex, etc. The drugs act slowly. Therefore, they must be used long-term and regularly.
· Nonsteroidal anti-inflammatory drugs (NSAIDs) are prescribed to reduce pain. NSAIDs are available in ampoules, tablets, suppositories, ointment and gel forms: diclofenac, ortofen, voltaren, indomethacin, movalis, ketonol, ketanov, etc. NSAIDs must be taken after meals.
· Surgical treatment – endoprosthetics.
Complications when using NSAIDs:
Stomach ulcer, gastric bleeding
sodium retention and edema
liver and kidney damage
destruction of articular cartilage
Compresses with dimexide on the affected joints (for 30-40 minutes) have a good analgesic effect. In the presence of reactive inflammation, hormonal drugs (Kenalog, Diproslon) are injected into the joint.
To improve joint function while reducing pain, complex treatment includes: exercise therapy, physiotherapy, massage, hydrotherapy, mud.
Nursing process in rheumatoid arthritis, deforming osteoarthritis" src="http://present5.com/presentacii/20170504/130-revm_artrit,_doa.ppt_images/130-revm_artrit,_doa.ppt_0.jpg" alt=">Nursing process in rheumatoid arthritis, deforming osteoarthritis" /> Nursing process for rheumatoid arthritis, deforming osteoarthritis
Control block Control of initial knowledge" src="http://present5.com/presentacii/20170504/130-revm_artrit,_doa.ppt_images/130-revm_artrit,_doa.ppt_1.jpg" alt=">Control block Control of initial knowledge" / > Control block Control of initial knowledge
1. Name the constituent elements of the joint" src="http://present5.com/presentacii/20170504/130-revm_artrit,_doa.ppt_images/130-revm_artrit,_doa.ppt_2.jpg" alt=">1. Name the constituent elements of the joint» /> 1. Name the constituent elements of the joint
2. Name the main functions of the joints Motor (moving the body in space) Supportive (maintaining position" src="http://present5.com/presentacii/20170504/130-revm_artrit,_doa.ppt_images/130-revm_artrit,_doa.ppt_3.jpg » alt=»>2. Name the main functions of the joints Motor (moving the body in space) Supporting (maintaining position) /> 2. Name the main functions of the joints Motor (moving the body in space) Supporting (maintaining the position of the body)
3. Name the types of joints based on the principle of their connection Synarthrosis » src=»http://present5.com/presentacii/20170504/130-revm_artrit,_doa.ppt_images/130-revm_artrit,_doa.ppt_4.jpg» alt=»>3. Name the types of joints according to the principle of their connection Synarthrosis » /> 3. Name the types of joints according to the principle of their connection Synarthrosis symphysis diarthrosis
4. What are synarthrosis? Give examples of such joints. Fixed joints connecting bones" src="http://present5.com/presentacii/20170504/130-revm_artrit,_doa.ppt_images/130-revm_artrit,_doa.ppt_5.jpg" alt=">4. What are synarthrosis? Give examples of such joints. Fixed joints connecting bones” /> 4. What are synarthrosis? Give examples of such joints. Fixed joints connecting the bones of the skull, spinous processes of the vertebrae, costosternal joints.
5. What are symphyses? Semi-movable joints of the cartilaginous type of rib » src=»http://present5.com/presentacii/20170504/130-revm_artrit,_doa.ppt_images/130-revm_artrit,_doa.ppt_6.jpg» alt=»>5. What are symphyses? Semi-movable joints of the cartilaginous type of the rib » /> 5. What are symphyses? Semi-movable joints of the cartilaginous type of the rib spine
6. Which joints are called diarthrosis? Give examples. Movable joints (true joints)" src="http://present5.com/presentacii/20170504/130-revm_artrit,_doa.ppt_images/130-revm_artrit,_doa.ppt_7.jpg" alt=">6. What joints are called diarthrosis? Give examples. Movable joints (true joints)» /> 6. Which joints are called diarthrosis? Give examples. Movable joints (true joints) knees, elbows, etc.
7. What is the function of joint fluid? The role of lubrication between articular surfaces." src=»http://present5.com/presentacii/20170504/130-revm_artrit,_doa.ppt_images/130-revm_artrit,_doa.ppt_8.jpg» alt=»>7. What is the function of joint fluid? The role of lubrication between articular surfaces." /> 7. What is the function of joint fluid? The role of lubrication between articular surfaces.
8. Name the types of movements in the joints" src="http://present5.com/presentacii/20170504/130-revm_artrit,_doa.ppt_images/130-revm_artrit,_doa.ppt_9.jpg" alt=">8. Name the types of movements in the joints» /> 8. Name the types of movements in the joints
9. What is joint contracture? Ankylosis? Contracture is a limitation of mobility in a joint » src=»http://present5.com/presentacii/20170504/130-revm_artrit,_doa.ppt_images/130-revm_artrit,_doa.ppt_10.jpg» alt=»>9. What is joint contracture? Ankylosis? Contracture is a limitation of mobility in a joint » /> 9. What is joint contracture? Ankylosis? Contracture – limited mobility in a joint Ankylosis – lack of mobility in a joint
10. What is arthritis? Joint inflammation" src="http://present5.com/presentacii/20170504/130-revm_artrit,_doa.ppt_images/130-revm_artrit,_doa.ppt_11.jpg" alt=">10. What is arthritis? Inflammation of the joint» /> 10. What is arthritis? Joint inflammation
11. What minerals give strength and hardness to bones? Calcium, magnesium, phosphorus.” src=»http://present5.com/presentacii/20170504/130-revm_artrit,_doa.ppt_images/130-revm_artrit,_doa.ppt_12.jpg» alt=»>11. What minerals give strength and hardness to bones? Calcium, magnesium, phosphorus.” /> 11. What minerals give strength and hardness to bones? Calcium, magnesium, phosphorus.
Risk factors for diseases of the musculoskeletal system; »>Risk factors for diseases of the musculoskeletal system old age female gender (women get sick" /> Risk factors for diseases of the musculoskeletal system old age female gender (women get sick 2 times more often than men) heredity excess body weight poorly balanced diet professional activity professional occupation sports joint injuries
Classification of joint diseases Joint diseases Arthritis is an inflammatory process in the synovial membrane, articular cartilage" src="http://present5.com/presentacii/20170504/130-revm_artrit,_doa.ppt_images/130-revm_artrit,_doa.ppt_14.jpg" alt= »>Classification of joint diseases Joint diseases Arthritis inflammatory process in the synovial membrane, articular cartilage» /> Classification of joint diseases Joint diseases Arthritis inflammatory process in the synovial membrane, articular cartilage and periarticular tissues inflammatory fluid in the joint cavity Arthrosis metabolic-dystrophic process cartilage atrophy, discharge bone tissue (osteoporosis) new formation of bone tissue (osteophytosis) deposits of calcium salts in joint tissue
Clinical signs - Localization of pain Nature and intensity of pain Circumstances of occurrence" src="http://present5.com/presentacii/20170504/130-revm_artrit,_doa.ppt_images/130-revm_artrit,_doa.ppt_15.jpg" alt=">Clinical signs – Localization of pain Nature and intensity of pain Circumstances of occurrence» /> Clinical signs – Localization of pain Nature and intensity of pain Circumstances of pain Causes that intensify or alleviate pain
Clinical signs - articular and periarticular symptoms Number of affected joints » src=»http://present5.com/presentacii/20170504/130-revm_artrit,_doa.ppt_images/130-revm_artrit,_doa.ppt_16.jpg» alt=»>Clinical signs – articular and periarticular symptoms Number of affected joints » /> Clinical signs – articular and periarticular symptoms Number of affected joints monoarthritis (one) – trauma oligoarthritis (1-4) – rheumatoid arthritis polyarthritis (>4) – rheumatoid arthritis
Clinical signs - periarticular symptoms inflammatory swelling of the tissues surrounding the joint effusion" src="http://present5.com/presentacii/20170504/130-revm_artrit,_doa.ppt_images/130-revm_artrit,_doa.ppt_17.jpg" alt=">Clinical signs – periarticular symptoms, inflammatory swelling of the tissues surrounding the joint, effusion” /> Clinical signs – periarticular symptoms, inflammatory swelling of the tissues surrounding the joint, effusion into the joint cavity. Swelling of joints Defiguration (short-term changes), deformation (persistent changes). Restricted mobility Muscle rigidity (stiffness) Hyperemia and local increase in t?
Clinical signs - general symptoms fever chills fatigue anorexia" src="http://present5.com/presentacii/20170504/130-revm_artrit,_doa.ppt_images/130-revm_artrit,_doa.ppt_18.jpg" alt=">Clinical signs - general symptoms: fever, chills, fatigue, anorexia" /> Clinical signs – general symptoms: fever, chills, fatigue, anorexia, weight loss, weakness, rheumatoid, rheumatic, gouty polyarthritis
functional state of the patient Mnemonic key ADEPTTS - how well the patient is “adapted” to his physical” src=”http://present5.com/presentacii/20170504/130-revm_artrit,_doa.ppt_images/130-revm_artrit,_doa.ppt_19.jpg” alt=»>functional state of the patient Mnemonic key ADEPTTS - how well the patient is “adapted” to his physical” /> functional state of the patient Mnemonic key ADEPTTS - how well the patient is “adapted” to his physical disability: A - Walking (Ambulation); D - Dressing; E - Eating; P - Personal hygiene; T - Transfers; T - Toilet; S - Sleeping/Sexual activities.
Principles of treatment Treatment goals Slowing the progression of the disease Reducing pain and "src="http://present5.com/presentacii/20170504/130-revm_artrit,_doa.ppt_images/130-revm_artrit,_doa.ppt_20.jpg" alt=">Principles of treatment Treatment goals: Slowing the progression of the disease Reducing pain and " /> Principles of treatment Treatment goals: Slowing the progression of the disease Reducing pain and inflammation Reducing the risk of exacerbations and damage to new joints Improving quality of life Preventing disability
Deforming osteoarthritis (DOA) DOA is a degenerative joint disease with elements of inflammation and changes in cartilage" src="http://present5.com/presentacii/20170504/130-revm_artrit,_doa.ppt_images/130-revm_artrit,_doa.ppt_21.jpg" alt =">Deforming osteoarthritis (DOA) DOA is a degenerative disease of the joints with elements of inflammation and changes in cartilage" /> Deforming osteoarthritis (DOA) DOA is a degenerative disease of the joints with elements of inflammation and changes in cartilage tissue against the background of mechanical overload, destruction of articular surfaces, deformation and dysfunction of mainly supporting joints
DOA - causes Primary - degeneration in healthy cartilage Secondary" src="http://present5.com/presentacii/20170504/130-revm_artrit,_doa.ppt_images/130-revm_artrit,_doa.ppt_22.jpg" alt=">DOA - causes Primary – degeneration in healthy cartilage Secondary» /> DOA – causes Primary – degeneration in healthy cartilage Secondary – degeneration of already changed articular cartilage Risk factors Genetic – female gender 2. Acquired old age excess weight joint surgery 3. Environmental factors mechanical load joint injuries
Pathogenesis Stages of the pathogenesis of osteoarthritis: A - healthy joint covered with articular cartilage; B - fragmentation" src="http://present5.com/presentacii/20170504/130-revm_artrit,_doa.ppt_images/130-revm_artrit,_doa.ppt_23.jpg" alt=">Pathogenesis Stages of the pathogenesis of osteoarthritis: A - healthy joint , covered with articular cartilage; B - fragmentation" /> Pathogenesis Stages of the pathogenesis of osteoarthritis: A - healthy joint covered with articular cartilage; B - fragmentation and thinning of articular cartilage; C - partial loss of cartilage and changes in the underlying layer of bone; D - rapid loss of cartilage, cystic degeneration of the underlying bone and formation of osteophytes.
Symptoms Starting pain in the knee joints in the morning ( Symptoms Starting pain in the knee joints in the morning ( Symptoms Starting pain in the knee joints in the morning ( DOA characteristic localization of the lesion Spine Load-bearing joints (knees, hips) Small joints " /> DOA characteristic localization of the lesion Spine Load-bearing joints (knee, hip) Small joints of the hands - interphalangeal joints of the hands - metatarsophalangeal joint of the first toes coxarthrosis gonarthrosis
secondary vocational education in Moscow
"Medical College No. 8 of the Moscow Department of Health"
Topic 3.7.1. Nursing process
rheumatoid arthritis, deforming
Section 3.7. Nursing process for diseases
musculoskeletal system and connective tissue
(movement of a body in space)
joint mobility
OTHERWISE THEY WILL NOT WORK.
• risk factors for joint damage;
• definition of the concept of “rheumatoid arthritis” - RA;
• clinical signs of RA;
• definition of the concept “osteoarthrosis” - OA;
• clinical manifestations, diagnosis of OA;
• principles of treatment of RA, OA;
• problems of patients with diseases of the musculoskeletal system;
• prevention of RA, OA, rehabilitation.
• female gender (women
get sick 2 times more often than men)
• overweight
• poorly balanced diet
• professional sports
inflammatory process in
articular cartilage and
inflammatory fluid in
cartilage atrophy, bone loss
new bone formation (osteophytosis)
deposits of calcium salts in joint tissue
hands and feet
monoarthritis (one) – injury
oligoarthritis (1-4) – rheumatoid arthritis
polyarthritis (>4) – rheumatoid arthritis
Nature and intensity of pain
Circumstances of pain
Reasons that strengthen or alleviate
Hyperemia and local
tissues surrounding the joint
•effusion into the joint cavity.
Acute sore throat
Diarrhea and abdominal pain
the patient is "adapted" to his physical
• A - Walking (Ambulation);
• D - Dressing;
• E — Eating;
• P — Personal hygiene;
• T — Transfers;
• T — Toilet;
• S - Sleeping/Sexual activity
joints with elements of inflammation
changes in cartilage tissue
against the background of mechanical overload
deformation and dysfunction
predominantly supporting joints
degeneration in healthy
degeneration of already changed
- joint surgery
3. Environmental factors
- mechanical load on joints
A - healthy joint covered with articular cartilage;
B - fragmentation and thinning of articular cartilage;
C - partial loss of cartilage and changes in the underlying layer of bone;
D - rapid loss of cartilage, cystic degeneration of the underlying bone and
• Mechanical pain – associated with physical activity
• “Blocked” pain – joint “mouse”
• Crunching in the joints (crepitus) when moving
• Increase in joint volume (proliferation
osteophytes, inflammatory edema)
• Heberden's or Bouchard's nodes permanent deformation
small joints of the hands and metatarsophalangeal
joints of the first toes
• Difficulty walking up stairs (especially downstairs)
Chelyabinsk State Medical Academy
Faculty of Higher Nursing Education and Management
Department of Nursing, Nursing and Management
Test of nursing in therapy. Topic: “Case history (deforming osteoarthritis).”
Completed by : 3rd year student of group 368, Filatova Natalya Anatolyevna. G. Chelyabinsk Komsomolsky pr-kt no. 84 A-kV. 353 s.t. 8-9068900432 I checked:
Name of the medical institution MUZ City Clinical Hospital No. 3 polyclinic
Date and time of admission 9.00 a.m. 07/06. 09
Day hospital department
Inpatient days spent 12 days
1. Full name : Skachkova Lyudmila Petrovna
4. Permanent place of residence Chelyabinsk, st. Molodogvardeytsev 70 A - apt. 132
5. Place of work, profession, school No. 41, teacher.
6. Who referred the patient to the surgeon at the clinic
7. Hospitalized as planned
8. Medical diagnosis Osteoarthritis with damage to the knee joints, FNS I-II stage. Synovitis.
1. Survey stage (data collection).
Upon admission to the hospital, the patient complained:
· pain in the knee joints that occurs at the beginning of movement, during prolonged sitting, gradually subsiding as physical activity continues, intensifying in the evening and decreasing after rest. Sometimes the pain intensifies with hypothermia and reacts to changes in atmospheric pressure (magnetic storms). Notes the presence of stiffness in the joints in the morning, which goes away after 10-15 minutes.
· crunching in the knee joints when moving;
· limitation of movements in the knee joints: limitation of flexion and extension, inability to squat, difficulty going down stairs;
· swelling of the knee joints, increased local temperature.
Considers himself sick for about 9 years. He associates this with standing on his feet for a long time (he works as a teacher). At first I was bothered by pain in my joints, which I didn’t pay attention to. She did not seek medical help; she was treated independently by taking diclofenac and warming her knee joints with salt.
I first turned to doctors about 5 years ago, when the pain became more frequent, the crunching in the joints increased, and there was some limitation in movement. It was recommended to take NSAIDs and limit the load on the joints.
This time I went to the doctor with increased pain, limited mobility and a slight enlargement of the joint. She was referred to a day hospital after consultation with an orthopedist.
She was not undergoing hospital treatment for this disease.
Born and raised in Chelyabinsk, she grew up and developed in good social and living conditions.
Married. Family composition: husband, 2 children.
Denies injuries, operations and blood transfusions.
Heredity is not burdened (father died at 67 years old from rectal cancer, mother is alive). There are no brothers or sisters.
Denies tuberculosis and sexually transmitted diseases.
There are no bad habits.
There are no allergic reactions to medications or food.
Among the past diseases, acute respiratory viral infections are not common.
Gynecological history: mensis since 13 years, regular, painless. Menopause from age 48. Pregnancy -4; childbirth - 2; abortion - 2. Pregnancy and childbirth without complications.
The work involves standing on your feet for a long time, as well as a lot of walking.
General condition is satisfactory. Consciousness is clear, facial expression is calm.
The physique is correct, the constitution is normosthenic. Weight 60 kg, height 162 cm. The skin and visible mucous membranes are pink. Skin moisture is moderate, tissue turgor and skin elasticity are preserved, there are no rashes.
There is deformation and deformation of the knee joints on both sides. Some limitation of movement in these same joints. Pain on palpation of the joints, swelling, normal temperature.
Breathing is deep, rhythmic, there is no shortness of breath. The chest is symmetrical. Both halves participate symmetrically in the act of breathing. NPV 16 per minute. No pain was detected on palpation of the chest. Voice tremor is not changed, it is carried out equally in symmetrical areas of the chest. With comparative percussion over the percussed surface of the lungs, the percussion sound is clear, pulmonary, and the same on both sides. Auscultation of the lungs revealed vesicular breathing over the entire examined surface. No wheezing, crepitus or pleural friction noise was detected. Bronchophony is symmetrical and not changed.
The arterial pulse is the same on both radial arteries, 68 beats/min, rhythmic, corresponds to the heart rate, full, soft, small, slow. Blood pressure 140/80 mm. rt. Art.
The boundaries of the heart are not changed.
The oral mucosa is pale pink, there are no cracks or ulcerations, the gums are pink, dense, without signs of bleeding. The soft and hard palates are pink, without plaques, ulcerations and hemorrhages.
The abdomen, when examined standing and lying down, has a normal configuration, symmetrical, and is involved in breathing. There is no visible peristalsis or dilated saphenous veins. The skin of the abdomen is not changed. Palpation revealed no tension in the anterior abdominal wall; the abdomen was soft and painless. There are no hernias of the linea alba or diastasis of the rectus muscles.
The liver is not enlarged. The gallbladder is not palpable,
The spleen is not accessible for palpation in the supine or lateral position.
The kidneys are not palpable in the lying or standing position. The symptom of tapping in the lumbar region is negative. The bladder is not palpable; upon percussion over the examined surface of the bladder, there is a dull tympanic percussion sound. Urination is regular and painless.
Examination of the thyroid gland did not reveal any increase in size. The isthmus of the gland is palpated with a soft consistency, painless, and mobile. Secondary sexual characteristics are expressed in the female type according to age and gender.
Mental development is not affected. Smell and taste are pronounced. Vision and speech are not impaired. The movements are coordinated, the finger-nose test is positive. Dermographism is fast, clear, red.
Syndromes : pain syndrome, joint syndrome.
Medical diagnosis: Osteoarthrosis with damage to the knee joints, stage I-II. Synovitis.
II . Nursing diagnosis: pain syndrome , joint syndrome.
Students, graduate students, young scientists who use the knowledge base in their studies and work will be very grateful to you.
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MINISTRY OF HEALTH OF THE NIZHNY NOVGOROD REGION
STATE BUDGETARY PROFESSIONAL EDUCATIONAL INSTITUTION OF NIZHNY NOVGOROD REGION
"NIZHNY NOVGOROD MEDICAL COLLEGE"
Specialty 02/34/01 Nursing
Topic: “Problems of patients with deforming osteoarthritis and planning of nursing care in a hospital rehabilitation department”
Olgina Lyubov Alekseevna
Nizhny Novgorod
Osteoarthritis is the most common form of joint pathology, affecting 10-12% of the population. Also the most common diseases of the musculoskeletal system. It affects at least 20% of the world's population. The disease usually begins after the age of 40 years. Radiological signs of osteoarthritis are found in 50% of people aged 55 years and in 80% of people over 75 years of age. Osteoarthrosis of the knee joint (gonarthrosis) develops more often in women, and of the hip joint (coxarthrosis) - in men. Before age 50, the prevalence of osteoarthritis is generally higher in men than in women. After 50 years, osteoarthritis of the knee joints, joints of the hands and feet is more often observed in women. Osteoarthritis occurs in young people and can develop after joint injuries, inflammatory processes, or against the background of congenital pathology of the musculoskeletal system.
The choice of the topic “Deforming osteoarthritis” is due to its relevance for practical healthcare.
Subject of study of the patient's problem and nursing process with deforming osteoarthritis.
The object of the study is a patient with deforming osteoarthritis.
The purpose of the study is to expand and systematize knowledge in the study of the nursing process for deforming osteoarthritis.
2. Drawing up a problem form.
3. Draw up a nursing care plan and evaluate the effectiveness of the nurse.
* empirical - observation, additional research methods: organizational, subjective, objective;
* biographical (analysis of anamnestic information, study of medical documentation);
The course work has the following structure: title page; table of contents; introduction; theoretical and practical part; conclusion; bibliography; six applications and consists of pages.
Deforming osteoarthritis is a chronic disease of the joints of a degenerative-inflammatory nature, which is characterized by damage to the hyaline cartilage covering the articular surfaces of bones, as well as the underlying bone tissue itself, the development of osteophytes, and in later stages - persistent deformation of diseased joints. (Annex 1).
The development of deforming arthrosis leads to many reasons, which can be divided into a number of categories:
· Mechanical. The main reason for the development of deforming arthrosis is macro- and microtraumatization of articular cartilage, leading to its destruction. As a result, the statics of the joint is disrupted and the load on individual areas of the cartilage increases, which are subsequently also destroyed. [eleven]
· Angiotrophic. The second most important cause of osteoarthritis is malnutrition of the joint due to damage to the blood vessels. Nutrition may also be impaired due to neurological disorders.
· Metabolic. Due to age-related changes and trauma, metabolic disorders occur in the cartilage. In particular, the amount of chondroitin sulfate decreases in the affected cartilage.
· Synovial. Great importance is attached to changing the composition of synovial fluid, which is a kind of lubricant in the joint. Also, the development of osteoarthritis is promoted by the constant presence of a certain amount of blood in the joint cavity.
1.2 Risk factors
· Trauma. Intra-articular fractures or fractures of tubular bones near the joint, sprains and ruptures of ligaments. [9]
· Chronic microtraumatization of cartilage . The main cause of arthrosis can be considered a discrepancy between the mechanical load on the articular surface of the cartilage and the ability of the cartilage tissue to resist this load. Therefore, arthrosis often develops in people who perform heavy physical work with mechanical overload of the joints, with frequently repeated stereotyped movements, as well as in athletes.
· Operations on joints. In recent years, surgical treatment of fractures has been carried out very often; in some cases, metal structures remain in the joint cavity and rub against the articular surface. In the long term, such operations lead to the development of deforming arthrosis.
· Flat feet . To prevent deforming osteoarthritis with flat feet, it is usually enough to wear properly selected insoles.
· Shortening of one of the lower limbs.
· Age. Both proteoglycan aggregation defects and fiber disintegration of the collagen cartilage framework are enhanced, resulting in favorable conditions for the development of deforming osteoarthritis.
· Genetic factors. The development of arthrosis of the interphalangeal joints of the hands with accompanying erosive changes is 10 times more common in women, which is explained by the autosomal dominant inheritance of this pathology in them and the recessive transmission of this trait in men. Recently discovered defects in the type II collagen gene lead to collagen degeneration.
· Inflammation. Acute or chronic infectious arthritis, including tuberculosis, nonspecific inflammation of the joint, rheumatoid arthritis, etc. lead to the development of arthrosis. The detection of immunoglobulins and complement fixed on the surface of articular cartilage suggests their role in the course of arthrosis.
· Neurogenic disorders . Impaired nerve conduction leads to a decrease in the tone of the muscles located near the joint, and as a result, to increased mechanical load on the joint.
· Metabolic disorders, especially so-called “storage” diseases, for example, hemochromatosis, ochronosis, chondrocalcinosis, gout. The deposition of various substances in the cartilage matrix usually leads to direct damage to chondrocytes and a secondary impairment of the shock-absorbing ability of cartilage. [12]
· Obesity. Overweight people have a high incidence of knee OA. Obese weight loss may reduce risk of developing OA
· Eating disorder. Insufficient consumption of foods containing initial building materials for the formation of cartilage.
· Ecology. Environmental disturbances adversely affect the digestive processes; as a result, many patients have impaired absorption of products containing proteoglycans.
· Urbanization. Urbanization has led to a sedentary lifestyle and a sharp limitation of physical activity; against this background, even minor physical activity can be perceived by the body as excessive.
Deforming osteoarthritis affects all tissues of synovial joints. The disease is manifested by morphological, biochemical, molecular and biomechanical changes in cells and matrix, which lead to softening, fiberization, ulceration and a decrease in the thickness of articular cartilage, as well as osteosclerosis with a sharp thickening and compaction of the cortical layer of the subchondral bone, the formation of osteophytes and the development of subchondral cysts ( Appendix 2).
It is customary to distinguish between primary and secondary osteoarthritis.
Primary (idiopathic) - if the cause of the disease is not established, then such arthrosis is usually called primary. [6]
Generalized (3 or more joints)
* with damage to large joints.
Secondary osteoarthritis has an obvious cause: it develops after injury, with metabolic disorders, endocrine diseases, as the outcome of a degenerative-necrotic process. In this case, mainly the large joints of the lower extremities (knees and hips) are affected.
According to the course of the course, deforming osteoarthritis occurs:
1. Slowly progressive
Degrees (Appendix 3)
1. Arthrosis of the 1st degree is characterized by a slight limitation of mobility in one direction for the diseased joint; radiographs reveal small osteophytes at the edges of the joint and a moderate narrowing of the joint space.
2. Arthrosis of the 2nd degree is characterized by limited mobility in the affected joints, crunching during movements, significant osteophytes and a pronounced narrowing of the gap between the articular surfaces of the bones.
3. Arthrosis of the 3rd degree is characterized by significant deformations of the joints, their forced position, a sharp limitation of mobility, the development of ankylosis, and the complete disappearance of the joint space.
1.5 Pathological anatomy
Cartilage changes from strong, elastic, glossy and blue to dry, yellow, dull with a rough surface. At an early stage, local zones of softening of the cartilage are formed in places of maximum load; at later stages, fragmentation, cracking of the cartilage, ulceration occurs with exposure of the underlying bone and separation of fragments that enter the joint cavity in the form of detritus. In places the cartilage becomes calcified. [3]
Bone articular surfaces, deprived of cushioning by cartilage tissue, experience a large and uneven mechanical load. The curvature of the articular surfaces changes compensatoryly, and marginal osteochondral growths—osteophytes—are formed. These compensatory changes provide an increase in the contact area, reduce pressure on the articular cartilage, but at the same time limit the range of motion in the joint and contribute to the development of contractures. The bone substance is discharged, areas of ischemia and necrosis appear with the formation of round defects - cysts. Reactive synovitis develops, the capsule thickens, and atrophy of nearby muscles occurs from inactivity due to pain when moving in the affected joints. The outcome of arthrosis is complete destruction of the joint with the formation of ankylosis - complete immobility of the joint or neoarthrosis with unnatural mobility. (Appendix 4) This is accompanied by severe impairment of limb function. Changes in arthrosis are irreversible.
1.6 Clinical picture
The main general clinical manifestations of deforming osteoarthritis are:
• Joint pain;
• A crunching sensation during active and passive movements in the joint (crepitus).
• Joint instability, periodic buckling in case of damage to the joints of the lower extremities.
• Difficulty walking up stairs.
• From time to time, inflammatory complications and synovitis occur.
Joint pain is the most common and severe symptom of osteoarthritis and is heterogeneous in nature. [2] Its causes may be destructive processes in cartilaginous and subchondral structures, microcirculation disorders, fibrosis of the joint capsule, inflammatory process in soft periarticular tissues, spasm of nearby muscles and reactive synovitis. In general, the disease is characterized by a mechanical rhythm of pain - the onset of pain under the influence of daytime physical activity and subsidence during the period of night rest, which is associated with a decrease in the shock-absorbing abilities of the cartilage and bone subchondral structures to loads. In this case, the bone beams bend towards the spongy bone.
Swelling of the joints in the early stages of the disease, swelling of the joints is usually mild and persists for a short time. Occurring under heavy loads, after rest or taking anti-inflammatory medications, it goes away.
The clinical course of osteoarthritis is characterized by waves, when short periods of exacerbation are followed by spontaneous remission. Severe swelling and a local increase in temperature over the joints are not typical, but can occur with the development of secondary synovitis.
Features of the course and therapy for different localizations of osteoarthritis
Despite the presence of general symptoms of joint disease, their location makes its own adjustments to the course of the process and the probable prognosis. For example, disability occurs mainly with arthrosis of the lower extremities. Accordingly, the methods by which the treatment of deforming osteoarthritis will be most successful for a given localization of the disorder may also differ.
a) Osteoarthritis of the hip joint
Symptoms by stage:
* the pain worsens and does not subside with rest, the muscles gradually weaken, and the amplitude becomes even smaller;
* the pain is constant, due to the immobility of the joint, muscle atrophy occurs, movement is possible only with the help of a cane supported by a finger, which causes the pelvis to deform and create a one-sided load on the lower back.
b) Osteoarthritis of the knee joint
Symptoms by degree:
* deforming osteoarthritis of the knee joint of the 1st degree is characterized by mild pain after exercise, which soon disappears, the joint is not changed;
* grade 2 deforming osteoarthritis of the knee joint starts with increased pain due to the frequent occurrence of synovitis, in which fluid is observed in the joint. Morning stiffness appears, the knees increase in size and change shape, a local increase in temperature occurs, knee blockade, osteonecrosis and blood in the joint are possible;
* with deforming osteoarthritis of the knee joint, grade 3, the manifestation of all symptoms reaches a maximum: the pain is constant, walking and movements are sharply limited, the joint is severely deformed, due to osteophytes or cysts, the joint space is almost absent on x-rays.
c) Osteoarthritis of the ankle joint
d) Osteoarthritis of the shoulder joint
e) Osteoarthrosis of the hands
deforming osteoarthritis nursing treatment
The main role in diagnosis is given to the nurse, since it is she who provides round-the-clock supervision, carries out doctor’s orders, informs about upcoming instrumental and laboratory research methods and preparation for them, i.e. she is maximally involved in the process of everyday contact with the patient, and on the quality her work largely depends on the patient’s recovery.
Diagnosis of deforming osteoarthritis begins with an external examination of the affected joint, palpation, and measurement of the range of motion in it. Then laboratory and instrumental examination methods are carried out. Instrumental methods for diagnosing deforming osteoarthritis include:
• magnetic resonance imaging (MRI);
Laboratory methods include:
• Blood chemistry.
• Biopsy of the synovium, examination of synovial fluid.
Magnetic resonance imaging (MRI)
For laboratory diagnosis of deforming osteoarthritis, a blood and synovial fluid test is performed. The blood shows a normal level of ESR and the absence of rheumatoid factor. These data allow us to exclude the inflammatory nature of joint disease and are an indirect confirmation of the diagnosis of osteoarthritis.
Synovial fluid for examination is obtained during puncture or arthroscopy of the affected joint. The following indicators of synovial fluid analysis are characteristic of deforming osteoarthritis: high viscosity, leukocyte content less than 2000 per 1 μl, neutrophils less than 25%.
Long-term progression of deforming osteoarthritis can be complicated by the development of secondary reactive synovitis, spontaneous hemarthrosis, ankylosis, osteonecrosis of the femoral condyle, and external subluxation of the patella. [10]
The general principle of treatment for deforming osteoarthritis is to limit the load on the affected joints. The choice of treatment methods depends on the stage of the disease. Patients are treated primarily on an outpatient basis.
The main types of treatment for deforming osteoarthritis:
1. Mechanical unloading of the joint is one of the most important points in the treatment of osteoarthritis. [1] This includes recommendations for reducing body weight in case of obesity, avoiding prolonged stay in a fixed position, long standing on the feet, long walking, repetitive stereotypic movements, carrying heavy loads, which leads to mechanical overload of certain surfaces of the same joints. In the initial stages of arthrosis, patients need to go swimming; other types of physical activity, especially during the period of exacerbation, are contraindicated; in advanced stages of the disease, the patient is recommended to wear prostheses, walk with a cane, crutches, any exercise is contraindicated, including swimming. In case of severe pain, bed and semi-bed rest may be prescribed during the acute phase. In this case, to relax the muscular-ligamentous apparatus of the limb, the limb is given an average physiological position.
2. Therapeutic exercise is carried out with gentle mechanical loads on the joints (sitting, lying down) to reduce painful muscle spasms, increase the tone of weakened muscle groups, enhance trophism of the affected joints, and improve the patient’s functional ability. Similar goals are pursued when performing therapeutic massage, which should also be gentle on the affected joints, avoid mechanical irritation of the joint capsule, and pay special attention to working with the muscles adjacent to the joint.
3. Sanatorium-resort treatment allows for comprehensive rehabilitation, including the positive effects of therapeutic mud, baths, saunas, physiotherapy, massage, and physical therapy. An important role is played by a change of environment, stress relief, and being in the fresh air. Sanatorium-resort treatment can be carried out only without exacerbation of the disease. However, it is necessary to realize that the course of treatment at the resort is only a short-term part of the ongoing process of treatment and rehabilitation.
4. Diet - healthy foods include jellied meat. When cartilage, beef and pork legs, ears and bones are cooked, the collagen that provides their strength goes into the broth. Substances formed during the breakdown of gelatin provide many vital functions of the body: they preserve the gastric mucosa, improve memory, and prevent platelet aggregation. And this, in turn, reduces the risk of developing acute circulatory disorders and slows down aging. For osteoarthritis, foods rich in calcium (lactic acid diet) and vitamins B and C, and therapeutic fasting are also recommended. Alcohol intake is traditionally and justifiably considered a provoking factor causing increased joint and muscle pain in osteoarthritis. (Appendix 5)
5. Herbal medicine. Here are just some recipes for osteoarthritis:
• For severe pain in the joints, you can apply a steamed cabbage leaf to the sore spot overnight, bandage it with a bandage and wrap it in a woolen scarf (external use); Infuse 2 teaspoons of lingonberries in a glass of boiling water for 15 minutes, take 1-2 sips throughout the day (internal use), etc.
• Applications with dimexide can also bring relief. Before use, dimexide is diluted to a 50 percent solution, for sensitive skin to 10 - 30 percent. Gauze moistened with this solution is applied to the affected joint for 20 - 30 minutes. The course of treatment is 10 - 15 procedures.
• Bishofite compresses help relieve pain. For this purpose, 20 - 30 g of solution is diluted with warm water 1:1. Gauze, folded in several layers, is soaked in the resulting solution and applied to the area of the diseased joint, covered with plastic wrap, a layer of cotton wool and secured with a bandage. The duration of the procedure is 2 hours, you can also leave the compress overnight. The course of treatment is 12 - 14 procedures daily or every other day.
• For people suffering from night pain, we can recommend an infusion of mint leaves, valerian root and hop cones (pour 1 tablespoon of the mixture into 2 glasses of cold water for 2 - 3 hours, then bring to a boil). It has a sedative, analgesic and antispasmodic effect. Take evenly throughout the day during exacerbation of the disease. In the treatment of osteoarthritis, it is recommended to use herbal sedatives, such as valerian, cyanosis, lily of the valley, hawthorn, motherwort, in addition, tea used for metabolic disorders (blueberries, corn silk, knotweed, lingonberry leaves, bean leaves, wheatgrass root).
However, herbal medicine does not replace drug therapy. Various medications are used to treat osteoarthritis. They are available in the form of tablets, capsules, powders, solutions for oral administration or injection, as well as creams, gels, ointments, suppositories (suppositories). The question of prescribing drug therapy should be decided by a doctor!
1. Drug therapy for arthrosis is aimed at relieving pain, reducing reactive inflammation, and normalizing metabolic processes in joint tissues.
Nonsteroidal anti-inflammatory drugs (NSAIDs) have a high analgesic and anti-inflammatory effect. Voltaren has proven itself most well due to its good tolerability when used. Brufen and ibuprofen, having slightly less therapeutic activity, are also well tolerated by patients, especially in old age. A new NSAID, Xefocam, is well tolerated and highly effective. You can successfully use drugs from other groups of NSAIDs: flugalin, piroxicam, indomethacin. The patient must be oriented towards a rational diet, as well as taking medications that protect the gastric mucosa. An alternative to prescribing NSAIDs is their use in the form of rectal suppositories and intramuscular injections, although this also retains the risk of developing gastropathy. Long-term or constant use of NSAIDs is not advisable due to the increased risk of complications, as well as the negative effect of a number of drugs in this group on cartilage metabolism. Therefore, these drugs are recommended to the patient during the period of exacerbation of arthrosis. It must be remembered that a decrease in joint pain when taking NSAIDs may prompt the patient to violate the regimen and increase physical activity.
Intra-articular administration of glucocorticoids (GC). The main indication for the use of GC is the presence of synovitis, and before administering GC it is necessary to remove synovial fluid, thereby reducing the pressure in the joint and preventing stretching of the capsule and ligaments. Local administration of GC is a palliative method of treatment, and over the course of one year the number of intra-articular injections into one joint should not exceed four. It is believed that the need for double injection of GC into one joint for 12 months. indicates the ineffectiveness of the treatment, deforming osteoarthritis and requires a revision of the entire patient management plan and correction of drug therapy. In terms of Kenalog, the dose of GC, depending on the affected joint, ranges from 20 mg for the knee joint to 4 mg for the proximal and distal interphalangeal joints of the hand. The effectiveness of GC depends on the technique of intra-articular administration, the severity of synovitis, the size of the joint and the type of drug. The least effective GC, which has more side effects compared to other ones, is hydrocortisone. (Appendix 6)
2. Intra-articular oxygen therapy in conditions of oxygen deficiency increases glycolysis in joint tissues, resulting in the accumulation of under-oxidized metabolic products: lactic and pyruvic acids. Their oxidation requires enhanced oxygen delivery to joint tissue in the treatment of joint arthrosis. In addition, oxygen stretches the joint capsule and creates an unloading “gas” cushion. The technique consists of 5-6 times the introduction of medical oxygen into the cavity of the knee (40-80 ml.) and hip (10-20 ml.) joints with an interval of 5-7 days. It is used as an independent method of treatment, and in combination with chondroprotectors and corticosteroids.
1. Physiotherapeutic methods for the treatment of arthrosis are widely used and reduce pain, muscle spasms, inflammatory processes, improve microcirculation and have a beneficial effect on metabolic processes in joint tissues.[5] These include electromagnetic fields of high and ultra-high frequencies (inductothermy, decimeter and centimeter wave therapy), ultrasonic exposure, low-frequency pulsed currents - sinusoidal modulated and diadynamic, electrophoresis of drugs (analgin, novocaine, dimexide, lithium), ultraviolet irradiation, electric field UHF, magnetic therapy, hydrocortisone phonophoresis. Thermal procedures, including applications of paraffin, ozokerite, silt, peat mud are indicated for arthrosis without synovitis with pain, proliferative phenomena, vasotrophic disorders, contractures. In the absence of synovitis in stages I-II of the disease, sea, radon, sulfide, and iodine-bromine baths are effective.
2. Endoprosthetics is a cardinal operation for the treatment of arthrosis. [4] Previously used all-metal domestic prostheses caused a complication - metallosis, that is, infiltration of the surrounding soft tissues with metal dust resulting from constant friction of the metal surfaces of the prosthesis. Therefore, new endoprostheses are promising, in which the sliding unit consists of a metal-polyethylene pair.
3. Surgical treatment for arthrosis is most often used for coxarthrosis and gonarthrosis. Palliative unloading operations are used, changing the force axes of the load in the joint, reconstructive operations with the removal of non-viable areas of bone and cartilage.
4. Shock wave therapy. In Switzerland, a unique method for the treatment of arthrosis of the knee joint was developed, where the method of shock wave ultrasound therapy was used.
5. Laser therapy is used as the main method of treatment (anti-inflammatory, analgesic, stimulating effects).
Treatment for different locations of deforming osteoarthritis:
Deforming osteoarthritis of the hip joint has its own characteristics - for example, in case of early pain and stiffness, it is recommended to take muscle relaxants instead of analgesics, since the syndrome is most often caused by muscle spasm. As the process progresses, painkillers, physical therapy, and exercise therapy are prescribed. At the last stage, to restore function, the only solution is joint replacement.
Treatment of deforming osteoarthritis of the knee joint depends on the stage of the disease and the presence of complications. Treatment of the concomitant inflammatory process is paramount. Steroidal anti-inflammatory drugs are used in the form of blockade and NSAIDs. After swelling decreases, physiotherapy and exercise therapy are recommended. The use of chondroprotectors over long periods is very useful.
When diagnosed with deforming osteoarthritis of the knee joint, treatment at the last stage is only possible with surgery. The possibility of restoring function exists only with knee replacement. Modern developments in surgery make it possible to do this using a low-traumatic method - arthroscopy.
Initially, great importance for deforming osteoarthritis of the ankle joint , which can significantly alleviate the pain syndrome.
Surgical treatment: deforming osteoarthritis of the foot requires surgical intervention in the absence of positive dynamics from treatment. Arthroscopic sanitation, arthrodesis (formation of immobility to relieve pain), and also, in case of severe disorders, endoprosthetics have proven themselves to be successful.
Even in your youth, you should take care of your joints and prevent osteoarthritis. [8] Do not overload these parts of the body. If you already have arthrosis of the knee, hip or ankle joints, you should avoid sitting for long periods of time, as this impairs blood flow to the affected joints. You don't need to jump or run or squat a lot. Try to alternate stress on your joints with rest. When resting, it is best to lie down or sit down and stretch your legs, but do not cross your legs or tuck your legs under you.
With all this, with arthrosis you need to play sports, but give yourself moderate loads. Go swimming. In this sport, the muscles are used, but the joints do not work. Go for walks by bike, but ride on smooth roads. The same applies to running or walking. Skiing also removes some of the stress from the joints.
The disease can have quite serious complications. Deforming osteoarthritis leads to complete destruction of the affected joints, serious dysfunction of the limbs, and lameness. Osteoarthritis often causes disability and the need for special prosthetics.
2. Practical part
2.1 Problem bank
Based on the clinical picture, the following set of problems for patients with deforming osteoarthritis can be identified:
1. Joint pain;
2. Swelling of the joints;
3. Joint stiffness;
4. A crunching sensation when moving the joint (crepitus).
5. The patient does not know the principles of rational nutrition.
6. The patient does not get enough sleep due to frequent waking up at night.