A. How do rheumatoid arthritis patients carry out home care?
A good family environment and harmonious atmosphere is very important for the treatment and recovery of rheumatoid arthritis patients.
(1) Spiritual care. Some rheumatoid arthritis patients, because of the disease affects the study, work, social activities or family life, which brings sadness, disappointment and other problems, then need the sympathy, understanding, consideration and help of family members, so as to increase the courage and confidence to overcome the disease.
(2) Life care. The home environment should be kept clean and quiet, the items used by the patient should be easy to access, and the facilities such as tables, chairs, beds, toilets or bath tubs should be suitable for the needs of the patient. Palatable food, regular indoor and outdoor activities and useful cultural entertainment will alleviate the patient’s illness.
(3) Supervise the patient to take medication and exercise. Supervise the patient to take medication on time, and guide and assist him/her to perform functional joint exercises. Encourage patients to take care of themselves, such as dressing, eating and walking by themselves. Patients and their families should understand that if they are bedridden for a long time, the joints of the limbs do not move, not only can they not cure rheumatoid arthritis, but also make the joints that may fully recover function become permanently disabled.
Second, what factors may aggravate the joint symptoms of rheumatoid arthritis.
Humidity, cold, rain, excessive fatigue, mental stimulation and irregularity in life can aggravate the symptoms.
Third, what should I pay attention to in my life?
Maintain a stable and good mood; pay attention to warmth and nutrition; have confidence; live a regular life; make a reasonable rehabilitation plan, and follow the plan for moderate intensity exercise.
Fourth, diet
Most patients with rheumatoid arthritis do not need to abstain from certain foods, in general, patients should have sufficient protein and vitamins in their diet, to be regular and quantitative, not overeating. Unsaturated long-chain fatty acids such as fish oil and certain trace elements such as selenium can help relieve symptoms, reduce the number of painful and swollen joints, shorten the duration of morning stiffness, enhance grip strength and delay fatigue, but do not change the course of the disease. In contrast, cereals (wheat, grains, oats), milk, tea, coffee, and citrus fruits may sometimes worsen symptoms in some patients, and explanations for this food intolerance are mostly thought to be due to allergies, increased intestinal permeability, or dysbiosis of the intestinal flora.
Current dietary treatment is available in two ways.
One is complementary therapy.
The second is elimination therapy. Supplemental therapy involves supplementing the patient with foods that are either deficient or beneficial in relieving the patient’s symptoms, such as fish oil, honey, algae, ginseng, vinegar, garlic, vitamin-rich vegetables, and selenium and calcium. Elimination of treatment means removing foods from the diet that the patient cannot tolerate. It is important to note that there is a high degree of individual variation in intolerable foods for each patient, and a food that is intolerable for one patient does not mean that it is intolerable for another patient.
The identification of the type of food that a patient cannot tolerate can be done as follows: first abstain from foods to which the patient may be allergic, and then gradually give the foods that are most likely to cause intolerance until symptoms worsen, and then find the “target food”. Diet is only an adjunctive treatment. The main treatment for patients with rheumatoid arthritis is medication under the guidance of a specialist. Patients with arthritis are not absolutely forbidden to drink alcohol, but they should not drink strong alcohol. During the stabilization period, you can drink a little yellow wine or medicinal wine to promote joint function recovery, but you should pay attention to the impact of alcohol on the patient’s stomach and liver function.
Five, rheumatoid arthritis patients why functional exercise, how to carry out?
Functional joint exercise is a treatment tool for rheumatoid arthritis in remission and has a very important role in its prognosis. Through joint exercises, muscle strength can be increased, joint mobility can be preserved, and joint contracture, ankylosis and muscle atrophy can be prevented. Therefore, as long as the patient can tolerate it, functional exercise of each joint should be carried out early and regularly.
There are many ways of functional exercise, which can be chosen according to the different parts of the diseased joint, such as bed exercise, resistance exercise, standing on crutches and walking. The amount of activity should be from small to large, the time from short to long, and the number of times from small to large. Generally speaking, the daily activity level should not aggravate the local symptoms and not affect the next day’s exercise. If the activity of the first day causes the aggravation of joint symptoms on the next day, it indicates that the amount of exercise is too much, and the original activity should be slightly reduced, and then the activity amount should be increased incrementally when the tolerance increases. In short, functional exercise should be gradual, persistent.
What is the rehabilitation treatment for rheumatoid arthritis?
Rheumatoid arthritis patients in remission can carry out functional rehabilitation, the purpose of rehabilitation is to increase the mobility and flexibility of the joints, to prevent deformity, to maintain the ability to take care of themselves. Functional training should be gradual, starting with exercises in bed, gradually getting out of bed, and further participating in activities such as walking, cycling, and tai chi; physical therapy, such as hot and cold therapy, magnetic therapy, infrared therapy, and acupuncture therapy, can also be performed under the guidance of a rehabilitation physician.
Rehabilitation is one of the treatment methods for many types of arthritis, however, rehabilitation is often easily ignored by many clinicians; on the other hand, it is difficult to get targeted rehabilitation treatment because of the dysfunction of community medicine and the concentration of patients in large general hospitals. Therefore, it is even more necessary to emphasize the need for rehabilitation.
Medical studies have shown that aerobic exercise is effective in improving physiological reserve indicators in patients with arthritis, and in addition there is credible evidence that exercise does not aggravate pain or accelerate the disease process. Rheumatoid arthritis has a variety of effects on the locomotor system, including: pain, swelling, limited range of motion, muscle weakness, and instability. The primary goal of rehabilitative exercise is to improve the patient’s function. A thorough evaluation of the patient is required prior to developing a rehabilitation exercise program, including: current treatment received, joint pain, inflammation, stability, range of motion, and muscle weakness. The above data provide the basis for developing an exercise program. The patient should also be evaluated for any underlying conditions that can be aggravated by exercise.
The first part of the exercise prescription is the physician-directed therapeutic exercises that address the symptoms that cause the functional deficit, such as pain, limited range of motion, and muscle weakness. The second part of the prescription is the patient’s own health exercises, which are designed to enable the patient to live independently and improve quality of life. Both therapeutic and health exercises include joint flexion and extension, strength and endurance exercises, and require individualized exercise prescriptions for each patient based on general principles.
Health education is also essential. Patients should be informed about the goals and benefits of exercise, and they should be aware of the details of their exercise prescription (e.g., intensity, duration, frequency) as well as precautions. Know the signs of over-exercise: joint pain during activity, pain for more than 1-2 hours after activity, swelling, fatigue, and weakness so that exercise parameters can be adjusted.
Basic exercise principles and parameters
Exercise prescriptions to improve flexion and extension, strength, and endurance are based on the overload and specialization theories. The overload theory states that when a muscle is subjected to more than the usual stress, the muscle produces adaptations and becomes larger in volume. Overload can be achieved by increasing the intensity, duration, and frequency of exercise. Specificity theory states that the increase in skeletal muscle capacity is determined by the training method. For example, to exercise the knee extensors, quadriceps resistance exercises are superior to bicycle pedaling exercises.
Exercise parameters include: intensity, time, frequency, and progression schedule. Intensity is expressed as a percentage of the individual’s maximum capacity. Duration for aerobic exercise is the time of a set or the total time of a week of exercise, for resistance exercises duration refers to the number of sets of exercises and the number of reps included in each set. Frequency refers to the number of exercises per week. Progressive program refers to the adjustment of intensity, time and frequency, the initial adaptation to exercise takes 2-3 months, thereafter, the intensity or time of exercise can be gradually increased (not at the same time).
Exercise techniques are classified according to muscle contraction, which is divided into resting and motor contractions. Resting or called isometric contraction does not change the length of the muscle does not move the joint. The limitation of isometric contraction exercises is that the muscles that maintain the joint at a certain angle are exercised, while the muscles at other angles are not exercised. Motor contractions change the length of the muscles and move the joints, and are further divided into isotonic and isometric contractions. Isotonic contraction is a constant angular velocity joint movement achieved by a machine. Isotonic contraction is a constant velocity joint movement produced by the joint against constant resistance. For patients with osteoarthritis, isotonic contraction is recommended to build muscle strength, and isotonic contraction is close to the condition of daily joint movement.
How to Develop an Exercise Program
The exercise program should focus on addressing the most significant problems that the patient perceives as affecting their life. Short-term and long-term goals should be available and patients should be involved in the development of the plan. Short-term goals can be achieved in 2-3 weeks, and the achievement of short-term goals can increase patients’ confidence and interest in exercise. Exercise duration starts at 20 minutes per day, 2 days per week, and gradually increases as the patient’s ability improves. Each workout consists of three phases: warm-up activity, exercise and adjustment. The warm-up activity is 5-10 minutes of low-intensity joint repetitive activities; the exercise includes joint flexion, strength, and endurance exercises (described separately below); and the adjustment period is 5 minutes of unresisted stretching of the exercised muscles.
Joint mobility exercises
Joint mobility exercises are usually the first step in the rehabilitation process. The main purpose is to reduce stiffness, increase joint movement, and prevent soft tissue contractures. The range of motion is different for inflammatory and non-inflammatory arthritis. In the acute phase of rheumatoid arthritis, joint movement should be within the pain-free range, while non-inflammatory arthritis performs resistance-free joint stretching and gentle joint movement within the patient’s comfort range while the joint movement should end with some resistance.
Precautions.
1.Select bedtime exercise for mild pain and stiffness.
2.Take a hot bath or apply local heat before exercise.
3, try to relax before exercise.
4.Joint movement slowly, within the patient’s comfort range, with a little resistance at the end of the joint movement.
5.Stay at the last angle of joint movement for 10-30 seconds.
6.Avoid pain and reduce the range of motion during the inflammation period.
Strength exercises
Resistance exercises can be effective in improving muscle strength to stabilize the joint. Develop a plan is to consider the following points.
1, joint stability and the degree of inflammation.
2, not to fatigue the muscles.
3, resistance must be less than the muscle maximum force.
4, inflammatory activity period, should be made isometric muscle exercises or non-resistance joint activities, the number of times to reduce.
5, inflammation period of the joint can not do isotonic muscle exercises.
6, joint pain for more than one hour and joint swelling suggests excessive exercise.
Strength exercises are further divided into isometric exercises and isotonic exercises.
Isometric exercises
The purpose of isometric exercises is to increase muscle strength, improve endurance, and prepare for greater athletic activity. Usually, isometric exercises are performed first in inflamed and unstable joints, but they can also be adapted well in patients with swollen and painful arthritis.
Isotonic contraction exercises
Isotonic contraction exercises are effective in improving a patient’s energy metabolism, islet function, and bone density. Isotonic exercises simulate the muscle activities of daily life and are the main exercise method for non-inflammatory arthritis. Recommended exercise methods.
1. 8-10 sets of resistance exercises for major muscles are recommended.
2, each set of exercises 10-15 times, or until the self-feeling fatigue.
3, do 2-3 days a week, at least one day between each exercise to allow muscle recovery.
4.Progressive step by step.
Aerobic exercise
Aerobic exercise can cause a variety of physiological changes to stop the body aging. Including: improve the body’s maximum oxygen consumption, improve pancreatic function, regulate the composition of plasma lipoproteins, and lower blood pressure.
1.Select exercise methods according to different conditions (whether the disease is active, joint stability, patient preferences). Several exercise methods should be selected to avoid excessive wear and tear on a particular joint and to avoid patients feeling bored with a single exercise. Common methods include: cycling, swimming, walking, dancing, tai chi, or doing apparatus exercises, and also include light work: skating the dog, mowing the lawn, sweeping the yard. Water temperature at 36 ℃ can reduce muscle pain, the buoyancy of the water reduces the stress on the joints, increases the range of motion of the joints without pain, and provides resistance to muscle exercises.
2. The daily exercise time is 20-30 minutes. For patients who cannot adhere to continuous exercise, it can be divided into 4-5 times to complete.