Having worked in orthopedic medicine for more than twenty years, I often encounter the problem that many patients who come to the hospital with localized joint pain, or swelling, or uncomfortable movement, etc., actively tell their doctors that they have arthritis and ask them to give them some good anti-inflammatory drugs. You do not know that there are many types of arthritis, and different types of arthritis have completely different treatment methods and treatment effects. Another problem I encounter is that some patients with bad joints tell me that because of the bad joints, he listens to the advice of others and exercises hard, such as climbing, leg pressing, dancing, squatting, etc., but the more he practices, the worse it gets, why is that? Now I will talk to you about these problems.
I. What is arthritis?
Arthritis is a general group of inflammatory diseases involving joints, that is, lesions damage the body’s joints, joints have redness, swelling, heat, pain, dysfunctional inflammatory manifestations, or pathological composition of the joints of the tissues have degeneration, exudation, proliferative changes to be called arthritis. There are a variety of tissues involved in the composition of a joint and there are many causes of tissue inflammatory response, therefore, there are many types of arthritis, joint pain arthritis rheumatism osteophytes.
Arthritis and joint pain are not the same thing. For example, some people have varying degrees of joint pain due to weather changes, no joint redness or swelling or only slight joint swelling, pain relief after a few hours or days, no abnormalities in all kinds of examinations, joint pain repeatedly for many years after the activity remains as usual, does not leave any sequelae, other tissues and organs of the whole body are not affected, this type of joint pain is mostly called rheumatism in Chinese medicine and benign joint pain in Western medicine. It is fundamentally different from septic arthritis, rheumatoid arthritis related to allergic reaction, rheumatoid arthritis related to autoimmune reaction, and osteoarthritis related to joint degeneration. In addition, joint pain can be caused not only by arthritis, but also by muscle lesions around the joints, tendon lesions, and lesions within the bones.
Arthritis is also not the same as rheumatism. Although many types of rheumatic diseases involve joints, arthritis is only one manifestation of many rheumatic diseases. In 1993, the Arthritis Foundation of America classified rheumatic diseases into 10 categories of more than 100 diseases, and this classification scheme was adopted by the World Health Organization.
Osteomalacia is a calcification of the tendons, ligaments and joint capsules around the joints due to strain and degeneration, and is not the main cause of joint pain. Only when the hyperplasia is too large or the site is not good, extrusion, wear and tear, and impact on the adjacent tissue will the pain manifest itself.
Arthritis can be divided into the following major categories according to the etiology and clinical manifestations.
1. Infectious arthritis: caused by infection with bacteria, viruses, rickettsia and parasites, such as septic arthritis, tuberculous arthritis, etc.
2. Polyarthritis of unknown origin: this includes connective tissue diseases, such as rheumatic fever, rheumatoid arthritis, systemic lupus erythematosus, systemic scleroderma and dermatomyositis; granulomatous diseases, such as nodular disease; seronegative arthritis, such as ankylosing spondylitis, etc.
3, metabolic endocrinopathies: such as gout, hyperparathyroidism, acromegaly, etc.
4, degenerative arthropathies: such as age-related changes and joint degeneration secondary to trauma, infection late in life, etc., called osteoarthritis, or osteoarthrosis, degenerative arthritis.
5, joint trauma.
6, neurological arthropathy: such as peripheral neuritis, sympathetic arthropathy, loss of innervation of the joint lesions.
7, allergic arthropathy: such as drug arthritis, serum sickness, allergic purpura, etc.
8, bleeding disorders: such as hemophilia or intra-articular bleeding directly caused by trauma, etc.
9.Tumors and tumor-like lesions: such as leukemia, metastases, etc.
10, caused by other diseases: such as inflammatory bowel, diabetic, etc.
The most common joint lesions mainly include: septic arthritis, tuberculous arthritis, rheumatoid arthritis, osteoarthritis, gout, ankylosing spondylitis, etc.
What are the treatments for arthritis?
The treatment of arthritis should be based on the following principles.
1. for those with clear causes and triggers, remove the causes and avoid triggers to prevent recurrence of the disease.
2. improving or eliminating the patient’s symptoms and signs, protecting joint function, and improving quality of life.
3.Continuously enhance the patient’s confidence to overcome the disease and improve the ability to resist the disease.
4.Use a combination of Chinese and Western medicine to avoid or reduce the toxic side effects of drugs as much as possible. The specific method of treating arthritis varies from person to person, from disease to disease, and from disease to disease.
Once arthritis has progressed to extensive destruction of joint cartilage and severe periarticular hyperplasia and sclerosis, there is no satisfactory treatment available internationally. Therefore, patients with arthritis must be treated early to prevent the disease from progressing to a severe level.
According to the principles of arthritis treatment, there are different treatment methods for different periods of time, mainly based on comprehensive treatment, which includes the following.
Medication, including anti-infective drugs, anti-inflammatory and pain relieving drugs, immunomodulatory drugs, metabolic regulating drugs, menstrual and blood relaxing drugs, beneficial qi and exorcism drugs, trace element drugs, gene regulating drugs, etc. The methods of medication include oral administration, intramuscular injection, intravenous injection, joint cavity injection, acupoint injection, external application, external application, external fumigation, external washing and soaking.
It is worth noting that.
1, the choice of drugs and medication methods should be based on different etiologies, different periods of lesions and decided.
2, the combination of Chinese and Western medicine, the combination of internal and external medicine will help to improve the therapeutic effect.
3.Anti-inflammatory and analgesic drugs mainly refer to non-steroidal drugs, currently on the market, there are Intaxin, Fotarine, Aubert, Cilobal, Meloxicam, Mobicol, Sodium diclofenac, etc. They are not antibiotics, but can reduce the tissue inflammatory response, so as to achieve pain relief and avoid the role of tissue damage degeneration. Therefore, they should not be refused because of side effects such as gastrointestinal tract. Only patients who need to take them for a long time or who have peptic ulcers and other pathologies should use them with caution.
Acupuncture, massage and physiotherapy aim to relax the meridians and activate blood, promote blood circulation, regulate metabolism, and regulate immune function. These methods, with clear efficacy, play an important role in minimizing joint stiffness and deformity changes in the late stages of inflammation, but the course of treatment is long, the effects appear slowly, and good patient cooperation is required. It should be noted that this method of treatment should be avoided during acute episodes of inflammation, i.e., when redness, swelling, heat, and pain are evident.
Rehabilitation training treatment, including passive joint mobility training, active muscle strength training, with good training, can prevent muscle atrophy and stiffness of intra-articular adhesions, thus protecting joint function and improving quality of life.
Minimally invasive surgical treatment, mainly refers to arthroscopic surgical treatment. In the past decade or so, arthroscopic technology has continued to develop and progress, and has become one of the important means of treating joint lesions. Its advantages are small trauma, direct lesion observation and treatment, fast efficacy, and quick functional recovery. Generally, patients can resume normal life and work 3-5 days after surgery. However, there is no effective treatment for the late stage of arthritis with severe cartilage damage.
Open surgical treatment, including arthrotomy, lesion removal, irrigation and drainage; arthroplasty deformity correction; artificial joint replacement and other surgeries. Open surgery is used only when the arthritic lesion is in an advanced stage of development and the above treatments are ineffective, in order to prevent further deterioration of the disease and joint function. Through decades of research and improvement by professionals, artificial joint replacement has become an important and mature treatment to improve joint function and quality of life, and the intactness and adaptability of the artificial joint prosthesis in the human body has been greatly improved.
In short, there are many treatment methods for joint diseases, patients must be guided and assisted by experienced doctors to choose and receive treatment, do not listen to doctors or independent treatment to avoid economic and physical and mental losses.
Third, bad joints, how to exercise?
Arthritis patients are afraid or refuse to move because of joint pain. Inactivity or reduced activity can cause osteoporosis, muscle atrophy, slowing of local blood circulation, slowing of tissue metabolism, etc., and then accelerate the change of joint sclerosis and tissue degeneration. Some studies have proved that joint fixation for more than three months can cause irreversible dysfunction. Therefore, it is important to exercise. However, improper exercise can aggravate joint wear and tear, and even aggravate damage to ligaments, muscles and tendons, further aggravating joint pain and destroying joint stability, which can also cause irreversible dysfunction.
In the exercise process should pay attention to the following issues.
1, reduce weight can relieve the compression and ligament muscle strain load on the spine, knees, hips, ankles and feet, etc., to reduce further wear and tear on the joints and strains.
2, relaxation, mental attitude is essential to reduce joint pain.
3, avoid persistent standing, sitting, squatting, often changing posture helps circulation and metabolism.
4, avoid half squatting force, such as climbing, climbing stairs, tai chi, etc., because half squatting force on the knee cartilage damage the most.
5, do not fatigue exercise, such as forced leg press, long time walking, repeated squatting and standing up, fast running, long time dancing, etc., these conditions are aggravated by joint damage.
6, do not exercise in the acute phase, joint redness, swelling, heat, pain is obvious, because the acute phase of the joint tissue due to the inflammatory response is obvious and become very fragile, normal activities are likely to produce tissue damage.
7, choose the joint compression wear less, or even no exercise, such as swimming, bicycling on flat ground, lying joint extension and flexion activities, easy walking, jogging, etc.
8, pay attention to the combination of static and dynamic, the continuous time of exercise should not be too long, the interval rest time between two exercises should exceed the time of the previous exercise.
9, the way and time of exercise, also according to different ages, different causes, different degrees, different periods of lesions easy.
The correctness of exercise directly affects the prognosis of the lesion and the function of the joint, and patients should exercise under the guidance of an experienced physician.
Arthritis is a multi-morbidity and common disease. The World Health Organization has designated October 12 each year as World Arthritis Day, wishing all arthritis patients good treatment and training with proper guidance and assistance to maintain a good quality of life and a happy mood.