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Arthritis is the inflammation that occurs in the joints that causes joint pain, swelling and stiffness. It can be caused by mechanisms “autoimmune”, infection, change “Degenerative” or defects in the genes.
Types of arthritis are:
- Osteoarthritis (OA)
- Rheumatoid Arthritis
- Infectious arthritis
- Polymyalgia Rheumatica
Signs and symptoms
- Joint pain (arm, wrist, fingers, ankles, knees, hips and lower spine, especially during and after activity.
- Swelling of the joints and swelling in OA there is tension in the joint environment.
- Joint force.
- Pain around the joints.
- Krepitus during movement (in OA).
- Shrinking muscle (thigh muscle for the knee joint arthritis).
- Joint movement and function are limited and disabled.
o difficult to perform certain tasks.
o pain worsens when excessive movement.
Risk factors for osteoarthritis
- Increasing age
o in the second – two knee joints that received OA
o OA mainly occurred at all joints.
- Excessive movement.
- Severe joint injury:
o Tear in the meniscus.
o damage to the ligaments
o OA knee joints among workers.
o Thigh joint OA among farmers.
Treatment of OA involves multi-disciplinary approach aims to eliminate symptoms and improve joint function. It involves treatment without medication and use of medications. For certain cases, surgery is required.
Patients suffering from OA should be informed about the disease and long-term effects need to be discussing. Patients who understand the disease and its effect will be overcome with better and complain less pain. The main objective is to inculcate a positive attitude.
Patients who have excess body weight should be determined to lose weight. Weight loss will reduce joint pain knee OA.
5 kg weight reduction will reduce the pressure above the knee joints of 15-30 kg for each step.
Physiotherapy should start as soon as possible to improve movement of joints. improve muscle strength, reduce pain and prevent prolonged disable. All patients need to take part in exercise program for menggerakan joints and strengthen the muscles surrounding.
Exercise program must be devoted to each individual.Combined exercises, including movement, increase strength and low intensity aerobic exercise is appropriate.
There are 2 types of exercise programs:
- Motion exercises and joint exercises to increase strength.
- Isometric exercise is encouraged in the first, followed by a workout that combines network berrintangan exercise. This exercise should be done every day.
Aerobic exercise is that the incentives include walking 30 minutes 3 times a week, cycling, swimming, aerobic dancing and therapy in water.
Aid to walk
- For thigh and knee joint OA, the use of stick on the contrary reduce pressure over the joints of 50%.
- Use the appropriate height stick.
- The top holders should stick to hand kepergelangan patients when he stood up.
- Absorbent and comfortable shoes are encouraged cracks.
Tool support for the knee
Use the knee support device can reduce the burden to the knee problem “Degenerative”.
“Taping” in the knee
For petello-femoral OA, “Taping” on the medial knee and thigh muscle followed by exercise (quadriceps) can reduce pain and restore function.
Methods to reduce pain
Method of heat therapy
o Method of heat therapy may be useful to reduce pain, increase flexibility and reduce swelling.
o This method of heat therapy using hot poultice bag, Short Wave Diathermy and ultrasound.
o Heat therapy is encouraged for the acute joint pain.
Method Transcutaneous Electrical Nerve Stimulation (TENS)
o TENS effectively eliminate pain if used for more than 4 weeks.
o The combination of high intensity and a strong explosion mode is effective.
The use of modified equipment can help on workstyle recovery.
Indication support the use of tools (Splinting)
Support tool used to restore function, correct position of joints or deformiti and reduce pain.
Example: Tool support protection hand (carpo-Shortened metacarpal) and supporting equipment to straighten the knee joint.
o Modification of footwear includes raising the heel and the use of tools supporting the feet.
o Pain is usually a combination of muscle spasms and signs of stress.
o Recovery instructor will teach relaxation techniques and planned activities that can help reduce pain.
* Patients may need to re-organize its activities to the extreme pain can be overcome.
The types of medication therapy
Injections in the joints
Provision of medication for elderly
- Kidney and liver function decreases when age increases.
- Therefore it is important to be more careful when giving pain medication that is often used for the elderly.
- Paracetamol proved more effective or less the same with ibuprofen to control pain and should be given priority compared Antiradang Without Steroid Drug (NSAIDs).
- COX-2 blocker drugs found effective as medicine Antiradang Without Steroid even less side effects gastrik.Kebelakangan it is proven to be safe for the heart.
- NSAIDs should be used carefully because of side effects such as gastric, disfunction buahpinggang, swollen feet and stimulate weak heart for some individuals.
- Tramadol may also cause constipation and confusion among the elderly if not vigilant.
Injection therapy in joint
This method of therapy can only be done by a trained medical officers only. Medications used for injections in the joints are:
- Topical NSAIDs
- Methylsalicylate Liniment (LMS)
- NSAID-containing plaster REMEDY as other options for treatment of arthritis.
+ Glucosamine soleplate useful for reducing pain and improving joint function for patients with mild and moderate OA.
+ It can stop the thinning and change the space between the joint effects of long-term illness.
If medication fails, ie pain persists, surgical treatment may be considered.
Measurements taken to select the best surgical method:
- Probability for success with the method chosen.
- Complications such methods.
Before making the best surgical method of choice for patients, the following factors should be taken into account;
- Age patients.
- Joints involved.
- Appropriate time for surgery.
- Expertise and skills available.
Surgical options include:
- Arthroscopic debridement
- Ligamentous reconstruction
- Unicompartmental arthroplasty
- Total joint arthroplasty
Complete conversion joint surgery is the best choice for those aged over 60 years.
This method temporarily relieve symptoms of knee OA that light to moderate but it can not correct the process degenaratif. Patients must be told clearly that complications may occur and further surgery rekonstruktif if necessary.
Ligamentous reconstruction of the knee joint
The main purpose of this method is to reduce pain and restore joint stability. Patients should be given counseling that this procedure aims to save the joint from damage.
The main purpose of osteotomy is to reduce pain and improve joint function. Osteotomy is also used for the hip joint to eliminate the symptoms and delay definitive surgery.
Traditionally, this surgical method used for patients with arthritis involving the knee joint of a specific part among patients aged over 60 years old and not active. This technique is difficult and reported successful treatment is done in the center of excellence.
Total joint arthroplasty
Replace joint surgery is major surgery to fully osteoarthritis knee joints, hips and shoulders. Most patients no longer have pain and joint function is almost normal after the successful surgery. Conversion complete joint lasted 15 years or more depending on the level of physical activity.
This procedure is proven effective in reducing pain and mostly done over the joints of the spine, wrist joints, hands and feet. For knee and hip joints it only seeks to save the joint.
Prime level prevention
- Prime level prevention will become reality if all risk factors are change.
- Many risk factors are important for the joints that accommodate the weight.
- Prevent obesity, weight loss and health education is needed especially the protection techniques of from joint injury is recommended as preventive measures.
- It is important if individuals at high risk to identify early prevention.
Adapted from: http://www.infosihat.gov.my