-
×èòàòåëü Íåäóã.Ðó
Ìíå 44/172/65
Ìåñÿöà ïîëòîðà íàçàä çàìåòèë, ÷òî âî âðåìÿ çàðÿäêè, ïðè ïðèñåäàíèè, ÷óâñòâóåòñÿ áîëü â ëåâîì êîëåíå. Ìîãó ïîëíîñòüþ ñåñòü íà êîðòî÷êè íà ïðàâîå êîëåíî. À ïîëíîñòüþ ñåñòü íà ëåâîå êîëåíî óæå íå ìîãó.
Ïîùóïàë âïàäèíó (ñ îáðàòíîé ñòîðîíû êîëåíêè). - Íà ëåâîé íîãå ÷óòü-÷óòü ïðèïóõëîñòü, ïî ñðàâíåíèþ ñ ïðàâîé íîãîé.
Òðàâìàòîëîã íà äíÿõ ïîñìîòðåë íà ðåíòãåí è âûíåñ âåðäèêò: àðòðîç êîëåííîãî ñóñòàâà îáîèõ íîã, íà÷àëüíàÿ ñòàäèÿ. Íà ðåíòãåíå âèäíû äâà øèïèêà íà êàæäîì êîëåíå. Íàçíà÷èë ëå÷åíèå (ðåêîìåíäóåò ñïèðòîâîé êîìïðåñ, ìàçü, ôèçèîòåðàïèþ, ñòàö.ëå÷åíèå, ìàññàæ, êàêîå-òî ëåêàðñòâî ïèòü, åùå ÷òî-òî). Ïîêà åùå íå õîäèë íà ëå÷åíèå.
Õîòåë áû ïîíÿòü ïðè÷èíó. ß íå áîëåë, òðàâìû íå áûëî. Åäèíñòâåííîå - ñèæó óæå â òå÷åíèå ãîäà öåëûìè äíÿìè äîìà çà êîìïüþòåðîì. Ìàëîïîäâèæíûé îáðàç æèçíè. Ìîæåò èç-çà ýòîãî? Ïðàâäà, ÿ èíîãäà, ñ âåñíû âûõîæó â ïàðê, ïîäòÿãèâàþñü íà ïåðåêëàäèíå, áåãàþ ïî ëåñíîé òðîïèíêå. Ïî óòðàì ñòàðàþñü áûñòðåíüêî ñäåëàòü çàðÿäêó.
Êîëåíêè ïîêà íå òðåâîæàò. Òîëüêî, åñëè ãëóáîêî ñåñòü íà êîðòî÷êè. Êîãäà õîæó, ñïëþ, áåãàþ - íèêàêèõ ïðîáëåì.
À êîãäà ñèæó äîëãî - ÷óâñòâóþ ñóáüåêòèâíî, ÷òî çàòåêàþò ñëåãêà òå ìåñòà íîã, íà êîòîðûõ ñèæó è ÿãîäèöû. Áîëè ïðè ýòîì íåò, íî íåïðèÿòíîå ÷óâñòâî "íàñèæåííîñòè".
ß íå ïîëíûé ïî êîìïëåêöèè, íî çà ïîñëåäíèå ãîäû ïîÿâèëèñü íåáîëüøîå îòëîæåíèå æèðà íà ïîÿñíèöå è ÿãîäèöàõ.
Õîòåëîñü áû óçíàòü êàêèå áóäóò çàìå÷àíèÿ è ñîâåòû äëÿ ìîåãî ñëó÷àÿ.
Æèâó â ×åáîêñàðàõ.
Êñòàòè, íàñêîëüêî ÿ ïîíèìàþ, óñòðàíèòü àðòðîç íåâîçìîæíî. Ìîæíî òîëüêî ïðèîñòàíîâèòü. À ìîæíî ïîëíîñòüþ îñòàíîâèòü àðòðîç íàâñåãäà?
Ñ óâàæåíèåì, âàø ïîêîðíûé ñëóãà.
-
×èòàòåëü Íåäóã.Ðó
Óâàæàåìûå ñïåöèàëèñòû!
Ïðîøó Âàøåé ïîìîùè. ß ñáèò ñ òîëêó .
Òðàâìàòîëîã ïîñòàâèë äèàãíîç: äâóõñòîðîííèé ãîíàðòðîç. Îí íàçíà÷èë:
- ËÔÊ, ìàññàæ
- èáóïðîôåí èëè äèêëîôåíàê. (íåñòåðîèäíûå, ïðîòèâîâîñïàëèòåëüíûå)
- èíäîìåòàöèíîâóþ ìàçü
- êîìïðåññ (ñïèðòîâûé, 40-50%)
À òåðàïåâò ìíå ñêàçàëà:
- Òåáå íàäî òîëüêî ËÔÊ è ìàññàæ. À îñòàëüíîå íóæíî, êîãäà áóäóò áîëè. À ó òåáÿ ïîêà áîëè íåò. Áîëè ìîãóò ïîÿâèòüñÿ ïîçæå, â îñåííå-çèìíèé ïåðèîä. Òîãäà è áóäåøü ïðèìåíÿòü íåñòåðîèäíûå, ìàçü è êîìïðåññ.
À òðàâìàòîëîã ãîâîðèò:
- ß äàë òîëüêî ðåêîìåíäàöèè. Îêîí÷àòåëüíîå ñëîâî - çà òåðàïåâòîì.
Òàê ÷òî æå ìíå äåëàòü? Íåóæåëè íåëüçÿ îñòàíîâèòü àðòðîç íà ðàííåé ñòàäèè, ïîêà íåò áîëè ? Íåóæåëè äàëüíåéøåå ðàçâèòèå àðòðîçà íåèçáåæíî è ìíå íàäî æäàòü ñíà÷àëî áîëè, ÷òîáû ïîòîì ëå÷èòüñÿ îò íåå ?
Ïîìîãèòå ïîæàëóéñòà ñîâåòîì.
(Äâèãàþñü è áåãàþ ïîêà ñâîáîäíî. Áîëü ïîÿâëÿåòñÿ â êîëåíå, òîëüêî åñëè ñåñòü ãëóáîêî íà êîðòî÷êè. Àíàëèçû ìî÷è è êðîâè - â íîðìå).
-
×èòàòåëü Íåäóã.Ðó
Åñëè ïðèíÿòü çà îòïðàâíóþ òî÷êó, ÷òî äèàãíîç îñòåîàðòðîçà óñòàíîâëåí, òî ñîîáðàæåíèÿ ñëåäóþùèå:
1) Íåñòåðîèäíûå ïðîòèâîâîñïàëèòåëüíûå ñðåäñòâà (äèêëîôåíàê, èáóïðîôåí, èíäîìåòàöèí) â ëþáûõ ôîðìàõ èìååò ñìûñë ïðèíèìàòü òîëüêî ïðè áîëÿõ / âîñïàëåíèè è íåò ñìûñëà ïðèíèìàòü ïðîôèëàêòè÷åñêè.
2) Äëÿ çàìåäëåíèÿ ïðîãðåññèðîâàíèÿ áîëåçíè ïðèìåíÿþò ò.í. õîíäðîïðîòåêòîðû (ãëþêîçàìèí, õîíäðîèòèí).
-
×èòàòåëü Íåäóã.Ðó
2) Äëÿ çàìåäëåíèÿ ïðîãðåññèðîâàíèÿ áîëåçíè ïðèìåíÿþò ò.í. õîíäðîïðîòåêòîðû (ãëþêîçàìèí, õîíäðîèòèí).
Ïðàâèëüíî ëè ÿ ïîíÿë, ÷òî îñòàíîâèòü ïðîãðåññèðîâàíèå áîëåçíè íåâîçìîæíî, ìîæíî òîëüêî çàìåäëèòü åå ?
Òîãäà ÷òî ìîæåò áûòü â áóäóùåì? ×òî ãîâîðèò ñòàòèñòèêà? Äî êàêîé ñòàäèè ìîæåò äîéòè áîëåçíü (äàæå ïðè ëå÷åíèè) è êàê áûñòðî? (ïîíÿòíî, ÷òî ó êàæäîãî ÷åëîâåêà ïî-ðàçíîìó, íî ñ "ñðåäíåì" ?
-
×èòàòåëü Íåäóã.Ðó
Ïî äàííûì êðóïíûõ èññëåäîâàíèé ïðè ïðèåìå õîíäðîïðîòåêòîðîâ (óïîìÿíóòûå êîëëåãîé), ìîæíî íå òîëüêî îñòàíîâèòü ïðîöåññ, íî äàæå åãî óìåíüøèòü, ïðè îáÿçàòåëüíîé ËÔÊ, èñïîëüçîâàíèè îðòîïåäè÷åñêèõ ïîñîáèé. Ïðàâäà ïèòü ëåêàðñòâà íóæíî ïðàêòè÷åñêè ïîñòîÿííî, áîëåå ïîäðîáíî â î÷íîé êîíñóëüòàöèè ó ðåâìàòîëîãà.
-
×èòàòåëü Íåäóã.Ðó
Åùå ìíå èíòåðåñíû ïðè÷èíû ãîíàðòðîçà.
Âåäü, íàâåðíîå, äàëåêî íå ó âñåõ, êîìó çà 40, îí âîçíèêàåò.
Âîëåþ îáñòîÿòåëüñòâ, ÿ óæå öåëûé ãîä ñèæó äîìó çà êîìïüþòåðîì, ñ óòðà äî ïîçäíåãî âå÷åðà. Èíîãäà äàæå íà óëèöó íå âûõîæó â òå÷åíèè äíÿ.
Ñòðàþñü èíîãäà, ðàçà 2 â íåäåëþ, ëåòîì, çàíèìàòüñÿ ôèçêóëüòóðîé, áåãîì â ïàðêå. Íî âèäèìî, ýòîãî íåäîñòàòî÷íî. Ñåé÷àñ, âîò, íà÷àë ïëàâàòü â ðåêå, ãîâîðÿò, ïîëåçíî.
Ïðåäïîëàãàþ, ÷òî èç-çà òàêîãî ìàëîïîäâèæíîãî, ñèäÿ÷åãî îáðàçà æèçíè àðòðîç çàðàáîòàë. Ò.å, ïîñòîÿííîå äàâëåíèå íà íîãè (êîãäà ñèæó), óìåíüøåíèå êðîâîîáðàùåíèÿ, óõóäøåíèå ïèòàíèÿ õðÿùåé. Íî ýòî ÷èñòî ìîå ïðåäïîëîæåíèå, ïîòîìó ÷òî ÷òî åùå? (òðàâì íå áûëî, íå çàñòóæèâàëñÿ). È ÿ äî ñèõ ïîð ÷óâñòâóþ ñåáÿ ïîêà ìîëîäûì, çäîðîâûì ÷åëîâåêîì, íè÷åãî íå áîëèò, âðåäíûõ ïðèâû÷åê íå èìåþ.
-
×èòàòåëü Íåäóã.Ðó
Îïèñàíèå ïðè÷èí ãîíàðòðîçà çàéìåò íåñêîëüêî ëèñòîâ ôîðóìà, âàì ýòî íè ê ÷åìó. Ó ëèö ñòàðøå 65 ëåò - 97%, òàê ÷òî âñå ìû â íåì áóäåì.
-
×èòàòåëü Íåäóã.Ðó
Ïîñìîòðåë âî âñåìèðíîé ñåòè ñàáæ.
Ñîâåòû, íà êîòîðûå îáðàòèë âíèìàíèå:
1. Ìàíóàëüíàÿ òåðàïèÿ ïðè ãîíàðòðîçå äàåò âåëèêîëåïíûé ðåçóëüòàò â ñî÷åòàíèè ñ òðàêöèåé ñóñòàâà, õîíäðîïðîòåêòîðàìè è âíóòðèñóñòàâíûìè èíúåêöèÿìè îñòåíèëà (ãèàëóðîíîâàÿ êèñëîòà). Òàêàÿ êîìáèíàöèÿ ëå÷åáíûõ ïðîöåäóð íàìíîãî ýôôåêòèâíåå ôèçèîòåðàïåâòè÷åñêèõ ìåðîïðèÿòèé.
2. Ñîñóäîðàñøèðÿþùèå (òðåíòàë, òåîíèêîë) ïîìîãàþò âîññòàíîâëåíèþ ñóñòàâà çà ñ÷åò óëó÷øåíèÿ ñóñòàâíîãî êðîâîòîêà è ñíÿòèÿ ñïàçìà ìåëêèõ ñîñóäîâ. Òîãäà è õîíäðîïðîòåêòèâíûå ïèòàòåëüíûå âåùåñòâà (ïðè èõ ïðèåìå) ïðîíèêàþò â ñóñòàâ ëåã÷å è â áîëüøåì êîëè÷åñòâå, ê òîìó æå àêòèâíåå öèðêóëèðóþò â íåì.
 ñâÿçè ÿ ýòèì èíòåðåñíî çíàòü:
- ×òî òàêîå òðàêöèÿ ñóñòàâà?
- ×òî òàêîå ìàíóàëüíàÿ òåðàïèÿ (ìíå æå "ïîçâîíêè âïðàâëÿòü" íå íàäî?).
-
×èòàòåëü Íåäóã.Ðó
Ìàíóàëüíàÿ òåðàïèÿ - íå âõîäèò â ðåêîìåíäàöèè ïî ëå÷åíèþ îñòåîàðòðîçà. Õîíäðîïðîòåêòîðû - äà, îñòåíèë - èíîãäà è íå âñåì.
Ïðèìåíåíèå ñîñóäîðàñøèðÿþùèú ñðåäñòâ ïðè îñòåîàðòðîçå - ýòî, ïî-âèäèìîìó, ÷üÿ-òî ôàíòàçèÿ
P.S.:Òðàêöèÿ - ýòî êîãäà ÷òî-òî òÿíóò.
-
×èòàòåëü Íåäóã.Ðó
Ñîâåðøåííî ñîãëàñåí ñ êîëëåãîé Ðîäèîíîâ.
Èññëåäîâàíèé ïî ïîâîäó ñîñóäîðàñøèðÿþùèõ ñðåäñòâ íå ïðîâîäèëîñü, ñèòàåòñÿ, ÷òî îäíèì èç ïàòîãåíåòè÷åêèõ ìåõàíèçìîâ áîëåé ïðè äåô.àðòðîçå íà ïîçäíèõ ñòàäèÿõ ÿâëÿåòñÿ óõóäøåíèå êðîâîòîêà â îêîëîñóñòàâíûõ îòäåëàõ êîñòåé èç-çà ìèêðîòðàâì, ïëþñ òðåíòàë ÿâëÿåòñÿ èíãèáèòîðîì ìåòàëëîïðîòåèíàç, ýòî ìîæåò ñëóæèòü ïîâîäîì äëÿ íàçíà÷åíèÿ ýòîãî ïðåïàðàòà è åìó ïîäîáíûõ, íî èõ ýôôåêòèâíîñòü ÍÅ ÄÎÊÀÇÀÍÀ.
-
×èòàòåëü Íåäóã.Ðó
Õîäèë ñåãîäíÿ ê ðåâìàòîëîãó, â äðóãîå ó÷ðåæäåíèå.
Âðà÷ ïðîïèñàë òåðàôëåêñ è êðåì (äîëãèò èëè õîíäðîêñèä).
Ìíå êàæåòñÿ, âíóòðèñîñòàâíûå èíüåêöèè ãèàëóðîíîâîé êèñëîòû òîæå áû íå ïîìåøàëè. Âðà÷ íå çàïðåùàë, íî è ÿ íå íàñòàèâàë, à ïîòîì çàáûë íàïîìíèòü. À òåïåðü ñîìíåíèÿ ãëîæàò, ìîæåò ýòó êèñëîòó òîæå âñå-òàêè èñïîëüçîâàòü ?
Ãîâîðÿò, äîðîãî. Íî çäîðîâüå äîðîæå. Åñëè ýòî íà ïîëüçó, ïî÷åìó áû è íåò?
Êàêèå ìíåíèÿ? Ó íàñ â ×åáîêñàðàõ íå âèäåë íè îñòåíèëà, íè áåòàìåòàçîíà, íè äèïðîñïàíà. ×òî ñåé÷àñ èç ãèàëóðîíîâîé êèñëîòû ïðàêòèêóåòñÿ ? Ñòîèò íà íåå âíèìàíèå îáðàòèòü ?
-
×èòàòåëü Íåäóã.Ðó
Íåñêîëüêî èíúåêöèé ãèàëóðîíîâîé êèñëîòû íå ñïàñóò. Ëó÷øå äëèòåëüíûé ïðèåì õîíðîïðîòåêòîðîâ âíóòðü, òîò æå òåðàôëåêñ (èëè ñòðóêòóì) è ìåñòíî ìàçü (õîíäðîêñèä èëè õîíäðîèòèí ÀÊÎÑ).  ñóñòàâ ëåçòü íóæíî â êðàéíåì ñëó÷àå, ïîñëåäñòâèÿ ìîãóò ðàçíûå. ß íèêîãäà íå ñëûøàë î äîêàçàííîñòè âíóòðèñóñòàâíûõ èíúåêöèé ãèàëóðîíîâîé êñèëîòû.
-
×èòàòåëü Íåäóã.Ðó
Ïî ïðåïàðàòàì ãèàëóðîíîâîé êèñëîòû íàäî ïîãëÿäåòü, ãäå-òî ìû, êàæåòñÿ, ýòî îáñóæäàëè.. ïî èñëåäîâàíèÿì çàâòðà íà ðàáîòå ïîñìîòðþ.
des, êîðòèêîñòåðîèäû - íå äëÿ Âàñ, ýòî ïàëêà î äâóõ êîíöàõ, ïîêà äàæå íå âñïîìèíàéòå.
Îñòåíèë, äóìàþ, ÷òî òîæå íå äëÿ Âàñ. Ýòî òîëüêî ñìàçêà, ñîáñòâåííîãî õîíäðîïðîòåêòèâíîãî äåéñòâèÿ ó íåãî âðîäå áû íåò.
-
×èòàòåëü Íåäóã.Ðó
 Ìåäëàéíå äîâîëüíî ìíîãî ïóáëèêàöèé ïî äåñêðèïòîðó "osteoarthritis hyaluronic acid"
Âîò íàèáîëåå óìåñòíûå èç ïåðâîé ñòðàíèöû.
Clin Exp Rheumatol. 2005 Mar-Apr;23(2):213-8. Related Articles, Links
Comparison of two hyaluronan drugs in patients with advanced osteoarthritis of the knee. A prospective, randomized, double-blind study with long term follow-up.
Karatosun V, Unver B, Gocen Z, Sen A.
Department of Orthopaedic Surgery, Dokuz Eylul University Hospital, Balcova, Izmir, Turkey. vasfi.karatosun@deu.edu.tr
OBJECTIVES: To compare the long-term effects of high and low molecular weight hyaluronic acid (HA) applications in severe (Kellgren Lawrence stage III) osteoarthritis (OA) of the knee. METHODS: In a prospective clinical trial 184 knees (92 patients) with radiographic Kellgren Lawrence stage III OA were randomized to receive either 3 intra-articular high molecular weight HA (Hylan G-F 20) injections or 3 low molecular weight HA (Orthovisc) injections at one-week intervals. Patients were evaluated by the Hospital for Special Surgery (HSS) Knee Score and were followed-up for 12 months. RESULTS: The total HSS score in high molecular weight HA patients improved from 71.8+/-11.6 to 86.7+/-11.6 and in low molecular weight HA patients from 66.7+/-11.0 to 86.6+/-9.1 at the end of the trial (p < 0.01). There were no statistically significant differences between the groups and both had improved in all parameters at the latest follow-up (p = 0.000). CONCLUSIONS: Three intra-articular injections at intervals of 1 week of both HA preparations resulted in a pronounced reduction in pain and improved function as measured by the HSS score during a period of 52 weeks, without complications.
Osteoarthritis Cartilage. 2005 Jun 17; [Epub ahead of print] Related Articles, Links
Successful nonoperative management of chronic osteoarthritis pain of the knee: safety and efficacy of retreatment with intra-articular hyaluronans.
Pagnano M, Westrich G.
Mayo Clinic College of Medicine, Rochester, MN, USA.
CONTEXT: Although there are many nonsurgical therapies available for the treatment of pain associated with osteoarthritis (OA), their long-term use and safety have not been systematically followed. Intra-articular hyaluronan therapy has been used in the treatment of symptoms associated with OA of the knee with a very favorable safety profile. Five intra-articular hyaluronan products are approved in the US. No systematic review of the safety and efficacy of their chronic use has been reported. OBJECTIVE: To evaluate the literature on the efficacy and safety of repeat courses of hyaluronan therapy in patients with OA of the knee. DATA SOURCES: MEDLINE, EMBASE, searched through October 2004. STUDY SELECTION: Databases were searched using the terms hyaluronan, sodium hyaluronate, hyaluronic acid, hylan, hylan G-F 20, osteoarthritis, adverse events, repeat treatment, and multiple courses. DATA SYNTHESIS: There are some data that support the benefit and safety of repeat treatment for all products. Data also indicate that one formulation of sodium hyaluronate (molecular weight [MW] 500-730kDa) is well tolerated and as effective after multiple courses of treatment as it is after a single course. There is also clinical evidence that prolonged use of sodium hyaluronate (MW 500-730kDa) may significantly decrease the rate of deterioration of joint structure. Localized severe acute inflammatory reactions reported with repeated treatment in some patients are not a class effect but may be linked to physicochemical characteristics of hylan-based treatment. CONCLUSIONS: Repeat courses of the hyaluronans are safe and effective in the treatment of pain associated with OA of the knee.
-
×èòàòåëü Íåäóã.Ðó
À âîò çàïðîñ "pentoxifylline osteoarthritis" ðåçóëüòàòà íå äàë