退化性膝關節炎

關節就是骨頭相連接的地方，方便人體活動。關節發炎可分為急性和慢性。在長者中，最常見的是退化性關節炎，是由於關節慢性勞損而引起，最常受影響的便是膝關節。

成因

隨著年月增進，關節液分泌減少。膝關節經長年累月的磨擦而勞損，軟骨變薄。若加上保護關節的肌肉及筋腱疲弱、身體過重、不正確的姿勢和活動，情況便會更差。

徵狀

最常見的症狀是膝部久不久痛楚，尤其是走動後，特別是下樓梯、擕重物時。間中亦有膝部紅腫發熱。長期患者，或會有關節僵硬，以致關節變形。

治療

膝蓋痛楚時最重要是應儘量休息，也可按情況決定冰敷、暖敷或用護膝繃帶以減輕負荷。

藥物的主要目的只是為了減少痛楚或減輕炎症，並不能根治已退化的關節。常用的有一般的止痛藥（例如必理痛）和止痛藥膏(例如冬青膏)。較強力的止痛藥包括有消炎和止痛作用的(非類固醇)消炎止痛藥，種類繁多，但都有不同程度的副作用，包括腸胃不適、胃出血、以致腎功能衰竭等，因此必須按醫生的指示下使用。

在關節內注射類固醇藥物，雖然能止痛，但會令退化惡化，非不得已，切勿採用。

嚴重的關節變形，或需手術矯正，以致人造關節替換術等。

預防和護理

退化了的關節不能還原，但適當的護理保養，可以減少痛楚、防止退化加劇或復發的機會。保護膝關節首要減少勞損，應注意：

減少膝關節的負荷，過重者要減肥。

避免攜帶過重物件，可利用手推車輔助。

避免長期站立或步行太久，有需要者應用枴杖。

避免膝關節長時間保持同一個姿勢，如長期坐矮凳、蹲等。

注意工作與休息之時間要平衡分配，留意及正視關節痛楚。

適當的強化大腿肌肉和膝關節運動能協助保護關節，可請教醫生或物理治療師。

如有下列情形應就醫檢查：

1.感覺有某個關節腫、痛或僵硬的情形超過兩個星期以上

2.在服用治療退化性關節炎的藥物期間，發生解黑便、嘔吐、頭暈等疑似藥物副作用的症狀

醫師可能做的診斷方式包括：

1.影像學檢查：包括關節X光；有需要時可能會做骨頭掃瞄、電腦斷層掃瞄或核磁共振攝影等

2.抽取關節液

3.血液檢驗(主要為了排除其他關節炎的可能性)

￭「怎樣治療和預防？」

日常生活型態的調整，包括：

規律的運動：步行、騎腳踏車、大腿四頭肌訓練運動

控制並維持適當的體重

良好的飲食習慣

運動前熱敷

選擇底部有良好襯墊的鞋子

急性疼痛發作時，第一、二天在患部冰敷，之後可用熱敷

治療方式包括：

止痛藥物：口服或外用

保養性口服藥物治療：葡萄糖胺、類軟骨質素

關節內藥物注射

手術治療：關節整形術、關節置換術

A joint is where two bones meet. Arthritis refers to inflammation of the joint tissue which can be acute or chronic. In the elderly, the commonest type of arthritis is osteroarthritis, which is degenerative arthritis, most commonly affecting the knees.

Cause

As part of the aging process, joint fluid decreases. With wear and tear, the cartilage becomes thinner. If the muscles and tendon protecting the joint become weakened, if there is overweight, or if there is persistent abnormal posture or activities such as squatting or sitting on low stools, the condition would become worse.

Presentation

The commonest symptom is pain or discomfort, especially after walking, e.g. walking downstairs or carrying heavy load. Occasionally there may be redness, swelling and warmth. Chronic problems include stiffness and deformity.

Symptoms

Common symptoms include joint pain, swelling, warmth and stiffness of fingers. Prolonged inflammation leads to reduced activity of fingers, and can result in muscle weakness and wasting. If there is also improper posture and activity, there may be permanent joint deformity.

Treatment

The best treatment for pain is rest. Depending on the situation, heat or ice therapy and knee bandage may be used as advised.

Medication for osteoarhritis can only reduce pain or inflammation. It cannot cure the disease. Common analgesia (e.g. panadol) and ointment (e.g. analgesic balm) are frequently useful. For more severe pain, non-steroidal anti-inflammatory drugs which have both analgesics and anti-inflammatory actions may be used. There are many kinds but invariably they have side-effects which can include gastro-intestinal discomfort or even bleeding, renal failure, etc. Therefore, they should be used with care and according to a doctor's advice.

Injections of steroids into the joint can relieve pain but it would aggravate the arthritis. It should not be used unless absolutely necessary.

Surgery may be required for certain severe cases of deformity. These include arthroplasty and knee replacement therapy.

Prevention and self-care

The degeneration of the knee joint cannot be reversed. However, with appropriate self-care and preventive measures, the process can be slowed, and it is possible to reduce pain and prevent relapse and deformity. To protect the knee joint, the most important is to reduce the wear and tear process:

Minimize weight bearing of knee joint. For the obese, reduce weight.

Avoid carrying heavy objects. Use a trolley.

Avoid prolonged standing or walking. Use walking aid if required.

Avoid putting the knee joint in one position for a long time e.g. sitting on low stool or squatting.

Ensure proper balance between work and rest. Watch out for and be mindful of joint pain.

Appropriate knee exercise and thigh muscle strengthening exercise can protect the knee joint. Consult a doctor or physiotherapist for advice.