Известно, что чем крепче кости, тем меньше риск развития заболеваний опорно-двигательной системы. Увы, есть много факторов, ухудшающих состояние человека. К примеру, очень ранимыми являются коленные суставы, на которые приходится максимальная нагрузка. В них могут развиться воспалительные процессы, способные сделать человека инвалидом.
Что такое артрит коленного сустава
Артрологи и ревматологи с беспокойством отмечают факт роста и «омоложения» данного заболевания. Что такое артрит коленного сустава? Так называется заболевание, при котором происходит воспаление в коленной чашечке. Гонартрит прогрессирует медленно, но верно, вызывая у людей огромный дискомфорт. Первичная форма возникает в случае попадания инфекционного агента при травмах, переломах, ушибах, вторичная – через ток крови, лимфы при разных заболеваниях. Некоторые виды заболевания:
- ревматоидный;
- артрозо-артрит;
- реактивный;
- туберкулезный;
- посттравматический.
Причины артрита
Недуг может протекать как самостоятельное заболевание, являться сопутствующим при других. Главные причины артрита коленного сустава:
- инфицирование;
- травмы, ушибы;
- аллергия, к примеру, на лекарственные препараты;
- нарушение обмена веществ в костных структурах;
- наследственность, наличие генетических патологий;
- длительное стоячее положение в течение дня;
- неправильное положение костей;
- невылеченные заболевания;
- общее переохлаждение, обморожение ног;
- наличие заболеваний: туберкулеза, болезни Бехчета, гонореи, сифилиса, крупозного воспаления вен, красной волчанки, подагры (подагрического артрита), лейкоза и других;
- укус некоторых видов насекомых.
Диагностика
Чтобы вылечить человека, врач осуществляет диагностику заболевания. Сначала он проводит внешний осмотр пациента, выслушивает жалобы, проверяет двигательную активность. Для диагностики артрита обязательно назначается рентгенография, на которой видны признаки заболевания: пониженная плотность костей, сращение, деформация суставных поверхностей, неподвижность сустава, эрозии, узлы.
Кроме рентгена, пациента направляют на анализ крови. Общее исследование при патологии показывает повышенное количество лейкоцитов, тромбоцитов, увеличение СОЭ, биохимическое – наличие ревматоидного фактора, СРБ. В редких случаях для диагностики заболевания используют МРТ, УЗИ, термографию, пробу Бюрне, контрастную артографию, компьютерную томографию, биопсию синовиальной оболочки.
Артрит коленного сустава у детей
Описываемое заболевание поражает малышей по разным причинам, среди которых: нарушенный обмен веществ, слабый иммунитет, наследственность, травмы, переохлаждение. Артрит коленного сустава у ребенка младше 2 лет определить очень сложно, поскольку малыш не может описать неприятные симптомы, а лишь капризничает, избегает резких движений. Определить болезнь можно по хромоте, капризам при совершении какого-либо движения. Чтобы вылечить ее, необходимо полное обследование.
Симптомы
Признаки артрита в основном зависят от причины, вызвавшей болезнь. Все же есть несколько общих симптомов, проявляющихся при любой этиологии. Это:
- Болевые ощущения. Признак непостоянный, на начальной стадии появляется периодически, по мере прогрессирования может стать постоянным. Усиливается после больших нагрузок, беспокоит по утрам. При остром течении боль в колене пульсирующая, не позволяющая совершать резкие движения.
- Опухлость в околосуставной области. Она появляется из-за воспалившегося сустава, самостоятельно не уменьшается.
- Ограничение объема движений в колене.
- Деформация. Вначале симптом появляется из-за боли, далее неправильное положение может закрепиться.
Иные возможные симптомы артрита коленного сустава:
- покраснение в пораженной области;
- массивный отек тканей;
- чувство тяжести в ноге;
- повышение температуры организма, озноб;
- абсцессы;
- повышенная потливость;
- эрозия поврежденной поверхности;
- общая слабость;
- атрофия прилегающих мышц;
- сниженный аппетит;
- накопление рубцовой ткани, экссудата в суставе.
Артрит коленного сустава – лечение
Чтобы улучшить состояние человека, снять воспаление, устранить последствия, предотвратить распространение инфекции, требуется длительная, комплексная терапия. При диагнозе артрит коленного сустава – симптомы и лечение должны вас заинтересовать. Как правило, врачи используют консервативные методы: медикаменты, местные инъекции, ЛФК, витамины, физиотерапию. При чрезмерном скоплении гноя, тяжелых случаях используется оперативный метод. Узнайте подробнее, как лечить артрит коленного сустава указанными способами.
Лекарства от артрита
Чем лечить суставы колена, какое лекарство от артрита использовать? Самые распространенные группы препаратов, назначаемые врачами:
- Нестероидные противовоспалительные таблетки для уменьшения болей, блокировки фермента циклооксигеназа. Это: Бутадион, Ибупрофен, Нимесулид.
- Кортикостероиды для быстрого снятия боли, устранения отечности: таблетки Гидрокортизон, Дипроспан. Уколы делают в полость суставной капсулы.
- Хондропротекторы. Содержат вещества, восстанавливающие деформированный суставной хрящ, нормализующие обменные процессы. Эти медикаментозные таблетки, уколы отличаются эффектом при первой степени поражения. Это: Терфлекс, Артра, Коллаген Ультра.
Как и при артрозе, для наружного применения часто используются мази. Они быстро впитываются в кожу, достигают поврежденного места и снимают боль, успокаивают воспаление. Могут использоваться:
- Фастум гель. Популярная обезболивающая мазь от артрита коленного сустава, содержащая кетопрофен.
- Диклофенак. Курс лечения кремом – не более 3 недель. Относится к нестероидным противовоспалительным средствам.
- Ортофен. Назначают при наличии болевого синдрома при артрозах, воспалениях коленного сустава. Если за 2 недели не наступает облегчение, применение необходимо прекратить.
В периоды ремиссии артроза, артрита пациентам показаны диета, специальные упражнения, призванные укрепить мышцы, восстановить хрящевую ткань, уменьшить боль. Как правило, гимнастика при артрите коленного сустава выполняется лежа или сидя. Ее полезно делать в воде. Помогает вылечить и массаж. Он снимает скованность в ногах, является профилактикой мышечной атрофии. Кроме этого, массаж обеспечивает доступ крови к поврежденным участкам. Примеры эффективных упражнений для лечения:
- сесть на стул, качать назад и вперед сначала левой ногой, затем правой;
- в сидячем положении поднять одну ногу параллельно полу, через 5 секунд отпустить; то же самое повторить с другой.
Лечение артрита в домашних условиях народными средствами
Методы народной медицины стоит использовать одновременно с лекарствами, уколами, массажем, мазями, правильным питанием. Простой метод – использование компресса из капусты. Нужно снять с кочана листья и нанести на вогнутую сторону мед. Обработанные капустные листья следует прикладывать к коленке вечером. Оставить на время сна, утром убрать. Процедуру делать в течение месяца. Лечение коленного сустава народными средствами можно осуществлять яблочным уксусом, принимая его около 5 раз в день, разбавив 1 ч. ложку в стакане воды. Длительность лечения – 3-4 недели.
Артрит коленного сустава – воспалительное заболевание коленного сустава различной этиологии, протекающее в виде моноартрита либо являющееся проявлением полиартрита. Клинические признаки артрита коленного сустава включают боль в покое и при движениях, ограничение функции, припухлость, гиперемию кожи над суставом, болезненность при пальпации, локальное повышение температуры. В диагностике артрита коленного сустава важную роль играют данные рентгенографии, УЗИ, МРТ, термографии, пункции сустава с исследованием синовиальной жидкости, артроскопии, биопсии синовиальной оболочки. В зависимости от этиологии и характера течения заболевания лечение артрита коленного сустава может включать медикаментозную терапию, внутрисуставные инъекции, иммобилизацию, физиотерапию, ЛФК, в тяжелых случаях – оперативное лечение.
Общие сведения
Артрит коленного сустава (гонартрит, гонит, остеоартрит) – острое или хроническое воспаление в коленном суставе, поражающее его костно-хрящевые концы или капсулу. Сложность анатомического строения и большая величина испытываемой нагрузки предопределяют высокую частоту поражения коленного сустава, а также многообразие клинических форм гонартрита. По данным ревматологии и артрологии, на долю артрита коленного сустава приходится 35%-52% воспалений суставов различной локализации. Заболевание может развиваться у людей различных возрастных групп, но чаще встречается у лиц 40-60 лет. Затяжное или рецидивирующее течение артрита коленного сустава может приводить к ограничению или полной потере движения в суставе и стойкой инвалидизации больного.
Коленный сустав образован тремя костными структурами — надколенником, бедренной и большеберцовой костями. Суставные поверхности костей покрыты хрящом, способствующим уменьшению трения сочлененных между собой суставных поверхностей. Функцию стабилизации сустава выполняют внутрисуставные и внесуставные связки, а функцию амортизации колена — хрящевые прослойки (мениски). Все элементы сустава заключены в суставную сумку, снаружи покрытую плотной фиброзной тканью, а изнутри выстланную синовиальной мембраной, продуцирующей небольшое количество синовиальной жидкости. Коленный сустав является крупнейшим опорным суставом, обеспечивающим сгибание и разгибание, а также вращательные движения нижней конечности.
Классификация
Самостоятельная классификация артрита коленного сустава не разработана. Как и артриты других локализаций, по причине возникновения гонартрит делится на первичный (являющийся самостоятельной нозологический формой) и вторичный (связанный с другими заболеваниями). С учетом клинической картины артрит коленного сустава может носить острое или хроническое течение.
По этиологии артриты подразделяются на инфекционные (специфические, неспецифические, инфекционно-аллергические), ревматоидные, реактивные, посттравматические, асептические. В зависимости от характера образующегося воспалительного экссудата артрит коленного сустава может быть серозным, серозно-гнойным и гнойным; по количеству вовлеченных суставов – односторонним или симметричным.
Причины артрита коленного сустава
Первичный артрит коленного сустава, как правило, является следствием травм (ушибов, открытых ран, разрыва коленной капсулы, повреждения мениска), обеспечивающих проникновение инфекции непосредственно в полость сустава. Возможно развитие гонартрита после выполнения диагностической пункции коленного сустава или хирургического вмешательства. Вторичный артрит коленного сустава может возникать на фоне системных заболеваний (ревматизма, псориаза, болезни Бехтерева, СКВ, болезни Рейтера и др.), инфекций (туберкулеза, сифилиса, гонореи, бруцеллеза, дизентерии, хламидиоза и пр.), гнойных процессов иной локализации (остеомиелита, фурункула, флегмоны, рожистого воспаления). Реактивный артрит развивается вследствие перенесенной мочеполовой или кишечной инфекции. Артрит коленного сустава часто обнаруживается у пациентов с гемофилией, саркоидозом, подагрой, злокачественными опухолями внутренних органов.
Предрасполагать к развитию артрита коленного сустава могут травмы суставных связок, бурсит, тендинит, лишний вес и ожирение, тяжелые физические (в т. ч. спортивные) нагрузки, гипермобильность суставов, плоскостопие. Нередко манифестацию острого артрита коленного сустава провоцирует инфекция, вакцинация, аллергическая реакция, хирургические вмешательства, аборт или роды, переохлаждение.
Симптомы артрита коленного сустава
Несмотря на то, что различные формы артрита коленного сустава имеют свои клинические особенности, всем им свойственны некоторые общие симптомы. К основным местным (суставным) признакам гонартрита относятся боль, припухлость и деформация сустава.
Боли в коленном суставе (артралгии) могут носить различный характер. В большинстве случаев интенсивность болей нарастает постепенно; вначале болевые ощущения возникают периодически, усиливаются после физических нагрузок или к вечеру. Иногда с самого начала больные с артритом коленного сустава отмечают «стартовые» боли, развивающиеся после периода отдыха. Часто болевой синдром сочетается с тугоподвижностью и скованностью пораженного сустава, лишающей человека возможности передвижения без вспомогательной помощи или опоры.
Артриту коленного сустава присущи все признаки воспалительного процесса: в области сустава возникает отек, отчего колено выглядит припухшим и увеличенным в объеме; отмечается гиперемия кожи над пораженным участком, локальное повышение температуры. В результате боли, опухания и мышечного напряжения ограничивается амплитуда пассивных и активных движений. При скоплении значительного количества экссудата определяется симптом баллотирования надколенника. Вследствие активного или длительного течения артрита коленного сустава могут развиться костные деформации, сгибательная контрактура сустава, гипотрофия мышц, анкилоз коленного сустава и утрата функции конечности.
При различных формах артрита коленного сустава могут отмечаться внесуставные поражения различных систем: сердечно-сосудистой (перикардит, миокардит, приобретенные пороки сердца), легочной (пневмонит, альвеолит), пищеварительной (энтероколит), мочевыделительной (амилоидоз почек, гломерулонефрит, ХПН), зрительной (конъюнктивиты, кератиты, увеиты), кожной (сыпь) и пр. Артрит коленного сустава может сочетаться с артритом голеностопного, тазобедренного, плечевого и других суставов.
Гнойный артрит коленного сустава (эмпиема сустава) сопровождается выраженным интоксикационным синдромом: лихорадкой, ознобами, головной болью, миалгией. Вследствие нарастания отека контуры сустава становятся расплывчатыми; возникают ощущения распирания в коленном суставе. Боль носит нестерпимый характер, как в покое, так и при движении, заставляя больного придавать конечности вынужденное положение (нога полусогнута в коленном суставе). Гнойный артрит коленного сустава может осложняться разрушением связок, патологическими вывихами, флегмоной капсулы сустава, сепсисом.
Диагностика артрита коленного сустава
При проведении диагностических мероприятий основные усилия должны быть направлены на выявление этиологии артрита коленного сустава. В связи с этим пациенты с гонартритом могут нуждаться не только в консультации ревматолога и артролога, но и травматолога-ортопеда, фтизиатра, венеролога и других специалистов. Обследование пациента с артритом коленного сустава начинается с осмотра, выяснения анамнеза заболевания, перенесенных и сопутствующих заболеваний.
При остром артрите в клиническом анализе крови обнаруживаются признаки активного воспалительного процесса (увеличение СОЭ, лейкоцитоз); в биохимическом анализе крови – маркеры воспаления (СРБ, серомукоид, РФ); в иммунологическом анализе (ИФА) — антитела к возбудителям инфекции. Рентгенография коленного сустава выявляет узурацию суставных поверхностей, сужение суставной щели, фиброзный или костный анкилоз. При дифференциальной диагностике гонартрита и гонартроза проводится МРТ коленного сустава. Характер и количество суставного выпота уточняется с помощью УЗИ коленных суставов. Вспомогательное значение среди аппаратных исследований имеет термография сустава, контрастная артрография и пневмоартрография.
Инвазивная диагностика артрита коленного сустава предполагает проведение диагностической пункции с последующим исследованием синовиальной жидкости; при необходимости – диагностической артроскопии коленного сустава, биопсии синовиальной оболочки.
Лечение артрита коленного сустава
В активной фазе течения артрита коленного сустава показано ограничение нагрузки на нижние конечности, иммобилизация пораженного сустава. Медикаментозное лечение артрита коленного сустава может включать антибиотикотерапию, прием НПВП, хондропротекторов, местное втирание мазей, аппликации димексида. При сифилитическом, туберкулезном гонартрите проводится специфическая терапия. В некоторых случаях показаны внутрисуставные инъекции кортикостероидов и гиалуроновой кислоты. В восстановительном периоде назначается суставная лечебная гимнастика, массаж, физиотерапия (импульсная магнитотерапия, ультрафонофорез, УВЧ, лазеротерапия, грязевые аппликации, минеральные ванны и др.), акупунктура. Больным рекомендуется использование адаптивных приспособлений (трости, ортопедической обуви, наколенников). С целью уменьшения нагрузки на суставы рекомендуется нормализация массы тела.
При неэффективности консервативной тактики в рамках лечения артрита коленного сустава могут быть использованы хирургические методы: лаваж сустава, артроскопическая санация очагов инфекции, артротомия, резекция сустава, иссечение синовиальных оболочек, эндопротезирование коленного сустава и др.
Прогноз и профилактика
В целом исход и последствия гонартрита во многом зависят от его формы, своевременности диагностики, полноты проведенного лечения, следования рекомендациям лечащего врача. Хроническое прогрессирующее течение артрита коленного сустава рано или поздно приводит к стойкому нарушению функции нижней конечности и инвалидизации больного. Наиболее опасной по своим последствиям является эмпиема сустава. Во многих случаях артрит коленного сустава можно предотвратить, избегая травм, чрезмерных физических нагрузок, переохлаждений, не допуская набора лишнего веса и пр. Профилактика вторичного артрита требует проведения адекватного лечения инфекционных и ревматических заболеваний.
Заболевание, для которого характерно воспаление внутри сустава и вокруг него – это артрит коленного сустава (гонит, гонартрит). Чаще поражается одно колено, реже – оба. Патология проявляется болью, отеком на пораженном участке, ограничением подвижности. При отсутствии лечения сочленение продолжает разрушаться, что приводит к инвалидности. Для лечения гонита применяют лекарственные препараты, ЛФК, физиотерапию, массаж, ортопедические приспособления и т. д. В запущенных случаях назначается операция.
Характеристика болезни, классификация
Коленный сустав соединяет надколенник (коленная чашечка), бедренную и большеберцовую кость. Эти структуры покрыты хрящевой тканью, которая защищает суставные поверхности от разрушения при трении. Связки внутри и снаружи сустава стабилизируют его, а мениск (хрящевая прокладка) – смягчает толчки и удары. Части костного соединения находятся в суставной (синовальной) сумке, которая покрыта фиброзной капсулой. Внутри она выстлана оболочкой и заполнена жидкостью. Колено выполняет такие функции: опорная, сгибание, разгибание, вращение.
При чрезмерной нагрузке или травме колена хрящ постепенно стирается. Коллагеновые волокна в его составе разрушаются, снижается эластичность, уменьшается высота, тогда он теряет амортизационные свойства. При дальнейшем развитии болезни повреждается костная ткань, появляются остеофиты (костные разрастания) в коленном суставе из-за трения костей друг об друга. Это приводит к неподвижности костного соединения.
Вылечить гонит легче на ранних стадиях. О симптомах и лечении артрита коленного сустава расскажет ортопед или травматолог. Главное обратится за помощью при появлении первых признаков болезни.
Гонартрит (код по МКБ-10 – М17, М17.1 – 17.5, М17.9) бывает острый и хронический.
Классификация артрита коленного сустава:
- По причине различают следующие виды артритов:
- Первичный – болезнь развивается спонтанно и не связана с другими патологиями;
- Вторичный – артрит провоцируют другие заболевания.
- По типу воспаления:
- Гнойный;
- Серозной-гнойный;
- Серозный.
- По количеству вовлеченных суставов:
- Односторонний (справа или слева);
- Симметричный (поражается правый и левый сустав одновременно).
- По этиологии:
- Инфекционный или септический артрит;
- Ревматоидный;
- Посттравматический;
- Реактивный;
- Асептический.
Диагноз «Артрозо-артрит» (деформирующий гонартрит) проявляется повреждением хрящей и костей сустава, деформацией колена. Для этой формы болезни характерны остеофиты.
Возможные причины
Первичный артрит колена чаще возникает на фоне травм: ушибы, открытые раны, разрыв капсулы сустава или хрящевой прокладки (мениск). После повреждения инфекция проникает внутрь, вызывая воспалительный процесс (посттравматический артрит). Иногда гонит возникает после пункции костного соединения или операции на колене, если врач нарушал технологию проведения процедуры.
Вторичный гонартрит провоцируют многие системные патологии. Так развивается ревматический, псориатический, гемофилический, саркоидный, подагрический артрит.
В отдельную группу относят микрокристаллические артриты, которые проявляются острым течением, поражением одного или нескольких суставов. Часто болезнь вызывают микрокристаллы уратов (подагра) и пирофосфата кальция (пирофосфатная артропатия).
Дегенеративно-дистрофические изменения колена возникают на фоне красной волчанки, анкилозирующего спондилоартрита, синдрома Рейтера, онкологических образований и т. д. Вероятность инфекционного гонита повышается при туберкулезе, сифилисе, гонорее, бруцеллезе, дизентерии. Болезнь вызывают гнойные процессы другой локализации: остеомиелит, фурункулез, рожистое воспаление ноги. Реактивную форму артрита провоцируют мочеполовые или кишечные инфекции.
Ревматоидный гонит диагностируют часто, особенно на фоне аутоиммунных патологий. Нередко болезнь возникает из-за поражения сустава стафилококками.
Другие причины, повышающие вероятность появления артрита коленного сустава:
- Тяжелая физическая работа, профессиональный спорт вызывают нагрузочный артрит;
- Повреждение связок сустава;
- Воспаление слизистых сумок костного соединения;
- Воспалительное поражение сухожилия;
- Избыточный вес;
- Гипермобильность суставов;
- Деформация стопы, при которой происходит ее уплощение;
- Нарушение обменных процессов;
- Частые стрессы;
- Передозировка медикаментами;
- Нарушение функций эндокринных желез;
- Инфекционные болезни (ангина, краснуха, ветрянка, паротит и т. д.).
Нередко артрит колена обостряется после вакцинации, аллергии, операции, аборта, родов или переохлаждения.
Клинические проявления на разных стадиях
Симптомы артрита коленного сустава нарастают постепенно. Сначала появляется боль после физических нагрузок или в конце дня, которая со временем усиливается. Больной быстрее устает, на пораженном участке появляется покраснение, отек, которые указывают на воспаление суставной капсулы. Потом болевой синдром дополняется ограничением подвижности ноги на пораженном участке.
На запущенной стадии артрита повышается температура, что свидетельствует о распространении инфекции по всему телу. Проявляется малоподвижность или полная обездвиженность костного соединения, деформируются мышцы, меняется форма кости.
Клиническая картина на разных стадиях артрита колена:
- Гонартрит 1 степени. Начальная стадия проявляется незначительной болью после физической нагрузки, которая быстро исчезает в состоянии покоя. Больной иногда прихрамывает, может появится легкое покраснение на пораженном участке. Другие признаки: быстрая утомляемость, хруст при движении коленом, незначительное ограничение подвижности. На этой стадии суставная щель немного сужается, что можно заметить во время ренгтенографии (см. фото ниже);
- Артрит коленного сустава 2 степени. Болевая реакция, хруст усиливается, больной не может полностью сгибать/разгибать конечность, истончается квадрицепс бедра. Значительно сужается суставная щель, появляются костные наросты, края суставных поверхностей сплющиваются;
- Гонит 3 степени – боль ощущается в состоянии покоя, сильный отек, местное повышение температуры. Осколки остеофитов иногда откалываются, блокируют сустав, тогда возникает сильная боль, неподвижность. Больной не может самостоятельно передвигаться, деформируется коленный сустав. На рентгене заметно, что ось конечности изменилась.
Симптомы артрита колена иногда дополняются перикардитом, миокардитом, пневмонитом, энтероколитом, гломерулонефритом, конъюнктивитом, кожной сыпью и т. д. Для гнойной формы болезни характерна лихорадка, озноб, головная боль, миалгия.
Установление диагноза
При появлении симптомов артрита колена обратитесь к ортопеду, травматологу, артрологу или ревматологу. Врач проведет диагностику для выявления причин и степени тяжести болезни.
Диагностика артрите включает такие методы:
- Рентгенография показывает сужение суставной щели, повреждение хрящевой прокладки или суставных поверхностей, остеофиты и т. д. МРТ или КТ позволяют послойно изучить сустав, заметить первые признаки болезни;
- УЗИ позволяет уточнить характер и объем выпота в суставе;
- Лабораторные исследования крови применяют для обнаружения признаков активного воспаления (увеличение СОЭ, повышение лейкоцитов, наличие маркеров воспаления, антитела к возбудителям инфекции);
- Артроскопия – это лечебно-диагностическая процедура, во время которой прокалывается кожа, в полость сустава вводится гибкий проводник с камерой на конце. Это исследование позволяет визуализировать все структуры сочленения, и при необходимости провести лечение;
- Биопсия суставной оболочки проводится для забора синовиальной жидкости и дальнейшего его изучения под микроскопом.
Два последних исследования самые информативные, так как позволяют выявить причины артрита колена. Но применяются они редко из-за повышенной травматичной и высокой стоимости.
Инструментальные процедуры иногда дополняются термографией, контрастной артрографией, пневмоартрографией.
Принципы лечения
Лечение артрита коленного сустава проводится по такому плану:
- Прием лекарственных препаратов при остром гоните;
- Физиотерапевтические процедуры и массаж на стадии ремиссии (исчезновение симптомов болезни);
- Лечебная физкультура;
- Ортопедическая коррекция;
- Диетическое питание;
- Применение народных средств.
При сильной деформации и разрушении хрящевой ткани проводится хирургическое лечение.
На 1 стадии артрита колена достаточно лечебной физкультуры, периодического массажа, применения ортопедических приспособлений и коррекции питания. На 2 стадии терапия дополняется медикаментами (наружного и местного действия). На 3 стадии при наличии осложнений назначают операцию. Потом следует длительный восстановительный период с применением всех вышеописанных методов.
Наколенники рекомендуется носить на начальных этапах артрита колена. Они устраняют дискомфорт, боль, признаки воспаления, улучшают кровообращение, восстанавливают подвижность. Закрытые бандажи показаны на 1 стадии гонартрита, открытые – при болезненных ощущениях на определенном участке, открытые с регулировкой степени натяжения – на разных стадиях патологии. Ортопедические фиксаторы колена на шарнирах расширяют диапазон движений во время ходьбы. Бандаж для больного помогает выбрать врач.
Медикаменты для лечения гоноартрита
Медикаментозное лечение артрита коленного сустава проводят для того, чтобы снять воспаление, боль, восстановить обменные процессы, нормализовать питание сустава, ускорить его регенерацию.
При гонартрите колена назначают лекарственные средства следующих групп:
- Нестероидные противовоспалительные препараты: Диклофенак, Ибупрофен, Индометацин, Кетопрофен, Мелоксикам, Целококсиб, Нимесулид. Их применяют перорально, внутримышечно или внутривенно при остром артрите коленного сустава. НПВС снимают воспаление, боль, отек;
- Кортикостероиды: Гидрокортизон, Кенолог, Дипроспан (внутрисуставные инъекции). Быстро купируют воспаление, боль, восстанавливают двигательную активность поврежденной ноги;
- Базовые препараты при ревматоидном артрите колена: Плаквенил, Ревматрекс, Арава, Неорал. Тормозят разрушение сустава, уменьшают активность иммунитета;
- Хондропротекторы: Дона, Артра, Терафлекс, Румалон, Структум. Замедляют разрушение хрящевой прокладки, ускоряют ее восстановление. Таблетки и капсулы принимают от 3 месяцев и более;
- Сосудорасширяющие средства: Кавинтон, Трентал, Актовегин, Упсавит, Аскорутин. Расширяют просвет сосудов, ускоряют ток крови, улучшают питание тканей вокруг сустава;
- Спазмолитики: Мидокалм, Сирдалуд, Тизалуд, Дротаверин. Расслабляют мускулатуру на поврежденном участке, уменьшают боль;
- Антибиотики: Азитромицин, Доксицилин, Офлоксацин и т. д. Применяются при септических видах артритов, помогают вывести инфекцию из организма.
Решение о назначении препаратов при артрите колена принимает врач, так как они имеют много противопоказаний, и нередко вызывают серьезные побочные реакции.
Кроме пероральных препаратов применяются местные средства в форме мазей, кремов, гелей: Апизартрон, Финалгон, Долобене, Фелоран, Фастум, Никофлекс и т. д. Они активизируют ток крови на поврежденном участке, согревают, ослабляют симптомы воспаления.
Раствор Димексида используют в виде примочек или компрессов. Препарат обладает инммунодепрессивным, противовоспалительным, спазмолитическим, антибактериальным эффектом.
Физиотерапевтические процедуры
Комплексное лечение артрита колена дополняется физиотерапевтическими процедурами:
- Лазерная, ультразвуковая терапия, инфракрасное облучение помогает ослабить воспаление;
- Водолечение, массаж, электростимуляция улучшают кровообращение, питание поврежденного колена, останавливают атрофию мышц;
- Плазмаферез – удаление плазмы крови, которая содержит токсические и метаболические вещества. Назначается при инфекционном и ревматоидном артрите колена;
- Криотерапия активизирует метаболизм, ослабляет боль.
Физиотерапия показана в восстановительном периоде.
Массаж и лечебная физкультура
Массаж при артрите колена помогает нормализовать кровообращение, питание тканей и лимфоотток. Его сочетают с медикаментами, ЛФК, физиотерапией для скорейшего выздоровления. При воспалении мышц выполняют расслабляющий массаж, на стадии ремиссии – стимулирующий. Рекомендуется провести от 8 до 12 процедур. При инфекционном гоните массаж не назначают.
Лечебные упражнения выполняют на стадии ремиссии. ЛФК делает связки более эластичными, укрепляет мускулатуру, нормализует ток крови, обменные процессы, улучшает общее самочувствие. Комплекс составляет врач для каждого пациента отдельно.
Тренировки нужно проводить ежедневно, чтобы быстрее восстановить подвижность больного колена. Для профилактики гонартрита выполняйте гимнастику Бубновского или упражнения из йоги. Ударные нагрузки (бег, прыжки, тяжелая атлетика) противопоказаны при заболевании.
Хирургические методики
Вылечить артрит колена на 2 – 3 стадии поможет операция, которую назначают в таких случаях:
- Отсутствие положительной динамики при консервативном лечении на протяжении 3 месяцев и более;
- Повреждение хрящевой прокладки;
- Образование внутрисуставных, хрящевых или костных телец;
- Остеофиты, которые нарушают подвижность структурных элементов сустава;
- Анкилоз (неподвижность костного соединения).
Для лечения гонита применяют такие хирургические методики:
- Артроскопия – малоинвазивная процедура, которая выполняется через небольшие отверстия с помощью эндоскопа и миниатюрной видеокамеры. Восстанавливает подвижность или стабильность колена, помогает промыть полость сустава от фрагментов хрящей или инфекции. Применяется на 2 стадии;
- Эндопротезирование показано при 3 степени гонартрита, когда хрящевая прокладка уже сильно повреждена. Во время процедуры коленный сустав заменяют на биосовместимый протез, который обеспечивает прежний объем движений. Срок службы такой конструкции – около 20 лет;
- Артродез – операция, во время которой суставные поверхности обездвиживаются (искусственный анкилоз). Процедура направлена на устранение нестабильности сустава, но его функциональность теряется.
Эндопротезирование – это самая эффективная методика хирургического лечения при артрите 3 степени, но ее стоимость слишком высокая.
Коррекция питания
Диета помогает снизить вес, уменьшить давление на больное колено, улучшить обменные процессы. Для этого нужно питаться часто, маленькими порциями, пить от 2 л фильтрованной воды.
Рацион при артрите коленного сустава пополняется такими продуктами:
- Овощи, фрукты, ягоды, зелень;
- Цельнозерновые продукты;
- Нежирное мясо (курица, индейка, телятина);
- Рыба;
- Кисломолочные продукты.
Важно отказаться от алкоголя, жирной, жареной, соленой, острой пищи, полуфабрикатов, продуктов, богатых на химические добавки. Крепкий кофе и чай лучше заменить травяными чаями, морсами, свежими соками.
Оптимальный способ термообработки продуктов – варка, готовка на пару, тушение, запекание без масла.
Народные средства
В домашних условиях облегчить симптомы артрита колена помогут такие рецепты:
- Компресс. Отбейте листья капусты, смажьте медом, приложите к больному участку, зафиксируйте повязкой, утеплите. Оставьте на всю ночь. Для компресса можно использовать измельченный лист алоэ с соком черной редьки. Смесь нанесите на больной участок, оберните пищевой пленкой, оберните повязкой. Через 40 минут снимите;
- Ванночка. Измельчите ножом или топориком ветки ели, залейте кипяченой водой, когда она остынет до комфортной отметки – опустите больную ногу, держите полчаса. Курс длится 14 дней;
- Настойка для приема внутрь. Залейте 500 мл водки 5 измельченных зубцов чеснока, закройте бутылку, поставьте в темное место на 7 дней. Принимайте по 1 ч. л. перед приемом пищи.
Народные средства будут эффективны только в составе комплексной терапии.
Чем опасен артрит колена
Главная опасность гонартрита в том, что он может приобрести хроническое течение. Тогда болезнь будет распространятся с колена на другие суставы.
Инфекционный гонит приводит к артрозу (разрушение и деформация сочленения), гнойному бурситу (воспаление слизистой сумки), синовиту (воспаление в суставной оболочке). При артрите повышается риск поражения почек, мочевого пузыря, печени, сердца.
Ревматоидный гонартрит быстро переходит на другие костные соединения (лучезапястный, локтевой, фаланговый и т. д.).
В худших случаях болезнь приводит к инвалидности или сепсису (заражение крови). Последнее состояние иногда заканчивается летально.
При появлении симптомов артрита колена нужно обратиться к ортопеду, травматологу, ревматологу или другому специалисту. После диагностики проводится лечение с применением медикаментов, ортопедических приспособлений. Дополнить лечение необходимо диетой, ЛФК, массажем, физиотерапией, народными средствами. В запущенных случаях показана операция.
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