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Tratamientos no farmacológicos de la artrosis

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Tratamientos no farmacológicos de la artrosis

  1. 1. ypresentanTratamientos no farmacológicos de laTratamientos no farmacológicos de laartrosisartrosis
  2. 2. ¿Cuándo se debe recurrir a lostratamientos no farmacológicos? Las recomendaciones internacionales relativas a la artrosis delas extremidades inferiores y las manos hacen hincapié en untratamiento individualizado, que combina medidas nofarmacológicas con tratamientos farmacológicos Interés: Efecto sintomático y funcional equivalente, como mínimo, a lostratamientos farmacológicos Ausencia de efectos secundarios Efecto estructural no demostrado hasta el momento2Rannou F. Prescrire les traitements non pharmacologiques dans l’arthrose des membres inférieurs. Rev Prat 2012;62:651-53.
  3. 3. ¿En qué consisten?Educación del pacienteEjercicios físicosAyudas técnicas: plantillas, bastones, órtesis, etc.Consejos dietéticosCrenoterapia (cura termal)Pérdida de peso si existe sobrecarga ponderal en los casosde gonartrosis3Rannou F. Prescrire les traitements non pharmacologiques dans l’arthrose des membres inférieurs. Rev Prat 2012;62:651-53.Sellam, J, Berenbaum F. Arthrose. Rev Prat 2011;61:675-85.
  4. 4. La pérdida de peso El tratamiento no farmacológico máseficaz en la gonartrosis Debe ser de un 5% del peso inicial,como mínimo, para que seaplenamente eficaz Mejora la función y reduce el dolor Tiene también un beneficiocardiovascular, que es importanteteniendo en cuenta la frecuencia decomorbilidades en estos pacientes4
  5. 5. Educación terapéutica (1)Su objetivo es conseguir que el paciente seamás autónomo y esté más alertaPermite una mejor gestión de los tratamientosEs diferente de la información y requiere unaplanificación en varias etapasDeben intervenir varios profesionalesSe integra en la atención sanitaria y se debeevaluar5 Beauvais C. Éducation thérapeutique en rhumatologie. Rev Prat Med Gen 2012 ;26 :155-60.
  6. 6. 6
  7. 7. Educación terapéutica (2) Principales objetivos terapéuticos ypedagógicos en la artrosis*: adopción de tratamientos nofarmacológicos gestión de analgésicos y AINE actividad física y gimnasia por cuentapropia (adopción, persistencia) pérdida de peso, en caso necesario7Beauvais C. Education thérapeutique en rhumatologie. Rev Prat Med Gen 2012;26:155-60.*Artrosis de las extremidades inferiores, artrosis digital
  8. 8. Medidas saludables de estilo de vida* Reducir el sobrepeso en el caso de los pacientesque lo padezcan Limitar la permanencia de pie de formaprolongada, los paseos largos, el levantamientode pesos durante los períodos dolorosos (reposorelativo) Favorecer la actividad física en ausencia deepisodios de la enfermedad Utilizar un bastón en el lado sano Calzado adaptado, suelas amortiguadoras8 Sellam, J, Berenbaum F. Arthrose. Rev Prat 2011;61:675-85.* Artrosis de las extremidades inferiores
  9. 9. Ejercicios físicos de resistencia* Tipo: marcha rápida (30 minutos 3 veces a la semana), bicicletaestática o gimnasia acuática Mejoran las capacidades aeróbicas de los pacientes y su calidad de vida Combaten la falta de condición física cardiorrespiratoria Actúan sobre la movilidad articular, el fortalecimiento muscular y lamotricidad, la mejora de la propiocepción, los trastornos del equilibrio9 Rannou F. Prescrire les traitements non pharmacologiques dans l’arthrose des membres inférieurs. Rev Prat 2012;62:651-53.Bonan I. Rôle de la rééducation dans le traitement de la gonarthrose. Rev Prat 2009;59:1246-47.* Artrosis de las extremidades inferiores
  10. 10. Gonartrosis: dos tipos de ejerciciosespecíficosAumento de la fuerza muscular Afecta a los músculos estabilizadores de la rodilla:especialmente al cuádriceps, pero también a losisquiotibiales Reduce los dolores, aporta un beneficio funcional Trabajo estático o dinámico contra la gravedad,resistencia natural o pesoEjemplo: pedir al paciente sentado que mantenga lapierna extendida (estático) o que alterne elmovimiento de flexión-extensión de la rodilla(dinámico)10• Aumento de la amplitud articular Ejercicios destinados a combatir la flexión de la rodillaRannou F. Prescrire les traitements non pharmacologiques dans l’arthrose des membres inférieurs. Rev Prat 2012;62:651-53.Bonan I, Carson P. Rôle de la rééducation dans le traitement de la gonarthrose. Rev Prat 2009;59:1246-47.
  11. 11. Artrosis femoropatelar: ejerciciosespecíficos Rehabilitación isométrica de las partes internasdel cuádriceps (vasto interno) Permite alinear la rótula y evitar su contacto conla tróclea, debido a una subluxación11Sellam J, Berenbaum F. Arthrose. Rev Prat 2011;61:675-85.
  12. 12. Gonartrosis: actividades de rehabilitación(ejemplo) 12 sesiones de quinesioterapia, con una frecuencia de 2 sesiones a lasemana Masajes descontracturantes Ejercicios de extensión de la rodilla Refuerzo motor suave isométrico, yposteriormente dinámico, del cuádricepsy los isquiotibiales Rehabilitación proprioceptiva Reencauzamiento del esfuerzo Aprendizaje de ejercicios de autorehabilitación12Bonan I, Carson P. Rôle de la rééducation dans le traitement de la gonarthrose. Rev Prat 2009;59:1246-47.
  13. 13. Gonartrosis: órtesis plantares o plantillas Consejos sobre el calzado: calzado deportivo con suela gruesa yblanda Plantillas de amortiguación: se recomiendan, independientemente del compartimentoafectado (femoraltibial interno o externo, femoropatelar) pueden reducir el dolor y mejorar la marcha las realiza un podólogo a medida o se adquieren en la farmacia Órtesis plantares: con un ángulo postero-externo pronador que alivia elcompartimento interno (gonartrosis femorotibial interna) o un ángulo postero-interno supinador (gonartrosis femorotibialexterna)13Rannou F. Prescrire les traitements non pharmacologiques dans l’arthrose des membres inférieurs. Rev Prat 2012;62:651-53.Zhang W, et al.EULAR evidence based recommendations for the management of hand osteoarthritis: report of a Task Force of the EULAR Standing Committee for International Clinical Studies Including Therapeutic
  14. 14. Gonartrosis: Órtesis de rodilla Órtesis suaves no adhesivas o rodilleras elásticas con o sindispositivo peripatelar Pueden reducir el dolor, mejorar la estabilidad y disminuirel riesgo de caída Se recomiendan especialmente en pacientes jóvenes, conel fin de reanudar una actividad deportiva, o en todos lospacientes con el fin de retrasar una sustitución protésica14Rannou F. Prescrire les traitements non pharmacologiques dans l’arthrose des membresinférieurs. Rev Prat 2012;62:651-53.Zhang W, et al.EULAR evidence based recommendations for the management of hand osteoarthritis: report of a Task Force of the EULAR Standing Committee for International Clinical Studies Including Therapeu
  15. 15. Coxartrosis: ejercicios específicos Conservación de las amplitudes articulares Fortalecimiento de los músculos estabilizadores de lacadera Lucha contra los malos hábitos y la pérdida de la marcha15Rannou F. Prescrire les traitements non pharmacologiques dans l’arthrose des membres inférieurs. Rev Prat 2012;62:651-53.
  16. 16. Artrosis digital Se recomienda:La práctica de ejercicios: para proteger las articulaciones,mejorar la movilidad y aumentar la fuerza muscularLa aplicación de calor (parafina, vendas calientes),especialmente antes del ejercicio físicoLas férulas para la artrosis de la base del pulgar (rizartrosis)Las órtesis de prevención o corrección de las deformidadesangulares en lateralidad y flexión16Zhang W, et al.EULAR evidence based recommendations for the management of hand osteoarthritis: report of a Task Force of the EULAR Standing Committee for International Clinical Studies Including TheraAnn Rheum Dis. 2007;66:377-88.
  17. 17. Tipo de actividades para una rizartrosis Artrosis que se asienta entre el trapecio y el primer metacarpiano,con bastante frecuencia bilateral Frecuente (8-22% de las mujeres); afecta principalmente a las mujeres(80%)17Actividad 1Mejora de la amplitud, la postura y la autopostura de la 1ª comisuraFortalecimiento de los músculos intrínsecos y extrínsecos de la mano, de la pinza pulgar-índiceTrabajo funcionalTrabajo aeróbicoAutoprogramaNo es necesaria la aplicación de ultrasonidos ni de masajesActividad 2Órtesis de reposo de la apertura de la pinza pulgar-índice que se utilizará durante la nocheRannou F, La rhizarthrose. Rev Prat 2012, 62:639.

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