This is a modern orthopedic booklet dedicated to patients suffering by severe arthritis, those who have recently undergone a joint replacement and those who have postponed a planned orthopedic surgery, due to coronavirus (covid-19). Recent Greek Ministry of Health’s declaration “Stay Home-avoid covid-19”, appears to be effective in transmitting the virus between each other, but the uncertainty over the duration of the restrictive measures, directly affects patients suffering from severe arthritis, major symptoms of which, is pain and limitation of functionality and consequently the level of daily activity.
Why can’t I have right now an operation for my arthritis since there is an exacerbation of pain? In addition to the ban imposed by the Greek Ministry of Health on the postponement of planned and not urgent operation, one must take seriously in mind the risks involved, both surgically and immediately postoperatively.
Even in emergency cases we operate, we prefer local anesthesia instead of general anesthesia, as it has been scientifically proven that tracheal removal can potentially infect the entire operation theatre if the patient is positive for covid-19. Who can assure you that they you will not be infected in resuscitation room or even in the ward by other patients or you will not infect nursing and medical staff? This is why we prefer outpatient or fast-track protocols (24-hour hospitalization) in a single room and almost zero visits from relatives during hospitalization. Even regular visits to the treating physician should be planed to a minimum, patients should have to wait to a minimum and clinical examination or other medical procedures should be performed with all the usual precautions (gloves, mask, antiseptic) to the least possible beneficial time. When you have questions or need further information you can contact your doctor with all electronic media available nowadays.
How to protect yourself and others from coronavirus
Follow this advice as strictly as possible and encourage others to follow this advice too.
- • Wash your hands properly and often
- • Cover your mouth and nose with a tissue or your sleeve when you cough and sneeze.
- • Put used tissues into a bin and wash your hands.
- • Clean and disinfect frequently touched objects and surfaces.
- • Avoid close contact with people – keep a distance of 2 m (6.5 feet) between you and others.
- • Avoid crowded places, especially indoors.
- • Do not touch your eyes, nose or mouth if your hands are not clean.
- • Do not share objects that touch your mouth – for example, bottles, cups.
- • Do not shake hands.
I suffer from severe arthritis. How can I suggest I’m positive in Covid-19 (coronavirus)?
It can take up to 14 days for symptoms of Covid-19 (coronavirus) to show. Symptoms of the virus include:
- • a cough
- • Shortness of breath
- • breathing difficulties
- •fever (high temperature)
How can I deal with my arthritis that afflicts me a lot while staying at home?
This manual aims to offer you a program that can help you live your daily life with as little pain as possible and without the help of a relative or other person. Through this you will also get useful information about the covid-19 so that you can improve your symptoms until you have an operation or improve the functionality of those who have recently had surgery and cannot visit your doctor on a regular basis. It is a combination of exercises that you can do at home, medication, diet and adaptation of the whole family environment to the daily problems of the person with arthritis.
Home Exercises. How exercise can help me with arthritis?
There are many reasons to make home exercises for arthritic pain and stiffness such as:
- • Exercise maintains the full range of motion of the joint.
- • Exercise strengthens the muscles that support the joint.
- • Strong muscles help the joint absorb the vibrations and forces exerted on it.
Exercise should not be difficult to be performed in order to be beneficial. In fact, simple, easy to perform and convenient exercises that do not require special equipment are best for knee and hip arthritis. They reduce stress on the joint as they increase its flexibility and strength. Do they slowly and gradually increase the number of repetitions as your muscles strengthen? At the end of the exercises, be sure to perform gentle stretching exercises, especially at the knee joint, to prevent the muscles around the affected joint from tightening. Consider exercising your knees and hips every other day to relax your muscles. Exercising a joint with severe arthritis at home may seem controversial at first sight, as it can have the opposite effect in the beginning (e.g exacerbation of pain), but regular exercise can reduce or even relieve arthritic pain and other symptoms such as stiffness and swelling. These exercises can also help, through the mobilization of the respiratory muscles, the respiratory function, as they do not allow secretion formation in the lungs and generally work protectively in patients who will potentially come close or are already positive in covid-19.
Below we present indicative exercises in small and easy to understand videos.
1. Lift of the limb (with the patient lying down) to strengthen the quadriceps femoris
2. Extensive femoral exercises (strengthening of the posterior femurs)
3. Extensive exercises in a semi-sitting position (strengthening of anterior-posterior femoris & gluteus muscles)
4. Deep seat with one foot (strengthening of anterior-posterior femoris & gluteus)
5. Leg extensions in a sitting position (strengthening the quadriceps femoris)
Medication for arthritis & covid-19.
Arthritis pain is usually treated with anti-inflammatory drugs (NSAID’s) and / or cortisone in cases of inflammatory arthritis. Recent studies (recently published in the prestigious journal Lancet) show an increased likelihood of major complications in covid-19 patients who are also suffering from hypertension and / or diabetes and taking anti-inflammatory drugs (NSAIDs) and especially ibuprofen (ibuprofen, Brufen, Aceclofenac, Advil,Algofren,etc), naproxen (Naprosyn, Naproxen etc), or diclofenac (Diclofen,Dicloplast, Voltaren, Voltarol,Vurdon,etc) . Keep in mind that these drugs are in nature nephrotoxic and increase cardiovascular complications and stroke.
One of the pain killers that can be used safely for arthritis pain even in patients with covid-19 is paracetamol (Depon, Apotel, Dolal, Lonarid, Panadol, Protalgon).
For those taking cortisone in a chronic base (patients with rheumatoid arthritis, lupus, psoriatic arthritis, etc.) or hydroxyl-chloroquine (Plaquenil), it would be advisable to contact their Rheumatologist either for precautionary reasons or even after covid-19 contamination.
The Covid-19 epidemic may last several months, so if you stop your medicine you will be likely to have a flare during this period and restart or have to take more intensive treatment with steroids. We do not recommend stopping your rheumatology medication and do not stop steroids suddenly or you may become very unwell.
Diet & arthritis
In general, “Staying Home message” does not mean that we spoil our diet, which in combination with lack of exercise and limited body burns, leads to extra pounds. Weight loss has been shown to reduce inflammation, pain and stiffness in the joints. Avoid ready-to-eat and canned foods, foods rich in omega-6 fats, sugars, sugar substitutes, red and fried meats, cheeses and foods high in polyunsaturated fats & carbohydrates and alcohol. Instead, you’d rather prefer broccoli-rich foods, omega-3 fatty fish, almonds and nuts, olive oil and spinach, which combined with a balanced diet will help you not only with arthritis pain but also avoid intake weight while staying home due to coronavirus. If you have recently had an operation for knee or hip arthritis, you should take protein-rich foods or/and supplements for at least 30 days post-operatively. Apart from that, you should prefer foods rich in iron and / or take supplements of iron-rich dietary supplements and other minerals if you have been instructed to do so, by your treating physician.
Communication with other people in the family environment at home.
For those of you who live daily with people suffering from severe arthritis while waiting to have surgery, or people who have recently had surgery, you should pay special attention to the following:
• Good communication is the most serious part. You need to be able to help the patient both improve their daily lives and psychologically. Try to understand the wishes and feelings of the chronically ill patient. • Learn to understand when it hurts a lot (pain makes the patient irritable, often angry or even depressed) because in that case, patient may need emergency help. • You need to understand that arthritis patients react differently and more slowly than you do. • Do not let the patient isolate himself, listen to his problems and give the appropriate solutions. • Share roles in the family to feel like an active member. • Also keep in mind that a patient with severe arthritis often complains of easy fatigue. Encourage him to perform repetitive movements several times a day at home, to perform his exercises reverently, and to have a specific sleep schedule (e.g sleeping at a specific time each night). • Try to change the ergonomics of the house to facilitate the patient’s movement inside the house, avoid carpets (possible fall), add special handles to the toilet that help the patient before or immediately after surgery to get up. • Keep all personal precautions required to protect against coronavirus (covid-19), and isolate in a private room a possible case of illness.
For more information & clarifications or if you want to discuss your problem directly with Dr. Stavros Alevrogiannis and his scientific team, do not hesitate to call +30 210 6502169 or connect with him in electronic form at:
E-mail: firstname.lastname@example.org Skype: stavros-alevrogiannis Website: http://stavrosalevrogiannis.gr
BIBLIOGRAPHIC ANNOTATION 1. Arthritis Research UK :arthritisresearchuk.org 2. Arthritis Ireland : arthritisireland.ie 3. www.thelancet.com/respiratory Vol 8 April 2020 4. https://www.healthline.com/health/osteoarthritis/easy-excercises-knee