Каково лечение первой линии при остеоартрите тазобедренного сустава?
Остеоартрит тазобедренного сустава рассматривается в нескольких ведущих клинических руководствах, которые сходятся в структурированном подходе первой линии. Данный протокол отражает рекомендации этих руководств и охватывает ряд нефармакологических стратегий с умеренным или высоким уровнем доказательности.
Подход к лечению
Протокол включает образовательные программы и программы самоконтроля наряду со структурированными физическими упражнениями — среди прочих методов, подкреплённых доказательной базой. Полная схема лечения, включая критерии выбора и последовательность каждого компонента, доступна по ссылке ниже.
References
DOI: 10.1016/j.rdc.2022.03.009.
- All guidelines made moderate to strong recommendations for education and self-management as part of OA management.
- Patients with OA should be advised to engage in regular low impact aerobic exercise (land or aquatic-based) and to lose weight if overweight.
- Balance training was conditionally recommended for knee and hip OA in the ACR/AF guidelines, and neuromuscular training, which includes balance, agility, and coordination exercises, was recommended for knee OA by AAOS.
- Tai chi was strongly recommended for knee and hip OA by ACR/AF and for knee OA by OARSI (also conditionally recommended for hip and polyarticular OA by OARSI).
- Thermal modalities were strongly recommended for hip OA by OARSI (conditionally not recommended for knee and polyarticular OA) and conditionally recommended by ACR/AF for knee, hip, and/or hand OA.
- Walking aids (e.g., canes, crutches) were generally recommended as needed for knee and hip OA, with moderate to high quality of evidence for use of canes.
- Acupuncture was conditionally recommended for patients with knee, hip, and/or hand OA in the ACR/AF guidelines despite limited evidence, given the positive effect of acupuncture for analgesia and low risk of harm.
- Cognitive behavioral therapy (CBT) was conditionally recommended for patients with knee, hip, and/or hand OA by ACR/AF on the basis of data regarding chronic pain management, although further study is needed to better assess the benefit of CBT in OA directly.