Osteoartrosi di Ginocchio
Cause, Prevalenza e Fattori di Rischio Modificabili
Autore: Massimo Cancelli Fisioterapista
L’osteoartrosi è la forma più comune di artrite e rappresenta la patologia muscolo-scheletrica progressiva più frequente tra gli anziani. I distretti articolari più colpiti sono l’anca, il ginocchio e la mano. Dopo le malattie cardiovascolari, è la seconda causa più comune di disabilità e riduzione dell’attività lavorativa tra le condizioni muscolo-scheletriche, oltre ad avere un forte impatto sulla qualità della vita.
In particolare, ci concentreremo sull’osteoartrosi di ginocchio, che ha una prevalenza stimata intorno al 10% negli uomini e al 13% nelle donne di età pari o superiore a 60 anni. Questi dati sono aumentati nel corso degli anni a causa dell’aumento dell’aspettativa di vita e dell’esposizione a fattori di rischio che favoriscono l’insorgenza e lo sviluppo della patologia.
Contrariamente a quanto si pensava in passato, l’osteoartrosi non riguarda solo la perdita di cartilagine articolare causata dal carico meccanico, ma coinvolge l’intera articolazione, provocando cambiamenti nella struttura, nel metabolismo e nella funzione di tutti i tessuti articolari.
I fattori di rischio per lo sviluppo dell’osteoartrosi possono essere non modificabili o modificabili. Tra i fattori non modificabili vi sono il sesso, con le donne più colpite, l’età sopra i 50 anni e precedenti traumi o infortuni articolari (come lesioni dei menischi o del crociato anteriore) e fattori anatomici come varismo o valgismo, che possono essere collegati all’osteoartrosi se diventano progressivi nel tempo.
Tra i fattori di rischio modificabili invece troviamo l’obesità, determinati fattori occupazionali come il lavorare in posizioni di inginocchiamento o sollevamento di pesi importanti, e lo stile di vita sedentario.
È interessante notare che l’attività fisica moderata non rappresenta un fattore di rischio per lo sviluppo dell’osteoartrosi, mentre uno stile di vita sedentario o un’eccessiva esposizione alla corsa intensa sono stati associati all’osteoartrosi dell’anca e del ginocchio. Pertanto, l’esercizio fisico può essere protettivo contro la patologia se eseguito con moderazione.
Patofisiologia
Il metabolismo cartilagineo è gestito dai condrociti, che sintetizzano tutti i componenti della cartilagine articolare. L’omeostasi interna è mantenuta grazie a un equilibrato turnover tra processi anabolici e catabolici, stimolati dal carico meccanico attraverso meccanocettori. Un carico meccanico adeguato è essenziale per preservare l’integrità della cartilagine, mentre uno scarso o eccessivo carico può portare a danni irreversibili e alla progressione dell’osteoartrosi.
Nel quadro clinico dell’osteoartrosi, devono essere considerate tutte le componenti dell’articolazione, poiché alterazioni ossee subcondrali e infiammazione della membrana sinoviale svolgono un ruolo significativo nella malattia. La comunicazione tra cartilagine e osso subcondrale è fondamentale per l’omeostasi articolare e la progressione della malattia, con cambiamenti nell’osso trabecolare subcondrale correlati allo stato della cartilagine.
Tra le cause patofisiologiche dell’osteoartrosi vi è la riduzione della funzione “shock absorber” del menisco, che può portare a perdita di lubrificazione, instabilità articolare e picchi di pressione intraarticolari. Nei pazienti con osteoartrosi confermata radiograficamente, è spesso presente un danno o una sofferenza del menisco.
Il paziente con osteoartrosi avverte dolore regionale correlato al carico, che peggiora durante o dopo l’attività e migliora con il riposo. Altri sintomi includono dolorabilità diffusa, lieve gonfiore, sensazione di instabilità del ginocchio e rigidità mattutina, che dura solitamente meno di 30 minuti.
È importante sottolineare che la gestione della patologia dovrebbe concentrarsi sul miglioramento dei sintomi e delle limitazioni funzionali, piuttosto che basarsi esclusivamente sui risultati degli esami di imaging, poiché segni di osteoartrosi possono essere presenti in alcuni anziani asintomatici e riflettere normali processi di invecchiamento.
Trattamento
La gestione ottimale dell’osteoartrosi di ginocchio richiede un approccio multimodale, personalizzato in accordo con le preferenze del paziente e sviluppato dal fisioterapista. È importante valutare lo stato di salute generale del paziente per ridurre gli effetti collaterali da farmaci e garantire un trattamento fisioterapico adeguato.
Le linee guida italiane suggeriscono trattamenti con forte evidenza, tra cui:
- Educazione: fornire informazioni personalizzate al paziente sugli obiettivi del trattamento e sugli interventi da seguire nel breve e lungo termine.
- Perdita di peso: promuovere la riduzione del peso corporeo, poiché è dimostrato che il sovrappeso influisce negativamente sull’osteoartrosi.
- Esercizio terapeutico: incoraggiare l’attività fisica generale con esercizi di forza, resistenza, aerobici o in acqua, basandosi sulle preferenze del paziente.
- Autotrattamento: consegnare al paziente un regime di esercizi personalizzati da eseguire quotidianamente.
- Utilizzo di ortesi e ausili: possono prevenire la progressione dei cambiamenti degenerativi e migliorare la funzione articolare.
- Trattamento farmacologico: l’uso di farmaci antinfiammatori non steroidei (FANS) e infiltrazioni di corticosteroidi può essere utile per controllare il dolore e l’infiammazione.
In conclusione, l’educazione e l’esercizio terapeutico rappresentano i trattamenti più efficaci per l’osteoartrosi di ginocchio. Oltre a ridurre il dolore e migliorare la funzione articolare, questi trattamenti possono avere benefici aggiuntivi sulla self-confidence, l’ansia, la depressione e favorire una migliore relazione terapeutica con il paziente.
Prognosi
Dal punto di vista prognostico, l’osteoartrosi è una patologia caratterizzata da una vasta variabilità nella sua presentazione, rendendo difficile fornire tempistiche precise per il miglioramento dei sintomi. Si tratta di una condizione che si estende lungo un continuum e può accompagnare il paziente per lunghi periodi, con fasi di riduzione della sintomatologia seguite da ritorni di limitazioni nelle attività quotidiane.
Una volta intrapresa la strada della terapia conservativa, è fondamentale creare un percorso riabilitativo personalizzato, distribuito nel tempo e con sessioni di monitoraggio degli esercizi. Una revisione sistematica della Cochrane ha dimostrato che un numero maggiore di sedute di esercizio supervisionato porta a risultati migliori rispetto all’esercizio non supervisionato. Tuttavia, è importante considerare che i benefici ottenuti dal trattamento sono spesso mantenuti solo per un periodo relativamente breve, generalmente compreso tra 2 e 6 mesi dopo la fine delle sedute.
Nella valutazione dei fattori che influenzano il successo della terapia conservativa, bisogna prendere in considerazione aspetti biologici, fisici e psicosociali. Gli aspetti psicosociali, come ansia, depressione, kinesiofobia (paura del movimento) e coping passivo (strategie di adattamento non attive), possono influenzare il risultato del trattamento. Inoltre, l’esposizione ai fattori di rischio precedentemente menzionati rappresenterà un elemento prognostico negativo.
Nel caso in cui il trattamento conservativo fallisca, la chirurgia ortopedica può essere presa in considerazione per i pazienti con evidenza radiografica di osteoartrosi grave, significativa disabilità, ridotta qualità della vita e dolore che non risponde ad altri trattamenti.
Autore: Massimo Cancelli Fisioterapista
Fisioterapia e Osteopatia a Brescia
If blood osmolarity is merely too excessive, meaning that the blood is not dilute
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70918248
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treatment is being withdrawn. If steroids are going to be taken long-term then it’s usually suggested to take drugs or supplements
to strengthen the bones and help prevent osteoporosis.
Typically the steroid therapy is progressively stopped if the condition improves, and restarted if it worsens.
This information shouldn’t be thought of full, up to date, and is not meant to be used
in place of a go to, consultation, or advice of a legal, medical, or
some other skilled. Your physician may also suggest you are taking them for a short while to treat
allergic reactions, like a extreme poison ivy rash.
Hydrodiurils potential unwanted side effects are similar
to those of related diuretics similar to Esidrix, Ezide, Dyrenium, Microzide and Oretic.
Your dose wants might change due to surgical procedure, illness, stress, fever, or infection.
The traits in query are rising bone mineral content material and enhancing collagen synthesis.
Due to these traits, Deca Durabolin is well-known for selling joint reduction, and for many athletes that’s the only reason they’ll use it.
Due to these traits, in addition to its ability to increase pink blood cell
rely, we can begin to see what forms of therapeutic advantages
this steroid can hold. For females, 5 – 10mg per day of the
oral preparation is known to be pretty common amongst female bodybuilders and athletes that want to avoid any risk of virilization or different side
effects. Though injectable Winstrol just isn’t very common amongst feminine
athletes and bodybuilders, 15mg injected each other day (for an approximate total of
60mg per week) is an efficient recommendation. The further proteins produced type the
building blocks of muscle, and with elevated protein production there’s increased
muscle development. Anabolic steroids that burn Fat and build muscle;
https://byizea.fr/js/pgs/?acheter_de_la_testosterone_2.html,
also velocity up how your physique breaks down advanced molecules into simpler molecules, known as catabolism, which provides power for muscle cells.
Deca Durabolin is an extremely in style anabolic steroid comprised of the steroidal hormone Nandrolone and is hooked up to the
massive Decanoate ester. The Nandrolone hormone first appeared
in 1960 and developed for industrial use in 1962 by Organon beneath the
commerce name Deca Durabolin. Since that time
quite a few Nandrolone Decanoate versions have hit the market, however Deca Durabolin remains
essentially the most recognized. This was not the primary Nandrolone compound
ever created, that might belong to Organon’s Durabolin, which is particularly
Nandrolone Phenylpropionate. The Phenylpropionate model is much quicker appearing with a less lively period,
and whereas Phenylpropionate varieties are in style, Deca Durabolin has largely dominated the Nandrolone marketplace.
Because Winstrol is a DHT-derived anabolic steroid,
it can’t convert into Estrogen at any dose. This means that no Estrogenic side effects ought to be experienced on account of Winstrol use alone.