ORGANIZATION OF TREATMENT OF OSTEOARTHRITIS OF THE KNEE JOINT

Abstract

According to modern ideas, the treatment of osteoarthritis should be comprehensive and include a combination of non-drug methods. In addition, routing patients for non-pharmacological treatment is a difficult problem. In addition, doctors of all specialties who, to a greater or lesser extent, are engaged in the treatment of osteoarthritis (therapists, surgeons, rheumatologists, neurologists) widely use local forms of glucocorticoids in the treatment of osteoarthritis. At the same time, many doctors are guided by outdated recommendations for the management of patients with osteoarthritis. Such a monodisciplinarian approach in the treatment of osteoarthritis of the knee joint, coupled with the patient's routing defects, has a number of significant drawbacks, namely, the lack of timely and adequate therapy of the disease based on a convincing evidence base, which ultimately leads to the progression of joint damage, the development of persistent health disorders and limitations of the patient's vital activity. We have analyzed domestic and foreign literature to identify the shortcomings of osteoarthritis treatment, as well as to understand what concepts need to be changed in the structure of the organization of treatment of osteoarthritis of the knee joint. Among the shortcomings of the existing system of care for patients with osteoarthritis of the knee joint, it should be noted the almost complete absence of dispensary monitoring of patients with pathology of the musculoskeletal system in outpatient clinics. In modern conditions of a market economy, an important aspect of the activities of healthcare institutions is the cost of a particular type of treatment, since the heads of medical institutions are forced to think about financing the organization. This situation leads to the fact that inpatient conservative treatment of osteoarthritis of the knee joint in therapeutic departments is unprofitable for a medical institution due to cheap CHI rates. On an outpatient appointment, doctors do not in all cases manage to reliably establish a diagnosis and make a plan for further treatment of the patient. The lack of continuity in the diagnosis and treatment of osteoarthritis of the knee joint leads to a high frequency of the establishment of the disease at late stages, untimely treatment and the development of pronounced persistent structural and functional disorders of the joints, which can only be compensated by radical surgical methods of treatment. On the other hand, primary care physicians (therapists and surgeons) have limited time to receive a patient, which does not allow for a full physical examination necessary for differential diagnosis of joint syndrome, especially considering that most patients with osteoarthritis have concomitant pathology that also requires attention. It should be noted that the shortcomings in the organization of treatment of patients with osteoarthritis of the knee joint are characteristic not only for the Russian Federation, but also for other European countries and the USA. In foreign countries, osteoarthritis is mainly treated in primary health care institutions, and the main role in this case belongs to the therapist (general practitioner). Thus, it can be stated that today the system of organization of treatment of osteoarthritis of the knee joint is imperfect. Outpatient orthopedic care is provided mainly by non-core specialists.