I. What is osteoarthritis?
Osteoarthritis, also known as degenerative arthritis and osteophytes, is a disease that affects the joints of the human body, in which the cartilage on the surface of the joints is destroyed and the surrounding bony tissue is proliferated. The affected joints produce pain, aggravated by activity, relieved by rest, and stiffness after a long period of inactivity.
How does osteoarthritis develop?
To understand how osteoarthritis occurs, it is important to first understand how a normal joint is composed and works. A joint is a connection between the bony ends of two bones. Most joints allow movement on only one surface, such as the knee, which is primarily flexion and extension with only a little lateral and rotational movement. Each bone end of the joint is covered with a thin translucent layer of tissue that we call cartilage. This smooth cartilage surface facilitates the free movement of the joint and acts as a cartilage cushion between the bones to distribute the pressure during stress. In some joints, such as the knee, a spacer-like tissue called the meniscus is embedded between the cartilage and the cartilage. The joint is surrounded by a membrane called the synovial membrane, which secretes a small amount of fluid called synovial fluid, which nourishes the cartilage and reduces friction. On the outside of the synovial membrane is a tough joint capsule that prevents excessive bone to bone movement. On the outside, there are stronger ligaments and tendons that keep the joint from moving too much or even dislocating within a certain range of motion.
When osteoarthritis occurs in a joint, the cartilage slowly becomes rougher and thinner, the bone beneath the cartilage thickens, and the edges of the bone grow outward to form what we call bone spurs. The synovial membrane swells and produces excess synovial fluid, making the joint look a little swollen. Over time the joint capsule and ligaments also slowly thicken and contract. This serves to stabilize the joint. The surrounding muscles also atrophy due to disuse.
When we look at a joint with osteoarthritis under a microscope, we see that the joint has an attempt to repair itself. All the tissues that make up the joint are more active than normal, such as bone spurs, which are new tissues created by the joint itself trying to repair the damage. In many cases, this repair is successful, which is why most people have osteoarthritis, while those who have symptoms are in the minority. These people’s self-repair cannot compensate for his damage, producing pain and difficulty in movement. It usually occurs in large joints such as the hip and knee.
The process of osteoarthritis is quite slow, measured in years. The vast majority are mild and insignificant, but a few are very severe. In severe osteoarthritis, there is little to no cartilage covering the surface of the bone ends. There is direct friction between the bone and the bone. The joint cartilage is missing, the bone is worn away, and the bone edges are enlarged, making the joint deformed.
Third, what are the risk factors for osteoarthritis?
The occurrence of osteoarthritis is related to many factors.
1. Age: Osteoarthritis rarely occurs before the age of 40, but is generally common after the age of 50 or 60.
2, gender: women are more common, and osteoarthritis is serious.
3, obesity: especially the knee joint, obesity is an important factor in the occurrence of osteoarthritis. At the same time, once osteoarthritis occurs, obesity in turn will aggravate the disease.
4, joint injury: joint trauma or surgery at a later stage can lead to osteoarthritis. Abnormal development of the joint itself can also lead to osteoarthritis in later stages, such as perthes disease of the hip joint. Strong repetitive joint activities can also cause damage to the joints, so heavy workers and professional athletes are more prone to osteoarthritis.
5, genetic: some parts of the osteoarthritis has a strong familial tendency, such as nodular osteoarthritis of the end of the finger. Also called Hebden’s nodes. Knee and hip osteoarthritis is not as strong a genetic predisposition as the end of the finger. Other studies have shown that the heritability of the spine, hip, knee and hand are above 50%, that is, more than 50% of the disease susceptibility to osteoarthritis is caused by genetic factors.
6, other joint diseases: such as wind-like off, synovial chondromatosis, secondary osteoarthritis.
Although there are so many causes related to osteoarthritis, the real cause is not clear. However, normal exercise, food, and weather are certainly not among the factors that lead to osteoarthritis.
Fourth, how common is osteoarthritis?
Osteoarthritis is the most common joint disease. The knee joint is more prone to osteoarthritis than the hip joint. Osteoarthritis of the hip or knee occurs in 10-20% of people over the age of 65 and is a major contributor to pain and disability in older adults. In the United States, about 8 million people have osteoarthritis and about 1 million need treatment. Most people, of course, do not experience any discomfort or pain despite the obvious osteoarthritis on X-rays. The disease also varies between races, with Europeans or people of European descent being more likely to have osteoarthritis of the hip and knee, while Chinese and African-Caribbean people are relatively uncommon. In our prevalence survey, the overall prevalence of osteoarthritis in Xi’an is 27.8%; in people aged 40 years, it is 16.8%; in people aged 60 years, it is 38.4%; and in people aged 70 years or older, it is 46.6%. In China, the prevalence of osteoarthritis in Shanghai, Shantou and Harbin were reported to be 6.11%, 10.8% and 2.5%, respectively.
In addition to the hip and knee, osteoarthritis of the hand, spine and big toe is also common.
V. What are the symptoms of osteoarthritis?
Osteoarthritis occurs and progresses very slowly, in months or years. Its main symptoms are joint pain and stiffness. The pain is usually worse in the morning when you start moving and in the evening when you feel tired, and the stiffness often improves after 1-2 minutes of joint movement. When you have osteoarthritis of the knee, you may feel or hear a “clicking, clicking” sound in the joint, and you may feel that the joint is not moving freely and is not normal. Sometimes leg weakness occurs due to muscle weakness or joint instability. Swollen, enlarged joints are also a sign of osteoarthritis. Some are hard bone spurs, some are due to joint effusion, and some may be due to muscle atrophy. Some patients with severe osteoarthritis can experience intense and persistent pain that cannot be relieved by either activity or rest, severely affecting the patient’s daily life. For example, osteoarthritis of the knee or hip can affect the patient’s daily activities such as walking up and down stairs, getting into and out of cars, getting up and sitting, putting on shoes and socks, etc., making the patient less able to take care of himself or herself and be self-sufficient.
However, the symptoms of osteoarthritis are not only unpredictable, but also vary from person to person. Sometimes a person may feel bad for weeks at a time, and then suddenly and dramatically improve over the next few months without any explanation. Furthermore, two people with the exact same osteoarthritis can have very different symptoms. One person can have nothing at all, while the other can be very heavy and have their movement affected. Some people have mainly pain and others have mainly impaired movement. Some patients do not change for several years, but others change quickly and dramatically. Because of this characteristic of osteoarthritis, it is meaningless to make comparisons from individual to individual.
How do doctors diagnose osteoarthritis?
Based on the signs and symptoms of the patient described above, a doctor can usually diagnose osteoarthritis without the need for hematologic testing. The only thing that is needed is an X-ray to determine the presence and severity of osteoarthritis, which can show narrowing of the joint space due to cartilage wear, bone changes such as spurs, and sometimes calcifications in the knee joint. However, it is important to note that there is no definite positive correlation between what is seen on the X-ray and the symptoms experienced by the patient. As for the prognosis, it is difficult for doctors to estimate the trend of osteoarthritis in an individual.
What should I pay attention to when I have osteoarthritis?
Although osteoarthritis is a disease that cannot be cured and there is no way to prevent its occurrence, there are many measures that can be taken to reduce symptoms and slow down the progression. Medical professionals can only serve as a guide. The key is for patients to take care of their own joints.
1.Reducing joint pressure
(1) Maintain an appropriate weight. Patients who are overly obese, even if they lose a little weight, the pressure on the hip, knee and ankle joints can be greatly improved.
(2) Reasonable arrangement of household chores. Spread out the chores over several periods of time and do not do all the chores in one go before resting.
(3) Wear thick, soft-soled shoes. Flat heels and thick soft-soled shoes can absorb shock. Many shoe dealers in the market today supply inflatable soft-soled shoes.
(4) Use a cane to assist with walking. A cane of the right length can reduce the pressure on the affected hip and knee.
(5) Protect the joints. Reduce unnecessary activities that can cause injury to the joints.
2. Activity and exercise
In addition to protecting the joints, it is also necessary to maintain the mobility of the joints. Joint training includes three aspects, the first is to maintain the normal mobility of the joint. Gentle pulling exercises keep the joints in the widest possible range of motion, which increases joint flexibility and reduces stiffness. The second exercise is called plyometrics. Strengthening the muscles around the joint, such as the quadriceps muscles of the knee, helps to stabilize and protect the joint and reduce pain. The third exercise is aerobic training or endurance exercises such as level walking or cycling training. Regular aerobic training can improve sleep and maintain a healthy physique, and also help to reduce pain and maintain vitality.
VIII. What treatments are available for osteoarthritis?
The aim of treatment is to maintain normal joint function by eliminating pain and stiffness, reducing joint swelling and stopping further damage to the joint surface.
1.Medication
(1) Analgesics: acetaminophen and its conforming dosage form, NSAIDs anti-inflammatory analgesics and central analgesics.
(2) Glucosamine and chondroitin: also known as joint improvers.
2.Physiotherapy
The purpose of physiotherapy is to reduce pain, improve local blood circulation, improve soft tissue contracture and increase joint mobility. Generally, heat therapy, water bath, short wave, ion introduction, acupuncture, massage, etc. are commonly used. Proper exercise activities and medical gymnastics can prevent and reduce the dysfunction of diseased joints.
3.Surgical treatment
If elderly patients have severe persistent pain and significant joint movement disorders that affect work and life, surgery should be considered. For early osteoarthritis of the knee joint, minimally invasive arthroscopic surgery can be used. The large amount of joint irrigation fluid can remove the particles stored in the joint and improve the nutrition of the joint cartilage, thus reducing and delaying the degenerative process and providing temporary relief of symptoms. Severe end-stage osteoarthritis requires artificial joint replacement or joint fusion.
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