Osteoarthritis of the knee develops slowly. When the disease progresses to a certain stage, it gradually changes to chronic and persistent pain with limited activity and reduced quality of life. At this time, conservative treatment can still be used to improve symptoms. Conservative treatment follows the principle of individualization and integrative treatment with Chinese and Western medicine.
(A) Commonly used Western medicine treatment
1.Non-steroidal anti-inflammatory drugs (NSAIDs)
These drugs are a kind of regular medication for pain and stiffness in degenerative osteoarthropathy. Typical drugs include ibuprofen, indomethacin (anti-inflammatory pain), aspirin, diclofenac sodium (fotarine), etc. Numerous studies have shown that acetaminophen is less effective than NSAIDs in relieving rest pain versus motion pain. Since the inflammatory response of the knee joint is one of the causes of local tissue destruction, the powerful anti-inflammatory effect of NSAIDs can reduce symptoms and eliminate various local factors that are detrimental to joint cartilage, thus achieving a therapeutic effect. These drugs not only relieve symptoms but also have a delaying effect on the progression of arthritis. However, these drugs can cause serious gastrointestinal reactions and should be used with caution in patients with a history of peptic ulcers; on the other hand, they can affect the body’s blood clotting function, especially when peptic ulcers are combined with bleeding, which can aggravate local bleeding. Therefore, the risk of gastrointestinal bleeding can be significantly reduced by applying GI mucosal protective agents, such as thioglycollate tablets (Daxil), in the process of drug administration.
2.COX-2 selective inhibitors
COX is a class of enzymes in human body, mainly COX-1 and COX-2, and COX-2 is related to the inflammation response such as redness, swelling, heat and pain, etc. NSAIDs produce analgesic and anti-inflammatory effects through dual inhibition of COX-1 and COX-2. NSAIDs are prone to gastrointestinal discomfort, with gastritis and even gastric ulcers being the most common adverse effects. In contrast, COX-2 selective inhibitors only inhibit COX-2 and hardly inhibit COX-1, which does not reduce the anti-inflammatory effect. In addition, because COX-2 selective inhibitors have relatively little damage to liver and kidney function, patients can take it for a long time, and it has a more desirable effect on the treatment of knee osteoarthritis.
3.Sodium hyaluronate (HA)
Sodium hyaluronate (HA) consists of glucuronic acid and acetyl glucosamine, and the representative of this type of drug is sodium glutamate. A certain amount of sodium hyaluronate is injected into the joint cavity: 1. It can locally raise the content of sodium hyaluronate in the joint cavity, so that sodium hyaluronate can gather at the cartilage defect and form a protective barrier to prevent further damage to cartilage and bone; 2. Sodium hyaluronate can reduce the damage to cartilage cells by various inflammatory factors; 3. Sodium hyaluronate can reduce the friction of joint activities and play a mechanical lubricating role for joint cartilage. In terms of safety, the treatment of osteoarthritis with sodium hyaluronate has been approved by the FDA (U.S. Food and Drug Administration). Studies have shown that sodium hyaluronate is comparable to NSAIDs in efficacy and has fewer adverse effects. Sodium hyaluronate is indicated for patients for whom non-pharmacologic and analgesic treatments have failed and for whom oral NSAIDs are not indicated.
4.Glucosamine sulfate
The main role of glucosamine sulfate is to supplement the cartilage matrix and synovial fluid of the knee joint, to promote the metabolism, repair and regeneration of cartilage by improving the matrix microenvironment, thus delaying the progress of the knee joint condition and relieving the symptoms rapidly. A large number of clinical studies have fully confirmed its exact efficacy. Those who take glucosamine sulfate for more than two years can prevent the joint structure of the knee from changing and make the symptoms improve significantly, and have fewer adverse reactions, especially in the gastrointestinal tract, which is safer than non-steroidal anti-inflammatory drugs.
5.Glucocorticoids
In life, many patients are sensitive to the word “hormone”. During the SARS period, hormone made many patients escape from the ghost gate, but also brought some patients extremely serious complications, such as femoral head necrosis, gastrointestinal bleeding, etc.. However, we don’t have to “talk about the tiger” because of this. Glucocorticosteroids are used for the treatment of knee osteoarthritis, mainly by intra-articular injection, and the concentration of the drug is concentrated in the joint cavity, which does not cause systemic adverse reactions like oral drugs. Commonly used glucocorticosteroids are represented by tretinoin, which not only has a very powerful anti-inflammatory effect, but also inhibits the proliferation of connective tissues and works within a few hours, maintaining its effect for up to 3 weeks.
6.Physical therapy
Commonly used physical therapy techniques include heat therapy, hydrotherapy, infrared, ultrashort wave, ionization, and electrical stimulation. For patients with knee osteoarthritis, the combined use of massage, acupuncture and acupressure can achieve the therapeutic effect of relaxing the tendons and channels, activating blood circulation and relieving pain, promoting local metabolism, relieving muscle tension and slipping the joints. From the psychological and objective factors, physiotherapy is more acceptable to patients than drug treatment, and has more advantages in long-term treatment compliance.
(B) Commonly used Chinese medicine treatment
1. Internal treatment of Chinese medicine
Chinese medicine treatment emphasizes the diagnosis and treatment, and on the basis of individualization, the main method is to tonify the liver and kidney and invigorate blood, emphasizing that the disease is mainly based on the original deficiency, and then according to the strength and weakness of the evil qi, supplemented by dispelling wind and removing dampness, invigorating blood and opening the ligaments, so that both the symptoms and the root can be treated with good results. The more common types of symptoms and prescriptions are
(1) Liver and kidney deficiency
Features: recurrent knee pain, weakness, joint deformation, or knee inversion, or tendon outward migration, accompanied by tinnitus, lumbar acidity, pale tongue, white fur, thin or weak pulse.
Treatment: Tonifying Qi and Blood, benefiting the liver and kidney, warming the meridians and clearing the channels.
Representative formula: Right Return Drink.
(2) Cold deficiency of Qi and Blood
Characteristics: Swelling and pain in the knee joint, which occurs with cold and is aggravated by exertion, with puffiness, pale complexion, warmth and fear of cold, and weakness of the limbs. The tongue is pale with white coating and the pulse is sunken and weak.
Treatment: Tonifying Qi and Blood. Warming the menstruation and strengthening the Yang.
Representative formula: Bajhen Tang.
(3) Damp-heat injection
Characteristics: Pain in the knee, redness and swelling, sensation of heat, relieved by coldness, severe by warmth, pain not approachable, inability to move the joints, yellow urine, red tongue with yellowish coating, slippery pulse.
Treatment: Clearing heat and relieving dampness, promoting menstruation and relieving pain.
Representative formula: Si Miao San.
(4) Wind-cold dampness paralysis
Features: swelling of the knee, fluid in the knee joint, soreness and heaviness of the knee, inconvenience in movement, lingering pain, aggravated by rainy, cold and damp weather, with a light red tongue with thin white greasy coating and a moist and slow pulse.
Treatment: Dispel wind and win dampness. Warming the meridians and clearing the channels.
Representative formula: Duluxiaosheng Tang.
2.Chinese medicine external treatment
(1) Chinese medicine ion guide method
Prescription: 15g each of red peony, qiangwu, frankincense, myrrh, dahurica, nanxing, 60g each of angelica, chuanxiong, cao wu, dandelion, dry ginger.
Operation: Add 1OOOml of water to the above drugs and soak them overnight, then boil them for 30 minutes on a gentle fire to about 500ml, filter and reserve the liquid. Take the appropriate amount of liquid, evenly moisten the liner and place it on the affected area to connect the anode. The auxiliary pole is placed in the corresponding department, the current is tolerated by the patient, 20 minutes each time, once a day, 15 times for a course of treatment.
(2) Hot compress method
500g of iron filings, 60-70ml of aged vinegar.
Operation: Take the appropriate amount of warm water and vinegar mix, the ratio of water to vinegar is 6:4
Then mix it with iron sand, put it into a pocket, wrap it with cotton cloth, and apply hot compress on the affected area with a towel for 1-2 hours each time, once a day, 15 times for a course.
(3) Fumigation method
Prescription: 30g each of raw Chuanwu, raw CaoWu, GuiZhi, DaHuang, KuanShuTeng, HaigongBi, ShuangFangZi, Half FengHuo
Operation: Boil the above drugs with water for 30 minutes and then fumigate and wash the affected area for 20 minutes each time, twice a day, 7-10 times for a course of treatment.
3.Manipulation treatment
(1) Thumb pushing and kneading method
Operation: The patient is lying on his back or sitting, the operator stands on the lateral side of the affected knee, one hand holds the affected limb fixed, the other thumb presses and kneads the affected knee, along the anterior knee capsule, patellar ligament, bilateral collateral ligaments, posterior joint capsule and other parts of the acupressure and kneading treatment, finger force from light to heavy, to the extent of local soreness and swelling, 5-10 minutes each time, once a day, 10 times for a course of treatment.
(2) Stretching muscle tendon method
Operation: The patient is lying or sitting on his back, the operator’s right thumb and the remaining 4 fingers are placed on the outside and inside of the knee, first use the thumb to flick and pinch the lateral knee tendons from outside to inside several times, then use the remaining 4 fingers to flick and pinch the medial knee tendons from inside to outside several times, finally the operator presents the right hand behind the knee and flicks the posterior N tendons several times. This is done once a day for 30-60 minutes each time, 10 times as a course of treatment.
(3) Pinch and push patella method
Operation: The patient takes a sitting position, and the operator pinches the patella with both thumbs and index fingers, first pushing it horizontally, then longitudinally, and finally turning it around and pushing the patella, repeatedly several times. Once a day, 20-30 minutes each time, 10 times for a course of treatment.
(4) Traction method
Operation: The patient lies supine with the affected knee elevated and the assistant supports and fixes the affected thigh. The operator holds his ankle in both hands and traction, while rotating, swaying and extending the knee. The traction time is 20-30 minutes. Every 1 time, 15 times as a course of treatment.
4.Acupuncture treatment
(1) Milli-needle method
Prescription: Knee eye, Liangqiu, Knee Yangguan, Yanglingquan, Foot Sanli, A-Ye points.
Operation: routine local skin disinfection. Acupuncture. After obtaining the qi, perform lifting and twisting strong stimulation; keep the needles for 15-20 minutes after operation, once a day or every other day, 10 times for a course of treatment.
(2) Moxibustion method
Prescription: Foot San Li, Knee Eye, Yin Ling Quan, A-Yi point.
Operation: Find the above-mentioned points on the affected limb, align the burning moxa stick to the points at a distance of 2-5 cm, and perform rotary moxibustion or bird-pecking moxibustion, to the extent that the patient can tolerate. The local skin is flushed. Each time 15-20 minutes, once a day, 10 times as a course of treatment.
(3) Ear acupuncture method
Prescription: Jiao-sen, Knee, Shen-Men and A-Yi points.
Operation: Find the above points on the auricle, sterilize the auricle strictly, twist the needle into the auricle quickly, after obtaining the qi, perform twisting and strong stimulation, keep the needle for 10-15 minutes, once a day or every other day, 10 times for a course of treatment.
(4) Ear pressure method
Prescription: Shen Men, Knee, Ankle, Jiaoshen, and A-Yi points.
Operation: Select the above points on the auricle. Press the acupuncture points with Lycopodium or Wang Bu Liuxing seeds for 2-3 minutes each, then fix the acupuncture points with adhesive tape, and apply pressure twice a week for 10 times.