You may often see older people walking with a hobbled gait, knee pain when going up and down stairs, or even “O” shaped legs. In fact, this is all due to osteoarthritis. Osteoarthritis, commonly known as “long bone spurs” and “osteophytes”, is a group of diseases caused by a variety of causes of damage to the integrity of joint cartilage and related symptoms and signs.
Although it is manifested in “spurs”, the underlying cause is the destruction of joint cartilage, resulting in pain and movement disorders, which can lead to severe limb disability. In short, although osteoarthritis starts from the articular cartilage, it affects the entire joint structure and eventually leads to joint deformity and loss of function due to total loss of articular cartilage. Zhang Fujiang, Department of Joint Surgery, Tianjin Hospital
Osteoarthritis is the most common joint disease in the world, and the prevalence increases rapidly with age; more than 50% of people older than 65 years have radiographic evidence of osteoarthritis, but 25% will have symptoms. 80% of people older than 75 years will have symptoms.
According to the World Health Organization (WHO), osteoarthritis is the fourth most prevalent disease among women and the eighth most prevalent disease among men. In China, the elderly population is about 100 million or more, and about 80 million people will have x-ray manifestations of osteoarthritis, and about 40 million people will have symptoms. A survey in Beijing showed that 5.6% of people over 60 years of age had symptomatic osteoarthritis in men, compared to 15% in women, while 21.5% of men and 42.8% of women were found to have osteoarthritis on X-rays.
Elderly people in developed countries account for 25%, and as the population ages and our country enters an aging country, this disease will continue to increase. Therefore, the prevention and treatment of osteoarthritis is a task that the whole society needs to pay attention to.
Secondly, there are more female patients, especially after menopause: in the age group of 45-55 years, the frequency of men and women is equal, while after the age of 55 years, there are significantly more female patients, and overall, women are twice as likely to suffer from osteoarthritis as men.
Again, obesity: epidemiological studies have found that obesity has an impact on the occurrence of osteoarthritis of the knee. In addition to the mechanical factors caused by obesity, it is also related to the systemic metabolic factors of obesity. The stress and direction of stress on the knee joint depends on the force line of the limb, body shape, muscle strength and their interactions. The incidence of knee osteoarthritis in obese women is four times higher than in normal weight women.
The effect of obesity on the mechanism of knee osteoarthritis development is complex and not fully understood. In addition, the distribution of fat in obesity correlates with the occurrence of osteoarthritis, i.e., patients with more fat in the waist are prone to hip and knee osteoarthritis, while fat in the hip and thigh rarely causes osteoarthritis.
Ethnic factors also influence the development of osteoarthritis, with a high incidence of hip osteoarthritis in Westerners and knee osteoarthritis in Easterners.
Some special occupations are prone to osteoarthritis: miners, cotton pickers, heavy laborers, professional athletes, dancers or teachers, etc., mainly due to long-term wear and tear of joint cartilage by high-intensity stress or injury.
Joint injuries are also an important factor in causing osteoarthritis: such as joint instability caused by ligament damage around the joint, meniscus damage or intra-articular fractures. China’s famous speed skating world champion Ye Qiaobo had surgery on his knee in his twenties for repeated injuries causing traumatic arthritis, removing a considerable amount of cartilage fragments and free bodies, and weakening muscle strength.
In addition, genetic changes, nutritional disorders of articular cartilage, metabolic abnormalities, neurological abnormalities and changes in the biomechanical environment of the joint can trigger osteoarthritis. Wearing high-heeled shoes with a sharp or wide heel increases the usual stress on the knee joint when walking and changes the stress point of the knee joint, which can also cause osteoarthritis.
Osteoarthritis can occur in joints throughout the body and manifests as pain, swelling, friction sounds, deformities, and limited movement in the corresponding joints. However, the incidence of osteoarthritis of the knee is the highest. Approximately 41% of patients with osteoarthritis have osteoarthritis of the knee. This is because the knee is a joint that is heavily loaded, active, and susceptible to trauma, strain, and wind and cold stimulation. Osteoarthritis of the hip joint accounts for 19%. Osteoarthritis joint pain is characterized by excessive activity and can be reduced after rest. Osteoarthritis of the knee joint also results in impairment of the affected limb in squatting, going up and down stairs, and inversion and flexion contracture deformity in severe cases, resulting in joint disability.
Although it is not yet possible to prevent osteoarthritis from occurring, there are a number of measures that can be taken to reduce or delay the onset of osteoarthritis. These measures include weight reduction, avoiding high heels, protecting the joints from injury, such as avoiding repeated impact or torque on the joints, minimizing frequent ascent, repairing or suturing through arthroscopy if there is meniscal damage, treating joint ligament damage in a timely manner, and surgical anatomical repositioning of intra-articular fractures.
If there is a deformity around the joint, surgery should be performed in time to correct the deformity. In addition, taking Vit A, Vit C, Vit E and Vit D supplements can also have a preventive effect on osteoarthritis.
Exercise for patients with osteoarthritis should be divided into two. Proper and appropriate exercise can prevent, delay and slow down the process of osteoarthritis. Beneficial exercises include: swimming, walking, cycling, supine straight leg raises or resistance training and non-weight bearing joint flexion and extension activities.
Improper over-exercise can aggravate osteoarthritis. Harmful exercises are those that increase joint torsion or overload the joint surfaces: activities such as mountain climbing, stair climbing or squatting and standing.
For patients with very early stage, very mild symptoms of osteoarthritis, medication may not be used and physical methods of treatment alone may be considered.
Physical methods include: patient education, weight reduction, exercise modification, following the correct exercises, doing exercises to enhance muscle strength, using weight reduction, using assistive measures: such as walkers and crutches, etc. You can also wear shoes that can absorb impact, use insoles that are low on the inside and high on the outside, and use medial knee braces.
Medications include the following.
Anti-inflammatory pain medication: acetaminophen is preferred abroad, which is effective in relieving pain, has few adverse effects and is inexpensive. Usually the total amount does not exceed 3g in 1 day, but long-term high doses have been reported to cause liver or kidney damage. If these drugs are not effective in relieving pain or are accompanied by knee effusion, other drugs are appropriate.
Non-steroidal anti-inflammatory drugs (NSAIDs): These drugs have anti-inflammatory, analgesic and antipyretic effects and are the most commonly used drugs for the treatment of osteoarthritis.
Glucosamine: Anti-inflammatory drugs can only relieve or reduce the symptoms of osteoarthritis and cannot change the progression of the lesion. For this reason, disease-modifying drugs that control the progression of osteoarthritis have been explored for many years. Glucosamine is considered to be the first disease-modifying or slow-acting drug for osteoarthritis, as it has both anti-inflammatory and pain-relieving effects on the development of knee osteoarthritis. In vitro experiments have also confirmed its good effect on cartilage metabolism, and it is also called a chondroprotective agent. Long-term treatment with glucosamine can stop the progression of osteoarthritis of the knee.
Diacerein: This drug can inhibit the activity of metalloproteinases and stabilize the lysosomal membrane to exert anti-inflammatory and protective effects on articular cartilage, thus improving the course of osteoarthritis. It has been shown to significantly improve the symptoms of patients, and its adverse effects are only transient diarrhea.
The drugs that can be injected into the joint cavity are usually hyaluronic acid preparations.
Hyaluronic acid preparations: The high viscosity of the synovial fluid in the joint cavity provides an almost frictionless surface for joint movement and is therefore very beneficial for normal joint function. In osteoarthritis, hyaluronic acid is destroyed, the viscosity of the synovial fluid is reduced, lubrication is lost and the smooth movement of the joint surface is lost, resulting in further joint destruction. Intra-articular hyaluronic acid supplementation is beneficial in relieving joint pain, increasing mobility, eliminating synovial inflammation and delaying disease progression. These drugs are mainly used for osteoarthritis of the knee and are indicated for those who do not respond well to conventional therapy or who cannot tolerate treatment with analgesics or non-steroidal anti-inflammatory drugs.
Treatment of osteoarthritis should focus on early diagnosis, early treatment and a long course of treatment. In other words, prevention and comprehensive treatment should be started before the patient develops symptoms, the articular cartilage is significantly diseased, the joint space is not yet narrowed and the bony bulge is not yet visible, and long-term follow-up is required.
Among the above mentioned drugs, vitamins and glucosamine can be used as basic and long-term drugs. Diacerein can be used in combination with glucosamine or alone at the beginning of treatment. Anti-inflammatory analgesics can be applied at any time for a short period of time depending on the patient’s manifestations such as joint pain or swelling. Hyaluronic acid supplementation has been shown to improve symptoms, function and quality of life, and should be promoted for patients with indications and conditions.
Although many of the above drugs are available to treat osteoarthritis, none of them can reverse and stop the course of osteoarthritis. Drug therapy can only reduce symptoms for a period of time. Therefore many patients eventually progress to an intermediate to advanced stage and will have to undergo surgery.
The common procedures used to treat osteoarthritis are arthroscopic debridement and artificial joint replacement.
Arthroscopic debridement: Arthroscopic debridement is used to remove or repair cartilage fragments, free bodies, meniscal fragments, and bone fragments that cause mechanical impairment of the joint, and to remove synovitis-causing inflammatory factors through intraoperative high-dose joint irrigation. Arthroscopic debridement reduces symptoms by eliminating mechanical impediments and inflammatory factors.
Planing of the degenerated cartilage and meniscus does not lead to their repair, so the purpose of the procedure is not to hope for new cartilage regeneration (rather it may accelerate the degeneration). Rather, it is intended only to relieve symptoms; it does not alter the pathological changes or course of osteoarthritis. It will not have any effect on cartilage dysfunction caused by already existing articular cartilage damage or abnormal cartilage metabolism. Arthroscopic cleanup may achieve better results in the relatively acute phase of symptom onset, and short-term improvement may be seen after arthroscopic surgery in patients with chronic progressive changes and in patients with osteoarthritis that has reached an advanced stage.
Arthroplasty: As can be seen from each of the above treatments, any treatment only temporarily reduces symptoms, and the most effective treatment is arthroplasty.
In summary, early osteoarthritis can be treated with a variety of medications that can reduce symptoms for a period of time. However, because there are no effective measures to control the progression of osteoarthritis, osteoarthritis will continue to develop and worsen. The only effective treatment for the advanced stages of the disease is artificial joint replacement. Artificial joint replacement is now a very mature procedure that can relieve pain, improve function and enhance the quality of life in later life for patients with advanced osteoarthritis.