I. What is osteoarthritis
Osteoarthritis is a chronic progressive joint disease that occurs after middle age, also known as osteoarthrosis, degenerative arthritis, age-related arthritis, etc. The main lesion of osteoarthritis occurs in the articular cartilage and is characterized by damage to the articular cartilage, patchy depressions, fractures and ulcers on the cartilage surface, and loss of homogeneity and compressibility of the cartilage. Compressibility of the cartilage is lost. In severe cases, no articular cartilage is present and the subchondral bone is exposed. Clinically, osteoarthritis mostly involves weight-bearing joints and is characterized by pain, deformation, and limitation of movement.
Etiology and classification
Osteoarthritis can be divided into primary and secondary osteoarthritis according to the causative factors.
(a) Primary osteoarthritis: the cause is unknown and is generally considered to be related to ageing, overuse, endocrine, cartilage metabolism, immune abnormalities, obesity and genetics, among other factors.
(b) Secondary osteoarthritis: secondary to a definite disease, such as trauma, infection, deformity, metabolic disease, and endocrinopathy. These diseases can cause damage to cartilage, which can lead to later osteoarthrosis.
Third, clinical manifestations
Who is susceptible to osteoarthritis?
The disease is usually seen after middle age, and is more common in older women than men. After middle age (40-50 years old), the function of muscles gradually decreases and the function of peripheral nervous system decreases, resulting in uncoordinated nerve and muscle responses, which can easily lead to joint injury. Once the mechanical force exceeds the capacity of the articular cartilage, it leads to cartilage damage.
The disease is also related to occupation. Long-term, repeated use of certain joints can cause an increase in the prevalence of these joints. For example, the knee and elbow joints of miners, the elbow and hand joints of wind drillers, the metatarsophalangeal joints of ballerinas, the shoulder and elbow joints of baseball players, the ankle, foot and knee joints of soccer players, etc.
In addition, obese people are also susceptible to osteoarthritis. In addition to excessive body weight, which increases the load on the joints, the changes in posture, gait and movement dynamics caused by obesity have an impact on the biomechanics of the joints. The load is concentrated on the medial aspect of the cartilage, which is the common site of knee joint pathology in most obese individuals.
Which areas are most likely to be involved?
The most common sites of involvement are the hip, knee, cervical and lumbar spine, distal interphalangeal joints, and the first metatarsophalangeal joint.
What are the common symptoms in patients with osteoarthritis?
The main symptom of osteoarthritis is joint pain, which is mild in the early stages and occurs during exercise and is relieved after rest; in the later stages, it is also painful at rest and often occurs at night.
The pain starts from mild to moderate dull pain, mostly intermittent, and in severe cases, tear-like or pinprick-like pain may occur, and it is persistent, and finally, the movement is limited. Pain is activity-related, and rest can reduce pain, while activity, especially weight bearing, can increase it. Certain activities are more likely to cause pain, such as osteoarthritis of the hand, where holding objects and opening bottle caps can cause pain. Hip forward flexion, internal rotation and abduction; knee extension and flexion; cervical back extension and rotation; lumbar forward flexion and lateral bending, etc. are all likely to induce the relevant symptoms. Pain on walking, especially when walking up and down stairs, is an important symptom of the disease. In some patients, the pain may be radiating. Localized morning stiffness, which is relieved after activity, is also a common symptom of this disease. It is usually not severe and is short in duration, mostly a few minutes, rarely more than 30 minutes.
Another common symptom is limitation of movement, which is also slowly progressive. In the early stage, the symptoms are often mild, only in the morning or after sitting for a long time, and can recover after activity. As the disease progresses, the symptoms gradually worsen, with a variety of different sounds and a reduced range of motion in the joints.
What are the common signs and symptoms of osteoarthritis?
The common signs of osteoarthritis are swelling of the joint, tenderness, rattling sound, limitation of movement and muscle atrophy. x-rays show narrowing of the joint space, sclerosis of the subchondral bone with cystic cavity formation, and bone redundancy at the edge of the joint. in the later stages, the joint space may disappear completely and the bone ends may become deformed.
IV. Treatment
What are the current treatments for osteoarthritis?
There are many treatment methods, including physical therapy, drug therapy and surgery, and also emphasize the patient’s subjective cooperation.
How does the patient cooperate with treatment?
Although most of the treatment methods can save the patient from pain, they do not touch the pathogenesis of the disease, so they do not affect the disease in general, but are only symptomatic. Patients should pay attention to eliminate or avoid causative factors, such as proper rest, weight loss, avoidance of mechanical injury, etc. Patients should know some special parts of the self-treatment methods, such as hand first wrist metacarpal joint osteoarthritis, braking (such as suspension band) is more effective. The use of a cane or crutches for hip involvement can help reduce the load on the involved joint. To avoid flexion contractures, patients are advised to lie prone 2-3 times a day and sit in a high chair rather than a low stool or sofa. Strenuous sports such as running and ball games should be avoided for those with knee involvement. To reduce pain, patients often prefer to sleep with a pillow under the knee, and should be advised not to do so, as this may lead to flexion deformity. Patients with cervical osteoarthritis should avoid prolonged ambulation, head tilting or neck turning. Those with lumbar spine involvement can sleep on a hard bed, and those with anterior abdominal protrusion can use a lap band. Patients with osteoarthritis of the first metatarsophalangeal joint of the foot can be relieved by preventing dorsiflexion of the toes through insoles and hard soles in the early stages. A cane may be used to reduce weight bearing in those with heel-spur joint involvement.
Does the patient need to avoid physical activity to avoid aggravation of the disease?
No, not really. Rather, patients need to engage in appropriate physical activity to supplement their treatment. Physical activity for patients with osteoarthritis can be divided into three categories.
(1) Exercises that maintain or increase the maximum mobility of the joint should be performed by the patient on his own initiative, gradually, more than three times a day.
(2) exercises to increase the strength and endurance of the muscles around the joint to increase the stability of the joint, such as static exercise as a simple and effective exercise to enhance muscle strength. If pain occurs during exercise, or if pain persists for more than 15 minutes after exercise, the number of exercises can be reduced appropriately.
③Increase outdoor activities to improve daily activities and endurance, such as walking and swimming, which patients should actively implement and gradually increase the time and amount of activities. Different patients should focus on different exercises, such as cervical and lumbar spine osteoarthritis, should often carry out neck, waist rotation, flexion and extension exercises, hand osteoarthritis patients should often do grasping, grip exercise. Chinese traditional taijiquan, qigong, etc. can also be tried.
Commonly used drug therapy
The drugs commonly used in the treatment of osteoarthritis can be divided into 3 categories.
① Fast-acting symptom relievers: These drugs mainly relieve pain and improve symptoms, analgesics, non-steroidal anti-inflammatory drugs and local hormone injections belong to this category. It should be noted that systemic use of glucocorticoids is absolutely unnecessary in osteoarthritis. For individual joints with acute inflammatory manifestations where other treatments have failed, as well as for periarticular osteochondritis and tendonitis, local injections may be given in the joint or at the site of the lesion. It should be noted that the disappearance of pain may lead to overuse of the joint, which may aggravate cartilage damage. In addition, local hormone injections themselves can damage cartilage, so they should not be used repeatedly.
② Slow-acting symptom relievers: This drug is slow to take effect (usually takes several weeks later), but the efficacy continues for a certain period of time (e.g. several weeks) after stopping the drug, and also has only a symptom relieving effect. Oral chondroitin sulfate, intra-articular injection of hyaluronidase, peroxide dismutase inhibitors belong to this category.
Chondroprotective agents: drugs that slow, stabilize, or even reverse the degradation of cartilage in osteoarthritis. These drugs also belong to the category of slow-acting drugs, which can relieve pain and improve joint function, but also have the effect of changing the disease. Research on chondroprotective agents is still in the experimental stage.
Surgical treatment
If the patient has persistent pain or progressive deformity and medication is ineffective, surgery may be considered. The choice of surgical option needs to be made separately according to the patient’s age, occupation, living environment and habits.
Currently, patients with osteoarthritis of the hip and knee over 50 years of age who have significant pain and movement disorders, especially those with secondary osteoarthritis due to injury, deformity or other causes, are favored for artificial joint replacement. Patients can move to the ground early after surgery to eliminate pain, increase range of motion and correct deformity.