Osteoarthritis is one of the most common joint diseases. It is a chronic joint disease characterized by degeneration and destruction of joint cartilage and osteophytes. The occurrence of this disease is related to aging, obesity, inflammation, trauma, joint overuse, metabolic disorders and genetic factors.
1.Common symptoms and signs
The disease occurs in the knee, hip, hand (distal interphalangeal joint, first carpometacarpal joint), foot (first metatarsophalangeal joint, heel), spine (cervical and lumbar spine) and other joints that carry more weight or activity.
(1) Joint pain and pressure pain
The most common manifestation of this disease is localized pain and pressure pain in the joints. The weight-bearing joints and hands are most likely to be involved. It is usually mild or moderate intermittent pain in the early stage, which improves with rest and worsens with activity. There may be localized pressure pain in the joints, which is especially noticeable in the presence of joint swelling. The pain may worsen in cold, wet and rainy days.
(2) Enlargement of the joint
In the early stage, there is limited swelling around the joint, and as the disease progresses, there may be diffuse swelling of the joint, thickening of the bursa or joint effusion. In the later stage, bony bulge may be detected in the joint.
(3) Morning stiffness
Patients may experience stiffness in the morning or after a period of resting, called morning stiffness, which may be relieved after activity. The duration of morning stiffness is usually a few minutes to ten minutes, but rarely exceeds half an hour.
(4) Joint friction sounds (sensation)
It is mostly seen in the knee joint. Due to the destruction of cartilage and roughness of the joint surface, a bone friction sound (sensation) occurs when the joint is moved.
(5) Restricted joint movement
Joint weakness and limitation of movement due to joint swelling and pain, reduced activity, muscle atrophy, and soft tissue contracture. It occurs slowly, with early signs of joint immobility and later a decrease in joint range of motion. It can also occur as a result of free bodies or cartilage fragments in the joint, which can cause “locking” when moving.
2, the performance characteristics of different parts of osteoarthritis
(1) Hand
The distal interphalangeal joint is most commonly involved, showing bony enlargement on both sides of the extensor surface of the joint, called Heberden’s node. The proximal interphalangeal joint is called Bouchard’s node. It may be associated with mild localized erythema, pain, and tenderness of the nodule. The involvement of the first carpometacarpal joint may result in a square hand deformity with osteophytes at its base, and a snake-like deformity with finger joint hyperplasia and lateral subluxation.
(2) Knee
Knee involvement is the most common in clinical practice. Risk factors include obesity, knee trauma, and meniscectomy. The main manifestation is knee pain, which is aggravated by activity, more pronounced after descending stairs, and relieved after rest. In severe cases, internal or external knee valgus deformity may occur. There is localized swelling, pressure pain, and limitation of flexion and extension movement in the joint, and most of them have bone friction sound.
(3) Hip
The hip joint is more commonly involved in men than in women, and more often unilaterally than bilaterally. The pain is mostly localized as intermittent dull pain, which may become persistent with the development of the disease. In some patients, the pain can radiate to the groin, inner thighs and buttocks. The hip joint motion is mostly limited by internal rotation and external rotation, followed by internal retraction, external rotation and extension. Gait abnormalities may occur.
(4) Foot
The metatarsophalangeal joint is often involved and may present with local pain, pressure and bony hypertrophy, as well as deformities such as bunions. Bone spurs may appear on the bottom of the foot, causing difficulty in walking.
(5) Spine
Involvement of the cervical spine is more common, and the third and fourth vertebrae of the lumbar spine are the most frequent sites. There may be hyperplasia and osteophytes of the vertebral body and posterior synovial joints, causing local pain and stiffness, and corresponding radiological pain and neurological symptoms when local blood vessels and nerves are compressed.
Compression of the vertebrobasilar artery by cervical spine involvement may cause symptoms of inadequate blood supply to the brain. Intermittent claudication and cauda equina syndrome can occur when lumbar spine osteophytes lead to spinal stenosis.