Osteoarthritis (OA) refers to a joint disease caused by a variety of factors that lead to fibrosis, cracking, ulceration, and loss of articular cartilage. The etiology is unclear, and its occurrence is related to age, obesity, inflammation, trauma, and genetic factors. The pathology is characterized by degeneration and destruction of articular cartilage, subchondral osteosclerosis or cystic changes, osteophytes at the joint edges, synovial hyperplasia, joint capsule contracture, ligament relaxation or contracture, muscle atrophy and weakness, etc. OA occurs in middle-aged and elderly patients at the age of 50, and the prevalence increases with age, with more women than men. OA can be divided into two categories: primary and secondary. Primary OA occurs mostly in the middle-aged and elderly, no clear systemic or local causes, and genetic and physical factors have a certain relationship. Secondary OA can occur in young adults, can be secondary to trauma, inflammation, joint instability, chronic and repeated cumulative strain or congenital diseases.
Clinical manifestations and signs]
OA may present with joint pain and pressure pain, and in the late stage, it may present with persistent pain or nocturnal pain. Joint enlargement, Heberden’s nodes and Bouchard’s nodes may appear in the hands.
Due to the destruction of articular cartilage and unevenness of the joint surface, a bone rubbing sound (sensation) occurs during joint movement, mostly in the knee joint.
X-ray examination: asymmetric joint space narrowing, subchondral bone sclerosis and/or cystic changes, joint edge hyperplasia and bone redundancy formation or with varying degrees of joint effusion, some of the joints can be seen in the free body or joint deformation.
Diagnostic points]
The diagnosis of OA is generally not difficult based on the presence of joint symptoms, bone rubbing sensation and other physical signs, X-ray manifestations of bone superfluous formation and laboratory tests, and also needs to be differentiated from rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, etc.
Treatment points]
OA treatment aims to reduce or eliminate pain, correct deformity, improve or restore joint function and improve quality of life. The treatment principle is a combination of non-pharmacological and pharmacological treatment, surgical treatment if necessary, and treatment should be individualized. Combine the patient’s own situation, such as age, gender, weight, own risk factors, lesion site and degree, etc. to choose the appropriate treatment plan.
(a) Non-pharmacological treatment: including patient education: self-behavior therapy (reduce unreasonable exercise, moderate activity, avoid poor posture, avoid prolonged running, jumping, squatting, reduce or avoid climbing stairs), weight loss, aerobic exercise, joint function training, muscle strength training, etc. Canes, crutches, walkers and other mobility support can be used to reduce weight bearing on the affected joints. Some patients may undergo physical therapy including heat therapy, hydrotherapy, ultrasound, acupuncture, massage, traction, transcutaneous electrical nerve stimulation (TENS), etc.
(B) Drug therapy: If non-drug therapy is ineffective, drug therapy can be selected according to the joint pain.
1, local drug therapy: non-steroidal anti-inflammatory drugs (NSAIDs) emulsions, creams, patches and non-NSAIDs rubs (capsaicin, etc.) For moderate to severe pain can be combined with local drugs and oral NSAIDs.
2, systemic analgesic drugs: OA patients generally choose acetaminophen, the effect of poor OA patients, according to the specific circumstances of the use of non-steroidal anti-inflammatory analgesics. nSAIDs treatment is ineffective or intolerant OA patients, you can use tramadol, opioid analgesics, or acetaminophen and opioids in combination.
3.Joint cavity injection.
①Sodium hyaluronate.
②Glucocorticoid. For those with persistent pain and obvious inflammation, intra-articular injection of glucocorticoid is feasible, usually up to 3-4 times a year.
4, improve the condition of drugs and chondroprotective agents: including diacetin, glucosamine, avocado soybean unsaponifiables (ASU), doxycycline, etc.
(C) Surgical treatment
The main ones are.
(1) free body removal.
(2) joint debridement.
(3) osteotomy.
(4) joint fusion
(5) arthroplasty (artificial joint replacement), etc. Surgical treatment is mainly through arthroscopy (speculum) and open surgery.