Treatment of osteoarthritis needs to be standardized.
Osteoarthritis, also known as osteoarthropathy or degenerative osteoarthropathy, is a chronic joint disorder syndrome characterized by progressive damage to joint cartilage. Osteoarthritis is one of the most common joint disorders and one of the most common causes of quality of life in middle-aged and older adults.
The standardized treatment of osteoarthritis means that
The clinical specialist, in the face of different patients, will develop a systematic treatment plan according to the degree of pain, the location of the disease, the duration of the disease, and the duration of pain, and will correctly select non-pharmacological treatment (including physical therapy, special traditional Chinese medicine treatment, health education for patients, etc.), pharmacological treatment (various types of medication), and minimally invasive surgery The treatment methods are: minimally invasive surgery, open surgery, etc. The standardized treatment of osteoarthritis is introduced using the knee and hip joints, which are the weight-bearing joints of the lower extremities, as an example.
Non-pharmacological conservative treatment.
This is the most basic form of treatment for osteoarthritis. Other treatment modalities including medication and minimally invasive surgery and open surgical treatment should be carried out on this basis. This should be the first treatment modality recommended by clinicians for patients with osteoarthritis who are seen for the first time but do not have severe symptoms.
Physical therapy.
1. Health education on patient disease knowledge: Educating patients themselves as well as their families on osteoarthritis health knowledge is a very important part of the osteoarthritis management process. A large foreign clinical trial found that through good disease health knowledge education, patients have a clear and systematic understanding of the causes of osteoarthritis, pathological changes and regression, which not only enables patients to eliminate tension, reduce subjective pain, reduce the number of visits to the hospital, and increase daily activities, thus significantly improving the quality of life of patients.
2.Physical therapy: After educating patients about the correct health knowledge of the disease, together with appropriate functional exercise and muscle strength exercises can not only reduce patients’ pain, but also reduce the amount of pain medication, thus improving the clinical treatment effect. For patients with osteoarthritis of the knee, the strength of the quadriceps is particularly important. Previously, we usually thought that quadriceps weakness in patients with osteoarthritis was due to disuse atrophy due to joint pain, but recent studies have found that some people with radiographic osteoarthritis manifestations but without clinical symptoms such as pain still exhibit quadriceps weakness. Therefore, the joint instability caused by quadriceps weakness may be the cause of the onset of osteoarthritis, not just the result of pain after the onset.
3. Weight reduction: For patients who are overweight, weight loss is a proven treatment for symptom relief. By losing weight, the load on the joints can be reduced, thus reducing further wear and tear on the joints. Recent studies have found that dieting alone is not as effective as exercising to reduce weight while increasing muscle strength.
4, Chinese medicine massage and acupuncture fire can treatment: through a large number of Chinese medicine clinical practice found that Chinese medicine massage and acupuncture fire can significantly improve the symptoms of osteoarthritis caused by joint pain and stiffness.
Drug treatment.
For patients with osteoarthritis who do not achieve significant results with simple non-pharmacological conservative treatment, relevant medications can be used, including oral medications, topical medications, and intra-articular medications. The application of western anti-inflammatory and analgesic drugs should follow the three-step medication principle recommended by the American Rheumatoid Society.
Acetaminophen is recommended by the American Rheumatoid Society as the drug of choice (first-line drug) for patients with mild to moderate pain in osteoarthritis. The analgesic effect of acetaminophen is not significantly different from that of common nonsteroidal anti-inflammatory drugs, but it is less expensive and has fewer side effects. However, patients must be warned that acetaminophen should be used with caution in patients with chronic liver disease or a history of chronic alcohol consumption.
2. For patients with moderate to severe painful osteoarthritis, non-steroidal anti-inflammatory drugs are recommended first.
3. For patients with severe painful osteoarthritis, opioids may be applied for pain relief if symptoms are not significantly relieved after the above-mentioned treatments, or if the application of medications is not appropriate. Recent studies have found that the analgesic effect of tramadol in combination with acetaminophen is significantly better than when used alone. The main adverse effects of opioid analgesics are nausea, vomiting, vertigo, constipation, etc.
In addition, doctors should consider other treatment options according to the specific conditions of the patient, such as the location of the disease, severity of pain, and concomitant disorders.
5. Recent clinical and research studies on other treatments: the therapeutic value of aminoglycans and chondroitin sulfate for osteoarthritis of the knee is gradually being recognized, and these drugs have few side effects and can be taken for a long time. They have good efficacy in repairing joint cartilage. The initial effect is satisfactory, but long-term follow-up is needed.
6. Chinese medicine has certain efficacy in both internal and external treatment. Due to the fear of side effects of western medicine, more and more patients gradually recognize the safety and unique efficacy of Chinese medicine, such as the neck, shoulder, waist and leg pain concoction developed by the orthopedic department of Chinese medicine hospital through a large number of clinical practice, external orthopedic external fumigation lotion, external application of Jinhuang cream, etc. have certain efficacy.
Surgical treatment.
It mainly includes minimally invasive surgery and open surgery. For patients with persistent joint pain that seriously affects the quality of daily life after the above-mentioned regular non-surgical treatment is ineffective, surgical treatment can be considered. For osteoarthritis of the knee and hip joints of the lower extremities, the most commonly used surgical treatments include joint washout, arthroscopic debridement, high tibial osteotomy, total knee and total hip arthroplasty, etc.
1. Arthroplasty and arthroscopic debridement are suitable for patients who are relatively young, whose joints are not heavily degenerated and who cannot adhere to medication because of the poor results of conservative treatment or because of the adverse effects of medication. Surgery is less invasive and quicker to recover, but the results depend on the degree of joint degeneration and the age of the patient. The more severe the degeneration and the older the patient is, the worse the outcome will be. The orthopedic department of the city’s Chinese medicine hospital performs joint irrigation for up to 800 patients each year. It should be noted that joint irrigation and debridement is a palliative procedure and not a radical one. Patients with osteoarthritis. The purpose of the surgery is to transfer the line of negative gravity of the lower extremity from the affected compartment to a relatively normal compartment, but it is not suitable for patients older than 60 years old, with flexion deformity of the joint and excessive internal and external rotation angle of the joint.
2, artificial joint replacement for osteoarthritis has made rapid progress in the past 20 years. Now both material science, prosthesis design, manufacturing process and surgical techniques have reached a fairly mature stage. Arthroplasty can be considered for patients with osteoarthritis who have persistent severe pain, significant radiological degeneration, and are 65 years of age or older. The age of the patient can be relaxed as the results of the surgery continue to improve. The outcome of artificial joint replacement is directly related to the timing of surgery, the experience of the surgeon, the overall conditions of the hospital, the patient’s preoperative physical condition, the perioperative management and postoperative rehabilitation. Our orthopedic department has widely carried out artificial total hip and total knee joint replacements. It has relieved the pain of many patients every year. In conclusion, osteoarthritis is a common degenerative joint disease, and clinicians should propose targeted and personalized standardized treatment plans according to the specific conditions of patients.