Reporter: Hello doctor! I am glad to have the opportunity to discuss the topic of OA with you. According to the definition of OA in the osteoarthritis diagnosis and treatment guidelines (2007 edition), it is a common orthopedic disease in the middle-aged and elderly, and is related to genetics and the system, that is to say, the disease can be inherited, is that so? Doctor: The current research results show that OA is a multi-gene disease, it is a multi-biological factors and mechanical damage factors interact to cause biomechanical disorders and degenerative pathological changes occurring in the joint parts. It is not necessarily limited to the middle-aged and elderly, but also occurs in people with heavy loads and activities, such as athletes and heavy manual workers. There is a good example to illustrate whether it is hereditary. In the ‘Case report of familial hip OA’ published by Cao Guanglei et al. in 2010, it was mentioned that there were six siblings in a family, four females and two males, two brothers without hip pathology, four sisters with different degrees of bilateral hip disorders, and Two of the sisters had hip replacement, and their father also suffered from bilateral hip disorders, so OA with complex etiology is a variety of different factors interacting with each other to cause destruction of articular cartilage, whether it is related to multiple genetic variants, the diagnosis of OA needs to be based on medical history, common symptoms of the disease, physical examination and X-ray film to confirm the diagnosis, so that it is also in line with the 1995 American Rheumatism Association OA diagnostic criteria for early diagnosis, early prevention and treatment. Reporter: In the information reviewed by the reporter, almost invariably show that the prevalence of OA is higher in women than in men, can you please tell us what is the cause of this phenomenon? Doctor: According to a study entitled ‘Epidemiological study of symptomatic knee osteoarthritis in middle-aged and elderly people in Guangzhou’ published by Su Yang and others at the Third Affiliated Hospital of Southern Medical University last year, the total prevalence of knee OA was 15.0% among the 1339 subjects included in the survey, of which 9.1% were men and 20.5% were women. 20.5%, with a significantly higher prevalence in women than in men. Subsequently, the study analyzed women’s menstrual history, physical activity (jogging, jogging and swimming) and work status (miners, forgers, four-season workers, weavers, agricultural workers and clerical jobs) and found that menstruation and jogging were risk factors for knee OA, while clerical jobs were protective factors. One reason for the higher prevalence of OA, especially in middle-aged and older women, may be related to postmenopausal hormone levels in women, with postmenopausal estrogen levels significantly lower than normal, suggesting an important role for estrogen in the development of OA. Some literature shows that the prevalence of OA is lower in postmenopausal women treated with estrogen than in untreated populations, while in vitro experiments and animal experiments also show that low doses of estrogen have a protective effect on OA. Reporter: According to the 07 osteoarthritis diagnosis and treatment guidelines, the disability rate of OA can even reach 53%, which is a very frightening rate, how can we avoid this worst outcome? Is early surgery the best option? Doctor: how to avoid the worst results, but also from the classification of OA. 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 triggers, and genetic and physical factors have a certain relationship. Secondary OA can occur in young adults and can be secondary to trauma, inflammation, joint instability, chronic and repeated cumulative strain or congenital diseases. According to different classifications and patient groups, different conditions, basically can be divided into three categories of non-pharmacological treatment, drug therapy and surgical treatment, the first two have been detailed in the guidelines, here I will not repeat. Here I will mainly introduce the third type of surgical treatment. I have worked for many years in the Department of Orthopedics at the Jishuitan Hospital of Peking University, and have come into contact with thousands of patients, in whom I found a common feature, that is, small diseases dragging big diseases. Because many times the initial stage of OA is no obvious symptoms, may only be accompanied by intermittent joint pain and pressure pain or joint stiffness, joint weakness, activity disorders and other phenomena, many people take a chance, that since it does not affect daily life, it is not considered a major disease. However, when the disease develops seriously and leads to loss of joint function, it is likely to cause disability. In this regard, we always advocate early diagnosis, prevention and treatment. For patients without surgical indications for physical therapy or drug therapy, conservative treatment is ineffective, there are indications for surgery can choose surgery. Reporter: It is understood that the surgical treatment of OA was first carried out in Europe and the United States, more than 40 years ago, is a relatively mature treatment method, how does the current domestic technology compare with it? Doctor: The domestic medical level in many areas can be compared with the world’s advanced level, but not enough popular. Take the OA we are talking about today, China’s population base is large, the number of people suffering from the disease is large and extensive, for example, the Jishuitan Hospital of Peking University, the annual volume of joint replacement surgery is nearly more than 2,000, which is a very impressive number. When I was invited to attend an academic tour in the United States, I shared a case of severe middle-aged and elderly OA patients that I often encounter in China with my European and American colleagues, and they were surprised to learn that they rarely encounter patients with severe osteoarthritis with such severe deformities. Because foreign medical conditions are better, people have a general awareness of medical examination and health care, there will be very timely treatment of disease, rarely like domestic patients will let the development of the disease. Practice makes perfect, and this is especially true in our profession. Doctors have access to a wide range of patients and have to consider a wide range of issues, and their skills will of course continue to improve as they continue to refine. From this point of view, it is clear that our treatment and surgical techniques are not inferior to those of our foreign counterparts. Reporter: According to the reporter’s understanding, joint replacement surgery is one of the effective ways to treat OA, you have been committed to research in this area for many years, can you please share your views with everyone. Doctor: Artificial joint replacement surgery refers to the use of artificially manufactured joints to replace the painful and loss of joint function, most commonly used in hip and knee joints. The main indications are osteonecrosis, dislocation of comminuted fractures that cannot be repositioned, osteoarthrosis with pain and movement disorders, rheumatoid arthritis with stiffness or difficulty in movement, ankylosing spondylitis and bone tumors, etc. It is a technically mature treatment. However, this method has high requirements for artificial joints. Generally, the materials used to make artificial joints require high strength, wear resistance, corrosion resistance, good biocompatibility, and non-toxicity, and are commonly used in alloys, carbon, microcrystalline ceramics, and silicone. And the design requires bionic body shape and biomechanics, now can be used for all joints, including the hip, knee, ankle, metatarsophalangeal joint, humeral head, elbow joint, vertebrae, pelvis, navicular, lunar and distal radius. Commonly used hip and knee prostheses are divided into two types: cemented and biologically fixed. However, there is still little research on the instruments required for joint replacement in China, and the investment is far from adequate and the research mechanism is immature. Therefore, foreign manufacturers have an absolute advantage and brand guarantee in this area, and only a very few domestic manufacturers can produce similar devices, but many of them are based on the gourd, with deviations in wear resistance and precision, making it difficult to meet the requirements I listed earlier, which is a pity. But the good thing is that the price of this imported device is about 20,000 to 30,000, plus surgery and hospitalization costs, only 50,000 to 60,000, most patients can still afford. If there is medical insurance, it can further reduce the burden of patients. Reporter: In addition, the genetic gene and gene therapy research on OA has also been launched, can you please talk about this aspect of the views. Doctor: OA has a complex pathogenesis, a variety of environmental and genetic factors contribute to the occurrence and development of the disease. The pathogenesis is still unclear, but relevant research has been conducted. It is known that as early as 60 years ago, scholars have demonstrated the role of genetic factors in familial OA. At that time, it was found that a woman whose sisters had Heberden’s nodes (OA nodes) in the intermetacarpal and interphalangeal joints was three times more likely to develop OA than the general population. To date, there is evidence from several studies that genetic abnormalities can lead to early onset of OA. However, it is still difficult to study the genetics of OA, but there are already findings that show that the identification of genes coding for OA susceptibility will advance the understanding of OA etiology beyond doubt and will provide new targets for therapeutic interventions and will assist in the prediction and direct surgical or pharmacological treatment of individuals. According to last year’s publication ‘Genes and Gene Therapy in Osteoarthritis’, the therapeutic principle of OA gene therapy IV is to control the expression of a number of genes, including controlling the synthesis of factors involved in cartilage degradation (anticatabolic) or increasing the expression of cartilage repair genes (anabolic). And currently known OA gene therapy protocols generally include three aspects: OA candidate genes, OA vectors that deliver therapeutic nuclei to appropriate cells, and OA gene delivery to candidate cells. However, research in this area is not yet mature enough to be promoted to the public.