Many of the orthopedic outpatients are middle-aged and elderly patients over 50 years old, and they are often troubled by joint pain, especially hip, knee and ankle pain in the lower limbs, and some of them even seriously affect their normal life. The main common cause of these pains is osteoarthritis, so what is osteoarthritis and how should we treat it if we suffer from it, we will talk about it today.
I. What is osteoarthritis
Osteoarthritis is one of the most common joint lesions, osteoarthritis has many names, such as hypertrophic osteoarthritis, degenerative arthritis, degenerative arthritis, proliferative osteoarthritis or osteoarthrosis, all referring to a disease, the domestic unified use of osteoarthritis. Its prevalence increases with age and is more frequent in women than in men. The distal and proximal interphalangeal joints of the hand, knee, elbow and shoulder joints, and spinal joints are susceptible to osteoarthritis, while the wrist and ankle joints are less frequently affected.
Osteoarthritis etiology and pathology
The main pathological changes of osteoarthritis are degenerative degeneration and loss of cartilage, as well as reactive hyperplasia of the joint marginal ligament attachments and subchondral bone to form bony redundancies, which cause joint pain, stiffness deformity and functional impairment. Normally, there is little friction between the joints to cause wear and tear, unless overuse or injury occurs. The most likely cause of osteoarthritis is an abnormality in the synthetic cartilage components, such as collagen (which is a tough, fibrous protein in connective tissue) and mucin (a substance that produces cartilage elasticity). In addition, the cartilage, although growing vigorously, is thin and its surface is prone to rupture. Bone overgrowth at the edges of the joint forms a mass that can be seen and felt (called an osteochondroma). Osteochondrosis causes unevenness of the joint surface, interfering with normal joint function and causing pain.
Clinically, osteoarthritis can be divided into two categories: primary and secondary. Primary osteoarthritis refers to osteoarthritis whose cause cannot be detected by all current examination methods, and is usually referred to as osteoarthritis. This type of osteoarthritis has a more limited lesion and is not accompanied by Herbertian nodes. People who repeatedly strain their joints are at high risk of developing osteoarthritis, such as foundry workers, miners and bus drivers. However, people who exercise as long-distance runners are not at high risk for this disease. Obesity is the main factor causing osteoarthritis, but the evidence is not yet sufficient
Three, osteoarthritis symptoms
1, primary osteoarthritis occurs after the age of 50, more women than men, secondary arthritis, the age of onset is younger, 30-40 years old, the most common joints for the cervical spine, lumbar spine, hip, knee, ankle, shoulder, elbow, fingers and other joints
2, the main early clinical manifestations of osteoarthritis are: stiffness is the main, exertion, cold or minor trauma and aggravated, limbs from one position to another when the difficulty, a little activity pain stiffness soon relieved: such as: morning when you get up or sedentary after standing up, stiffness, pain, symptoms are obvious, after the activity of joint symptoms to reduce or disappear, due to the early appearance of this symptom is not taken seriously, coupled with the lack of timely Due to the early appearance of this symptom is not taken seriously, coupled with the lack of timely treatment, this symptom slowly aggravated, every 1-2 years acute attack, the attack of slight swelling of the joint or a small amount of fluid, sometimes joint activities appear friction, function is affected to a certain extent.
3. In the late stage of osteoarthritis, the joint pain increases, and the pain is constant until the joint is deformed, swollen, and the functional activity is impaired and cannot take care of itself.
Four, osteoarthritis diagnostic tests
1.Symptoms and signs.
2, X-ray examination, diagnosis. Osteoarthritis is specific: the joint cartilage is mainly hyperplastic, the joint surface is rough, and the joint space is narrowed.
3, laboratory tests, osteoarthritis patients with negative serum rheumatoid factor, blood sedimentation is not fast, C peptide-reactive protein is not elevated.
Five, osteoarthritis treatment methods
1.Osteoarthritis non-pharmacological treatment
Including patient health education, self-training, weight loss, aerobics, joint mobility training, muscle strength training, the use of walking aids, wedge insoles for internal knee roll, occupational therapy and joint protection, daily life aids and so on. A significant portion of patients in Europe and the United States can reduce their symptoms and return to normal life and work through the above treatments. China’s investment in this area and the perception of health care professionals is still weak, and strengthening this work in the future is something that medical professionals at all levels should pay attention to.
Patients with osteoarthritis of the knee often present with reduced quadriceps muscle strength, which was previously thought to be caused by disuse atrophy, but recent studies abroad have concluded that quadriceps muscle atrophy is not entirely caused by osteoarthritis, and that reduced quadriceps muscle strength may be one of the risk factors for osteoarthritis of the knee. Therefore, it is beneficial to strengthen the training of quadriceps muscle strength and aerobic training for patients with osteoarthritis.
2, osteoarthritis drug treatment
(1) Sodium hyaluronate: It is the main component of the synovial fluid of the joint cavity and one of the components of the cartilage matrix, which plays a lubricating role in the joint and reduces the friction between tissues. It is often injected intra-articularly, 25mg once, once a week for 5 weeks, subject to strict aseptic operation.
(2) Glucosamine: It is the most important monosaccharide that constitutes polyglucosamine (GS) and proteoglycan in articular cartilage matrix. Normal people can synthesize GS by amination of glucose, but in osteoarthritis, the synthesis of GS in chondrocytes is blocked or insufficient, resulting in softening of cartilage matrix and loss of elasticity, destruction of collagen fiber structure, and increase of cartilage surface lacunae, causing bone wear and destruction. Glucosamine can block the pathogenesis of osteoarthritis, promote the synthesis of proteoglycans with normal structure in chondrocytes, and inhibit the production of enzymes (such as collagenase and phospholipase A2) that damage tissue and cartilage, reduce damage to chondrocytes, improve joint movement, relieve joint pain, and delay the course of osteoarthritis. It is best taken orally 250-500mg once, 3 times a day, with meals.
(3) Non-steroidal analgesic anti-inflammatory drugs: can inhibit the synthesis of cyclooxygenase and prostaglandin, counteract the inflammatory response, and relieve joint edema and pain. You can use ibuprofen 200-400mg once, 3 times a day; or aminoglycosaminide 200mg once, 3 times a day; nimesulide 100mg once, 2 times a day for 4-6 weeks.
3.Surgical treatment of osteoarthritis
If the symptoms of osteoarthritis are very serious, drug treatment is ineffective, and it affects the patient’s daily life, surgical intervention should be considered.
(1) For osteoarthritis of the knee, some people advocate arthroscopic arthroscopic debridement first, which has certain efficacy in the near future for some patients, but the long-term effect is not certain.
(2) Joint replacement surgery is effective in relieving pain and restoring joint function in most patients with osteoarthritis, femoral head necrosis, and rheumatoid arthritis, but there are certain immediate and long-term complications of joint replacement surgery, such as loosening and wear of components and osteolysis, which cannot be completely resolved at present. Therefore, it is important to strictly control the surgical indications for joint replacement.
Strictly speaking, surgical indications include.
① the presence of radiological evidence of joint damage.
② the presence of moderate to severe persistent pain or a disability that has resulted.
(iii) Patients who have failed to respond to various non-surgical treatments.
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