I. What is osteoarthritis
Osteoarthritis is one of the most common joint lesions. There are extremely many names for osteoarthritis, such as hypertrophic osteoarthritis, degenerative arthritis, degenerative arthritis, proliferative osteoarthritis or osteoarthrosis, all referring to one disease, and osteoarthritis is used uniformly in China. 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.
Etiology of osteoarthritis
The main pathological changes of osteoarthritis are degenerative degeneration and loss of cartilage, as well as reactive hyperplasia of the ligamentous attachments and subchondral bone at the joint edges, resulting in joint pain, stiffness and 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). Osteoarthritis can be clinically 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 category of osteoarthritis has more limited lesions 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 a major factor in osteoarthritis, but the evidence is not yet strong.
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 clinical manifestations of early 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: for example: morning get up or sedentary after standing up
When getting up in the morning or standing up after sitting for a long time, stiffness and pain appear, and the symptoms are obvious, and the joint symptoms are reduced or disappear after activities.
The symptoms of osteoarthritis can be seen in the joints of the first and second stages.
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.
Four, osteoarthritis diagnostic criteria
1.Symptoms and signs.
2, X-ray examination, diagnosis. Osteoarthritis is specific: joint cartilage is mainly hyperplasia, joint surface roughness, joint space narrowing.
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.Non-pharmacological treatment
Including patient health education, self-training, weight loss, aerobics, joint mobility training, muscle strength training, the use of walking aids, wedge walking insoles for knee inversion, occupational therapy and joint protection, daily living 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, as a result of reduced quadriceps muscle strength, the stability of the knee joint is affected and the normal muscle’s proper Therefore, it is beneficial to strengthen the training of quadriceps muscle strength and aerobic training for patients with osteoarthritis.
2. Drug therapy
(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.
After intra-articular injection, it can significantly improve the inflammatory reaction of synovial fluid, enhance the viscosity and lubrication of joint fluid, protect joint cartilage, promote the healing and regeneration of joint cartilage, relieve pain and increase the mobility of joints. It is often injected intra-articularly, 25mg once, once a week for 5 weeks.
Must be strictly aseptic.
(2) Glucosamine: It is the most important monosaccharide that constitutes polyglucosamine (GS) and proteoglycan in the cartilage matrix of joints.
However, in osteoarthritis, the synthesis of GS in the cartilage is blocked or insufficient, resulting in softening of the cartilage matrix and loss of elasticity, destruction of the collagen fiber structure, and increased lacunae on the cartilage surface, resulting in 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 aminoglycoside zinc 200mg once, 3 times a day; nimesulide 100mg once, 2 times a day for 4-6 weeks. For patients with combined gastrointestinal symptoms, celecoxib, 200mg, one capsule a day may be used.
(4) IL-1 inhibitor: IL-1 can induce chondrogenesis, analgesic, anti-inflammatory and antipyretic effects; does not inhibit prostaglandin synthesis; has the effect of slowing down the disease process in osteoarthritis. It can be taken orally after meal, 50mg per day for a long time. It can be used in combination with NSAIDs, and the liver function should be reviewed every 6 months.
3.Surgical treatment
If the symptoms are very serious, drug treatment is ineffective, and affect the patient’s daily life, surgical intervention should be considered.
For osteoarthritis of the knee joint, some people advocate arthroscopic arthroscopic debridement first. This type of surgery has certain efficacy in the near future for some patients, but the long-term effect is not certain.
2, joint replacement surgery for most patients with osteoarthritis, femoral head necrosis, rheumatoid arthritis, in the relief of pain, restoration of joint function has significant results, but because of joint replacement surgery there are certain recent and long-term
complications, such as loosening and wear of components and osteolysis, which cannot be completely resolved at present. Therefore, it is important to strictly control the indications for joint replacement surgery. Strictly speaking, the indications for surgery 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.
VI. Prevention of osteoarthritis
Prevention of osteoarthritis and maintenance of normal joint function should begin in youth. From this period we should care for the joints, cherish the joints, and treat the joints well. There are three levels of prevention strategies for osteoarthritis.
First, early on, the focus should be on keeping healthy people healthy and preventing the onset of the disease. Experts consider effective weight loss in women over the age of 50 as one of the strategies to prevent the development of osteoarthritis. In terms of diet, vitamin-rich foods should be eaten, such as green vegetables, leeks, spinach, persimmon peppers, citrus, grapefruit, kiwi and sour dates, which contain more vitamin C. Milk, egg yolk, animal liver and sea fish contain more vitamin D. Vegetable oils, cereals, nuts and meat contain more vitamin E. Three meals should be eight minutes full, which can control weight and reduce joint load. In addition, appropriate exercise can also help reduce weight. Before exercising, preparatory activities should be done. Middle-aged and elderly people should master the correct method when exercising and do the right amount of activities according to their physical condition, and it is better not to do strenuous exercises to prevent excessive strain on the joints.
Secondly, the focus of medium-term prevention is to detect patients early and stop the progress of the disease. The early symptoms of osteoarthritis are localized pain in the joints, characterized by increased pain with activity and reduced pain with rest, which can be accompanied by a feeling of weak legs and a desire to fall, and sometimes the phenomenon of strangulation, with the development of the disease, the pain gradually worsens and is persistent, joint movement is limited, and finally deformation occurs. Trauma to the joint, such as injury to the meniscus and fork ligaments, and wrong exercise methods can cause traumatic osteoarthritis. Therefore, if trauma occurs during activity, it should be promptly checked and treated at a hospital to prevent further injury. There are some other diseases that cause osteoarthritis, such as rheumatoid arthritis and synovitis, so the original disease should be treated as early as possible to prevent serious damage to the joint. Finally, late prevention involves stopping joint dysfunction, relieving the patient’s pain, and providing appropriate clinical treatment. osteoporosis can be prevented in women over 50 years of age by applying estrogen, strengthening the muscles and exercising the quadriceps in general can help maintain the stability of the knee joint, aerobic exercise can slow the onset of dysfunction, and a controlled diet and vitamin D plus calcium therapy are also effective prevention strategies.
In conclusion, osteoarthritis is a preventable and treatable disease. With the continuous development of high-tech medical technology, early detection and early treatment play an invaluable role in preventing premature joint degeneration. Young and middle-aged people with various joint sports injuries and various joint deformities, such as internal derangement of the knee, external derangement of the knee and patella, should seek early treatment at a specialized hospital to ensure a healthy and happy old age.