Osteoarthritis is a common chronic joint disease, whose main lesions are degenerative changes of joint cartilage and secondary osteophytes, mostly seen in middle-aged and elderly people, more women than men, and most commonly found in weight-bearing parts of the knee, hip, spine and finger joints. Osteoarthritis can be divided into two categories: primary and secondary.
Overview
Osteoarthritis is a chronic joint disease characterized by the degeneration and destruction of joint cartilage and osteophytes. Osteoarthritis belongs to the category of Chinese medicine. Its main changes are degeneration of the cartilage surfaces of the joints and secondary osteophytes. The main manifestations are joint pain and inflexibility. X-rays show narrowing of the joint space, dense subchondral bone, fractured trabeculae, sclerosis and cystic changes. There is lip-like hyperplasia at the edge of the joint. In the later stage, the bone ends are deformed and the joint surface is uneven. The cartilage in the joint peels off and the bone fragments into the joint, forming intra-articular free bodies.
1.Disease alias
Degenerative joint disease, proliferative osteoarthritis, osteoarthritis, also known as degenerative arthritis, is actually not an inflammatory disease, mainly degenerative changes, is the premature aging of joints, especially the aging of articular cartilage. Osteoarthritis represents the aging of the joints and is therefore called age-related arthritis. The broader term osteoarthritis also includes other aseptic arthritic disorders. Osteoarthritis is a limited disorder and the systemic cause is not important.
2.Disease etiology
The occurrence of this disease may be related to the following factors.
(1) obesity
The increase in weight and the onset of osteoarthritis of the knee are proportional. Obesity is also an aggravating factor. Weight loss in obese people can reduce the onset of osteoarthritis of the knee.
(2) Bone density
When the subchondral bone trabeculae become thin and stiff, their tolerance to pressure decreases, thus increasing the chance of osteoarthritis in people with osteoporosis.
(3) Trauma and force tolerance
Abnormal state of the joint, such as when the link is in an unstable state after patellar resection, when the joint undergoes muscle force imbalance and combined with local pressure, degenerative degeneration of cartilage can occur. Normal joints and activities or even after strenuous exercise is not osteoarthritis.
3, genetic factors
Joint involvement varies from race to race, for example, osteoarthritis of the hip and carpometacarpal joints is more common in Caucasians, but less common in people of color and nationalities, and gender also has an effect, with the disease being more common in women. Data show that the incidence of osteoarthritis in women with Heberden’s nodes is 2-3 times higher in their mothers and sisters than in their families without the disease.
4.Pathophysiology
Osteoarthritis pathogenesis: Articular cartilage is made up of 1-2mm thick collagen fibers, glycoproteins, and hyaluronate aggregates, which act as a cushion when hydrated to absorb and disperse the weight and mechanical forces that are applied. Under physiological conditions, articular cartilage relies on periarticular and thermal contraction and the subchondral bone to perform the above tasks completely. The contraction of the muscles, in addition to driving joint movement, also acts as a rubber band, absorbing a large amount of the incoming impulse and protecting the joint. When an accident occurs (such as a fall), because the muscles do not have a timely protective response to this sudden shock and make the joint heavier, it can cause damage to the joints. In addition, muscle aging, peripheral neuropathy, muscle energy absorption function is also greatly reduced. Another factor that helps the cartilage to bear the weight is the bone mass under the cartilage showing a reticular distribution, whose texture is softer than the bone cortex although it should be more cartilage, so it has a high degree of elasticity and is conducive to bearing pressure.
It can be seen that osteoarthritis is new in the following two situations: first, when there are abnormalities in the articular cartilage, subchondral cortex, and periarticular muscles, such as senile degeneration, osteoporosis, inflammation, and metabolic diseases; second, when the articular cartilage, subchondral bone mass, and periarticular muscles are normal but under excessive pressure, such as obesity and trauma.
Pathology: The deformation of articular cartilage occurs earliest and has characteristic lesions. When the cartilage matrix loses glycoprotein, the cartilage on the surface of the joint softens and fractures at the site of pressure, leaving the cartilage surface in the form of a fine filamentous material. Later, the cartilage is gradually shed in sheets and the cartilage layer becomes thin or even disappears. Small fractures and necrosis of the subchondral bone occur, and the osteophytes in and around the joint surface constitute osteosclerosis and bone arthrosis and bone cystic changes on X-ray. The synovial membrane of the joint may show mild proliferative changes including proliferation of synovial cells and infiltration of lymphocytes due to destruction of cartilage and bone and shedding of metabolites such as the joint cavity, which is much less pronounced than in rheumatoid arthritis. In severe osteoarthritis, the joint capsule wall is fibrotic and the surrounding tendons are damaged.
5.Signs and symptoms
The disease starts slowly. Symptoms appear mostly after the age of 40, and the number of people who develop the disease increases with age. The incidence is higher in women than in men.
Arthralgia in this disease has the following characteristics: it is mostly found in weight-bearing joints such as knees and hips; the pain is related to activity and is relieved after rest; after the joints have been stationary for a long time and then moved, there is a transient local stiffness that lasts no more than 30 minutes and disappears after activity; in severe cases, there is arthralgia and limitation of activity even at rest; the affected joints are often accompanied by pressure pain, bony hypertrophy, bony friction sounds, and a few patients have deformities. A small number of patients have deformities.
The common sites of osteoarthritis and their characteristics are as follows. More than one site may be present in the same patient.
(1) Hand
The interphalangeal joints are most commonly involved, especially the distal interphalangeal joints. Swelling and pressure pain are less pronounced and rarely interfere with joint motion. The characteristic change is the formation of bony growths on the medial and lateral surfaces of the dorsal phalanges, called Heberden’s nodes in the distal phalanges and Bouchard’s nodes in the proximal phalanges. These nodules develop very slowly. Only a small number of patients eventually develop a flexion or external oblique deformity of the distal phalangeal joint. When the first carpometacarpal joint is involved and there is osteophyte growth, a “square” shaped hand is formed, which is rare in the Chinese population.
(2) Knee
Knee pain is a common complaint of patients with this disease. Early symptoms are pain when going up and down stairs, especially when going downstairs, alternating unilaterally or bilaterally, and joint enlargement, mostly due to bony hypertrophy, or joint effusion. Synovial hypertrophy is rare. In severe cases, the knee is deformed.
(3) Hip
Pain in the greater trochanter, lateral hip and groin may be radiated to the knee. Internal rotation and extension of the hip are limited. Osteoarthritis of the hip is less common in our population than in Caucasians.
(4) Foot
The first toe joint is a common site for lesions to appear. Wearing tight footwear and repeated trauma are the causes. Symptoms are localized pain, bony hypertrophy, and bunions.
(5) Spine
Degenerative lesions of the vertebrae, intervertebral discs, and synovial joints cause lesions of the vertebrae in the cervical and lumbar segments. Localized pain and stiffness occur. In a few severe cases, various radiological pains or neurological symptoms occur due to labral hyperplasia and bone arthrosis at the vertebral body margin compressing local nerve roots, spinal cord or local blood vessels.
6.Diagnostic tests
There is no specific laboratory test for this disease, but it can be further differentiated from other diseases. Blood sedimentation is normal in most patients, C-reactive protein is not increased, and rheumatoid factor is negative. The joint fluid is yellow or straw yellow with normal viscosity and a normal coagulation test, and its leukocyte level is less than 2 × 109/L. The sugar level is rarely less than 50% of the blood glucose level.
X-rays of the joints are helpful in the diagnosis of this disease. The affected joints show the following changes on X-rays according to the severity of the disease.
(1) Narrowing of the joint space.
(2) Sclerosis of the subchondral bone.
(3) Bone artifact formation at the joint margin.
(4) Cystic changes in the subchondral bone and, in rare cases, ship chisel-like bone changes.
(5) Bone deformities including flattening of the femoral head and/or subluxation of the joint. It should be noted that many patients with the above X-ray changes do not have clinical symptoms of the disease.
7.Treatment and medication
Treatment: Osteoarthritis is a common disease among middle-aged and elderly people, and there is no complete cure, however, there are many symptomatic treatment methods.
(1) Chinese medicine treatment
Osteoarthritis in Chinese medicine was first described in the “Nei Jing”, “Su Wen? The “Treatise on Palsy” states that “wind, cold and dampness come together to form a paralysis, with wind prevailing as a walking paralysis, cold prevailing as a painful paralysis, and damp prevailing as a paralysis. In addition, “Su Wen? In addition, the “Treatise on Paralysis” also believes that “the so-called diet and residence are the basis of the disease”, and that the production of paralysis is related to diet and living environment. And in “Su Wen? In the “Commentary on Heat Diseases”, it is said that “wind and rain, cold and heat, must not be deficient, can not hurt people alone”, and “not with wind, cold and dampness, so not for paralysis”. It can be seen that the ancients saw the external factors of the onset of arthritis and also realized its internal causes. In general, wind, cold, damp and heat are the external conditions for the development of arthritis, while the deficiency of memory and the deficiency of positive energy are the internal causes of its onset.
(2) Drug treatment
Sodium hyaluronate: It is the main component of synovial fluid in the joint cavity and one of the components of cartilage matrix. It plays a lubricating role in joints and reduces friction between tissues, and can significantly improve the inflammatory response of synovial tissue after intra-articular injection, enhance the viscosity and lubricating function of joint fluid, protect joint cartilage, promote the healing and regeneration of joint cartilage, relieve pain and increase joint mobility. It is often injected intra-articularly, 25mg once, once a week for 5 weeks, subject to strict aseptic operation.
Glucosamine: It is the most important monosaccharide that constitutes polyglucosamine (GS) and proteoglycan in the cartilage matrix of joints. In normal people, GS can be synthesized through the 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 cavity, 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 and anti-inflammatory drugs: Topical patches can inhibit the synthesis of cyclooxygenase and prostaglandins, 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.
(4) Miao formula treatment: Miao medicine divine paste Miao formula Tong Piao paste as Miao Ling traditional black ointment, selected from a variety of valuable herbs concoction, adhering to the ancient Miao medicine external treatment theory, directly applied to the lesion, to achieve multiple effects such as activation of blood, circulation, expel blood stasis, pain, drive away evil, support the righteousness, etc., to achieve a full range of therapeutic effects, so that the root of osteoarthritis disease pain completely uprooted.
(3) Surgical treatment.
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.
For osteoarthritis of the knee, some people advocate arthroscopic arthroscopic debridement, which is effective for some patients in the near future, but the long-term effect is not certain.
②For most patients with osteoarthritis, femoral head necrosis, and rheumatoid arthritis, joint replacement surgery has significant effects in relieving pain and restoring joint function, 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 indications for joint replacement surgery.
(4) Non-pharmacological treatment
This includes patient health education, self-training, weight loss, aerobic exercises, joint mobility training, muscle strength training, use of walking aids, wedge walking insoles for internal knee rolls, occupational therapy and joint protection, aids for daily life, etc. 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.
8, diet taboos
(1) high-fat food: avoid eating high-fat food (such as beef, pork fat, etc.) and too acidic, alkaline, salty food and synthetic food, pickled food, fried and deep-fried food. Salt is limited to 6 grams per day is good.
(2) sweet food: avoid or eat less sweet food, such as sweet cakes, sweet snacks, candy, ice cream, chocolate, etc.
(3) Stimulating foods: avoid or less eat pepper, spiny pepper, and avoid or less eat tomatoes, spinach, amaranth, wild rice, eggplant, potatoes, etc., avoid alcohol and carbonated beverages, less strong tea and coffee, avoid shellfish, dried fruits, foods with MSG additives and preservatives.
It is important to mention here that for overweight people, weight loss is one of the ways to treat osteoarthritis, and they should exercise in moderation, regulate the structure of their diet and control the amount of food they eat. Patients can change their diet of three meals a day and adopt the diet of eating less and more, eating before feeling hungry, which can be an apple, a bowl of boiled vegetables, mainly fruits and vegetables. However, weight loss should not be rushed, and it is generally appropriate to lose 250 to 500 grams per week. After weight control in the normal range, still need to adhere to more than six months.
9, the appropriate diet into
(1) nutritious: diet should be rich in nutrients, especially to supplement the body’s need for protein, can eat fish, shrimp, meat, eggs, etc. in moderation. Diet should be light. Drink more than 250 ml of milk or soy milk every day.
(2) supplement calcium: it is advisable to eat more calcium-rich green leafy vegetables and fresh fruits, such as soybean products, capers, potherb mustard, rape, lettuce, celery, carrots, bok choy, pumpkin, watercress, beets, appropriate to eat some lemons, citrus, plums, apples and other fruits as well as small fish, shrimp, kelp, etc.
(3) Drink more water: you should drink l 500 ml (6 to 8 cups) of water every day.
10.Preventive care
Osteoarthritis is a chronic arthritis caused by joint degeneration and destruction of joint cartilage. Patients are mostly middle-aged and elderly people over 45 years old. The onset of the disease is slow, often multi-joint disease. There may be persistent vague pain in the affected joint, which is aggravated by activity and improves after rest. Sometimes there may be acute pain episodes with joint stiffness and a popping sound when the joint is moved. The joint stiffness increases after sitting for a long time and improves after a little activity. In the late stage, there may be swelling and enlargement of the joint and limitation of movement.