Primary osteoarthritis often develops after middle age, and the incidence increases with age. The main symptom is joint pain, which often occurs in the morning and is relieved by a little activity, but if there is too much activity, the pain is aggravated by joint friction. Several joints may be involved at the same time, but unlike rheumatoid arthritis, there is no systemic symmetrical polyarthritis, and the affected joints may be mildly swollen. (a) Degenerative changes of the finger joints manifest in the distal interphalangeal joints of Heberden’s nodes are more common in the middle finger and index finger, while Bouchard’s nodes in the proximal interphalangeal joints are less common and are often mistaken for rheumatoid nodules. The occurrence of Heberden’s node is related to genetics and gender, and is more common in women. Most of the patients have no obvious pain, but they may have difficulty moving and mild numbness and tingling, and may cause distal interphalangeal joint flexion and oblique deformity. (B) Primary osteoarthritis of the knee affects the knee joint most commonly. Patients often complain of a clicking sound in the joint, pain when walking, which improves after rest, stiffness of the joint when sitting and standing for a long time, walking and relaxing the muscles can make the stiffness disappear, the symptoms are sometimes mild and sometimes severe, and can even vary from day to day, the joint enlargement is often caused by osteophytes, but also by a small amount of exudate, acute swelling suggests bleeding in the joint cavity, and the knee joint is restricted when the disease progresses. Acute swelling suggests intra-articular hemorrhage. When the disease progresses, the knee joint may be limited in movement, causing disuse muscle atrophy and even valgus or inversion deformity. (C) the spine has two sets of joint devices, namely the intervertebral disc and the upper and lower synovial joints, in the cervical spine 2 to 7 there is still a hook vertebral joint (Lushka joint), primary due to degenerative disc degeneration after middle age, dehydration of the nucleus pulposus, resulting in narrowing of the intervertebral space, bone wear and tear with osteophytes, most do not have clinical manifestations, if there are symptoms also vary in severity, most chronic course, but sometimes due to injury, weight lifting, sudden movement of the spine and other external causes. In the cervical vertebrae, the bone superfluous at the edge of the hook vertebral joint can cause the cervical nerve root to be squeezed when it penetrates the intervertebral foramen, resulting in recurrent cervical local pain, which can be radiated to the forearm and fingers, and there can be numbness and lack of movement of the fingers, etc. The bone superfluous at the posterior edge of the vertebral body can protrude into the spinal canal and squeeze the spinal cord, causing numbness and weakness of the lower limbs and then the upper limbs, and even tetraplegia, and when the vertebral artery is compressed, there can be The main symptoms are lumbago with sciatica, which often occurs after sprains, heavy lifting and bending, local pressure pain on physical examination, positive straight leg elevation test, and changes in sensation, muscle strength and tendon reflexes. Secondary osteoarthritis of the spine is mostly caused by congenital deformity of the spine, scoliosis, fracture and bone tuberculosis. (d) Primary osteoarthritis of the hip joint, which is relatively rare in China, is often part of the systemic degenerative joint disease, occurring mostly over 50 years of age, more men than women, secondary to ischemic necrosis after fracture of the femoral head or neck, or congenital hip dislocation, rheumatoid arthritis, etc. The clinical manifestations are mainly hip pain, which can radiate to the groin, inner thigh or even above the knee, starting at When the disease develops seriously, the hip joint is flexed and internally retracted, and the lumbar vertebrae are compensated for anterior convexity, then there can be severe lower back pain and even inability to walk. Primary generalized osteoarthritis often occurs in menopausal women and involves most joints, often affecting the finger joints and the first metacarpophalangeal joint, and generally has an acute painful phase, sometimes easily confused with rheumatoid arthritis. Diffuse idiopathic skeletal hyperostosis is seen in elderly men, with massive bone growth, sometimes fused together, clinical symptoms are not as severe as the x-ray presentation, the patient complains of mild pain and joint stiffness, but can maintain good mobility. Calcification or ossification in the anterior part of four consecutive vertebral bodies; no severe disc lesions; sclerosis of the vertebral body edges; sometimes extra-spinal calcification is seen, especially in the eminence and the heel bone, where large bone spurs are visible.
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