Primary osteoarthritis tends to occur after the age of 50, with more female patients than male. Secondary osteoarthritis has a younger age of onset. Primary osteoarthritis involves fewer joints, most often the knee, hip, fingers, lumbar spine, cervical spine and other joints.
The disease is slow to develop and most often results in pain and soreness in the joints after exposure to cold, strain or minor trauma. Pain is a common symptom of osteoarthritis. The pain is mostly intermittent and dull, but in severe cases, it can be persistent or even tearing or pins and needles pain. In the early stages of the disease, pain occurs after activity and is more pronounced after weight-bearing, and can be relieved at rest. As the disease progresses, pain can occur at rest or even at night. Morning stiffness is also one of the main manifestations of osteoarthritis. It is characterized by temporary stiffness after weight-bearing, or inconvenience in moving from one position to another, and is more pronounced in the morning after waking up or sitting for a long time. The stiffness lasts for a short time, usually within 30 minutes, and can be relieved after activity. The pain can also be aggravated in cold or rainy weather, and in severe cases, it can lead to impaired movement.
The above symptoms can be aggravated slowly. In the late stage, when the bone superfluous forms, the superfluous stimulates the synovial folds and produces inflammatory reaction, which increases the pain and may produce joint deformation or joint movement limitation. In the early stage, the symptoms are mild, mostly when sitting or waking up in the morning, but as the disease progresses, the range of motion of the affected joints decreases, or even becomes fixed in a certain position. If there are free bodies or floating pieces of cartilage in the joint, “interlocking” phenomenon may occur when the joint is moving. These symptoms may occur intermittently, but after several episodes, the interval may gradually shorten and eventually the symptoms may become persistent.
A common sign of osteoarthritis is pressure pain, mostly on the joint line, but also non-specific pressure pain around the joint. Severe arthritis may present with joint deformity due to flexion contracture, malalignment, subluxation or swelling. In severe arthritis, joint deformity may occur due to flexion contracture, poor alignment, subluxation or swelling.
1. Knee joint: It is the most common clinical osteoarthritis, and primary is more common in women. Symptoms can occur insidiously, with more involvement of the medial tibiofemoral surface and patellofemoral surface and less involvement of the lateral tibiofemoral surface. Pain can be felt during walking in the early stages, and in the later stages, especially at night when resting. Active and passive movement pain is a distinctive feature of joint involvement. The pain may increase with activity, especially when walking up and down stairs, and there is localized pressure pain in the joint, and the pressure points are usually asymmetrical. Joint swelling and impaired movement may occur due to joint effusion. In severe cases of exudation, isolated cysts (Backer cysts) may develop in the posterior part of the knee joint. Most patients can develop a bone rubbing sound with activity.
As the arthritis progresses, joint deformities may develop, predominantly internal knee valgus and occasionally external knee valgus. The American Rheumatism Association diagnosis of knee osteoarthritis requires knee pain and radiographic basis and at least one of the following.
(i) Age greater than 50 years.
(ii) Morning stiffness lasting less than 30 minutes.
(iii) A sensation of joint friction with activity.
Secondary knee osteoarthritis is relatively less common than primary and can occur secondary to.
① rupture of the meniscus.
(ii) exfoliative osteochondritis caused by local blood supply disorders.
(iii) chondromalacia patellae.
④ joint instability due to knee ligament injury.
⑤ osteoarthritis secondary to rickets.
2, hip joint: clinically more male patients than female, unilateral disease than bilateral disease. In China, primary patients are less common, secondary hip osteoarthritis is more common in.
① congenital dislocation of the hip joint.
(ii) acetabular dysplasia.
(iii) Ischemic necrosis of the femoral head.
④After trauma and inflammation. The superior and lateral aspects of the hip joint are commonly involved, accounting for 60% of cases. In 80% of patients with osteoarthritis of the hip joint, congenital acetabular dysplasia and epiphyseal chondromalacia of the femoral head are combined. The main symptoms are abnormal gait and hip pain during activity or weight bearing. Hip pain can radiate through the foramen ovale to the groin, thigh and knee. There may also be soreness and swelling around the hip and at the greater trochanter of the femur, radiating to the posterior lateral aspect of the thigh. X-rays show subchondral cystic degeneration of the hip joint, narrowing of the hip joint space and formation of bone redundancy.
3, interphalangeal joints: mostly distal interphalangeal joints, more primary, less in the proximal interphalangeal joints, occasionally in the palmar interphalangeal joints. There is often more than one joint involved. The main symptom is the presence of Heberden’s node, which appears as a bony enlargement of the medial or lateral side of the extensor surface of the joint, as a proliferating bone spur or a bulging joint capsule, with mild flexion deformity of the affected joint. The enlargement of the proximal interphalangeal joint is called Bouchard’s node, and the enlarged joint may show symptoms such as soreness, limitation of movement, and a feeling of bone friction.
4. Spine: Both primary and secondary osteoarthritis of the spine are more common. It is due to degenerative lesions of the vertebrae, intervertebral discs and lordotic joints. It mostly occurs in the 3rd and 4th joints of the lumbar spine. In primary cases, the degenerative degeneration and dehydration of the intervertebral discs after middle age lead to narrowing of the intervertebral spaces, reduced stability between the vertebral bodies, wear of the cartilage at the edges and intervertebral joints, and the generation of bone fragments. It can also occur in the cervical spine, mostly in the joints with the cervical spine 5-6 and 4-5. The main symptoms are localized pain and stiffness in the cervical, thoracic and lumbar spine, and in severe cases, symptoms due to nerve compression may occur. When the nerve root is compressed it can cause numbness and loss of reflexes in the nerve distribution area as well as muscle atrophy. If the basilar artery of the neck is compressed, it can cause insufficient blood supply to the vertebrobasilar artery, such as vertigo, nausea, and nystagmus. If the lumbar nerve roots are compressed, sciatic nerve symptoms may occur.
5. Foot and ankle joints: Less common clinically, the 1st metatarsophalangeal joint is often involved, which can lead to typical bunions. The course of the disease is mostly slow, and acute symptoms may also occur during the onset of complications such as bunions. Local pain, pressure and bony formation may be associated with bunions in severe cases, and walking difficulties may occur.
6.Other special osteoarthritis
(1) Primary systemic osteoarthritis: characterized by slow progression, insidious onset, initially involving one or two joints. It is an autosomal dominant disease, mostly in middle-aged menopausal women. Hand symptoms are more prominent, with the distal interphalangeal joint, proximal interphalangeal joint and first carpometacarpal joint being the most prevalent. Others can be seen in the hip, knee, and spinal joints. The affected joints may have episodes of pain, localized fever, and joint effusion in some joints.
Systemic osteoarthritis can be divided into two categories: nodular and non-nodular. The nodular type is characterized by hand involvement, mostly in the distal interphalangeal joints, with Heberden’s nodes observed on physical examination, more often in women, and more often with a family history; the nodular type is mainly in the proximal interphalangeal joints, and family aggregation is not obvious.
(2) Erosive osteoarthritis: This disease is a subtype of osteoarthritis, mostly seen in menopausal women, involving mostly small joints of the hands, with the distal and proximal interphalangeal joints being the most common, and some patients may develop rheumatoid osteoarthritis. Some patients may develop rheumatoid osteoarthritis. The symptoms are mostly recurrent pain and stiffness with limited joint movement. A small number of patients may have dry syndrome.
(3) Diffuse idiopathic bone hypertrophy syndrome: Diffuse idiopathic bone hypertrophy syndrome (DISH) is a kind of osteophyte disease that mainly involves the spine. It is also seen in people over 50 years of age and may be associated with diabetes or abnormal glucose tolerance. The symptoms are dominated by stiffness of the spine. Diffuse idiopathic osteophyte syndrome is dominated by the formation of osteophytes, which usually extend from one vertebral body to another, forming bony ridges. Unlike generalized spinal osteoarthritis, the disease does not involve small joints and is not associated with degenerative cartilage, and can be differentiated from generalized spinal osteoarthritis on imaging and pathology.