The clinical manifestations of OA are slow, progressive, recurrent joint pain. Pain can be triggered by exertion and exposure to cold. Joint swelling, deformation joint stiffness, limited movement with secondary synovitis, manifested as joint swelling, fluid accumulation. OA with synovitis is difficult to treat. Treatment of OA: Inhibit cartilage degeneration, increase synthesis and actively explore symptomatic treatment to relieve pain and improve function to prevent disability. Basic principles of OA treatment The pyramid model of osteoarthritis treatment recommended by the International Health Organization (Figure 10) OA treatment options 1) drug therapy; 2) surgical treatment; 3) adjuvant therapy; Classification of drugs for treating osteoarthritis Nonspecific drugs 1) antipyretic and analgesic drugs: Aspirin, acetaminophen, etc.; 2) non-steroidal anti-inflammatory drugs: ibuprofen, diclofenac, anti-inflammatory pain, etc.; 3) steroid (hormone) anti-inflammatory drugs; Specific drugs. ) anti-inflammatory drugs; specific drugs (symptom-relieving drugs, disease-modifying drugs) Amino glucose chondroitin sulfate hyaluronic acid (mucus replenishment therapy) What are NSAIDs? 1. It is the abbreviation of Non-steroid Anti-inflammation Drugs. Chinese: “non-steroidal (hormonal) anti-inflammatory drugs” for short Definition of NSAIDs: 2, is in addition to adrenocorticotropic hormone, used to treat inflammation, especially rheumatoid arthritis Non-steroidal Anti-inflammatory Drugs NSAIDs NSAIDs Currently, the conventional treatment of osteoarthritis is a non-steroidal anti-inflammatory drug. NSAIDs work by inhibiting the enzyme cyclooxygenase, which inhibits the synthesis of prostaglandins, resulting in anti-inflammatory and pain relief. Treatment with NSAIDs lacks specificity for osteoarthritis, a degenerative disease of the articular cartilage. Prolonged use of some NSAIDs may even exacerbate the pathologic progression of osteoarthritis (e.g., anti-inflammatory pain, etc.). In addition NSAIDs have relatively large side effects, such as gastrointestinal irritation. In recent years the international development of COX2 selective cyclooxygenase inhibitors has reduced gastrointestinal irritation and the side effects of their clinical use have decreased. However, there is still a lack of specificity in the treatment of osteoarthritis. It should be noted that some of these drugs, when taken for a long period of time, can inhibit the repair of articular cartilage and reduce the efficacy of glucosamine-type drugs or injectable hyaluronic acid drugs. Consult a physician specializing in joint surgery before taking them. Steroidal (hormonal) anti-inflammatory drugs intra-articular closure: anti-inflammatory, reduce swelling. I advocate not routinely applying them, only for patients with concurrent synovitis. However, long-term application has the potential to aggravate the condition. The most commonly used drug is Depo-Prostone, which is a mixture of long-acting and short-acting actions and lasts up to 3 weeks with a single application. Joint infections must be excluded before use. Use with caution in diabetic patients. Specific drug therapy – Glucosamine Glucosamine is a physiological substance necessary for the biometabolism of chondrocytes. Chondrocytes use glucose to synthesize large molecules of mucopolysaccharides, proteoglycans that form an important part of the cartilage matrix and, together with type II collagen fibers, maintain cartilage form and function. (Figure 11) Figure 11 The structure of articular cartilage The efficacy of glucosamine has been shown in domestic and international clinical studies to be equal to or better than that of traditional osteoarthritis medications, such as non-steroidal anti-inflammatory drugs (NSAIDs), in terms of short-term improvement in the symptoms of osteoarthritis patients, with a safety profile that is more than 10 times that of NSAIDs. Unlike NSAIDs, the therapeutic effect of glucosamine does not disappear quickly after discontinuation of the drug, but is maintained for a considerable period of time. The results of domestic research suggest that after taking glucosamine treatment for 5 weeks, 2/3 of the patients whose therapeutic effect lasted for 4-6 months. The results of the latest foreign studies suggest that after 3 years of continuous administration of glucosamine, compared with the control group, glucosamine was able to maintain the joint space of the diseased joints unchanged, while the joint space of the diseased joints in the control group was significantly narrowed, with a decrease of 1mm per year. Specific drug treatment – hyaluronic acid intra-articular injection therapy In the 1970s, Balazs et al. first proposed to restore the synovial fluid by supplementing with exogenous HA, which is the main component of the synovial fluid. In the 1970s, Balazs et al. were the first to propose that by supplementing exogenous HA, the lubricating function of synovial fluid could be restored, and the repair of cartilage could be promoted, thus improving the joint function. Figure 12 Schematic diagram of VS therapy VS therapy maximally satisfies the four principles of OA treatment 1) protect cartilage; 2) lubricate joints; 3) inhibit inflammation; and 4) relieve pain. It promotes endogenous HA secretion, thereby: 1) relieving pain; 2) improving function; 3) alleviating disease progression; and 4) improving quality of life. Physiological functions of sodium vitrate in joints 1) lubricate joints, cushion stress, and reduce friction; 2) act as a filler and diffusion barrier; 3) scavenger function Non-pharmacological treatment 1) Reduce weight-bearing on joints, avoid harmful movements, and in the acute stage, splinting or plaster casts Swimming, walking, low-exercise aerobic exercise, and range-of-motion exercises for joint extension and flexion, and static contraction exercises. 2) Cold and hot compresses: moist heat therapy, hot water baths, paraffin baths, steam baths, spa baths. Dry heat therapy. Ice packs to reduce swelling and relieve pain. Cold compresses are contraindicated in patients with poor circulation. 3) Transcutaneous Electrical Nerve Stimulation (TENS): subcutaneous electrodes are placed in the painful area, pulsed electrical stimulation.TENS blocks nerve signaling and improves the perception of pain. 4) Acupuncture: Stimulate the brain and nerve center to release natural analgesic substances. 5) Body massage: increase local blood circulation, massage therapist should know the disease very well. Adjunctive treatment 1) Weight loss, weight control physiotherapy physical therapy body therapy support cane walker Chinese medicine: dialectic treatment, drive away wind and dampness, blood circulation and blood stasis, soothing tendons and pain relief. 2) Physical therapy, how to develop an exercise program Exercise program should focus on solving the most important problems that patients believe affect their lives. It should have both short-term and long-term goals. Patients should participate in the development of the plan, short-term goals can be achieved in 2-3 weeks, the realization of short-term goals can enhance the patient’s confidence and interest in exercise. Exercise time starts at 20 minutes per day, 2 days per week and gradually increases as the patient’s ability improves. Each workout consists of three phases: warm-up activities, exercise, and conditioning. Warm-up activities are 5-10 minutes of low-intensity joint repetitive activities Exercises include joint flexion, strength, and endurance exercises (described below) Adjustment period is 5 minutes of non-resistance stretching of the exercised muscles. Joint mobilization exercises Joint mobilization exercises are usually the first step in the rehabilitation process. The main goal is to reduce stiffness, increase joint motion, and prevent soft tissue contractures. The range of motion is different for inflammatory arthritis and non-inflammatory arthritis. Joint movement in the acute phase of rheumatoid arthritis should be within a pain-free range. Non-inflammatory arthritis is performed with non-resistance joint extension and gentle joint movement within the patient’s comfort range while joint movement should end with some resistance. Precautions: Choose bedtime exercises for mild pain and stiffness. Take a hot shower or apply localized heat before exercise. Try to relax before exercise. Move the joint slowly, within the patient’s comfort range, with a little resistance at the end of the joint movement. Stay at the final angle of the joint movement for 10-30 seconds. Avoid pain and reduce the range of motion during inflammatory periods. Strength Exercises Resistance exercises can be effective in improving muscle strength to stabilize the joint. The program is developed by considering the following: 1) The degree of joint stability and inflammation. 2) No muscle fatigue. 3) The resistance must be less than the maximum muscle force. 4) During the active phase of inflammation, isometric muscle exercises or non-resistance joint activities should be performed with a reduced number of repetitions. 5) Isometric muscle exercises should not be done for joints in the inflammatory phase. 6) Joint pain for more than an hour and joint swelling suggests over-exercise. 7) Strength exercises are subdivided into isometric and isotonic exercises. Surgical treatment of osteoarthritis at the end stage, extensive damage to the articular cartilage, subchondral bone necrosis, collapse, joint deformity (O-shaped leg or X-shaped leg), at this point, any conservative treatment can only temporarily improve the symptoms, can not be treated from the root, so can only be treated by surgery. Remember the analogy of siding and wall tiles? It’s like the wall tiles underneath the siding have become uneven or even missing, and even the best wall paint can’t restore the original wall surface.