I. How is osteoarthritis caused?
Osteoarthritis, commonly known as osteophytes, is an age-related disease that mostly develops around the age of 50. When the body tends to age, or due to trauma or disease, joint cartilage degenerates and loses elasticity, followed by cracks, erosions and ulcers, making the cartilage surface rough and unpleasant. The unsmooth cartilage surfaces rub against each other, further aggravating the cartilage damage. At this time, the integrity of the articular cartilage is destroyed, the subchondral bone plate due to the lack of cartilage protection, local abnormal pressure and hyperplasia (bone spur formation), that is, the osteoarthritis.
What kind of people are prone to osteoarthritis? Why are these people prone to osteoarthritis?
The cause of primary osteoarthritis is still unknown, but it is generally believed to be related to a variety of factors such as obesity, ageing, trauma, endocrine, and cartilage substitution. Obese patients with increased joint weight, the human body to maintain the center of gravity will occur in the knee of the inversion deformity, so that both sides of the knee joint gap weight imbalance, resulting in degenerative changes, the accumulation of minor injuries can cause subchondral bone hardening changes, affecting the resistance of articular cartilage to joint weight, resulting in the degeneration of cartilage, up and down the stairs to slide a seemingly non-heavy injury, can be transmitted to the articular cartilage in a very short period of time too heavy load.
Second, the incidence of osteoarthritis gradually increases with age. The incidence has been reported to be less than 5% in people aged 15 to 44 years, 25. 3% in people aged 45 to 64 years, and up to 60% or more in people aged >65 years. In addition, gender is closely related to the occurrence of osteoarthritis. The incidence of osteoarthritis in women before menopause is similar to that of men, but after menopause, the incidence of osteoarthritis in women is significantly higher than that of men.
The incidence of osteoarthritis is also higher in people with special occupations, such as miners who are in a semi-squatting or squatting position for a long time, which causes an increase in osteoarthritis of the knee joint. Many occupational sports and overexertion can also cause osteoarthritis such as soccer and weight bearing flexion can lead to knee osteoarthritis. A small number of patients with osteoarthritis are familial.
How many types of osteoarthritis are there?
Primary osteoarthritis can be divided into two categories, primary and secondary osteoarthritis, mainly degenerative aging of joint cartilage, with age and increasing aggravation, cartilage aging is a normal physiological evolution, but can vary from person to person on the basis of genetics, some occur earlier, more rapid, and some occur later, more slowly, the general progress of the disease is related to excessive fatigue and joint overload. Secondary osteoarthritis, that is, other diseases such as trauma, ischemic necrosis of the bones, and gradually lead to joint cartilage lesions.
4. What are the common symptoms of osteoarthritis?
Common symptoms include joint pain, stiffness, restricted movement or reduced joint stability; they can resolve spontaneously or recur. The most common symptoms are pain in the affected joints, aggravated by activity, relieved by rest, and stiffness after a long period of inactivity, etc. The symptoms are not heavy at the beginning, but gradually become painful during activity and after fatigue. If the patient has been in a fixed position for a long time, the pain can be felt at the beginning of the activity, but after a little activity, the pain is reduced.
When a large piece of cartilage falls off and becomes free in the joint, the patient has a sudden interlocking of the joint (the feeling that the joint is stuck), but some patients only find bone growth (bone spurs) when taking X-rays, but they do not have any symptoms, which is called asymptomatic osteoarthritis in medicine.
V. What tests are often needed for osteoarthritis?
Osteoarthritis can usually be diagnosed based on the patient’s complaints and the physician’s physical examination, but sometimes some relevant ancillary tests are still needed.
(1) For patients with fever and polyarticular pain, routine blood tests, blood sedimentation and C-reactive protein tests should be performed to rule out rheumatism, rheumatoid arthritis and infectious arthritis.
(2) Imaging examinations.
(1) X-ray film: X-ray film of the joint can record abnormalities in the general aspect of the lesion, reflecting the degree of joint damage, the extent of lesion progression and response to treatment, and its a routine examination item for patients with osteoarthritis.
(2) Magnetic resonance imaging (MRI): MRI can clearly show bone, articular cartilage, meniscus, ligaments, synovium and joint effusion.
(3) Synovial fluid examination, which has a confirmatory value for traumatic arthritis, infectious arthritis and gouty arthritis.
(4) Arthroscopy and synovial biopsy, arthroscopy can directly view the lesion, and can cut synovial tissue for pathological examination, and can also do some treatment such as free body removal and synovectomy under the arthroscope.
What are the treatments for osteoarthritis?
The goal of osteoarthritis treatment is to relieve symptoms, improve joint function, reduce deformity, and reduce the risk of progression of the disease. For those with less severe symptoms can be addressed through physical therapy, physical exercise and self-adjustment, and do not necessarily require medication. The disease can be characterized by automatic remission or recurrence, and when the symptoms are controlled, medication can be stopped without the need for long-term medication. Treatment includes non-pharmacological treatment, pharmacological treatment and surgical treatment.
Non-pharmacological treatment includes the establishment of a reasonable lifestyle, such as adjusting labor intensity, protecting the affected joints; always maintaining an optimistic mood, eliminating depression, and fighting the disease with a positive attitude; paying attention to self-protection of the joints, avoiding inappropriate weight-bearing, medical sports, physical therapy and auxiliary devices; obesity is the only expected factor affecting the prognosis of osteoarthritis, and overweight people should actively reduce their weight to help prevent the progression of the disease. It helps to prevent the progression of the disease; perform appropriate outdoor exercise, appropriate exercise not only does not cause further damage to the joint, but also helps to relieve the symptoms.
Physical therapy can increase local blood circulation, increase the range of motion of the joint exercise, exercise to enhance the corresponding muscle strength, can increase the protection of the joint, pain relief and improve the function also has a significant effect; choose the appropriate footwear, the outer sole of the shoe padding (for those with inversion of the knee), to protect the joint; joint movement inconvenience, can be used to reduce the weight of the joint cane or crutches.
Seven, osteoarthritis patients how to do physical exercise?
Patients with osteoarthritis can improve functional energy through moderate physical exercise. The previous concept of emphasizing rest for the affected joint has been replaced by medical sports. Physical exercise must be based on the patient’s specific situation, within the range of motion of the diseased joint, by the patient’s automatic exercise, step by step, including increased joint mobility exercise, enhance the muscle strength around the joint exercise and increase endurance exercise.
For patients with heavy symptoms, only muscle contraction without joint movement should be performed at the beginning, and it is best to exercise in water because the body weight in water is only 1/8 of the land weight.
Eight, can bone spurs be worn off through exercise?
The bone spur itself is caused by the degeneration of the joint, and once it occurs, it will not disappear with exercise, but proper exercise only helps to reduce the patient’s symptoms and delay the degeneration of the joint. Whether or not a bone spur becomes symptomatic depends on the presence of inflammation. There is no magic pill that can shrink or remove bone spurs, but inflammation can subside.
Once the inflammation is eliminated, the exudation and swelling are reduced, and the pain is relieved, which is a clinical cure. Therefore, the treatment of bone spurs is actually an anti-inflammatory treatment. This is the answer to the mystery that after treatment of osteoarthritis, the bone spurs remain and the symptoms disappear.
Is climbing mountains or stairs every day good for the knee joints of the elderly?
The load on the knee joint varies greatly with the body’s movement and gait pattern. The force on the knee joint in the standing position is 0.43 times the body weight, while it can be 3.02 times the body weight when walking and 4.25 times the body weight when going upstairs. It is often seen that some elderly people cannot go downhill when climbing, because the weight on the joints is four or five times higher than normal when climbing, and it is difficult for the joints to bear.
When elderly people must take the stairs, they must hold the railing or wall, do not stride up the stairs, wait for all feet on a step, and then take the next step to reduce the weight of the joints.
Ten, what does the drug therapy for osteoarthritis include?
There are many causes of pain in patients with osteoarthritis, most of which are not inflammation or only mild inflammation. In most cases, analgesics are available for treatment, paracetamol is a better choice, and if the response to analgesic treatment is poor, non-steroidal anti-inflammatory drugs such as ibuprofen and diclofenac can be used. Pain itself is a protective response of the body, and its presence can remind patients with osteoarthritis to reduce the load on the affected joints themselves and avoid overuse.
Overuse of symptom relievers may aggravate the damage to the affected joint if the patient forgets that the joint is diseased and engages in overload activities as usual. Therefore, it is important to use analgesics appropriately to protect the affected joints. Usually, anti-inflammatory analgesics should be used only when pain occurs at rest or during daily activities.
Can intra-articular injections cure osteoarthritis?
Intra-articular injections are mainly based on changes in the physical and chemical properties and biological characteristics of the joints, and can be used to promote the repair of joint cartilage and relieve symptoms by changing the intra-articular environment so that it is close to normal and achieve therapeutic purposes. For example, intra-articular injection of sodium hyaluronate can improve the quality of synovial fluid, protect cartilage, reduce pain sensitivity, reduce the wear and tear of joints by lubricating joints, and rebuild the disrupted balance in osteoarthritic joints, but because osteoarthritis is a degenerative disease, it can only delay the progress of osteoarthritis and cannot achieve the purpose of cure.
What are the advantages and disadvantages of intra-articular hormone injections for osteoarthritis?
For those who have synovitis, intra-articular injection of adrenal corticosteroid corticosteroid can be effective. Hormones can improve the symptoms, but the application of large doses of hormones can hinder the cartilage repair process, and the injection itself may damage the articular cartilage, and there is a risk of infection. Repeated use is not advisable, and repeated use may aggravate the destruction of the joint.
Can joint debridement cure osteoarthritis?
Osteoarthritis occurs when the cartilage in the joint is damaged, which usually leads to pain, swelling and impaired movement. Arthrocentesis or arthroscopy is used to remove cartilage, meniscus fragments and other free bodies, remove loose cartilage and other debris located in inflamed joints, grind the bone, degenerated meniscus, articular cartilage and synovial tissue, and repeatedly flush the joint cavity to improve the intra-articular environment, which can help to relieve symptoms.
XV. Which patients with osteoarthrosis are suitable for joint cleaning?
Joint debridement is suitable for patients who have most of the joint surfaces intact, but feel joint pain when bearing weight, which brings difficulties to work and life; free bodies in the joints, resulting in restricted joint movement and interlocking; palliative treatment for patients with low treatment requirements, which is mainly suitable for patients with mild to moderate chronic arthritis. Overall, the more severe the disease, the worse the results, the shorter the postoperative duration, and the earlier the recurrence. Arthrocentesis is relatively temporary and may delay joint replacement. Arthroscopy is now mostly performed in an arthroscopic manner, with little damage and quick recovery.
16. How to prevent osteoarthritis? What do patients with osteoarthritis need to pay attention to in their daily life?
Patients with osteoarthritis should pay attention to appropriate adjustments and changes in their lifestyles in their daily lives, with the aim of improving symptoms, controlling disease progression, maintaining normal joint function, avoiding deformity and disability, and improving their physiological and psychological health and social activities. Lifestyle changes cover a wide range of topics, including adjusting physical work intensity, changing poor work and rest habits, adjusting dietary structure, and ensuring sufficient sleep.
Secondly, avoid overworking, overworking is one of the taboos of chronic diseases, because the organism and diseased tissues and organs of patients with chronic diseases have low tolerance ability and need more rest than healthy people, overworking makes the diseased organism hard to bear, which will inevitably cause adverse consequences. Furthermore, it is important to maintain a balanced diet in order to get enough nutrients to maintain good health. The key to joint protection is to
(1) Use the joints less and reduce the load on them.
(2) Protect the functional position of the joints and do not overstretch, rub or squeeze the tendons, ligaments and the joints themselves during extension and flexion.
(3) Do not do the same action for a long time or make the joint fixed in the same posture, and develop the habit of fully stretching the joint frequently.
(4) Avoid movements that are too fast paced.
(5) Stop the joint movement immediately when pain occurs.
(6) Protect the joints with the help of instruments when necessary.
(7) Care should be taken when moving to prevent slips, falls or sprains.
(8) Pay attention to joint warmth in cold weather.
(9) Reduce body weight to avoid overload on the joints.
Does arthroscopy help in treating osteoarthritis?
When medication and other methods fail to provide relief, arthroscopy can be resorted to for debridement or lavage. Arthroscopy can not only examine the joint comprehensively, but also accurately understand the scope and degree of osteoarthritis; it can also clean and irrigate the joint, remove cartilage and meniscus fragments, grind the cartilage surface and synovial membrane of the joint with bone flab, serious degeneration, and repeatedly irrigate the joint; cartilage fragments in the joint can stimulate the inflammation of synovial tissue and joint effusion, and remove cartilage or meniscus fragments that cause mechanical dysfunction of the joint through irrigation. Removal of cartilage or meniscal fragments that cause mechanical dysfunction of the joint by flushing can immediately improve function and reduce symptoms, and by improving the intra-articular environment, the degeneration of articular cartilage can be stopped. Whereas soft tissue healing and recovery of muscle function after traditional arthrotomy cleanup takes at least several weeks, and sometimes longer, the application of arthroscopy significantly reduces these complications and has the advantages of less trauma and faster recovery.
XVIII. What are the surgical treatments for osteoarthritis?
The common surgical treatments for osteoarthritis are osteotomy, joint cleaning, joint fusion and artificial joint replacement. Osteotomy is mostly used for orthopedic knee osteoarthritis, through osteotomy to correct the force line and force distribution of the joint, to relieve pain and delay the time of joint replacement. Joint debridement is a surgical procedure that involves flushing, diseased cartilage repair, removal of the broken meniscus and synovectomy in the knee joint.
It is suitable for patients with mild to moderate chronic osteoarthritis and has good clinical results; joint fusion is to fix the diseased joint in a medically functional position, which is the position the patient uses most often in daily life. This procedure results in a stable, painless, and weight-bearing joint, but with loss of joint mobility and some ability to live and work. Artificial joint replacement can significantly reduce pain, improve the patient’s joint function, and improve the quality of life for joint lesions with extensive joint destruction, severe deformity, and significant pain, and is widely used clinically with good results.