The main manifestations of the diseased joint pain, pressure pain, stiffness, swelling, weakness, impaired mobility, etc. Depending on the condition, you can choose physical therapy, drug therapy, surgical treatment, etc. After standardized treatment can reduce the symptoms, slow down the development of the disease, and maintain the function of the joints can not be self-healing.
What is Osteoarthritis?
Definition of Osteoarthritis
Osteoarthritis is a chronic joint disease characterized by degenerative changes in the articular cartilage, followed by synovial membrane hyperplasia and bone growth.
The disease can affect the entire joint, including bone, cartilage, meniscus, ligaments, joint capsule, synovial membrane, and muscles around the joint.
It tends to occur in the knee, hip, spine, and interphalangeal joints because these areas are more weight-bearing or active.
Classification
Classification according to the cause
Primary osteoarthritis: the etiology is unknown, related to genetic and physical factors, mostly occurring in middle-aged and old people over 50 years old.
Secondary osteoarthritis: secondary lesions occur on the basis of trauma, inflammation, joint instability, infection congenital diseases and other pre-existing lesions, and can also occur in young adults.
Morbidity
Osteoarthritis occurs well in middle-aged and elderly people, and more than half of the people over 65 years old suffer from osteoarthritis.
The incidence of the disease is higher in women than in men, especially in postmenopausal women, where the incidence is significantly higher.
With the gradual increase in aging, the overall incidence of osteoarthritis is on the rise.
Questions you may be concerned about
What is degenerative osteoarthritis?
Degenerative osteoarthritis is a degenerative and injurious disease of joint cartilage caused by aging, obesity, strain or trauma.
Degenerative osteoarthritis is characterized by pain, stiffness, enlargement, and impaired mobility of the joints, as well as bone rubbing sounds and sensations when the cartilage in the joints is destroyed.
The diagnosis can be confirmed by symptoms, signs and imaging tests. Treatment is mainly conservative, such as exercise therapy, physical therapy, medication, supportive devices, etc. Surgery can also be performed in severe cases.
What is the best solution for osteoarthritis pain?
Osteoarthritis does not have a so-called “best solution for pain”. Pain relief should be chosen according to the degree of damage to the articular cartilage, including physical therapy, medication, and surgery, etc. In the early stage of osteoarthritis, heat therapy can be used to relieve pain.
In the early stages of osteoarthritis, physical therapy such as heat therapy and ultrasound can be used to relieve pain.
In addition, medications such as non-steroidal anti-inflammatory drugs (NSAIDs), chondroprotectors, and intra-articular injections can be used.
If the above methods are ineffective, then surgical treatment needs to be considered.
What kind of food should I not eat for osteoarthritis?
There is no absolute contraindication to osteoarthritis diet, and it is recommended that the daily diet should be nutritionally balanced.
Osteoarthritis patients can eat foods high in protein and calcium, such as milk, lean meat, eggs, etc., as well as fresh vegetables, fruits and other foods high in vitamins.
It is also recommended that foods high in sugar, oil and fat should be eaten sparingly, so as not to increase weight, aggravate the burden on the knee joint and worsen the symptoms of arthritis.
Causes
Causes
The etiology of primary osteoarthritis has not been fully clarified. It is generally believed that it is the result of the interaction of multiple pathogenic factors, such as mechanical and biological, and it is also believed that the core developmental element of osteoarthritis is aseptic inflammation.
Risk factors
Age.
Trauma.
Obesity.
Genetics.
Inflammation.
Metabolism.
Gender, especially postmenopausal women.
Osteoporotic individuals.
Pathogenesis
The development of primary osteoarthritis is a long-term, chronic, progressive process.
The earliest and most significant changes in osteoarthritis occur in the articular cartilage.
The articular cartilage deteriorates, degenerates, wears out, or even disappears, and is unable to maintain its original function.
In the course of the disease, the subchondral bone undergoes changes at the same time, and the joint margins form bony encumbrances (osteophytes), accompanied by synovial membrane hyperplasia, joint capsule, peripheral ligaments, etc. degeneration, fibrosis, atrophy, restricting the normal joint activities.
Eventually, the joint surface is destroyed and deformity occurs.
Symptoms
Main Symptoms
The main symptom of osteoarthritis is pain. As the disease progresses, joint stiffness, enlargement, abnormal popping, weakness, and impaired mobility can occur.
Joint pain and tenderness
Pain is the main symptom.
Initially, it is a mild or moderate vague pain that does not appear continuously, is relieved at rest, and is aggravated by activity. The pain can be triggered by weather changes, dampness and cold.
As the disease progresses, the pain can be felt at rest or in the morning, relieved by slight activity, and reappear after excessive activity.
In the advanced stage, the pain can be continuous and can also occur at night.
Localized joint tenderness may occur, which may be noticeable when accompanied by joint swelling.
Joint stiffness
Joints may feel tight and stiff when you wake up in the morning, which may be relieved by movement.
If the air pressure decreases (such as when rain is imminent) or the humidity increases, the stiffness may worsen, but it is usually short-lived, usually lasting from a few minutes to ten minutes, and rarely more than thirty minutes.
Swollen joints
When it occurs in the hands, significant swelling and deformity of the joints can be noticed.
Knee joints sometimes appear enlarged due to bony encumbrances or joint effusion, thickening of synovium and joint capsule.
Joint weakness and impaired mobility
Due to joint pain and decreased mobility, muscle atrophy occurs and soft tissue contractures lead to joint weakness.
When osteoarthritis occurs in the joints of the lower limbs, the legs feel weak and tender when walking, and in severe cases, they cannot be fully straightened, and impaired mobility occurs.
Joint popping and bone rubbing sound (sensation)
The joint cartilage is destroyed, the joint surface is not flat, and there is an abnormal sound when the joint moves, or a feeling of bone rubbing.
Most of them occur in the knee joint.
Other symptoms
If the osteophytes press on the nerves, they can cause symptoms such as numbness in the limbs, abnormal sensation, and muscle weakness (less common).
Consultation
Department of Medicine
Orthopedics
If symptoms such as joint pain, stiffness, enlargement, weakness and impaired mobility occur, it is recommended to seek medical attention promptly.
Preparation
Preparing for your visit: registering, preparing your documents, and frequently asked questions.
Tips for seeking medical treatment
If you have many clinical symptoms, you should try to record the symptoms you have experienced and the frequency of episodes, etc., so as to give the doctor more references.
For those with limited mobility, it is recommended that their family members accompany them to the doctor, and the patient can move around with the help of a wheelchair or crutches in order to prevent falls or accidents.
Avoid self-medicating with painkillers to avoid aggravating the symptoms or masking the condition.
Preparation List
Symptom list
Pay particular attention to the time of onset of symptoms, special manifestations, etc.
Which part of the body is in pain? Is the pain in one joint or several joints?
Is it accompanied by symptoms such as joint stiffness and swelling?
Is there a feeling of weakness in the limb? Is joint movement limited?
What conditions predispose to pain?
Medical History Checklist
Has there been any trauma? How was the injury sustained?
Any congenital hip dislocation, knee inversion, knee valgus, or other skeletal deformities?
Are there any diseases such as tuberculosis or gout?
Checklist
Examination results in the last six months, which can be brought to the doctor’s office
Imaging examination: X-ray examination, CT examination, magnetic resonance imaging examination
Laboratory tests: blood tests, immune complex test, C-reactive protein test
Others: Arthroscopy
Medication List
Medications used in the last 3 months, if available in boxes or packages, bring them with you to the doctor’s office.
Chondroprotective agents (oral): aminoglucose sulfate or hydrochloride, bisacodyl ryanin
Diagnosis
Diagnostic Basis
Diagnosis of osteoarthritis relies on x-rays, combined with history, symptoms, and signs. Laboratory tests can help rule out infection, immunity, and other related joint inflammation.
Medical history
May have had trauma.
May have congenital dislocation of the hip, knee inversion, knee valgus and other deformities.
May have been engaged in heavy physical labor for a long time, or have played high-intensity sports for a long time, etc.
Clinical manifestations
Symptoms
Joint pain, stiffness, localized swelling, weakness, impaired mobility, etc. Joint popping, bone rubbing sound or bone rubbing sensation may be felt during activities.
Physical signs
Flexion and extension activities are limited, and individual patients are unable to fully extend, which is called knee interlocking.
Pressing on the joint can be painful.
The meniscus McKnight’s test is often positive, and the anterior and posterior drawer tests are mostly negative.
Laboratory Tests
Blood tests
Indicators such as a white blood cell count can assist in helping to determine if there is an infection and help to rule out joint inflammation due to infection.
Indicators are usually within normal limits.
The test requires a venous blood draw and does not require fasting.
Immune Complex, Serum Complement Test
This test measures the level of immune-related substances in the blood to help rule out joint inflammation related to the immune system.
Indicators are generally within normal limits.
The test requires a venous blood draw and does not require fasting.
They may be mildly elevated in the presence of synovitis.
Blood is drawn from a vein and fasting is not required.
Imaging
X-ray
X-rays are the “gold standard” for a definitive clinical diagnosis, i.e. the most reliable and accurate test.
Three typical changes can be detected
Asymmetric narrowing of the joint space.
Sclerosis and/or cystic degeneration of the subchondral bone.
Formation of a bony capillary at the edge of the joint.
Joint swelling, intra-articular free bodies, and joint deformity may also be detected.
CT
Primarily helps to differentiate osteoarthritis from other diseases.
Changes similar to those found on X-rays may be found.
Magnetic Resonance Imaging (MRI)
MRI can help diagnose early osteoarthritis, but it can also provide insight into the soft tissues around the joints and help with differential diagnosis.
The test can reveal thinning and defects in the thickness of articular cartilage, bone marrow edema, and joint effusion.
Other
Arthroscopy
It can directly observe the situation inside the joint and understand the damage of cartilage, synovium and other soft tissues.
Histopathologic examination can be performed on the diseased tissue to provide a basis for differential diagnosis.
The examination is invasive and is usually performed at the same time as arthroscopic treatment, i.e., the examination is performed at the same time as the treatment.
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Diagnostic Criteria
Different types of osteoarthritis have different diagnostic criteria.
Diagnostic Criteria for Hip Osteoarthritis
Recurrent hip pain within the last 1 month.
Erythrocyte sedimentation rate ≤20mm/1h.
Radiographs show formation of bony encumbrances and proliferation of the acetabular rim.
X-ray shows narrowing of the hip joint space.
Diagnostic criteria for knee osteoarthritis
Recurrent knee pain in the last 1 month.
X-ray (standing or weight-bearing position) shows narrowing of the joint space, subchondral osteosclerosis and/or cystic degeneration, and formation of bony encumbrances at the joint margin.
Age ≥ 50 years.
Morning stiffness ≤ 30 minutes.
Bone rubbing sound (sensation) during activity.
Diagnostic criteria for osteoarthritis of the interphalangeal joint
Interphalangeal joint pain, soreness and stiffness.
Bony expansion in ≥2 out of 10 interphalangeal joints.
Bony enlargement of ≥2 distal interphalangeal joints.
Swelling of <3 metacarpophalangeal joints.
Deformity in ≥1 of 10 metacarpophalangeal joints.
Differential diagnosis
Infectious arthritis
Similarities: both present with joint pain, swelling, and limitation of movement.
Differences: Infectious arthritis has a rapid onset, with redness and fever in the joints, accompanied by chills, fever, malaise, lack of appetite, etc. Joint puncture reveals purulent, cloudy joint fluid, and joint fluid examination can sometimes culture a clear source of infection. Laboratory tests may reveal abnormalities in white blood cells, red blood cells, and other indicators.
Rheumatoid arthritis
Similarity: Both will have joint pain and swelling.
Differences: Rheumatoid arthritis has heavy systemic symptoms, several joints may be affected, the skin on the surface of the joints is red and hot, but the activity is normal, the joint function is not affected after the period of attack, and there is no obvious change in the X-ray film, which is mostly accompanied by cardiac lesions.
Rheumatoid arthritis
Similarity: recurrent swelling and pain in the joints, morning stiffness, and swelling of the joints, with the development of the disease may appear impaired mobility.
Differences: rheumatoid arthritis morning stiffness is more obvious, lasts longer, can occur in symmetric or multiple joints, distal interphalangeal joints are the typical morning stiffness. x-ray examination can find osteoporosis, articular surface bone destruction and absorption, or even bony healing, ankylosing deformity. Laboratory tests may show increased erythrocyte sedimentation rate and positive rheumatoid factor.
Differences: Ankylosing spondylitis occurs in male young adults, affects multiple joints, and the spine is severely affected. x-ray examination may reveal calcification of the spinal ligaments, bamboo-like changes, and narrowing and blurring of the sacroiliac joint space. Laboratory tests may reveal an increased or normal erythrocyte sedimentation rate and a positive HLA-B27.
Treatment
Aims and principles of treatment
The purpose of osteoarthritis treatment is to reduce or eliminate symptoms, slow down joint degeneration, maintain joint function and restore daily life as much as possible.
The specific treatment plan needs to be chosen according to the severity of the disease. When the disease is mild, the symptoms can be improved through joint protection, exercise therapy, physical therapy, etc. When the disease worsens, medication can be chosen according to the doctor’s advice, and if the long-term regular and standardized treatment is ineffective, then surgical treatment can be considered.
Treatment
Joint protection
Exercise in moderation and reduce unreasonable exercises, such as running, jumping and squatting for a long time, and reduce or avoid climbing stairs.
Weight loss can improve joint function and reduce pain. You can choose aerobic exercises such as swimming and cycling, which can effectively burn calories and protect the knee joints at the same time. It works better when combined with a calorie-restricted diet.
Exercise therapy
Under the guidance of a doctor, choose appropriate low-intensity aerobic exercises to help improve joint function and relieve pain.
According to the condition, develop a strength training program for the muscles around the joints to improve joint stability and promote local blood circulation. Commonly used methods are:
Quadriceps isometric contraction training.
Straight leg raise to strengthen quadriceps training.
Gluteal muscle training.
Static squat training (not recommended for patients with severe patellar chondromalacia).
Resistance training, etc.
Flexion and extension activities of the knee joint in the non-weight-bearing position, do joint function training, help to maintain the maximum mobility of the joint. Commonly used methods are:
Passive movement of the joint.
Pulling.
Joint assisted movement and active movement, etc.
Physical therapy
It can promote local blood circulation and reduce the inflammatory response.
Treatments include heat therapy, hydrotherapy, ultrasound, acupuncture, massage, traction, transcutaneous electrical nerve stimulation and so on.
Different people are suitable for different treatments, and doctors will choose according to the situation.
Assistive Devices Support
Necessary assistive devices, such as canes, crutches, joint supports, walking aids, etc., can be selected under the guidance of the doctor, or shoes with flat soles, thick, soft and loose.
Assistive devices can reduce the weight bearing on the joints, thus relieving the pain.
If there is inversion or eversion deformity, appropriate orthopedic supports or orthopedic shoes can be used according to the situation.
Medication
If non-pharmacological treatment is not effective, medication can be chosen according to the joint pain.
Localized medication
Non-steroidal anti-inflammatory drugs (NSAIDs): including latex, creams, patches and applications.
They are effective in relieving mild to moderate joint pain and have less gastrointestinal adverse effects than oral systemic medications.
Adverse skin reactions should be noted when administered locally.
Systemic medications
Non-steroidal anti-inflammatory drugs
Include celecoxib, etoricoxib, aspirin, ibuprofen, indomethacin, diclofenac, and naproxen.
They can relieve joint pain, reduce joint stiffness, reduce joint inflammation and improve joint function.
However, it should be noted that long-term use of such drugs have gastrointestinal adverse reactions such as gastric ulcers and bleeding. Patients with cardiovascular and cerebrovascular diseases need to be used with caution, as it can further cause renal impairment, renal function abnormalities are prohibited in principle.
Chondroprotective agents
Including glucosamine sulfate or hydrochloric acid, bisacodyl ryanodine and so on.
It is possible to partially relieve arthritis pain symptoms, and has the effect of delaying the progression of osteoarthritis.
Intra-articular drug injections
Joint injections are sterile procedures that must be performed by a healthcare professional.
Sodium hyaluronate
Sodium hyaluronate (sodium vitrate) lubricates the joints and protects the articular cartilage, which in turn may partially relieve pain.
It can sometimes cause adverse reactions such as joint pain and swelling.
Long-acting extended-release glucocorticosteroids
Have anti-inflammatory effect and can be used for acute and chronic phase to relieve pain.
Note that repeated use of glucocorticosteroids for a short period of time may exacerbate the damage to articular cartilage.
Intra-articular injection of glucocorticosteroids is not advocated as an option, and is even more opposed to repeated use. The indications for this type of injection are severe synovial inflammation and high fluid accumulation.
Platelet-rich plasma: intra-articular injection of this product can reduce the local inflammatory reaction and participate in the repair of articular cartilage, which is suitable for mild and moderate arthritis.
Sedative drugs
Osteoarthritis long-term pain can take diazepam and other drugs under the guidance of specialized doctors to relieve mental anxiety and tension.
Surgical treatment
It is suitable for people whose non-surgical treatment is ineffective and whose condition affects their normal life, aiming at eliminating pain, correcting deformity and improving joint function.
Surgical methods include articular cartilage repair, arthroscopic cleaning, osteotomy, joint fusion and artificial joint replacement.
Cartilage Repair
Surgery to repair damaged hyaline cartilage on the joint surface.
It is suitable for young, active people with cartilage defects in a single small weight-bearing area.
Older, multiple injuries, hormone-induced necrosis, etc. are less effective.
Specific techniques include autologous cartilage transplantation, chondrocyte transplantation and microfracture.
Arthroscopic minimally invasive treatment
Arthroscopy allows observation of intra-articular conditions and treatment.
It is suitable for osteoarthritis of the knee with mechanical symptoms such as limited joint movement, e.g. meniscal tear and presence of free bodies.
Surgery is less invasive, and from long-term follow-up results, the difference in outcome from conservative treatment may not be significant in general osteoarthritis patients (except for patients with meniscal tears and free bodies), and needs to be evaluated by a physician before selection.
Osteotomy
Mostly used to treat osteoarthritis of the knee combined with internal and external deformities and to maximize joint preservation.
Methods include proximal tibial osteotomy, proximal fibula osteotomy, distal femur osteotomy, etc.
It is suitable for young and middle-aged people with high activity level and good joint mobility.
Unicondylar knee replacement
It is mainly used for patients with damage to the inner and outer compartments of the knee joint, especially for patients with damage to a single compartment, and is currently considered to be more effective than high tibial osteotomy.
Artificial joint replacement
For end-stage osteoarthritis, artificial joint replacement is a mature and effective treatment.
Artificial joint replacement is an option for osteoarthritis of the hip, knee, elbow, shoulder and ankle.
The procedure is not suitable for patients with infectious diseases of the knee and neurological disorders.
Total joint replacement will place a prosthesis in the body, complications may occur after the surgery and the prosthesis may need to be revisited.
Rehabilitation
Physical therapy, exercise therapy, occupational therapy, and rehabilitation aids are options for osteoarthritis rehabilitation.
Physical therapy includes heat therapy, hydrotherapy, ultrasound, acupuncture, massage, traction, and transcutaneous electrical nerve stimulation.
Exercise therapy includes low-intensity aerobic exercise, muscle strength training around the joints, and joint function training under the guidance of a doctor.
Occupational therapy is mainly based on the condition, choose some suitable daily life activities to improve the joint function.
Rehabilitation aids can protect the joints and reduce the pressure on the joints, such as reducing the weight bearing on the joints through canes and crutches.
Prognosis
Cure
Standardized and reasonable treatment can reduce pain, maintain or improve joint function, slow down the progression of the disease, and help to resume normal work and life.
Harmfulness
Osteoarthritis is a chronic disease that develops gradually. If left untreated, it may lead to muscle atrophy around the joints, joint deformity, inability to move normally, and then disability.
Osteoarthritis may increase the rate of cardiovascular events and all-cause mortality (death from all causes of death).
Daily
Daily Management
Protecting the joints
When symptoms occur, it is necessary to reduce the amount of activity, especially to avoid moving the affected joints and preventing drastic activities.
Reduce unreasonable exercise, such as running, jumping and squatting for long periods of time, and reduce or avoid climbing stairs.
You can use devices such as canes and crutches to assist your activities under the guidance of your doctor to reduce the burden on your joints.
Wearing knee pads and elastic sleeves can protect the knee joints. Choose flat, thick, soft and loose shoes that can cushion the pressure and avoid wearing high heels.
Maintain correct posture to prevent excessive stress on individual joints.
Avoid bearing weight in the same position for a long time.
Limit your usual activities to those that do not cause pain.
In your daily life, be careful to avoid triggers for osteoarthritis. Try not to carry heavy objects on your back or carry heavy objects upstairs.
During the cold and wet fall and winter seasons, pay attention to keep warm, avoid the affected area contact with cool wind and do not touch cool water. In summer, it is better to wear knee-length pants.
Daily exercise is essential, must strengthen the muscles around the joints, you can carry out the following kinds of exercise, such as cycling, exercise bike, swimming, short-distance walks, etc. The frequency of exercise should not be too much, such as swimming, cycling, generally 2 to 3 times a week is appropriate.
Weight management
Weight reduction can effectively reduce the pressure on joints.
Activities such as swimming and cycling can be chosen.
To control calorie intake, reasonable recipes can be made according to professional advice.
Diet management
Appropriately reduce the intake of high oil and high sugar foods, and avoid spicy and stimulating foods.
Low sodium diet with no more than 5 grams of salt per day can effectively relieve sodium and water retention.
Vegetable oil (soybean oil, walnut oil, etc.) is preferred for cooking oil, try to avoid animal fats and oils (e.g. lard, chicken skin, duck skin, etc.), and reduce the intake of cholesterol-rich foods such as animal offal.
You can moderately increase the intake of omega-3 polyunsaturated fatty acids and vitamin D foods, such as deep-sea fish, nuts, cauliflower, etc., which can assist in relieving inflammation, but should not be excessive.
Choose calcium-rich foods such as milk and soy products to prevent osteoporosis and control the overall calories in your diet. Daily intake of 300 ml of liquid milk should be ensured. For those with high blood fat and high blood pressure, low-fat milk can be used, and for those with lactose intolerance, unsweetened yogurt or low-lactose prepared milk can be used.
Increase the intake of fresh fruits and vegetables and replace some of the staple foods with whole grains to prevent constipation.
Ensure that you drink 1,500 milliliters of water daily.
Take vitamin and calcium supplements under doctor’s supervision.
Regular follow-ups and mindset adjustment
Osteoarthritis is a chronic disease that requires regular follow-ups according to the doctor’s requirements. When symptoms occur or worsen, it is also important to consult the doctor promptly to have the condition evaluated and the treatment plan adjusted.
Although osteoarthritis is a chronic disease, if you can get standardized treatment at an early stage, you can effectively control the progression of the disease and do not need to worry too much.
Post-discharge management for surgeons
Sitting posture
In the first 3 months after hip replacement surgery for hip arthritis, it is best to sit in a high chair with armrests, not too short a chair or toilet, not cross-legged, and keep the lower limbs straight after surgical treatment.
Sleeping position
For 6 weeks after surgery, it is best to lie on your back or stomach.
For hip replacement, sleep with your legs slightly apart, and put a pillow between your legs to help keep them apart to prevent dislocation of the hip joint.
For knee replacements, put something soft under the affected leg and elevate the leg to help reduce swelling.
Going up and down stairs
If you have to go up and down the stairs, it is recommended that you use crutches or other supports to protect you at the beginning. When you go up the steps, the healthy side goes up first, and when you go down the steps, the operated side goes down first, which can be called “good going up, bad going down”, and two steps at a time.
Normal activities
Within 6 weeks after surgery, try to walk with crutches or a walking frame.
After 8 weeks, if the wound is healing well, you can swim and bike 2-3 times a week, and other activities such as walking and dancing are allowed.
Avoid sports that require bouncing or joint impingement, such as soccer and basketball.
Prevention
Maintaining a reasonable body weight can be achieved by controlling diet and increasing exercise appropriately. You can determine whether you are overweight by your body mass index.
Body Mass Index (BMI) = weight (kg) ÷ [height (m)]2.
China’s adult body mass index determination standard: less than 18.5 for underweight, 18.5 ~ 24 for normal, 24 ~ 28 for overweight, more than 28 for obese.
When overweight people reduce weight, it is best to choose aerobic exercise with less joint pressure such as swimming.
Avoid prolonged running, jumping, squatting, stair climbing, mountain climbing and so on.
If there is joint ectropion, entropion, instability, etc., you should seek medical treatment in time to prevent further damage to the joints.
Moderate exercise, sun exposure and daily intake of 300 ml of liquid milk can supplement calcium and vitamin D, etc. to improve muscle function and prevent osteoporosis.