1.What is osteoarthritis?
Osteoarthritis (OA), also known as degenerative joint disease, hypertrophic osteoarthritis, is a kind of joint pain, degenerative changes in joint cartilage as the core, involving the bone and including the bursa, joint capsule and other structures of the joint, multi-level, varying degrees of chronic aseptic inflammation. It is more common in middle-aged and elderly people, more women than men, with a prevalence of up to 50% over the age of 60 and up to 80% at the age of 75. The disability rate of osteoarthritis can be as high as 53%, which may lead to shortened life expectancy.
2.What are the clinical manifestations of osteoarthritis?
The clinical manifestations of osteoarthritis include: joint pain, initially mild to moderate intermittent vague pain, which improves with rest, and pain often associated with weather changes. In the late stage, there may be persistent pain or nocturnal pain, local pressure pain, swelling is particularly obvious; joint stiffness, joint stiffness and tightness when waking up in the morning, relieved after activity, the duration is short, often a few minutes to ten minutes, rarely more than 30 minutes; joint enlargement, part of the knee joint due to the formation of bone superfluous or joint effusion; bone friction sound, due to the destruction of joint cartilage, joint surface unevenness, joint activities appear bone Friction sounds, mostly seen in the knee joint; decreased mobility, soft tissue contracture can cause joint weakness, walking with a soft leg or can not be completely straightened or activity impairment; check the X-ray shows: asymmetric joint gap narrowing, subchondral bone sclerosis and/or cystic changes, joint edge hyperplasia and bone superfluous formation or with varying degrees of joint effusion, some joints can be seen in the free body or joint deformation.
3.How do pain specialists treat osteoarthritis of the knee?
First of all, drug treatment is the foundation. For any pain, pain relief is the first priority. A pain specialist can individualize the appropriate anti-inflammatory pain medication to the patient. This reduces the sterile inflammation in the joint and reduces the patient’s pain. Drugs that enhance the metabolism of the cartilage and improve its function, such as “aminoglucose and chondroitin sulfate”, can be given for a long time to suitable patients.
In the muscle strain points around the knee joint, the application of a combination of Chinese and Western medicine can often improve the elasticity of the muscles, enhance the toughness of the muscles, and reduce the burden on the joint. At present, we carry out a variety of methods such as herbal fumigation, electroacupuncture stimulation, acupuncture point moxibustion, acupuncture and bloodletting, silver needle, small needle knife loosening, etc., which are chosen according to the patient’s constitution and identification.
4.Is intra-articular injection just a closure?
Intra-articular injection is a very widely used treatment method. Many doctors apply this technique, but not every doctor can master the indications. Pain specialists seek to maximize the benefits of this therapy while minimizing side effects through individualized administration.
Intra-articular hormone injections, traditionally known as closures, do work quickly and cheaply, but they tend to aggravate joint degeneration and osteoporosis. Therefore, we do not recommend multiple injections for a long period of time, but for some patients with clear pain in the joint cavity and severe aseptic inflammatory reaction, a small amount of hormone injection can quickly reduce inflammation and pain, restore the patient’s ability to take care of himself, and enhance the patient’s confidence in the treatment.
Intra-articular ozone injection is a popular injection method in recent years, which can play a good anti-inflammatory and pain-relieving role without the side effects of hormones. For some patients with joint swelling and effusion, especially purulent effusion, the effusion and inflammation in the joint can be basically cleared after two to three ozone injections. It is indeed a good method, but so far, the specific mechanism of action of ozone on joint cartilage and nerves is not very clear, and for some patients, its effect is not very obvious, therefore, it is also necessary to choose individually.
Intra-articular injection of sodium hyaluronate can change the rheological state of joint fluid in the joint cavity, increase the lubrication of the joint, protect the articular cartilage, blunt the sensitivity of receptors to stimuli, reduce pain, and induce the production of endogenous sodium hyaluronate, which can inhibit the further development of the disease. However, recent international guidelines do not consider it to slow down joint degeneration and not as a recommended treatment. In our clinical applications, some patients do have pain relief and achieve a multi-year clinical cure. Therefore, you can not always blindly believe in the guidelines, or to clinical practice as a guideline.
5.In addition to treatment, how should patients pay attention to protect the knee joint in general?
We always emphasize that chronic pain management is ultimately up to you! Doctors help patients to reduce joint pain and improve the function of the knee, but if patients do not pay attention to protection, then all the work is in vain. So how do patients take care of their precious knee joints?
[1] Keep warm;
[2] Mobility support: Mainly reduce the weight bearing of the affected joint, cane, crutches, walkers, etc., change the negative gravity angle line, according to the deformity, use the corresponding orthopedic brace or orthopedic shoes;
[3] Functional training: such as knee flexion and extension activities in non-weight-bearing position to maintain maximum joint mobility;
[4] Aerobic exercise: such as swimming, cycling, etc;
[5] Weight loss: obesity can induce the development of knee osteoarthritis through intermediate products of metabolic processes;
[6] Self-protection: Do not squat or kneel to get things, sit on a low stool, sleep on a low bed to increase the friction and weight on the joints
[7] Reduce unreasonable exercise, such as knee osteoarthritis patients like to exercise the joints with exercises such as playing Tai Chi (repeated squatting), climbing, which only increases joint torque or overload the joint surface, resulting in more wear and tear on the joints moderate activity, avoid poor posture, avoid long periods of running, jumping, squatting, reduce or avoid climbing stairs.