As the old saying goes, old age comes before old age. It is not uncommon to see hobbled elderly people crossing the street carefully and struggling to get into and out of cars, most often because they are suffering from osteoarthritis.
Decline in quality of life
Osteoarthritis (OA) has many names: such as age-related arthritis, degenerative arthritis, proliferative arthritis, hypertrophic arthritis, degenerative osteoarthropathy, osteophytes, etc. In recent years, it is generally referred to as “osteoarthritis”. Therefore, osteoarthritis is actually a general term for proliferative arthropathies that contain a variety of different causes (most of which are unknown).
Osteoarthritis is very common: it is the most common type of joint disease clinically, with more patients than all other arthritis combined, and is the most common cause of joint pain.
According to statistics, 15% of the total U.S. population suffers from arthritis, 15% of which is osteoarthritis. Radiological evidence of osteoarthritis is present in 80% of the U.S. population older than 65 years of age, of which approximately 60% will be clinically symptomatic, and in at least 1 joint per person over 75 years of age; osteoarthritis is the second leading cause of inability to work in the male population over 50 years of age, second only to ischemic heart disease.
As the aging population increases, osteoarthritis will become more prevalent and may become the number one disease of the next century. Osteoarthritis is a degenerative disease of the cartilage in the joints, and many people will experience symptoms of varying degrees of severity after the age of 40, and if half of people will develop osteoarthritis around age 60, almost 100 percent will develop it after age 70. In the United States, there are currently about 20 million patients with osteoarthritis in at least one joint, and it is estimated that the number of people with osteoarthritis could rise to 40 million by 2020.
In China, the population is aging, and many large cities have reached or are close to the standards of an aging society, with approximately 120 million people over the age of 60, so it is estimated that about 60-70 million people have osteoarthritis. Therefore, osteoarthritis is increasingly becoming a common medical and social concern. In recent years, medical and surgical techniques have developed rapidly, providing clinicians with extensive and effective ways to treat symptomatic osteoarthritis.
Osteoarthritis: is a chronic, progressive, degenerative joint disease: involving one or more joints, the primary impact on the articular cartilage, characterized by progressive degeneration of articular cartilage tissue, exfoliation, disappearance and reactive changes in the joint edges and subchondral bone tissue is dominant, with new bone formation at the joint edges, with varying degrees of osteophytes, the rate of degeneration exceeds the rate of repair and regeneration, eventually leading to The rate of degeneration exceeds the rate of repair and regeneration, leading to loss of function. The clinical manifestations are progressive, chronic development of joint swelling and pain, stiffness, and limitation of motion, with secondary synovitis.
Osteoarthritis can be divided into two types: primary and secondary.
Primary (idiopathic) osteoarthritis: no obvious causative factors, such as Herberden’s nodes in the distal interphalangeal joints of the fingers, transmitted by the first autosomal gene, such as dominant in women and recessive in men.
2, secondary osteoarthritis: is based on certain pre-existing lesions occurring with age and joint movement changes, including metabolic, anatomical, traumatic and inflammatory factors.
Common causes are.
(1) congenital anatomical abnormalities of the joint, such as acetabular dysplasia and hip subluxation
(2) Changes in joint structure during childhood, such as ischemic necrosis of the femoral head with dysplasia forming a flat hip, slipped epiphysis of the upper end of the femur, etc.
(3) Traumatic arthritis, which occurs after trauma, such as intra-articular fractures and dislocations, etc.
(4) mechanical wear and tear, such as non-force line weight bearing, resulting in stress concentration, such as obesity, internal and external knee deformity, etc.
(5) Osteonecrosis.
(6) Crystal deposition arthropathy, such as gout, pyrophosphate arthropathy, etc.
(7) Metabolic abnormalities causing cartilage degeneration, such as browning disease.
(8) other diseases that cause cartilage wear, such as intra-articular infection, hemophilia, neurogenic arthropathy, etc.
IV. Etiology.
1.Age factor
2, genetic factors
3, obesity factors
4.Bone density and bone mass
5. Repetitive overstress.
6, other factors: related to race, geography, lifestyle and other factors.
The involvement of joints varies with age and gender, for example, male patients often have hip and spine involvement, female patients often have hand and knee involvement, unlike rheumatoid arthritis, osteoarthritis joint invasion is asymmetric and limited to one or a few joints. Osteoarthritis usually involves the distal interphalangeal joint, proximal interphalangeal joint, first carpometacarpal joint, first metacarpophalangeal joint, hip joint, knee joint, cervical spine and lower lumbar spine.
1. Knee joint
In the knee joint, pain is associated with movement, stiffness and swelling of the joint, and limitation of movement. In the later stages of the disease, joint subluxation or inversion and flexion contracture deformity may occur, with inversion deformity being relatively common.
2. Hand
Female patients are more likely than male patients to have hand symptoms, typically Heberhden’s nodes in the distal interphalangeal joints and Bouchard’s nodes in the proximal interphalangeal joints, and cysts filled with jelly-like material on the dorsal aspect of the distal phalanges, which can be softened by inflammation, but are often asymptomatic in later stages.
3. Hip joint
Osteoarthritis of the hip joint develops slowly but worsens progressively and can eventually lead to painful claudication. Pain can occur in the lateral hip joint, groin area, medial thigh, buttocks and involved pain in the knee joint, sometimes masking the truth and leading to misdiagnosis. Typically, the affected limb is deformed in a flexed and externally rotated position, and the restricted movement of the joint makes sitting and standing very difficult. As the disease progresses, the femoral head may be subluxed to the proximal side, resulting in hip inversion deformity and limb shortening.
4. Spine
Osteoarthritis of the small joints of the spine may cause pain, stiffness and discomfort, and some patients may develop neurological symptoms. The pain and neurological symptoms may be caused by compression of the nerve roots and spinal cord by bony bulges, narrowing of the intervertebral foramina, degenerative protrusion of the intervertebral discs or subluxation of the articular processes. Cervical spine involvement can not only cause neurological symptoms, but can also affect blood flow to the vertebral artery, causing dizziness, visual disturbances, headaches and vertigo. Lumbar spine osteoarthritis is one of the common causes of lower back pain. With age, significant changes in the structure, tissue composition and nature of the intervertebral discs occur, further leading to degeneration of small joints and formation of bony redundancies, resulting in lumbar spinal stenosis and intermittent claudication in typical cases.
VI. Clinical manifestations
Pain and its characteristics: slow onset, progressive, appearing after activity at the beginning, relieved after rest, developing into persistent pain, even affecting the patient’s sleep.
Stiffness, morning stiffness, gluing phenomenon, joint enlargement
Patients often feel a sense of friction when moving the joints, and the joints are enlarged due to the formation of bony redundancy. In the late stage, there is a decrease in mobility, inconvenience in movement, joint deformity, such as inversion deformity of the knee joint, and muscle spasm and secondary joint contracture may also occur.
VII. Treatment
Conservative treatment: weight reduction, physical therapy, exercise: misconceptions about exercise, joint protection, use of assistive devices.
Medication: anti-inflammatory and analgesic drugs, drugs to alter the course of the disease, intra-articular injections
Surgical treatment: arthroscopy, minimally invasive surgery, osteotomy, artificial joint replacement, spinal surgery.