Osteoarthritis is a common chronic joint disease of the elderly in which the main lesions are degenerative changes of joint cartilage and secondary osteophytes.
The prevalence of osteoarthritis increases with age and is more common in women than men. According to the World Health Organization, the prevalence of osteoarthritis is 50% in people over the age of 50 and 80% in people over the age of 55. In 1990, there were only 40 million osteoarthritis patients in China, but in 2000, the number of patients reached 80 million, and the number of patients reached more than 100 million, according to the WHO forecast, by 2015, China will reach 150 million patients with bone disease, and China will become one of the countries with the largest number of osteoarthritis patients in the world.
Pathological basis of osteoarthritis and predisposing factors
Osteoarthritis occurs in weight-bearing joints such as the hip, knee, ankle, foot, and spine, and in commonly used joints such as the hand joints.
The pathological basis: The human body spends its entire life in the process of injury and repair, and osteoarthritis is characterized by degenerative changes in joint cartilage and secondary osteophytes. It can be assumed that the occurrence of osteoarthritis is associated with an imbalance between injury and repair of the joint area. Depending on the form of injury, we can broadly classify osteoarthritis into two categories: primary osteoarthritis and secondary osteoarthritis. Injury to the joint will induce repair mechanisms, but pathological repair will lead to the development of arthrosis. (As we age, the repair gradually loses the race against the injury, eventually leading to the aging of the joint)
The predisposing factors for osteoarthritis include two categories of controllable and uncontrollable factors.
Uncontrollable factors include
Familial susceptibility: Genetic factors leading to abnormal expression of certain proteins in the cartilage matrix may lead to early degeneration of the cartilage and become a trigger for osteoarthritis.
Age factors: inevitable decline in repair capacity with age
Gender factors: The decline in estrogen levels after menopause in women with the disease may contribute to the high incidence.
Controllable factors include
Overuse of the joint
Fractures or other injuries around the joints
Obesity
Weakness or imbalance in muscle strength
Clinical manifestations of osteoarthritis.
Symptoms.
Pain: Pain is the main symptom of the disease and the main cause of functional impairment. It is characterized by insidious onset and persistent dull pain, which mostly occurs after activity and can be relieved by rest. As the disease progresses, joint movement may be limited by pain, and pain may occur even at rest. As the muscles around the joint are damaged during sleep, the protective function of the joint is reduced and the pain-inducing activity cannot be restricted in the same way as when awake, and the patient may wake up in pain.
Joint stiffness and clinging sensation: Morning stiffness suggests the presence of synovitis. However, unlike rheumatoid arthritis, it is relatively short-lived, usually not exceeding 30 minutes. Adhesive sensation means that after a period of rest, the joint begins to move with stiffness, as if it is stuck, which is relieved by a little movement. These conditions are most often seen in the elderly, lower extremity joints.
Joint interlocking is common in osteoarthritis with joint free bodies.
Other symptoms: As the disease progresses, joint contracture, instability, rest pain, and pain that worsens with weight bearing may occur.
Physical signs.
Joint swelling: caused by localized bony hypertrophy or exudative synovitis, which may be accompanied by increased local temperature, fluid accumulation and synovial hypertrophy, and in severe cases, joint deformity and subluxation.
Pressure pain and passive pain: The affected joint may have localized pressure pain, especially when it is accompanied by synovial exudation. Sometimes there is no pressure pain, but pain can occur when moving passively.
Bone rubbing sound: This may be caused by cartilage loss and joint irregularity.
Restriction of motion: Restriction of joint motion may occur due to bone loss, cartilage loss, periarticular muscle spasm, and joint destruction.
X-Ray Features
Cartilage changes result in x-ray manifestations of joint space narrowing. Subchondral bone lesions appear as cystic changes, sclerosis, and bone redundancy formation. Free bodies may be produced as a result of cartilage exfoliation or bone fragmentation.
Treatment of osteoarthritis.
General therapy: Rest, immobilization, and physical therapy (painless functional exercises) for controllable risk factors do not stop and reverse the disease process, but may delay the postponement of surgical treatment.
Pharmacological treatment.
# systemic medication: application of symptom-improving drugs, which can reduce joint pain and improve joint mobility after medication
i. Non-steroidal anti-inflammatory drugs (NSAIDS) are widely used, including COX-2 inhibitors (reduces the gastrointestinal side effects of the drugs)
ii.Use of chondroprotective agents: can relieve symptoms and maintain and restore joint function. such as polyglucosaminide
Topical medication: intra-articular injection of sodium hyaluronate.
Conservative treatment can only provide symptomatic relief and slow the progression of the disease, but it is not possible to reverse structural joint lesions, just as we do not yet have the means or drugs to rejuvenate the joint. Unrealistic exaggerations of the effects of certain drugs will mislead patients, and over-reliance on drug therapy will aggravate drug side effects.
Surgical treatment
Arthroscopic exploration and joint debridement: both diagnostic and therapeutic, valuable for early mild osteoarthritis especially in patients with free bodies and limited cartilage damage, but not very helpful for moderate to severe arthritis.
Osteotomy: In patients with mild arthritis with severe periarticular deformity, extra-articular osteotomy orthopedics can improve joint alignment, reduce abnormal stress transmission, and slow down the process of arthritis. High tibial osteotomy is widely used to treat internal derangement of the knee.
Artificial joint replacement: Artificial joint replacement is arguably one of the greatest breakthroughs in orthopaedic surgery in this century. It has been used in the treatment of the shoulder, elbow, and other joints. Wrist joints, interphalangeal joints, hip joints, knee joints and ankle joints, but total artificial hip and knee joint replacements are the most common. The design and materials of artificial joints are the result of the continuous efforts of biomechanics experts, material engineers and orthopedic surgeons. They are made of metal and high-density polymer materials, which follow the structure, shape, and function of the human joint. The metal types include alloy, cobalt-chromium alloy, and stainless steel, while the polymer materials are high-density, wear-resistant polyethylene or ceramic. In layman’s terms, an arthroplasty is the removal of a worn and damaged joint surface and the implantation of an artificial joint to restore a normal smooth joint surface, just like a dental brace. For patients with end-stage osteoarthritis, artificial joint replacement is the way to preserve joint function, improve joint deformity, and enhance quality of life.
Summary.
It is common in the elderly population, with weight-bearing joints being the most common.
Painful stiffness plus deformity, diagnosis relies on X-rays.
Conservative treatment is difficult to reverse, and joint replacement is often required at the end.