Prevention and treatment of Osteoarthritis OA
Osteoarthritis (OA) is characterized clinically by joint pain, deformation and restricted movement. It is mostly seen in middle-aged and elderly obese patients, more women than men, and mostly involves weight-bearing joints. The World Health Organization has ranked OA, together with diabetes and cardiovascular disease, as one of the three major killers of the health of middle-aged and elderly people.
Osteoarthritis (OA), characterized by degeneration and destruction of cartilage and osteophytes, is the most common form of arthritis worldwide. 15% of people over 40 years of age suffer from symptomatic osteoarthritis. In China, the incidence of osteoarthritis is increasing rapidly as the aging society progresses.
Osteoarthritis of the hands is common in white women, lower in black South Africans, Indians and Chinese than in white Europeans and Americans, and less common in Africans and Malays with more frequent osteoarthritis of the hands. The incidence of OA is significantly higher in the north of China than in the south, and the incidence of OA is significantly lower in old China, analyzing the reasons related to a low-sugar diet. there are significantly more women than men after age 50. the incidence of OA increases 1.5-fold in men who are 20% overweight at age 37, and 2.1-fold in women.
Osteoarthritis is associated with a variety of sports, including marathon (hip) and soccer (hip and knee) sports. Congenital structural abnormalities and defects (congenital hip dislocation, acetabular dysplasia, and dislocation of the femoral epiphysis), abnormalities in cartilage or bone metabolism/obesity, and osteoporosis have the potential to influence it.
The development of osteoarthritis can be divided into three phases.
I. Initiation phase Mechanical factors, biochemical factors physical factors, etc. cause cartilage damage, coarctation of the articular cartilage surface, coupled with mechanics and abnormal weight bearing, cell proliferation within the cartilage, and deformation of the joint due to strong weight bearing.
Second, the progressive phase The formation of tissue proliferation from osteoblasts at the joint surface injury, and there can also be neovascularization at the intersection of bone and cartilage. It has the destruction of articular cartilage in the progressive phase of osteoarthritis.
Third, the expansion phase osteosclerosis and marginal osteophytes, i.e., the formation of osteophytes, the near disappearance of articular cartilage, and the formation of bone spurs at the edges of the joint.
Characteristics of osteoarthritis.
It occurs mostly after the age of 50, and is more common in women than men. The most commonly affected are knees, hips, fingers, lumbar spine, cervical spine, etc. The main symptoms: pain, aggravated by weight gain and activity, the affected joints may have a sense of immobility and stiffness, and in the presence of synovitis, there may be fluid in the joint. In case of synovitis, there may be fluid accumulation in the joint. There is a feeling of friction, “interlocking” and atrophy of the muscles around the joint. In severe cases, joint deformity and limited joint movement may occur.
(1) Knee: The most common clinical diagnosis of knee osteoarthritis requires knee pain and radiological basis and at least one of the following conditions: >50 years of age; morning stiffness lasting <30 minutes; joint friction during activity. Knee osteoarthritis can be secondary to: meniscal rupture; exfoliative chondritis; chondromalacia patellae; joint instability; rickets.
(2) Hip joint: more males than females; unilateral than bilateral, primary patients are less common in China, secondary hip osteoarthritis is more common in: congenital hip dislocation; acetabular dysplasia; ischemic necrosis of the femoral head; trauma and inflammation. X-rays show: narrowing of the joint space and formation of bone redundancy in the subchondral cystic changes of the hip joint.
(3) Interphalangeal joint: the primary is more frequent, mostly in the distal interphalangeal joint of the most distal side of the finger, which can be and raised hard node, the technical term is called Heberden’s node. The manifestations are soreness, limitation of movement, and a feeling of bone rubbing.
(4) Spine: kyphosis, and “hunchback”. The main symptoms: local pain and stiffness in the cervical, thoracic and lumbar spine, and in severe cases, numbness and pain in the extremities and many other clinical symptoms may occur.
(5) Foot and ankle joints: foot bunion may appear and walking difficulties may occur.
Auxiliary examinations.
(1) X-ray film: shows asymmetric narrowing of the joint space and bone spur formation at the edge of the joint. Intra-articular free bodies, joint deformation and subluxation can be seen.
(2) MRI: direct observation of damage to articular cartilage, synovium, meniscus, periarticular ligaments and periarticular soft tissues can be seen.
Laboratory tests: generally within the normal range. Check blood sedimentation, C-reactive protein, rheumatoid factor, etc. to distinguish from rheumatoid arthritis; check blood uric acid to distinguish from ventilatory arthritis.
Treatment: There is no effective radical cure.
(1) non-pharmacological treatment: patients rational diet, regular life, weight loss (weight loss 5kg, the incidence of symptomatic knee arthritis reduced by 50%), aerobic exercise program (muscle coordination exercise and muscle strength can reduce joint pain symptoms).
(2) Physical therapy: Effective combination with aerobic exercise can help improve muscle strength, improve joint range of motion, enhance local blood circulation, and enhance joint function.
(3) Drug therapy.
1, non-steroidal anti-inflammatory drugs: relieve pain, reduce stiffness, reduce inflammation, improve function, such as aspirin, ibuprofen, indomethacin, diclofenac, naproxen, celecoxib, etc.
2.Chondroprotective agents: hyaluronic acid, intra-articular administration. d-glucosamine: improve joint pain and repair early joint lesions, improve osteoarthritis symptoms and slow down the progression of the disease with long-term use. Intra-articular injections of corticosteroids should not be used. Although they may provide short-term relief, the damage to cartilage may increase with the number of injections, which is noteworthy.
(However, some people still believe that intra-articular injections of corticosteroids can be used for short-term pain relief. However, the latest American Academy of Orthopaedic Surgeons (AAOS) guidelines for the treatment of osteoarthritis do not recommend the use of intra-articular injections of sodium hyaluronate because they agree with the findings of a 2007 study with inconclusive results (the AAOS also disagrees with widely accepted treatments such as puncture irrigation, the use of nutrients such as glucosamine, sulfate or chondroitin sulfate, and traditional orthopedic devices such as heel wedge pads). traditional orthopedic devices like heel wedge pads, etc.). There are no such findings in China yet.
(4) Surgical treatment
The purpose of treatment: to eliminate or reduce pain, correct deformity, improve function and improve the quality of life.
Surgical treatment: In the late stage of deformity or persistent pain, life can not be self-care, surgical treatment such as arthroscopic surgery, osteotomy, joint fusion, joint replacement.
1.Arthroscopic surgery: mainly for patients with osteoarthritis who have meniscal tears or free bodies in the joint cavity.
2.Osteotomy: The purpose of osteotomy is to improve the balance of joint forces, so that the load on the joint can be shifted from the damaged joint space to a more normal joint space and improve joint pain.
3.Joint fusion surgery: With the successful use of artificial joint technology, joint fusion has been rarely used in recent years. However, for patients with advanced arthritis, joint destruction is severe and joint instability is feasible with joint fusion. In addition, joint fusion can also be used as a salvage surgery after joint replacement failure.
4, joint replacement surgery: the common surgical procedure for patients with advanced osteoarthritis: such as knee, hip replacement, etc.. With the continuous development of science and technology and surgical skills, we see that artificial joint replacement surgery has developed to a more mature stage, and a large number of patients with osteoarthritis have corrected their deformities, relieved their symptoms and improved their quality of life significantly through surgical treatment. There is no doubt that joint replacement has tremendous value in the treatment of end-stage osteoarthritis.
New surgical treatments: such as cartilage transplantation and autologous chondrocyte transplantation have the potential to be used in the treatment of osteoarthritis, but further clinical studies are needed.