First of all, it should be clarified that the correct diagnosis for this patient is neither “osteophytes” nor “bone spurs”, but rather “osteoarthritis”. Osteoarthritis is a disease of aging and is a localized manifestation of systemic aging in the joints, as described in our last issue, and “osteophytes” and “bone spurs” are only a limited aspect of osteoarthritis and cannot be used to refer to the entire disease. The term “osteoarthritis” and “bone spurs” is only a limited aspect of osteoarthritis and should not be used to refer to the entire disease. This misrepresentation has a deep-rooted market in China, because although osteoarthritis is a very old and very common disease, our knowledge and understanding of it is just beginning, and the use of “spurs” and “osteophytes” to refer to osteoarthritis is exactly what was used to describe the disease. Osteoarthritis is the result of a superficial understanding of its etiology and pathology. In the ancient world, it was important to have the right name and the right words, and if the name is not right, the words are not right. In the case of osteoarthritis, the need for a “proper name” is now very urgent, and many irregular treatments are carried out under the guise of various “non-names”.
The initial symptoms of osteoarthritis can be varied, and are usually joint pain of varying severity during specific movements such as squatting, walking up and down stairs, etc. This pain can be located anywhere around the joint, and can be good or bad at times, or can persist once it appears, and can start at the same time in both left and right joints, or may occur years apart. The above patient’s case is also typical. Cold, prolonged walking or excessive strenuous exercise usually aggravate the pain and sometimes trigger acute synovitis or acute joint effusion. Because this is a degenerative disease of aging, once it starts, it cannot be reversed back to normal, i.e., it cannot be “cured”. In many cases, years can pass between the first and second symptoms, and even if the first symptoms disappear completely after appropriate treatment and do not recur for many years, it does not mean that the disease itself is cured. Therefore, the proper goal of treatment is to control the symptoms and slow down the progression of the disease through reasonable measures.
Currently, most of our clinical treatment measures for osteoarthritis follow European and American guidelines, which are developed from rigorous randomized controlled clinical studies and are based on the strength of support for the study findings to determine the level of evidence for evidence-based medicine. Typically, these treatments are divided into three main categories: non-pharmacologic, pharmacologic, and surgical.
Non-pharmacologic treatment is the basic treatment for osteoarthritis and is no less important than pharmacologic treatment. The 2008 guidelines of the International Osteoarthritis Research Society recommend 11 non-pharmacologic measures, including patient health education, telephone follow-up, physical therapy, regular aerobic exercise, muscle and joint mobility training, weight loss, use of walking aids, knee braces, orthopedic insoles, heat therapy, transcutaneous electrical nerve stimulation, acupuncture, and more.
A total of 8 medication measures are recommended.
1. acetaminophen is recommended as the drug of choice for mild to moderate pain.
2. short-term use of the lowest effective dose of non-steroidal anti-inflammatory analgesics to avoid their long-term application.
3. topical NSAIDs or capsaicin may be added alone or as an adjunct.
4. intra-articular corticosteroid injection can be considered when moderate to severe pain and oral treatment is ineffective.
5. Intra-articular injections of sodium hyaluronate have a slightly slower onset of action, but are more effective than hormonal injections.
6. glucosamine sulfate has better efficacy in osteoarthritis of the knee joint.
7, glucosamine sulfate has a certain role in improving the structure of the knee joint, and diacetin may have a certain role in improving the structure of both hip and knee arthritis.
8, when symptoms recur and other drug treatment is not effective, weak opioid narcotic analgesics can be considered.
Traditional medicine in China usually classifies degenerative joint diseases as “paralysis”, so medicine is often used to activate blood circulation and remove blood stasis, which can also achieve certain results. However, because TCM emphasizes individualized treatment, prescriptions need to vary from person to person, and the use of proprietary drugs into large-scale clinical trials is rarely done, thus lacking the evidence-based medical evidence required by modern medicine, the effects of these drugs are not widely recognized by the Western academic community.
A combination of non-pharmacologic and pharmacologic treatments is the general principle of conservative treatment of osteoarthritis. However, at the end stage of the disease, when these tools are not effective, pain is difficult to control, and quality of life is significantly reduced, surgical treatment must be considered.
OARSI has five recommendations for this.
1. including end-stage recommended artificial joint replacement surgery.
2. unicondylar replacement is recommended for unilateral interval knee osteoarthritis.
3. young patients may be considered for osteotomy or other procedures that preserve their own joints.
4. arthroscopic lavage and cleaning surgery is not recommended.
5. Patients with failed replacements can consider joint fusion.