Osteoarthritis is a chronic, progressive, degenerative joint disease involving one or more joints, with primary effects on the articular cartilage, characterized by progressive degeneration of the articular cartilage tissue, with exfoliation, loss and predominantly reactive changes in the articular margins and subchondral bone tissue. The rate of degeneration exceeds the rate of repair and regeneration, eventually leading to loss of function. This disease belongs to the category of “paralysis” in Chinese medicine.
Degenerative arthritis is more common in the elderly, especially in women, who are 4-6 times more likely than men to have the disease. According to Chinese medicine, in middle age and old age, the liver and kidneys are insufficient, the bone marrow is not filled, and the source of nutrition is lacking.
Modern medicine believes that the disease is secondary to congenital or acquired deformities of the joints, joint injuries, joint inflammation, etc. The primary cases are mostly seen in the elderly, and its occurrence is often related to genetics and physique.
Clinical symptoms.
Most patients with osteoarthritis present with joint pain, mostly deep pain of indeterminate localization, initially of a dull, diffuse nature, with soreness and swelling in the joint area, and some patients first feel joint pain after minor joint trauma or a heavy physical activity. The pain and stiffness occur at the beginning of the activity, but later it is relieved and the pain can last for several hours after the activity stops. In the later stages of the disease, the pain gradually worsens and develops into persistent pain, with throbbing pain at night, even affecting the patient’s sleep, gradually decreasing joint mobility, inconvenient movement, joint deformities, such as inversion of the knee, and muscle spasms, secondary to joint contractures.
Osteoarthritis can invade any synovial joint, and the involved joints vary with age and gender, for example, male patients often involve the hip and spine, and female patients often involve the hand and knee joints, which are mostly asymmetrical and limited to one or a few joints.
Diagnostic points.
Knee joint
1. Secondary cases are more common, mostly in women, especially more obese women, with previous history of internal or external knee deformity, meniscal injury, exfoliative osteochondritis, habitual patellar dislocation or intra-articular fracture, and knee ligament injury.
2. Knee pain associated with activity, joint stiffness and swelling, and restricted movement.
3. Late onset of joint subluxation, internal and external rotation and flexion contracture deformity, with internal knee rotation deformity being relatively common.
4. The affected joint often has a “gluing phenomenon” and can be palpated with a rubbing sensation, and sometimes the floating patella test is positive.
Hip joint
1, secondary, often secondary to acetabular dysplasia, femoral head necrosis, hip inflammation and fracture dislocation, mostly unilateral joint.
2, slow development, but progressive aggravation, appear painful limp.
3, Painful sites often occur in the lateral hip joint, inguinal region, inner thigh, hip and knee joint with involvement pain, sometimes masking the truth and leading to misdiagnosis.
4. The typical deformity of the affected limb is in flexion and external rotation position, and even the femoral head is semi-dislocated to the proximal side, resulting in hip inversion deformity and limb shortening.
Interphalangeal joint
1, mostly primary, commonly found in the distal interphalangeal joint, occasionally in the proximal interphalangeal joint, multiple joints involved.
2. Most often seen in older women.
3.Heberhden’s nodes appear in the distal interphalangeal joints, and cysts filled with jelly-like material appear on the dorsal side of the base of the distal phalanges, and the inflammation softens the nodes, which are asymptomatic in the late stage, with deformities causing hand dysfunction.
Spine
1.Commonly, degenerative arthritis occurs in the lower cervical spine and lower lumbar spine where there is much activity and significant bearing, and in the hook vertebral joint of the cervical spine, the posterior articular eminence of the spine, and the intervertebral disc.
2, accompanied by spinal cord or nerve root compression symptoms, cervical spine involvement can not only cause neurological symptoms, but also affect the blood flow of the vertebral artery, causing dizziness, visual impairment, headache and vertigo.
3, lumbar spine involvement can cause neurological symptoms in addition to the degeneration of small joints and the formation of bone redundancy with age, resulting in lumbar spinal stenosis and intermittent claudication in typical cases.
X-ray plain film examination
X-ray plain film is the most valuable diagnostic tool for the clinical evaluation of osteoarthritis. Soft tissue swelling, narrowing of the joint space, asymmetry, increased subchondral bone density, cystic changes, uneven joint surfaces and bone redundancy formation can occur as the disease progresses, and joint subluxation, deformity and poor alignment can occur.
Differential diagnosis
1, rheumatoid arthritis: mostly in young women, chronic onset, and repeatedly more involved in small joints, symmetrical, manifest joint swelling and pain, deformity, morning stiffness, pain is persistent, aggravated after rest, rheumatoid factor test positive anti-O positive.
2, acute septic arthritis: mostly seen in children, the onset of the disease is rapid, most often in the knee and hip joints, joint redness, swelling and pain, may have fever, anti-O negative, blood test leukocytes high, antibiotic treatment is effective.
3, gouty arthritis: blood uric acid is not normal, uric acid salt deposition in the joints to produce a series of clinical symptoms.
4, neurological arthritis: secondary to damage to the central nerve or peripheral nerve deep sensory nerve caused by arthropathy, the clinical appearance of proprioception, loss of joint sensation, lack of protective mechanisms in the joints, excessive wear and tear, and ultimately joint deformity, dislocation, instability. Most commonly seen in diabetes mellitus, spinal cord cavitation, and spondylolisthesis.
Treatment measures
Treatment by community physicians The non-steroidal drugs fenbuterol, fotarine, or anti-inflammatory pain extended-release tablets, Isidin can be used, and the use of hormones must be used with caution. Take hydrochloric acid, gluconolactone sulfate, and intra-articular injection of sodium hyaluronate once a week, five times a course. Increase intra-articular synovial fluid for the purpose of protecting and nourishing joint cartilage.
Chinese medicine treatment
Kidney deficiency and marrow deficiency (hidden joint pain, unfavorable movement, dizziness, tinnitus, dizziness), nourishing kidney yin and nourishing marrow with Six Flavors Dihuang Tang or Zhi Bai Dihuang Wan plus or minus.
Yang deficiency and cold clotting (joint pain, heaviness, aggravated by weather changes) nourish kidney yang, promote circulation and disperse cold, take Jin Kui Kidney Qi Pill plus or minus.
Stasis of blood (joint pain, deformity and obstruction of movement), activate blood circulation, regulate qi and relieve pain.
1. topical medicine, dog skin ointment, blood activating and pain relieving ointment.
2, acupuncture techniques to relieve pain and improve symptoms.
3, physical therapy: physical therapy can promote the absorption of exudation, eliminate swelling, analgesia, relieve symptoms, Chinese medicine ion introduction, ultra-short wave electrical therapy, ultrasonic therapy, magnetic therapy, medium frequency electrothermal therapy, etc.
Self-treatment at home When the disease occurs, you should try to reduce the weight of the affected joints, pay attention to joint warmth, rest, joint instability can apply elastic knee, ankle, wrist guards, local application of heat to the affected joints, small home physiotherapy instrument to relieve pain, also cane, walker to reduce the pressure on the affected joints.
Prevention and rehabilitation.
Prevention: avoid trauma or strain, participate in physical exercise should pay attention to the method, reduce the load and pressure on the joint, can take a sitting position under non-weight-bearing fitness equipment for joint and muscle exercise, the body should reduce weight if it is too fat.
Rehabilitation: to minimize the load and wear of joint cartilage to enhance joint stability as a principle, to avoid further damage to joint cartilage, to carry out joint functional exercises gradually, and to avoid some inappropriate activities that may aggravate joint degeneration.