As the weather changes, more and more patients are coming to the hospital’s orthopedic clinic for joint pain, and they are mostly middle-aged and elderly. “When I move my knee joint, why does it make a clicking, clicking sound?” “Why can’t I stand up after squatting?” “My knee joint is so painful, will it be paralyzed?” ……
Although the problem is different, it is actually “osteoarthritis” that is causing the problem. Osteoarthritis (OA for short) is characterized by joint pain and is a common occurrence in middle-aged and elderly people, sometimes with joint swelling and even joint dysfunction. Osteoarthritis, also known as degenerative arthritis, is the premature aging of joints, especially the aging of joint cartilage. Osteoarthritis represents the aging of the joints and is therefore also called age-related arthritis. The incidence of osteoarthritis increases with age. According to the 2007 edition of the Chinese Medical Association Orthopedic Branch Guidelines for the Treatment of Osteoarthritis, more than 50% of people over the age of 60 suffer from this disease, and 80% of people over the age of 75. The disability rate of the disease can be as high as 53%.
The disease has a slow onset. Symptoms tend to appear after the age of 40, with an increase in onset with age. The incidence is higher in women than in men. More than one site may be present in the same patient. The common sites of osteoarthritis and their characteristics are as follows.
1. Knee pain is the most common reason for patients with this disease to seek medical attention. The early symptoms are pain when going up and down stairs, especially when going downstairs, unilaterally or bilaterally, and often joint enlargement, mostly due to osteophytic hypertrophy, or synovitis and joint cavity effusion. In severe cases, there is a knee inversion deformity, which is common in rotundity.
2. The interphalangeal joints are most often involved, especially the distal interphalangeal joints. Swelling and pressure pain are less pronounced and rarely affect joint movement.
3, The hip shows pain in the lateral hip and groin, which may radiate to the knee. The internal rotation and extension of the hip is limited.
4.The first toe joint of the foot is the common site of lesions. Wearing tight footwear and repeated trauma are its causes. The symptoms are local pain, bony hypertrophy and bunion.
5, degenerative lesions of the spinal vertebrae and small synovial joints cause lesions of the vertebrae in the cervical and lumbar segments. Local pain and stiffness occur. In a few severe cases, various radiological pains or neurological symptoms occur due to the compression of local nerve roots, spinal cord or local blood vessels by lipoid hyperplasia and bone redundancy at the vertebral body margin.
As a common and frequent disease, it is not difficult for a professional orthopedic surgeon to make a diagnosis of osteoarthritis by asking questions, physical examination and routine x-rays and other examinations.
There is no specific treatment for osteoarthritis, but treatment can be used to slow down the process and control the symptoms. The principles of treatment for osteoarthritis are a combination of non-pharmacologic and pharmacologic treatments, and surgery when necessary.
I. Non-pharmacological treatment includes patient health education, self-training, weight loss, aerobics, joint mobility training, muscle strength training, use of mobility aids, wedge insoles for internal knee rolls, occupational therapy and joint protection, aids to daily life, etc. Patients with osteoarthritis of the knee often have reduced quadriceps muscle strength, so strengthening quadriceps muscle strength training and aerobic training is beneficial to patients with osteoarthritis.
Second, drug treatment such as non-pharmacological treatment is ineffective, according to the situation can choose drug treatment.
1, local drug therapy: for hand and knee OA, you can start with creams, emulsions of non-steroidal anti-inflammatory drugs, patches, etc.
2.Systemic analgesic drugs.
1) Acetaminophen (up to 4 g/day) is effective and safe, and is preferred in mild to moderate pain.
2) Patients with poor efficacy of acetaminophen can add or switch to the least effective dose of non-steroidal drugs (there are about a dozen of these drugs commonly used clinically, such as fenbuterol, fotarol, etc., but these drugs have certain side effects, so please consult your physician on how to use them).
3, joint cavity injection.
1) Sodium hyaluronate: It is the main component of the synovial fluid in the joint cavity, which plays a lubricating role in the joint and reduces friction between tissues. Injection into the joint cavity can significantly improve the inflammatory response of synovial tissue, enhance the viscosity and lubricating function of the joint fluid, protect joint cartilage, promote the healing and regeneration of joint cartilage, relieve pain and increase joint mobility.
2) Glucocorticoids: can effectively reduce pain, but cannot be used for a long time, and should not be used more than 3-4 times a year at most.
4) Chondroprotective agents, etc.: glucosamine, diacetin, doxycycline and other drugs can delay the course of the disease and improve the patient’s symptoms to a certain extent.
Third, surgical treatment
If the symptoms of osteoarthritis are very serious, medication is ineffective, and it affects the patient’s daily life, surgical intervention should be considered. Artificial joint replacement surgery is the most mature surgery in human organ transplantation, and it is also the ultimate and only effective treatment for severe lesions of advanced joints, which is widely used at home and abroad and is regarded as one of the important milestones in the history of orthopedics in the 20th century. Nowadays, the annual volume of artificial joint replacements has reached more than 100,000 units. By choosing a suitable artificial joint and a specialist with a relatively stable skill level, the life expectancy of the artificial joint made is generally over 90% in 25 years. Joint fusion is also a treatment for severe arthritis, but it requires sacrificing the mobility of the joint.
Preventive care for osteoarthritis in the elderly is very important, how should it be prevented in daily life?
Patients with osteoarthritis often have their condition worsened by some wrong exercises and lack of attention in daily health care. For example, many elderly people like to exercise their joints by playing Tai Chi, squatting repeatedly, climbing mountains and stairs, but this can increase joint torque or overload the joint surfaces, making the joints more worn. The principle of exercise for arthritis patients is to move slowly to stretch the joints to the maximum without pain, and to do aerobic exercises such as swimming, walking, cycling and supine straight leg raises.
Get more sunlight, pay attention to cold and dampness, and keep warm so that the knee joint gets good rest. After the pain is relieved, walk slowly on flat ground once or twice a day for 20-30 minutes each time. Try to reduce weight-bearing exercises for the knee joint such as going up and down steps and running to avoid and reduce the wear and tear of joint cartilage. Avoid squatting or kneeling to get things, sitting on low stools, sleeping on low beds, which can reduce the friction and weight on the joints. Obese people should lose weight to reduce the load on the joints.
Do not stay in one position for a long time, and do not blindly do exercises such as repeatedly flexing and extending the knee joint, rubbing and pressing the patella, and shaking the knee joint. Exercise the function of the quadriceps to make them strong and powerful, which can reduce knee pain.