Osteoarthritis

Introduction to osteoarthritis Osteoarthritis, also known as osteoarthrosis, proliferative arthritis, senile arthritis, degenerative arthritis, hypertrophic arthritis, etc., is a chronic joint disease, the main change is articular cartilage degenerative disease and secondary bone Hyperplasia. According to the pathogenesis factors, it is divided into primary osteoarthrosis and secondary osteoarthrosis. In China, secondary osteoarthrosis is more common, and primary osteoarthritis is rare. Where normal joints have no obvious cause and gradually undergo degenerative changes, called primary osteoarthrosis; if cartilage destruction or joint structure changes due to some known reasons, future joint friction or pressure imbalance The cause of degenerative changes is called secondary osteoarthrosis. basic knowledge The proportion of illness: 0.005% Susceptible people: more common in the elderly Mode of infection: non-infectious Complications: joint pain

Causes of osteoarthritis

A variety of factors cause joint cartilage fibrosis, cleft palate, ulceration, joint disease caused by loss, the cause is not clear, its occurrence is related to age, obesity, inflammation, trauma and genetic factors, its pathological features are articular cartilage degeneration and destruction Subchondral bone sclerosis or cystic changes, joint bone hyperplasia, synovial hyperplasia, joint capsule contracture, ligament relaxation or contracture, muscle atrophy and so on.

Osteoarthritis prevention

1. Patient education: self-behavioral therapy (reducing unreasonable exercise, moderate activity, avoiding bad posture, avoiding long running, jumping, squatting, reducing or avoiding climbing stairs), weight loss, aerobic exercise (such as swimming, cycling, etc.) , joint function training (such as knee joint flexion and extension activities in non-weight position to maintain maximum joint mobility), muscle strength training (such as hip joint OA should pay attention to the training of abductor muscle group).

2. Physical therapy: mainly increase local blood circulation and reduce inflammation, including hyperthermia, hydrotherapy, ultrasound, acupuncture, massage, traction, transcutaneous electrical nerve stimulation (TENS).

3. Action support: mainly reduce the weight of the affected joints, using canes, crutches, walking aids, etc.

4. Change the negative gravity line: According to the varus or valgus deformity accompanied by OA, the corresponding orthopedic brace or orthopedic shoe is used to balance the load of each joint surface.

Osteoarthritis complications Complications joint pain

Osteoarthritis complicated by joint movement disorder of the limbs, in severe cases, limbs and flexion contracture deformities, and finally joint disability.

Osteoarthritis Symptoms Common Symptoms Joint swelling Joint pain Joint deformity Joints Hard finger joints Luminized synovial inflammation Inflammatory muscle atrophy Incompetent bone wear with osteophyte hyperplasia Compensatory lumbar lordosis

1. The main symptom is joint pain, which occurs when the activity occurs and disappears or improves after the break. In acute exacerbations, the pain is exacerbated, and joint swelling, joint stiffness, and intra-articular friction can be observed.

2. Some patients have joints in a certain position for too long, or in the morning, they feel joint pain, so-called rest pain. After the patient has gradually moved the joint for a certain period of time, the pain disappears and the joint can feel loose.

3. Hyperplastic bones stimulate or compress adjacent nerves to cause radiation pain, such as upper limb pain caused by cervical vertebra hyperplasia, lower limb pain caused by lumbar hyperplasia, and anterior medial pain caused by hip hyperplasia. Severe hyperplasia of the spine can compress the spinal cord and nerve roots, causing sensation, movement, dysfunction, nerve stimulation, and even paraplegia.

4. There is no abnormality in the shape and movement of the joints in the early stage. The joints with less soft tissues around the knees and fingers can be seen to have thickening of the bones, joint swelling, muscle atrophy and joint deformation. The joints have tenderness, limited mobility, and friction during activities. sense.

Examination of osteoarthritis

Patients with osteoarthritis routine examination of hematuria and erythrocyte sedimentation rate, mucin, rheumatoid factor, etc. are in the normal range, synovial fluid examination color, transparency and mucin clot test is normal, white blood cell count is between 200 ~ 2000 / mm3, microscopic examination No bacteria or crystals, but cartilage fragments and fibers are visible, and the degree of cartilage degradation can be roughly estimated from the number of fragments.

X-ray plain films generally have typical manifestations, mainly for joint space stenosis, subchondral bone sclerosis, marginal lip-like changes and osteophyte formation, intracapsular saccular changes around the joint, etc., in addition to the above changes in the spine, such as nucleus pulposus Subchondral nodules are formed in the upper and lower vertebral bodies, so-called Schmorl's nodes, which are sometimes differentiated from spinal space-occupying lesions. CT and MRI can clearly show joint lesions, disc herniation, posterior longitudinal Ligament thickening calcification, etc., has diagnostic significance for osteoarthritis.

Diagnosis and diagnosis of osteoarthritis

Diagnose based on

1. Middle-aged men are more common.

2. The well-developed parts are more active and more weight-bearing joints, such as the hip, knee and ankle, and the lumbar vertebrae are the most common.

3. The main symptom is joint pain, which occurs when the activity occurs and disappears after the break. There are also symptoms of rest pain.

4. There is no abnormality in the shape and movement of the joints in the early stage. The joints in the late stage can be swollen, effusion and deformity, joint tenderness, stiffness, limited activity, and a sense of friction during activities.

5. X-ray film can show the joint gap is narrow, the joint surface is uneven, the cartilage is not hardened, the subchondral osteoporosis, cystic change, the edge of the joint lip-like bone hyperplasia, the joint cavity can be seen in the free body, joint deformity and half Dislocation changes. The diagnosis is based on clinical performance and laboratory data, and it is not difficult to judge.

1. Rheumatoid arthritis This disease is particularly confused with the onset of rheumatoid arthritis. The following points can be identified:

1 Onset is usually abrupt, with sore throat, fever and increased white blood cells.

2 It is more common in the joints of the extremities, which is swollen and painful in the migratory joints. There is no permanent damage after the joint symptoms disappear.

3 often have carditis at the same time.

4 serum anti-streptolysin "O", anti-streptokinase and anti-hyaluronidase were positive, and RF negative.

The efficacy of 5 salicylic acid preparations is often rapid and significant.

2, tuberculous arthritis: rheumatoid arthritis is limited to a single joint or a small number of joints should be identified with the disease, the disease may be associated with other areas of tuberculosis, such as spinal tuberculosis often paravertebral abscess, more than two joints at the same time Less common, X-ray examination is not easy to distinguish in the early stage. If there is local bone destruction or paravertebral abscess shadow, it can help diagnosis. The joint cavity fluid is often positive for tuberculosis culture, and anti-tuberculosis treatment is effective.

3, other connective tissue diseases: systemic red wolf, scleroderma dermatomyositis and so on.

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