osteoarthritis Osteoarthritis (OA) is the most common joint disease, primarily characterized by damage to joint cartilage and involving the entire joint tissue. It ultimately leads to degeneration, fibrosis, rupture, and damage to the entire joint surface. It manifests as joint pain, stiffness, enlargement, and limited mobility, most commonly affecting weight-bearing joints such as the knees, hips, cervical and lumbar vertebrae, as well as the distal interphalangeal joints, proximal interphalangeal joints, first carpometacarpal joint, and first metatarsophalangeal joint. This condition predominantly affects middle-aged and elderly individuals and is a major cause of disability in the elderly.

Osteoarthritis (OA) is the most common joint disease, primarily characterized by damage to joint cartilage and involving the entire joint tissue. It ultimately leads to degeneration, fibrosis, fractures, defects, and damage to the entire joint surface. It manifests as joint pain, stiffness, swelling, and limited mobility, often affecting weight-bearing joints such as the knees, hips, cervical and lumbar spine, as well as distal interphalangeal joints, proximal interphalangeal joints, first carpometacarpal joint, and first metatarsophalangeal joint. This condition is common among middle-aged and elderly individuals and is a major cause of disability in the elderly.

Primary Osteoarthritis

The exact cause of primary osteoarthritis is not fully understood, and it presents as a slow and progressive pathological process. Its etiology is not a single factor but rather the result of multiple factors, commonly associated with genetics, age, obesity, and injury. This type is more prevalent in individuals over 50 years of age.

Secondary Osteoarthritis

Secondary osteoarthritis often occurs as a result of osteoarthritic changes on a pre-existing condition, such as infection, trauma, joint instability, metabolic diseases, and congenital joint deformities. This type can occur in young and middle-aged individuals.

Joint Pain and Tenderness

In the early stages, patients often experience mild to moderate intermittent pain, which improves with rest and worsens with activity. Pain is often affected by weather changes, worsening in cold and damp conditions. In the late stages, continuous joint pain or pain at rest may occur, with localized tenderness, particularly evident when joint swelling is present.

Limited Joint Mobility

In the morning, the joints may feel stiff and have reduced range of motion, known as "morning stiffness," which improves with movement. Joint stiffness worsens with decreased air pressure or increased air humidity, with a generally short duration, usually lasting from a few minutes to over half an hour. Patients may experience joint locking in the mid-stage of the disease, and as the disease progresses, joint mobility limitations worsen, ultimately leading to disability.

Joint Swelling or Deformity

Affected joints may become red and swollen, with significant enlargement and deformity, commonly occurring in the joints near the fingertips (Heberden's nodes) or the middle joints of the fingers (Bouchard's nodes). Some knee joints may show enlargement due to osteophyte formation or joint effusion, causing inward or outward deviation of the joint, resulting in "bow legs" or "knock knees."

Joint Crepitus

Joint cartilage reduces friction within the joint. When the cartilage is damaged, and the joint surface becomes irregular, joint movement may produce a sensation of friction or a creaking sound, known as joint crepitus.

Joint Weakness and Impairment

In the late stages, patients may experience persistent joint pain, reduced mobility, and muscle atrophy, leading to joint weakness. Patients may feel leg weakness, inability to fully extend the joint, or movement impairment while walking.

Muscle Atrophy

Muscle atrophy is common in knee osteoarthritis, where joint pain and reduced mobility can lead to muscle atrophy around the affected joint, resulting in joint weakness.

The primary goals of acute phase treatment are pain relief, reduction of swelling, and improvement of joint function. Patients may use a cane or crutch to assist with mobility, reducing weight-bearing on the joint, while avoiding excessive and strenuous activity. Anti-inflammatory and pain-relieving medications are commonly used to alleviate pain and improve joint function and should be used under medical guidance.

Graduated Treatment

Doctors tailor treatment based on the patient's age, gender, weight, risk factors, the location and extent of the lesion.

Foundational Treatment

Foundational treatment includes patient education, exercise therapy, physical therapy, and mobility-assistance therapy, suitable for all osteoarthritis patients. In the early stages, appropriate foundational treatment plans can be selected based on the patient's needs and general condition.

Secondary Treatment

As the patient's condition worsens, they may progress to secondary treatment, including anti-inflammatory and pain-relieving medication, intra-articular injection therapy, symptomatic relief medication, and traditional Chinese medicine treatment. The selection of the appropriate route of administration and type of medication should be based on the patient's affected areas and risk factors.

Tertiary Treatment

As the condition further deteriorates, and foundational and medication treatments are ineffective, surgical treatment may be considered, including arthroscopic surgery, cartilage repair surgery, and osteotomy. Treatment plans should be comprehensive, considering the patient's affected areas, the extent of the lesion, general condition, and personal preferences.

Quaternary Treatment

In advanced stages of osteoarthritis, when the patient's condition is severe and reparative treatment is ineffective, joint reconstruction surgery, including joint replacement and osteotomy, may be necessary.

When foundational and medication treatments are ineffective or the condition worsens, surgical treatment may be considered.

Arthroscopic Debridement

Arthroscopy serves both diagnostic and therapeutic purposes, suitable for patients with intra-articular loose bodies or meniscal injuries. Arthroscopic debridement and meniscal shaping can alleviate symptoms in some early and mid-stage patients. However, arthroscopic surgery alone is not effective for patients with mechanical symptoms and significant joint space narrowing.

Osteotomy

Osteotomy is commonly used for early and mid-stage knee osteoarthritis, altering the lower limb alignment to change the force distribution on the joint surface, preserving the body's own joint, especially in individuals with high activity levels and poor knee alignment.

Joint Fusion Surgery

The purpose of joint fusion surgery is to alleviate joint pain, but it results in joint dysfunction and is not a routine treatment for large joint osteoarthritis such as the knee and hip. However, it has good efficacy for severe ankle, toe, or interphalangeal joint osteoarthritis.

Total Joint Replacement Surgery

Total joint replacement surgery may be used for end-stage osteoarthritis, effectively relieving joint pain and improving joint function. It is a mature and effective treatment method widely accepted by both patients and physicians.

When osteoarthritis symptoms occur, patients should control their activity levels, use a cane or crutch to assist with mobility, reduce weight-bearing on the joint, and avoid excessive and strenuous activity. Applying anti-inflammatory and pain-relieving medications externally or orally at home can rapidly alleviate or control symptoms. It should be noted that anti-inflammatory and analgesic medications have gastrointestinal side effects and should not be used for prolonged periods.

Lifestyle Guidance

Healthy diet: Change poor eating habits and times, consume more fresh vegetables and fruits, pay attention to calcium intake, and prevent osteoporosis.

Weight management: Overweight individuals increase joint burden and should maintain standard body weight.

Avoid excessive or inappropriate exercise that may lead to joint injury, such as long-distance running, climbing, climbing stairs, and prolonged poor body posture (prolonged standing, squatting).

Joint protection: During osteoarthritis flare-ups, wear knee pads, elastic sleeves, and appropriately sized athletic shoes, avoiding high heels. During the acute phase, use crutches or walkers to assist with mobility and reduce joint burden.

Exercise Therapy

Engage in rehabilitation exercises under the guidance of a physician, including low-impact aerobic exercise and strength training of muscles around the joints (such as cycling, swimming, walking, etc.).

Joint Function Exercise

Joint function exercise involves stretching and flexing the joints in a non-weight-bearing condition to maintain the mobility of the affected joints.