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Degenerative joint disease of bone: Gold | Source: Shijiazhuang Golden Delicious Bone Specialist | Time :2009-1-15 | [Add Favorite]
Degenerative joint disease known as osteoarthritis, in fact, not inflammation, mainly degeneration, premature aging is a joint, especially articular cartilage of aging, also known as age-related arthritis. Degenerative joint disease, the key is "retrograde" word, is the growth of human bone with age, decreased activity, resulting in reduction of bone and joint synovial fluid, nutritional imbalance, which led to the formation of bone and joint degeneration and osteoarthritis, multiple the knee to bone proliferation (bone spurs), synovitis, chondromalacia patella, meniscus, joint bursitis and other forms of reflected, the performance of the aseptic inflammation and more swelling, pain, cold, flexion and extension negative, etc. severe joint deformation, standing, walking difficulties. Incidence of the disease within the blood circulation is the source of bone and joint tissue blood circulation around the obstacle, so the key to treatment of degenerative joint disease of bone lies in how to improve the blood circulation, increase bone and joint nutrition.
Common classification of degenerative joint disease
Degenerative knee osteoarthritis. Knee said the uneven gaps narrow, widened and changed the articular surface flattened lip-like edge of cortical bone spurs, intra-articular loose bodies see a (arrow).
Hip degenerative joint disease. Hip narrow, articular surface sclerosis whitening, bone under the articular surface of femoral head has multiple sizes pseudocyst honeycomb, surrounding bone whitening.
Thoracic degenerative joint disease. Chengbian rectangular thoracic vertebrae, a number of anterior vertebral bone spurs the formation of a lip-like.
Etiology and pathology of degenerative joint disease
Degenerative joint disease, is a fibrous articular cartilage degeneration and subsequently by the continued wear and tear damage, and even disappear. Articular cartilage is produced under the reactive hyperplasia, causing the edge of lip-like protrusion, bone spurs and bone sclerosis, and cystic changes may have. Basic features of the disease cartilage degeneration, bone hyperplasia, appear with increasing age, and gradually increased. Besides who can damage cartilage lesions such as infection, toxins, injury, secondary to the disease can.
Early osteoarthritis pain, after a break in the night there, take a activity is lost, and later pain after the event. Of the disease manifested in the advancement of time and gradually increased, serious affect sleep. Joints are the main signs of strong, early occasionally, often after the onset and gradual deterioration. Led to the shrinkage of joint capsule joint deformity, occurring in the hip, the result of hip flexion and adduction deformities were found in lower limbs gradually become shorter. Swelling can be seen only in superficial j
No scar around the joint, but the performance of mild disuse because it was swelling and joint effusion, particularly in the knee joint for the obvious? Toe metatarsophalangeal joint common with osteophyte production, visible deformity often has the hip in flexion entry and external rotation deformity. Joint local temperature does not increase, and sometimes superficial and tender joints to check the fluid, but also can be found in the proliferation of osteophytes. Joint activities are often limited in a certain range of activities is painless, asymmetric restriction of motion, often on one side than the other side of the weight. Asymmetry in such activities may be limited due to movement from the joints of fibrosis, rather than as true activity limitations due to arthritis, muscle spasms around the joint caused.
Clinical manifestations of degenerative joint disease
More common in the elderly, onset is slow. If because of special local primary disease, age of onset may be early, often to a normal joint, a pair of joints or a group of joint symptoms occur, the lesion showed dull pain, tingling, joint activity limitation. Generally do not have joint swelling and stiffness phenomenon. Occur in the hip, knee, spine and interphalangeal joints, usually without symptoms.
Differential diagnosis of degenerative joint disease
Occurred in and rheumatoid arthritis finger identification is sometimes required. In addition, sometimes need to pay attention to whether the secondary.
X-rays showed joint space width or narrow range, joints, osteoporosis, osteoarthritis or joint swelling, as well as joint deformity, subchondral bone plate sclerosis and osteophyte formation is osteoarthritis of the characteristics of the basic X ray. Previous article: I remember! Frozen shoulder is not the next article: bone and joint disease etiology and prevention
Osteoarthritis (osteoarthritis, OA) is to occur in middle age, a chronic, degenerative joint disease, often involving the hands and weight-bearing joints and distal refers to events after the joint pain, limited mobility and joint deformation its clinical features. Pathological changes of the first involving the cartilage, subchondral bone plate after the violation, such as synovial tissue around the joints, causing focal, erosive cartilage destruction, sclerosis, cystic changes and compensatory osteophyte formation. With aging, trauma, inflammation, obesity, metabolic disorders and genetic factors are closely related. Changzhou City Second People's Hospital Division of Rheumatology Learning in Jiangsu Province
Osteoarthritis may be the disease in the world, is a very common form of arthritis, age, sex, occupation, ethnic and geographical environment. Recent data shows that people under the age of 45, the prevalence was about 10% of people over the age of 60 the prevalence of up to 40-60%. Light and spine osteoarthritis patients, no significant difference in incidence between men and women; and for people over 60 years of age, patients with severe osteoarthritis, more women than men hair; but osteoarthritis of the hip incidence of men than women. Chinese was significantly lower than the West, the black incidence of osteoarthritis than whites. As the population ages, the prevalence of osteoarthritis will also be significantly increased.
In the etiology of osteoarthritis can be divided into primary and secondary two types, primary osteoarthritis of unknown etiology, while secondary osteoarthritis was secondary to a clear causes, such as other systemic diseases. This chapter discusses the primary osteoarthritis. Primary cause of osteoarthritis is unclear, the incidence is not caused by a single factor, but with age, trauma and excessive fatigue, obesity, genetic and other factors are closely related. The prevalence of osteoarthritis increase with age increased, but also with the growth of body weight was positively related to some occupational labor, strenuous exercise and congenital dislocation of the joint staff may induce osteoarthritis, and women menopause, estrogen levels change, is involved in the pathogenesis of osteoarthritis of the important factors. Heberden nodules associated with osteoarthritis of the women, their relatives in the female prevalence rate higher than the normal 2 to 3 times the population.
In trauma, metabolic and genetic and other factors under the influence of damaged cartilage damage occurs, the metabolism of cartilage cells had abnormal cartilage matrix dissolve the one hand, it also makes an exception of newly synthesized matrix, which affects The biological stability of the cartilage, resulting in decreased elasticity of cartilage. Inflammatory cytokines IL-1 and TNF-a, contributing to the cartilage cells to produce a large number of matrix metalloproteinases and increased type II collagen and cartilage proteoglycan synthesis inhibition, leading to cartilage destruction, bone of bone arthritis exposed Late change.
(A) of articular cartilage: cartilage damage, degeneration is the pathological features of this disease. Early manifestation of elastic cartilage changes, limitations of the softening, a small flake off the surface is not smooth, then there's cracks, erosion, ulcers, cause severe bone bare, microscopic cartilage cells decreased, but the damage to the cartilage piles near the edge of chondrocyte proliferation or fibrosis, myxoid matrix softening occurs, the ulcer may be covered by connective tissue or fibrous cartilage, accompanied by new small blood vessels.
(B) of the bone changes: joint marginal osteophyte formation, bone marrow hyperplasia, cystic subchondral bone, osteophytes, can form joint cavity separated from the so-called "joint mice" that intra-articular loose bodies.
(C) of the synovial changes: there may be early synovial hyperemia, perivascular lymphocyte and plasma cell infiltration of limitations. Late, synovial hyperplasia and loss of hair showed flexibility, accompanied by small pieces of broken cartilage or bone, but rarely the formation of granulation tissue, or pannus.
Occult onset, slow progression, mainly in the 40 years of age, more women than men, often involving the distal interphalangeal joint of the site is the hip, knee, and first carpometacarpal joints, first metatarsophalangeal joint, cervical and so on.
(A) of the symptoms of a pain: Osteoarthritis is the most common symptom of early mild to moderate intermittent dull pain, rest after mitigation, the development of sustainable future, and even tear-like or needle-like pain, can lead to activity limitation. Joint pain can occur in activities or events, the rest can not alleviate the serious and can occur at night the pain got worse. 2 morning stiffness: the slow-onset limited mobility, often in the morning or after the feeling of motion is not sedentary freely, such as adhesion with stiff, as can be quickly restored after the event, usually not more than 30 minutes.
(B) signs a tender: involvement of the joints can have local tenderness, especially with arthritis symptoms, sometimes Although there were no tenderness, but the passive joints can cause pain. 2 joints snapping or friction rub: often occurred in the knee joints can be checked by touching the joints feel a click, this may be due to the rough surface of cartilage and joint damage caused. 3 swollen joints: may be due to local bone caused by hyperplasia or exudative synovitis caused. Swelling can cause severe joint deformities, subluxation and so on.
(C) common in different parts of osteoarthritis
1 osteoarthritis of the knee: is the most common clinical osteoarthritis, the performance of the knee pain may be unilateral or bilateral early alternating, activity increased, especially on the downstairs pain, the following stairs When significant, visible when the knee examination swelling, joint tenderness was localized, limited range of motion may be relevant section of bone snapping or friction rub. Knee joint effusion, joint swelling significantly, floating patella test positive, disease can result in severe varus deformity. Small number of patients, there may be disuse atrophy of muscles around the joints.
2 hand osteoarthritis: the distal interphalangeal joint involvement most common, occurs in middle aged women. May be associated with Heberden nodules (Heberden node), which occurs in joints on both sides inside and outside the extension on the side of the bone nodules. The same occurred at the proximal interphalangeal joint nodules called Buxia have nodules (Bouchard node). Clinical manifestations of mild pain and tenderness, discreet or hand movements may induce pain. About 60% involved the first carpometacarpal joint, the base of the bone hyperplasia, hypertrophy and the formation of the square hand.
3 hip osteoarthritis: to occur in male patients with unilateral onset more, about 80% with congenital hip dysplasia or femoral head disease. Hiding place for the clinical manifestations of chronic hip pain, may radiate to the groin, inner thighs, buttocks, and sometimes radiation to the knee. Physical examination shows different degrees of lameness and internal rotation and limited outreach activities, there may be severe adduction, external rotation and stretching limited.
4 foot osteoarthritis: the most common site of involvement is bilateral 1st metatarsophalangeal joint, manifested as local pain, tenderness, and bony hypertrophy, can be aggravated by shoes are too tight to the pain, when severe hallux valgus deformity, leading to difficulty walking.
5 spondyloarthritis: mainly due to fibrocartilage disc degeneration, vertebral facet joint after injury and caused by degenerative changes. Most commonly involving the cervical and lumbar, showing a sense of local pain and stiffness, severe hyperplasia of the vertebral bodies and osteophytes lip nerve and blood vessels, leading to the corresponding parts of the radiation pain and nervous system symptoms. Cervical joint involvement: mainly for the neck back pain, stiffness, extension and rotation is limited, such as the oppression of vertebral - basilar artery insufficiency can cause symptoms such as dizziness, diplopia, tinnitus, nystagmus, ataxia and so on. Force can occur in severe loss of positioning or fall, but rarely consciousness. Joint involvement can cause lumbar spine, hip pain and radiation to both lower extremities, causing pain in the ankle or lower leg, resulting in reduced or lost knee tendon reflexes. Nerve can cause paresthesia corresponding region. Spinal stenosis, the performance of intermittent claudication. Severe nerve root compression can be caused by cauda equina syndrome. Thoracic joint involvement can lead to chest wall pain, intercostal neuritis similar symptoms, should be identified.
(D) a special type of osteoarthritis
1 Primary systemic osteoarthritis (primary generalized osteoarthritis): to occur in postmenopausal women with distal interphalangeal joint, proximal interphalangeal joints and first carpometacarpal joint is the most common site of involvement, knee , hip, and metatarsophalangeal joints and spine can also be affected. Clinical manifestations of recurrent episodes of joint pain, effusion, with joint local heat, there may be increased ESR laboratory. The Heberden nodules as the main performers, have a family tendency to disease. Without Heberden nodules performers to the main proximal interphalangeal joint involvement, no family, the tendency to disease, arthritis often repeated several times. X-ray examination showed spinal bony articular surface suddenly increases, to form the upper and lower cone connected; knee joint space narrowing, bone spurs was "melting wax-like" change.
2 erosive inflammatory osteoarthritis (erosive inflammatory osteoarthritis): more common in postmenopausal women, often involving the distal and proximal interphalangeal joints, carpometacarpal joint and so on, have a family tendency to disease, early recurrent joint pain, and ultimately leading to joint deformity, stiffness or even ankylosis of involved joints may appear around the frozen gel capsule, with pain or tenderness. X ray shows disappearance of joint space, osteophyte and subchondral bone sclerosis, and visible signs of bone erosion. Sometimes the disease is accompanied by immunological abnormalities, and some can be combined Sjögren's syndrome.
3 diffuse idiopathic bone hyperplasia (diffuse idiopathic skeletal hyperostosis, DISH): is a special spine bone hyperplasia, occurred in the 50 years of age to obesity are more often accompanied by diabetes or glucose intolerance exception. Most patients are asymptomatic patients showed a small part of shoulder pain and stiffness, numbness of fingers or low back pain, no pain during activity. X ray shows the entire spine involvement, the following changes in thoracic most significant osteophyte showed many large posterior margin, anterior and posterior longitudinal ligament calcification front of bone hyperplasia, hypertrophy, ossification to form bone growth connecting bridge, However, facet and sacroiliac joints are not involved.
A routine examination: blood, erythrocyte sedimentation rate and C-reactive protein normal, but the arthritis symptoms may occur ESR. Antinuclear antibody and rheumatoid factor were negative, serum complement normal. Urine routine examination without specific findings.
2 joint fluid examination: synovitis can occur when significant joint effusion, fluid and transparent, light yellow, sometimes muddy and bloody effusion, the normal fluid viscosity, mucin solidification good or slightly more than normal white blood cells increased, but
3 X-ray examination: the diagnosis of osteoarthritis is very important. Its main characteristics of non-symmetry of joint space narrowing; sclerosis and subchondral joint surface deformation; joints and free edges osteophyte osteophyte formation (joint mice); subchondral cystic change, the edge of the clear boundaries; hip and joint deformation subluxation. The application of CT and MRI of osteoarthritis in addition to diagnosis and differential diagnosis of a meaningful, the right to learn more about the progress of disease and drug efficacy have reference value, but the price is higher.
[Diagnosis and differential diagnosis]
(A) Diagnosis: According to the clinical manifestations and signs, typical of synovial fluid examination and X-ray, etc., is not difficult to diagnose osteoarthritis, diagnosis should pay attention to the following conditions (1) the patient's age and length of history ; (2) the type of joint involvement, such as hands, knees or hip, etc.; (3) is associated with inflammation, swelling of the joints, fever; (4) X-ray films bone, joint, proliferative changes, rather than simple erosion damage.
(B) the differential diagnosis:
1 rheumatoid arthritis rheumatoid arthritis osteoarthritis of 30-50 year old age about 50 years old predisposing factors for the infection, autoimmune, endocrine trauma of genetic and environmental factors, obesity, aging, metabolic disorders and genetic factors in the slow onset , with occasional acute exacerbation nearly that slow affected joints, metacarpophalangeal, wrist and other small joints beyond the main knuckle, knee, hip and neck, lumbar-based morning stiffness less than 1 hour and more than 30 minutes no visible subcutaneous nodules rheumatoid factor positive and negative X-ray soft tissue swelling, joint space narrowing, joint cystic degeneration, bone destructive changes in osteophyte formation, joint space narrowing, subchondral bone sclerosis
2 ankylosing spondylitis ankylosing spondylitis disease has certain characteristic features is not difficult to grasp the identification of: â‘ disease more common in young men. â‘¡ mainly for low back pain or joint pain or swelling of the lower limb symmetry. â‘¢ often accompanied by side tendon inflammation, such as heel pain and so on. â‘£ X ray or CT can be manifestations of changes in the sacroiliac joint involvement, advanced spine showed a bamboo-like change. â‘¤ 90% of patients positive for HLA-B27. 3 psoriatic arthritis, psoriatic arthritis and osteoarthritis has some similar characteristics, its performance can be a variety of joints, including hands polyarticular osteoarthritis and is similar, but the psoriasis arthritis, psoriasis disease with characteristic rash and nail disease, help identify.
4 neuropathic arthritis: The main manifestations of mild knee or hip pain, joint ossification around the common joint laxity, and with obvious neurological symptoms, X online no osteoarthritis of the performance characteristics, can be identified.
Treatment should be based on the situation of joint function and objective inspection, the key to symptomatic treatment. 1 First, a correct understanding of the education of osteoarthritis patients, eliminating unnecessary burden of thinking, to avoid disadvantage. In acute arthritis, chronic physical therapy to eliminate pain and restore joint function is very important. Physical exercise can be carried out step by step, but the joint pain can be reduced significantly by exercise intensity and shorten the training time. More obese patients, it is recommended to lose weight to reduce the burden on joints.
2 drug therapy: can be divided into topical and systemic administration (1) local administration, including intra-articular injection of hyaluronic acid â‘ (hyalouronis acid), the main role is to maintain and lubrication, synovial membrane and cartilage restoration of physiological barrier; inhibit inflammatory process, to reduce the intra-articular effusion, joint pain relief, common Sofastin, Xinwei can. â‘¡ glucocorticoid (corticosteroid): glucocorticoid apply only with marked synovitis, joint effusion occurs when only intra-articular injection, commonly used Diprospan and so on. (2) systemic administration of drugs to control symptoms into disease and changes in the cartilage protective agent â‘ drugs and drugs to control symptoms include non-steroidal anti-inflammatory drugs (nonsteroidal anti-inflammatory drugs, NSAIDs): commonly used drugs for the dual current Diclofenac Sodium, sulindac, etc., but the anti-inflammatory pain, such as aspirin and phenylbutazone effects should be avoided Cartilage Metabolism. COX-2 inhibitors is currently of more general use, the main side effect is that it was significantly lower than the traditional non-steroidal anti-inflammatory drugs, Vioxx and on behalf of drugs such as Celebrex. â‘¡ change the condition of the drug and cartilage protective agents: These drugs slow the onset, it generally takes several weeks before the treatment effective, but can slow, steady or even reverse osteoarthritis cartilage destruction process, including glycosaminoglycans (glycosaminoglycan) , superoxide dismutase (superoxide dismutase), D-glucosamine (D-glucosamine), etc., on behalf of a peacekeeping Glucosamine and other drugs. (3) Other: estrogen, growth hormone, calcitonin, IL-1 and TNF inhibitors are starting to clinical application.
3 surgical treatment: For a serious condition, continuous pain and joint function was impaired, there are obvious joint deformities can be taken to surgical treatment, including arthroscopic synovial membrane, cartilage removed, surgery arthroplasty or autologous chondrocyte transplantation.
[Prognosis] Most patients with good prognosis, prognostic factors are: general, poor, accompanied by weakness and muscle atrophy, mental burden heavier, more joint involvement, low levels of education, patients older than and large.
What is a degenerative joint disease?
Source: 2008-11-5 13:44:40 degenerative joint disease can be due to normal articular cartilage matrix to withstand the unusual stress, degenerative joint disease or because of abnormalities of the articular cartilage or subchondral bone under normal stress, regression bone and joint disease or because of abnormalities of the articular cartilage to withstand the unusual stress, eventually leading to osteoarthritis. This kind of understanding is useful, because it is stressed that a lot of osteoarthritis lesions secondary to the underlying causes of these reasons can cause the increase of articular cartilage to withstand stress, or directly affects the cartilage or subchondral bone itself, causing articular cartilage degenerative joint disease from occurring. The treatment of degenerative joint disease degenerative joint disease, there is no effective therapy at present, but if the degenerative joint disease through proper treatment, the pain can still be mitigated. When the acute attack should be a short rest. After the acute phase should be carried out appropriate activities and planned functional exercise. Old right and exercise, can enhance joint stability and improve muscle strength around the joints, slow down the degenerative changes occur. However, to avoid excessive activity and chronic damage. Diathermy, and a variety of massage techniques, can promote blood circulation, play a role in pain relief. Service Fenbid, indomethacin, Saridon, Ruili Fen and other drugs, can ease the pain. Chinese herbal medicine by promoting blood circulation can also relieve symptoms. There are limitations on the tender point of patients, can be partially closed from the anti-inflammatory, reduces swelling, pain, but does not eliminate joint degenerative changes, and should avoid long-term heavy use. If the application of the above treatments ineffective, significant joint deformity and joint dysfunction, may consider surgery. What is a degenerative joint disease of knee osteoarthritis and ossification of cartilage to bone and joint disease, knee degenerative joint disease, hypertrophic arthritis. Is a set of primary, disease developed slowly, mainly composed of violation of a knee joint synovial disease. The main features of its pathological limitations of the knee cartilage degeneration. Subchondral bone hyperplasia, sclerosis, joint marginal osteophyte formation, and joint deformities. Clinical manifestations of recurrent knee pain, synovial edema, joint stiffness, limited mobility. Radiographic examination, the performance of the knee space narrowing, subchondral bone hyperplasia, density increased, the formation of subchondral cysts and marginal osteophyte formation. First of degenerative changes affecting the knee joint cartilage, to form shallow beginning, and gradually extended to the deep, and finally violated the cartilage layer. Is now generally accepted view that can be, osteoarthritis (osteoarthrosis) is a cause not yet clear, mainly affecting the original healthy articular cartilage. In general the literature as "primary osteoarthritis," although that mainly occurs in the elderly, but of primary osteoarthritis of the articular cartilage Morphological, biochemical, and physiological characteristics of metabolic changes and other aspects of aging cartilage
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