osteitis deformans
Introduction
Introduction to osteoarthritis Deformative osteitis refers to a chronic bone disease characterized by unexplained etiology, rheumatoid arthrodesis, spinal and limb deformities, pathological fractures and brain and spinal cord compression symptoms, also known as Paget's disease and malformation. Osteitis. The incidence rate varies greatly depending on region, race and age. It is more common in Western Europe, Australia, New Zealand and other regions, and rare in Africa and East Asia (including China). Both men and women can develop symptoms, often occurring in those over 40 years old, and 15% have a family history. basic knowledge The proportion of illness: 0.002% Susceptible people: no specific people Mode of infection: non-infectious Complications: fractures, deafness
Cause
Causes of osteoarthritis
Virus infection (40%):
It has been found by electron microscopy that there is an RNA virus nucleocapsid in the cytoplasm and nucleus of osteoclasts in the lesion site, and it is speculated that the paramyxovirus infection may be related to the disease. However, similar structures have recently been found in osteoblasts of bone giant cells and osteoblasts of osteopetrosis. Other studies have found that measles virus and canine distemper virus infection may also be associated with this disease. The relationship between viral infection and malformation osteitis has not been further confirmed and verified by animal models.
Genetic (30%):
15% to 30% of patients have a positive family history, suggesting that the disease has a genetic predisposition. It has been reported that the disease is autosomal dominant, and it has been reported that this disease is associated with HLA-DQw1 antigen, but it has not been widely verified.
Prevention
Osteoarthritis prevention
1. Primary prevention:
Primary prevention measures are taken in response to the risk factors for their occurrence and development. In primary prevention, consideration should be given to changing risk factors that have a universal effect, as well as changing risk factors with special effects.
(1) weight loss; (2) prevention of joint damage; (3) prevention of occupational joint chronic strain; (4) hormone replacement therapy; (5) prevention of other diseases.
2. Secondary prevention:
Early diagnosis and early treatment.
(1) Adjustment and lifestyle changes: its purpose is to reduce the load on the affected joints, reduce or avoid further strain on the affected joints. Patients are required to: A. reduce the total amount of exercise per day; B. avoid or reduce knee flexion; C. adjust the type of work if necessary; D.
(2) Medical gymnastics: The purpose is to maintain or improve the range of joint motion and increase muscle strength, thereby indirectly reducing joint load and improving patient exercise capacity. Medical gymnastics includes: A. Joint gymnastics: maintain or increase joint mobility to prevent joint contracture. B. Isometric exercises: Make the muscles contract for isometric contraction (static tension, no joint movement), which is an effective way to strengthen muscle strength and prevent disuse muscle atrophy. The isometric contraction lasts for 5 s each time, and then it can be repeated after 30 to 40 repetitions. C. Stretching: stretching the muscles and tendons around the joints, preventing contractures, and improving muscle coordination, improving gait in patients with lower extremity osteoarthritis. D. Endurance exercise: Generally, the bicycle is fixed and the appropriate endurance exercise is carried out under the weight of the knee joint. The time is usually no more than 8 to 10 minutes. It can also be used for swimming, walking on the ground, etc., but it is not suitable for uneven roads. Or walk on the slopes. E. Note: When there is an acute exacerbation or severe pain in osteoarthritis, the medical gymnastics is suspended, or only a few muscles of equal length contraction are practiced.
(3) Joint protection: A series of simplified and effortless actions to reduce the load on the joints are used to complete daily activities so that the affected joints are not strained.
(4) Nutrient intake of antioxidants.
(5) Quit smoking.
(6) drug treatment.
Complication
Obstructive osteitis complications Complications, fractures, deafness
Bone pain, skeletal deformity; pathological fracture; secondary arthritis; neurological complications such as spinal stenosis, incomplete paralysis or paraplegia; deafness.
Symptom
Deformative osteoinflammation symptoms Common symptoms Paraplegia gait skull enlargement fatigue bone pain varicose vein ectopic calcification
Most often asymptomatic, with insidious onset, symptoms of pain, stiffness, fatigue, bone deformity, headache, hearing loss, increased head, Paget bone pain is deep soreness, occasionally severe pain, night can be aggravated, pain also It can be caused by nerve compression or related to osteoarthritis.
Signs for the cranial enlargement of the crotch, forehead bulge, scalp varicose veins, one or bilateral neurological deafness or otosclerosis, vascular-like lines on the fundus, short torso on the torso, shaped like apes, gait, femur or calf Anterior lateral flexion and periosteal tenderness and temperature rise, hearing loss, spinal stenosis, incomplete paralysis or paraplegia are manifestations of nerve compression, because Paget bone disease is a metabolically active and severely affected blood vessel, it can occur high Painful heart failure, osteoarthritis of curved long bones and adjacent joints can develop into a deformity, pathological fractures can occur, and sarcoma degeneration occurs in about 1% of patients, and the pain is becoming more and more severe.
Examine
Examination of osteoarthritis
The disease is often accidentally discovered by X-ray and laboratory tests for other reasons. X-ray examination of the diseased bone is characterized by increased density, structural abnormalities, cortical thickening, bending and overgrowth, microfracture of the tibia or femur, laboratory The results showed that serum alkaline phosphatase increased, urinary excretion of hydroxyproline increased, serum calcium and phosphorus levels were generally normal, and bone radionuclide scanning (-labeled phosphate) showed local intake of nuclides in Paget lesions. increase.
Diagnosis
Diagnosis and differentiation of osteoarthritis
diagnosis:
Most patients with osteoarthritis have no clinical symptoms and are difficult to diagnose in the middle and early stages of the disease. Patients with the following clinical symptoms should be suspected of osteoarthritis and further examination:
1. The head is increasing year by year, accompanied by deafness or other symptoms of cranial nerve damage;
2. The upper and lower limbs have an arched deformity that progressively worsens;
3. Pathological fractures of unknown cause;
4. Unexplained blood ALP increased. X-ray examination helps to diagnose the affected area.
Differential diagnosis:
Bone end involvement, sharp boundary of the osteolytic zone, wedge-shaped translucent area, extensive sclerosis, increased bone volume, thickening of the trabecular bone, etc. help to distinguish from other diseases. Extensive bone density increases should be differentiated from bone metastases (especially prostate cancer bone metastases), myelofibrosis, renal osteodystrophy, skeletal fluorosis, fibrotic dysplasia, and tuberous sclerosis. Skull hypertrophy can occur when deformed osteitis involves the skull, and should be differentiated from frontal plate hypertrophy, fibrosis, anemia, and bone metastases. The pelvic sclerosis of this disease is asymmetrical or unilateral, the affected bone is enlarged, and the trabecular bone is thickened. When the spine is involved, the diseased vertebral body is framed and densely surrounded. The hemangioma is characterized by longitudinal trabecular thickening, and the renal osteopathy is characterized by a football scalloped spine in addition to the disease of the kidney itself.
