Osteoarthritis in the elderly
Introduction
Introduction to osteoarthritis in the elderly Osteoarthritis (OA), formerly known as proliferative arthritis, degenerative arthritis, osteoarthrosis, etc., is a kind of slippery phenomenon in the elderly characterized by cartilage regressive and/or joint bone hyperplasia. Membrane joint disease, clinical manifestations of joint pain, stiffness and dysfunction, is generally considered to be non-inflammatory joint disease, in fact, long-term joints can also appear synovitis. basic knowledge The proportion of illness: 0.002% Susceptible people: the elderly Mode of infection: non-infectious Complications: periostitis, bone hyperplasia, osteoarthritis in the elderly, osteoarthritis
Cause
The cause of osteoarthritis in the elderly
Primary osteoarthritis:
The cause is still not clear, and the following factors are generally considered to be related to the disease.
(1) Age: The older the age, the more damage the joint accumulates. In addition, the amount of mucopolysaccharide in the cartilage matrix of the elderly is reduced, the fiber component is increased, the toughness of the cartilage is reduced, the fatigue resistance is reduced, and the mechanical damage is caused. Sexual change.
(2) Inheritance: Primary systemic osteoarthritis (GOA) has varying degrees of genetic factors. These patients have distal interphalangeal arthritis and Heberden nodules, and others have multiple chondrodysplasia, inheritance. Sexual bone-near dysplasia, congenital hip dysplasia.
(3) Obesity and sturdy body shape: significant body weight, increased joint load, poor posture and gait change the biomechanics of the joint, leading to joint degeneration.
(4) Diet: Increasing the vitamin C content of food in the animal model of Dutch guinea pig can protect the cartilage against damage. The low-calorie oriental diet has been used to explain why the incidence of hip disease in Chinese is low.
(5) Mechanical and traumatic factors: Long-term abnormal load can affect the resistance of articular cartilage, leading to degenerative changes of cartilage, such as acrobats, gymnasts, hips, elbows, spine, ballerinas, football players, High compression gas drill operators have a higher incidence of scapular arthritis.
(6) Various factors that can cause stagnant venous stasis and intraosseous hypertension.
Can lead to the onset or aggravation of osteoarthritis, Sun Gang, Wang Yongzhen through the animal experiment ligation of the lower extremity vein caused by the distal femur, increased proximal bone pressure of the humerus, can induce osteoarthritis, Chen Hanqing and other measurements by intraosseous pressure The intraosseous pressure in the osteoarthritis rest pain group was higher than that in the painless group and the active pain group.
(7) Others: such as endocrine disorders, low immune function, enzymes, interleukin IL, growth factors, etc. have a certain relationship with the onset.
Secondary osteoarthritis:
The following diseases are common:
(1) joint deformity: scoliosis and kyphosis can cause concave osteoarthritis, congenital dislocation of the hip, congenital hip dysplasia, hip varus, knee varus, knee valgus, etc. can cause lesions Articular cartilage injury at the site, and the onset of osteoarthritis with age.
(2) joint damage: ligament rupture, traumatic joint dislocation, intra-articular fracture, knee meniscus resection, etc. can cause joint instability caused by osteoarthritis.
(3) Other arthritis: septic arthritis, tuberculous arthritis, rheumatoid arthritis and other inflammation control, because the joint has suffered a certain damage, resulting in uneven joint surface, the future incidence of osteoarthritis is greater .
Articular cartilage softening:
In the early stages of the disease, there are small nodules formed by the deposition of calcium apatite in the bone. This crystallization can cause acute inflammation. Later, at the edge of the bone, there is osteophyte formation, that is, the spine and peripheral joints seen by radiology. Lip-shaped "protrusion" and "spurs", etc., in severe cases, the cartilage disappears in the late stage, bone destruction, resulting in sickness.
OA includes three stages: destruction, damage repair and inflammation. Cartilage is the transmitter of impact force. Subchondral bone is the absorber of impact force. Due to the microfracture of subchondral bone, cartilage changes due to various factors. The conduction becomes uneven, and the result is reshaping of the bone and hyperplastic changes of the joint edge. The meaning of this epiphysis or spur may be to further enlarge the articular surface to disperse the impact and simultaneously "crack" the joint to prevent Its activities to promote healing.
Prevention
Osteoarthritis prevention in the elderly
As the bone ages, the degeneration becomes more and more serious, and the natural course of the disease cannot be reversed. However, through reasonable and timely treatment, it can not only effectively relieve symptoms, improve joint function, prevent joint deformity, and improve quality of life.
OA is not an inevitable outcome for the elderly. In fact, changes often start in middle age and take longer to develop until the old age. In addition to age, obesity, occupational strain, sports injuries, etc. And the important factors of development, other arthritis-induced ligament or subchondral bone changes can accelerate the development of OA, any secondary osteoarthritis that can detect the cause, thus removing the risk factors and the cause of the disease is prevention Important measures for the disease.
Observing the movements of people of different age groups, it can be found that as the spine is shortened with age, the person's body is gradually shortened. Many elderly people lean forward slightly when they walk, the hips and knees are slightly flexed, and the gait is slow or even dragged. The time it takes to walk or run across a certain height is extended, because the magnitude of the stride is reduced at the same time as the speed of walking or running. If you adhere to age-appropriate physical exercise from the early years, you can prevent or delay this change. Prevention or delay of degenerative changes, in the absence of exercise or elderly people who have already developed OA, proper rest may prevent or reduce the role of traumatic factors, rest as the main conservative measure, apply to most joints of the body, heavy joint involvement Those who climb stairs, walk or stand too long should be reduced, those who are overweight, and lose weight will help reduce the burden on the joints.
Complication
Osteoarthritis complications in the elderly Complications periostitis bone hyperplasia elderly osteoarthritis osteoarthritis
Complicated with periostitis, joint damage or joint deformity.
Symptom
Symptoms of osteoarthritis in the elderly Common symptoms Disc herniation traumatic dull pain Knee varus rheumatoid arthritis Back pain hardening Joint deformity Joint pain nodules
Pain
It is characterized by insidious seizures, persistent dull pain, and more often after joint activity. Rest can be relieved. Because of muscle damage around the joints during sleep, the joint protection function is reduced, and the movement causing pain cannot be restricted as in waking. The patient may wake up. .
2. Morning stiffness and adhesion
The morning stiffness of this disease is relatively short, generally no more than 15min. After the adhesive joint is static for a period of time, it feels stiff when starting activities. If it sticks to the general, it is more common in the elderly, lower limb joints, and can be improved after the activity.
3. Other symptoms
As the disease progresses, joint deformity, instability, rest pain, increased pain during weight bearing, dysfunction due to poor joint surface joints, muscle spasm and contraction, joint capsule contraction, and mechanical atresia caused by bone spurs or joint rats may occur. In the weight-bearing joint, sudden loss of function can occur.
OA performance is often limited to certain joints, unlike rheumatoid arthritis, which spread from the first onset joints and other joints, the general symptoms are mild, accompanied by moderate pain, rarely affecting activities unless invading the weighted joints, such as the hips, knees , the spine, generally does not affect the function or cause disability, many patients find the lesions during radiological examination, because the disease is related to the long-term wear and tear of joint movement, therefore, it occurs mostly in the hips, knees, spine and fingers, these joints are in motion The part subjected to the maximum stress is most susceptible to damage. Conversely, joints such as wrists and ankles where stress is dispersed to multiple articular surfaces are rarely involved.
The natural passage of OA and its influence on function and treatment vary depending on the site of invasion.
1 hand: OA in the elderly is mostly limited to the interphalangeal joint of the hand, the lesion occurs in the dorsal bone, the distal interphalangeal joint is called Heberden's nodule, and the proximal interphalangeal joint is called Bouchard's knot. Section (the latter is often mistaken for rheumatoid nodules), often with little or no symptoms, such as a finger-foot or side-shift, a serpentine appearance, occasionally invading the first metacarpophalangeal joint, the first metacarpal Joint involvement with the majority of the bones, local swelling, thumb adduction, intermuscular muscle atrophy, subluxation at the base of the metacarpal, forming a so-called "square hand" deformity.
2 hips and knees: OA of these two joints is the most vulnerable to joint function and lead to disability. The main symptom is joint pain, which starts with unilateral, but quickly involves the contralateral side. Hip pain can be released to the inside of the rat's ankle or knee. The joint activity is limited in all directions, with obvious extension and internal rotation. The knee joint has local tenderness, mostly at the medial temporal or medial ligament attachment point, causing knee varus or valgus deformity. If there is synovial fluid, Then bulging in the knee joint, which can form swelling called Baker's cyst.
3 Spinal column: The affected spinal joint includes the intervertebral disc, the posterior condyle joint and the Lushka joint. It is located at the posterior margin of the vertebral body. Because the cervical nerve root and the Lushka joint are very close, the former is most susceptible to the stimulation and compression of the joint and its nearby degeneration. It is usually seen in the largest spine part of the neck 5, neck 8, waist 3 ~ 4, etc. The characteristics of pain and the nervous system are seen, depending on the level of involvement; pain often occurs in the trapezius muscle region of the clavicle, but also widely Dissipation to the neck, occipital, cervical disc herniation or osteophyte reaction can cause painless progressive myelopathy. Vertebral spur compression of the vertebral artery can produce dizziness or visual impairment, intervertebral disc, osteoarticular joint, and various degeneration of the paraspinal ligament. Lesions can cause low back pain, the most common cause of back pain with back pain is intervertebral disc prolapse, intervertebral disc prolapse can occur in any plane, but more than 90% occur in lumbar 4 and lumbar 5 ~ 1, proliferative degeneration of intervertebral joints Spinal stenosis caused by arthrosis, characterized by radiculitis and a neurogenic claudication, primary systemic osteoarthritis refers to the most middle-aged women a degenerative joint disease, but the inflammation is beyond normal. In addition, there is an osteosynthesis (erosive osteoarthritis), a syndrome characterized by destructive changes in the interphalangeal joint, occasionally in menopausal women. It is characterized by jumping pain in both hands and obvious at night. The small joints of the hands are often swollen and red, and the knees and cervical vertebrae are less invaded. Radiological examination shows joint erosion, narrow joint space, marginal hyperplasia, and erythrocyte sedimentation rate may accelerate in the acute phase. Return to normal when it subsides.
Atypical symptoms: OA development may also have acute inflammation and pain, but the time is very short, the affected joint may have been traumatized in the past, and several joints occasionally attack at the same time, although the cause of each joint injury may be different, OA can be combined with the shoulder in the elderly Fibrotic inflammatory pain occurs in the periorbital tendon or elbow palpebral and hip trochanteric sac. This condition may be similar to systemic diseases such as rheumatoid arthritis, joint stiffness and viscous state (gelling ) Also seen in OA, but the time is short, after exercise, hyperthermia and medication are easy to relieve.
The diagnosis of osteoarthritis is generally based on clinical manifestations and signs. Since the disease is not a systemic disease, serological tests are only used to expel other rheumatic diseases.
X-ray plain film examination is the most important means. Typical X-ray findings include osteophyte formation, narrow joint space, subchondral bone sclerosis and cystic cavity formation. In some joints, such as the knee joint, it can be filmed at the weight position. Thus, the joint space is narrowed, and there is a serious accumulation of joint fluid. The typical synovial fluid is often clear or light yellow, moderate to severely viscous, and the number of white blood cells is often less than 3000/mm3 (non-infected). Sex), other components (such as articular cartilage fragments or calcium-containing crystals, etc.) are also visible.
Examine
Examination of osteoarthritis in the elderly
There is no specific laboratory index for this disease. Most patients have normal erythrocyte sedimentation rate, C-reactive protein is not increased, rheumatoid factor and autoantibody are negative, joint fluid is yellow or yellowish, viscosity is normal, coagulation test is normal, and white blood cell count is less than 2×109. /L, the sugar content is rarely less than 50% of the blood sugar level, which can be distinguished from autoimmune joint disease.
ESR is generally normal in OA, but it should be noted that the blood sedimentation has a tendency to increase with age. In elderly patients with OA, the moderate increase in erythrocyte sedimentation rate is not necessarily indicated as rheumatoid arthritis (RA), but one has Patients with extensive stiffness and arthritis have a sudden increase in erythrocyte sedimentation rate, which may indicate that the patient has RA. Because OA is very common, RA often occurs in patients with existing OA. If the OA of the interphalangeal joint begins to have symptoms and signs of inflammation, And cause rigidity, it is likely to be RA. Conversely, RA can also occur in the late stage of natural processes. If diuretic-induced hyperuricemia, cartilage calcification and OA occur simultaneously, it will cause more diagnostic difficulties.
Imaging examination is very important for the diagnosis of this disease. X-ray findings are mainly joint space stenosis, subchondral bone sclerosis and cystic changes, joint edge osteophyte formation, articular surface collapse, deformation and joint subluxation, etc. MRI can show Early cartilage, meniscus and other joint structure lesions are conducive to early diagnosis, CT for the diagnosis of intervertebral disc disease, better than X-ray.
The joint space is narrowed, the subchondral bone is hardened, the marginal bone spurs are connected to the osteogenesis bridge, and bone cysts and deformities are also seen. If these changes are found, they can be used as a basis for diagnosis and estimate the degree of joint damage, but the degree of radiological changes is not It must be completely consistent with clinical manifestations. OA usually has no or few symptoms at an early stage. Only when it is secondary to inflammation, pain or affecting joint activity, the patient only seeks a doctor. At this time, joint damage has occurred for a long time, and pain is in individual patients. It can also occur before radiological changes. Radiological changes are often often used to explain clinical symptoms. For example, spine changes are used to explain back pain. In fact, back pain is mostly caused by factors such as mental and emotional stress, and has little to do with the disease.
Diagnosis
Diagnosis and diagnosis of osteoarthritis in the elderly
Diagnosis of osteoarthritis relies on typical clinical manifestations, signs, and radiological examinations, but in the early stages of the disease, it is more difficult to diagnose when clinical manifestations are atypical or if no significant pathological changes have occurred.
In the early stage of osteoarthritis, physical examination and radiological examination may be normal. The diagnosis at this time is generally joint pain caused by weight or activity, accompanied by morning joint stiffness, and the site of the disease meets the characteristics of the disease, serum Rheumatoid factor negative, erythrocyte sedimentation rate, C-reactive protein negative, etc. is conducive to the differential diagnosis of the disease, the disease should be distinguished from rheumatoid arthritis, infectious arthritis, crystalline arthritis, rheumatoid arthritis most often involved The joints are lumbar vertebrae and finger joints, often accompanied by increased rheumatoid factor titers and different bone destruction characteristics.
Crystal precipitates, especially calcium pyrophosphate precipitates, are also common in the joints of the elderly. They can be found in the same joint as osteoarthritis in the elderly. Therefore, the formation of these crystal precipitates may be related to the pathological changes of osteoarthritis. In patients with osteoarthritis, if there is acute pain and there is swelling of the unilateral joint, a joint fluid test should be performed to rule out the possibility of other diseases, such as arthritis or infectious arthritis.
