Osteoarthritis can start at the age of 20, but most of them are asymptomatic and generally difficult to find. The prevalence of osteoarthritis increases with age, and women are more common than men. According to the statistics of the World Health Organization, the incidence of osteoarthritis in people over 50 years old is 50%, and that in people over 55 years old is 80%. According to foreign surveys, in the 45-64 age group, 25% of men and 30% of women have obvious X-ray evidence of osteoarthritis. In the age group aged 65 or above, the proportion of men rose to 58% and that of women rose to 65%. Through clinical investigation, it is also confirmed that the incidence of osteoarthritis accounts for 29% between 59 and 69 years old, and about 70% over 75 years old. In China, people over 60 are classified as the elderly. It is estimated that by the end of this century, the elderly population in China will reach 654.38+0 billion. If the incidence of osteoarthritis is roughly estimated by borrowing the above-mentioned foreign surveys, the number of elderly osteoarthritis patients in China can reach about 50 million. Because of this, osteoarthritis is also called "the disease of the second half of life". From 65438 to 0999, the World Health Organization listed osteoarthritis, cardiovascular disease and cancer as the three major killers threatening human health.
Etiology and classification
The main pathological change of osteoarthritis is cartilage degeneration and disappearance, and osteophyte is formed at the attachment of ligament and subchondral bone, which causes joint pain, ankylosing deformity and dysfunction.
In general, the friction between joints is very small and will not cause wear unless it is overused or damaged. The most likely cause of osteoarthritis is the abnormality of synthetic cartilage components, such as collagen (a tough fibrin in connective tissue) and mucin (a substance that produces cartilage elasticity). In addition, although cartilage grows vigorously, it is very thin and its surface is easy to break. Bone overgrowth at the edge of the joint forms a visible and palpable mass (called osteophyte). Osteophytes cause uneven articular surface, interfere with normal joint function and cause pain.
Osteoarthritis can be divided into primary and secondary clinically. Primary osteoarthritis refers to osteoarthritis whose cause can't be found by all examination methods at present, and the commonly mentioned osteoarthritis belongs to this category; Secondary osteoarthritis refers to pathological changes induced by other causes or diseases, such as trauma, rheumatoid arthritis and neuroendocrine diseases. The pathological changes of this kind of osteoarthritis are relatively limited, and there are no Hebden nodules. People who repeatedly sprain their joints are at high risk of osteoarthritis, such as foundry workers, miners and bus drivers. However, people who do long-distance running are not the high-risk group of this disease. Obesity is the main cause of osteoarthritis, but the evidence is not sufficient at present.
First, non-drug therapy
There are many non-drug treatments, including health education, self-training, weight loss, aerobic exercise, joint mobility training, muscle strength training, the use of walkers, knee varus wedge insoles, occupational therapy and joint protection, and auxiliary facilities for daily life. A considerable number of patients in Europe and America can alleviate symptoms and return to normal life and work through the above treatment. China's investment in this area and the concept of medical staff are still relatively weak, and medical staff at all levels should pay attention to strengthening this work in the future.
Patients with knee osteoarthritis often suffer from weakness of quadriceps femoris muscle strength, which used to be thought to be caused by disuse atrophy. However, recent studies abroad believe that quadriceps femoris muscle weakness is not entirely caused by osteoarthritis, but may be one of the risk factors of knee osteoarthritis. Due to the weakening of quadriceps femoris muscle strength, the stability of knee joint is affected, and the buffering capacity of normal muscles is reduced. Therefore, strengthening muscle strength training and aerobic training of quadriceps femoris is beneficial to patients with osteoarthritis.
Is there a specific medicine for osteoarthritis?
(1) Sodium hyaluronate (Archie, Helgen, Spert): It is the main component of synovial fluid in joint cavity and one of the components of cartilage matrix, which plays a lubricating role in joints and reduces the friction between tissues. After being injected into the joint cavity, it can obviously improve the inflammatory reaction of synovial fluid, enhance the viscosity and lubrication of synovial fluid, protect articular cartilage, promote the healing and regeneration of articular cartilage, relieve pain and increase the number of articular cartilage. Intra-articular injection, 1 time 25mg, 1 time for 5 weeks, must be strictly sterile.
(2) glucosamine sulfate (vitiligo, Jiejiekang. Glucosamine): As the most important monosaccharide in articular cartilage matrix, normal people can synthesize GS by glucosamine, but the synthesis of GS in chondrocytes of patients with osteoarthritis is blocked or insufficient, which leads to the softening and loss of elasticity of cartilage matrix, the destruction of collagen fiber structure, the increase of cartilage surface cavities and the wear and tear of bones. Glucosamine can block the pathogenesis of osteoarthritis, promote chondrocytes to synthesize proteoglycan with normal structure, inhibit the production of enzymes (such as collagenase and phospholipase A2) that damage tissues and cartilage, reduce the damage of chondrocytes, improve joint mobility, relieve joint pain and delay the course of osteoarthritis. Oral 1 time, 250-500 mg, 1 time, three times a day is the best, lasting for 4- 12 weeks, which can be repeated 2-3 times a year, and the interval between repeated treatments should be 1-2 months.
(3) Non-steroidal analgesic and anti-inflammatory drugs: can inhibit the synthesis of cyclooxygenase and prostaglandin, resist inflammatory reaction, and relieve joint edema and pain. Ibuprofen/kloc-0, 200 ~ 400 mg each time,/kloc-0, three times a day; Or glucosamine 1 time 200mg, 1 time 3 times a day; Nimesulide 1 time 100mg, 1 time twice a day, with a course of 4-6 weeks.
Source of information: experts on the website of China Pharmaceutical Association.
Third, intra-articular injection therapy.
This is also a treatment that can relieve joint symptoms. Commonly used drugs are hyaluronic acid preparation and glucocorticoid. The former has been used clinically in China for some time and has a certain curative effect. The mechanism of action is mainly to inhibit inflammatory mediators, such as cytokines and prostaglandin; Stimulate cartilage matrix synthesis and inhibit cartilage degradation; However, the analgesic effect appears slowly. The analgesic effect of glucocorticoid appears soon. It is worth noting that intra-articular injection therapy is an invasive operation. In order to avoid iatrogenic intra-articular infection, the application of glucocorticoid should be cautious.
Fourth, surgical treatment.
If the symptoms of osteoarthritis are very serious, drug treatment is ineffective and affects the daily life of patients, surgical intervention should be considered. For knee osteoarthritis, some people advocate arthroscopic joint dissection first. This kind of operation has a certain effect on some patients in the near future, but the long-term effect is not necessarily. For most patients with osteoarthritis, femoral head necrosis and rheumatoid arthritis, joint replacement surgery has a significant effect in relieving pain and restoring joint function. However, due to some short-term and long-term complications of joint replacement surgery, such as loosening and wear of components and osteolysis, these complications can not be completely solved at present. Therefore, it is very important to strictly grasp the surgical indications of joint replacement. Strictly speaking, surgical indications include: ① radiological evidence of joint injury; ② Moderate or severe persistent pain or disability; (3) For all kinds of patients who are ineffective in non-surgical treatment.
Because the effect of artificial joint replacement is closely related to the length of operation, the doctor's experience, the patient's preoperative physical condition, perioperative management, rehabilitation training and so on. Therefore, a good joint surgeon should have all kinds of knowledge, be well-trained and skilled, and be competent for artificial joint replacement independently.
Besides, I have a good news for you. The third-generation aminoglycoside nutrition developed by China has been marketed, which contains glucosamine, chondroitin sulfate, keratin sulfate, hyaluronic acid, collagen, Vc and other substances, and can comprehensively promote the regeneration of articular cartilage. It is the most reasonable formula for conservative treatment of osteoarthritis at present. I suggest you try.
D- glucosamine hydrochloride
D- glucosamine hydrochloride
Content (98% ~ 102%)
Specific curl [a] 20d+72 1?
Loss on drying ≤ 0. 1%.
Residue on ignition ≤ 0. 1%
Heavy metal ≤ 10 ppm
Iron salt (iron ion) ≤ 10ppm
The pH value is 3.5 ~ 5.0
Chloride 16.2% ~ 16.7%
The production capacity (ton/meter) is 40 tons.
D- glucosamine sulfate (potassium salt)
D- glucosamine sulfate
Project project
canonical parameter
exterior
white crystal
Content content
98 % ~ 10 1 %
Drying loss
≤ 0.5 %
Ignition residue
26.8 % ~ 29.8 %
Specific curl [α]
+ 50 ~ + 54
Chlorinated substance chloride
≤ 12 %
PH
3.5 ~ 4.5
Iron salt iron
≤ 10 PPM
Heavy metal
≤ 10 PPM
Arsenic salt
≤ 0.5 PPM
Bulk density
0.85 ~ 1.0 g/ml
total number of bacteria
& lt5000 PCs/g
Escherichia coli
No negative effects.
salmonella lignieres
No negative effects.
Yeast and mold
& lt 100 PCs/g
D- glucosamine sulfate (sodium salt)
D- glucosamine sulfate
Project standard parameters standard parameters
Appearance white crystal white crystal
The content is 98% ~ 10 1% 0%
Loss on drying ≤ 0.5%.
Residue on ignition residue on ignition 23.7% ~ 25.8%.
Specific curl [α]+50 ~+54 54
Chloride chloride ≤ 12%
The ph is 3.5 ~ 4.5.
Iron salt iron ≤ 10 PPM
Heavy metal ≤ 10 PPM.
Arsenic salt ≤ 0.5 PPM
The bulk density is 0.85 ~ 65438 0.0g/ml.
total number of bacteria
Escherichia coli. Escherichia coli is not negative.
Salmonella. Salmonella is not negative.
Yeast and mold
N- acetylglucosamine
N- acetylglucosamine
CASNo.: 75 12- 17-6
Appearance: white shining needle crystal
Clarity: clarity
Loss on drying ≤0.5%
Chloride content ≤0. 1%
Residue on ignition ≤0. 1%
Specific curl [α] D20+39 ~+42
Melting point: 196 ~ 205℃
Purity: ≥99%
Heavy metal: ≤ 10ppm
Iron salt: ≤ 10ppm
Arsenic: ≤0.5ppm
Uses: It is mainly used to enhance the function of human immune system, inhibit the excessive growth of cancer cells or fibroblasts, and play a role in inhibiting and treating cancer and malignant tumors. Can effectively treat various inflammations; It also has therapeutic effect on osteoarthritis and joint pain.
At present, amino sugar products on the market are roughly divided into three generations.
1 In short, glucosamine, glucosamine sulfate and glucosamine hydrochloride are commonly used to treat osteoarthritis.
The second generation is amino sugar plus mucopolysaccharide plus MSM (dimethyl), and some products add some calcium and so on.
The third generation amino sugar is added with mucopolysaccharide (including hyaluronic acid, keratin sulfate and chondroitin sulfate), collagen and some vitamins.
For patients with mild to moderate osteoarthritis, aminoglycosides can play a very good therapeutic role. For patients with severe joint deformity, it is also a wise choice to cooperate with aminoglycosides and collagen after operation to recover and prevent recurrence.
In terms of price, 1 generation products are mostly around 200 yuan every month.
The third generation is around 300 yuan every month.
If you are in Beijing, you can attend lectures on bone and joint knowledge and get bone and joint information for free.
If you don't understand anything, you can call me at 010-87991301Zhang Jianqing.