Degenerative joint pathology

2021-01-26 12:00 AM

Some special imaging methods can early detect lesions of articular cartilage and disc such as tomography, density tomography

Outline

Define

A chronic disease of joints including the spine that causes pain and deformation.

Epidemiology

The disease occurs in all ethnic groups, men and women are equally affected. The higher the age, the higher the rate.

Bach Mai Hanoi Hospital: osteoarthritis accounts for 10.41% in the department of musculoskeletal.

In France, osteoarthritis accounts for 28.6% of osteoarthritis diseases.

America: 80% of people> 55 years old with X-ray sign are osteoarthritis.

The most common order for osteoarthritis is the lumbar spine, neck spine, pillow, groin.

Causes and mechanisms

Ageing

It is the main cause of primary osteoarthritis, which appears late, usually in the elderly (> 60), many locations, progressing slowly, not seriously. Cartilage cells age, the ability to synthesize substances that makeup collagen fibres and mucopolysaccharides will decrease and disorder, cartilage quality will deteriorate, bearing capacity and elasticity decrease, moreover, adult cartilage cells do not have the fertility and regeneration.

Mechanical factors

Mainly causes secondary osteoarthritis, common in young people (under 40 years old), localized to a few locations, severe and rapidly progressing. This factor is represented by an abnormal increase in compression on the joint, called an overload phenomenon. Including:

Excessive weight gains due to obesity, an increase in occupational load.

Secondary joint deformation after injury, inflammation, tumour, dysplasia changes the morphology and correlation of the joint.

Birth defects change the compressed area of ​​the joint faces.

Another factor

Genetics: premature aging.

Endocrine: menopause, diabetes mellitus, endocrine osteoporosis.

Metabolism: gout disease, dark brown skin disease.

New trend

The latest studies have focused on the effects of growth factors and cytokines on the metabolic activity of cartilage. It is now well known that proinflammatory cytokines, especially Interleukin 1 (IL-1) and TNF-α, are capable of causing cartilage cells to secrete metalloproteinases such as collagenase and stromeolysine, which enhance destruction. cartilage and resulting in irreversible cartilage destruction. In human cartilage cytokines work mainly by inhibiting synthesis rather than by stimulating the breakdown of cells. However, it is still unclear what other factor can stimulate cartilage cells to increase their molecular activity in the early stages.

Pathology

The basic lesion of the disease is degenerative cartilage and disc, changes in the bone below the cartilage and synovial membrane.

Joint cartilage and disc are yellow brown, opaque, dry, soft, lose elasticity, thin and crack, there may be ulcers, the cartilage organization is destroyed to reveal the bone below the cartilage, the nucleus Disc mucus loses swelling and becomes flattened.

Micro-cartilage cells are sparse, the collagen fibers are broken, broken in many places, structure is messy, there are thickening of the bones under the cartilage and there are small holes in the synovial fluid. The junction between bone and cartilage grows bone spines.

Symptom

clinical

Pain: Pain with movement and relief with rest, called "motorized" pain.

Location: Joint or segment of the spine is degenerated, less spread unless there is compression of roots and nerves.

Characteristics: Dull pain, may have spinal attacks appear and increase with movement, change of position, pain relief at night and at rest (other pain caused by inflammation). Pain without swelling, heat, redness, or fever.

Evolution: In waves, long and short depending on the case, but it is possible to increase pain continuously (secondary joint degeneration), after which the pain may be gone, and then another recurrence.

Restriction of movement: Due to pain and when much restraint is usually caused by muscle contraction reactions. Patients may not be able to do some movements such as neck rotation, ground close, squatting ..., some patients show signs of "joint leakage" in the morning or at the beginning of the movement.

Deformation: Due to growth of bone spines, dislocations or herniated synovial membrane.

Other symptoms:

Muscle atrophy: Due to inactivity.

Joint effusion: due to congestive reaction and synovial fluid secretion, usually found in the knee joint.

Exercise scratching: of little value because it can be found in normal people or in other ailments.

X-ray

There are 3 basic signs:

Joint stenosis: Uneven narrowing, irregular margin, decreased disc height in the spine. Narrow but never joint.

Characteristics of bones under cartilage: The bone head, concave vertebrae have a dark translucent shape (much contrast) in the dense bone, showing some small brighter niches.

Osteomalacia: At the junction between bone, cartilage and synovial membrane, at the outer edge of vertebral body. The bone spines are coarse and bold (different from the bridge of the bone), some fragments of the bone spines fall out of the joint or soft around the joint.

Some special imaging methods can early detect the lesions of articular cartilage and disc such as: tomography, density tomography, contrast injection into the joint, into the disc.

Other tests

Blood and joint fluid tests: nothing have changed.

Arthroscopy: Seeing degenerative lesions of articular cartilage reveals fragments of bone spines falling in the joint.

Synovial membrane biopsy: To differentiate other joint diseases.

Diagnose

Implementing the quadrants

Onset: Age, mechanical agent, history.

Clinical symptoms.

X-ray signs.

Differential diagnosis

Distinguishing from inflammatory joint diseases: Mainly based on inflammatory markers.

Treatment

Current treatments are aimed at relieving pain and restoring joint function. The goal of osteoarthritis treatment remains to motivate the patient's morale, preserve joints, exercise against muscle atrophy and impair joint function. Use nonsteroid pain relievers or anti-inflammatory drugs, corticoid injection topical. Coordinate internal medicine, physics, surgery.

Medical

Pain relief:

Aspirin. 1-2g / day - in divided doses. Acetaminophen: 1.5 -2 g / day.

Anti-inflammatory nonsteroid. Diclofenac 100 - 150mg / day. Piroxicam 20mg / day. Meloxicam 15mg / day. Célécoxib 100-200mg / day.

Since many patients have the disease in old age, it is necessary to monitor liver and kidney function before and after treatment with nonsteroid anti-inflammatory drugs, especially for patients on prolonged drug administration.

Do not use systemic corticosteroids, when pain and swelling can be used topically.

Increases cartilage nutrition. Effects of uncertainty such as: sex hormones (Testosterone), anabolic enhancement drug. Philatop, high bone ...

Slow acting drugs:

Glucosamine sulphate. As the sulfate compound of natural Glucosamine amino monosaccharide. Glucosamine, a natural component that constitutes glycosaminoglycan in joint cartilage and synovial fluid. The mechanism of action of Glucosamine sulphate so far is not completely clear. Effects such as inhibition of superoxide free radicals, inhibition of nitric oxide biosynthesis are also an explanation of the rapid effect of the drug in short-term clinical trials. However, in a long-term clinical trial, the effect of the drug is probably due to metabolic changes of articular cartilage, including stimulating anabolic activity such as increased synthesis of proteoglycan, and reduced catabolic activity of articular cartilage as above. metalloprotease enzymes. Presentation and dosage: 0.25g tablet, 1.5g pack. The daily dose is 1.5g. Time of use: many years. The drug has a high safety, no side effects have been reported.

Chondroitin sulphate. Works by inhibiting cartilage-digesting enzymes, especially metalloprotease. Presented in the form of tablets, the average dose: 3 tablets per day. Time of use: at least 1-2 months.

Several drugs are being tested. Includes chloroquine, Doxycycline, a synthetic glycosaminoglycan or hyaluronate, which can enhance cartilage recovery or reduce cartilage destruction or both.

Oil replacement therapy. In osteoarthritis, there is a decrease in the concentration and molecular weight of hyaluronic acid, which reduces the mucus of the joint fluid. So, injected into the joint hyaluronic acid high molecular weight has the effect of replenishing the mucus of the joint fluid. Presented in the form of sodium hyaluronate (Hyruan) tube 200mg / 2.5ml. Dosage and administration: depends on large joints, small joints.

For knee joint: Inject into the joint 1 time, 2.5ml / week for 5 consecutive weeks. Side effects: mild pain, a feeling of heaviness in the joint after injection.

Physical therapy

Exercises for each osteoarthritis position.

Manual treatment: massage, acupressure, exercise.

By heat: infrared rays, hot mud, paraffin.

By water: mineral water, hot water, swimming.

Use orthopaedic tools.

Simple treatments, including physical therapy, acetaminophen, or nonsteroid anti-inflammatory drugs, have been shown to relieve pain in more than 70% of patients with early osteoarthritis.

Surgery

Correction of joint deformities by chisels and bone grafting, disc herniation treatment, joint stiffening in functional posture, artificial joint transplant.

Prevention

In daily life

Preventing bad postures in living and working.

Avoid strong, sudden, or incorrect posture when carrying or carrying.

Fight obesity with diet and exercise.

Workers with heavy labour periodically check for early detection and treatment.

Detect defects

Of bones, joints, spine to take orthopaedic measures, prevent secondary degeneration.

Examination of children

Early treatment of rickets, knee joint defects: bent legs, walking around, horse feet, hunchbacked spine.