Degenerative arthritis and treatment

Osteoarthritis is a common disease of the elderly. This is a disease of the cartilage and discs, depending on age and occupation.

Characteristics of cartilage and some causes of degeneration:

Joints include ligaments, muscles, tendons, cartilage, and joint capsules (with a synovial membrane lining the inside). Ligaments attach joints together and stretch rhythmically; muscles contract and stretch to make joints move; tendons attach bones to the body to transfer muscle contraction to bones; joint capsules contain synovial fluid: which lubricates the joint, helping the joint to move smoothly and synovial fluid also nourishes the joint. Cartilage is a component of the protective cushion, playing an extremely important role in avoiding friction between the two ends of the bone during movement, lubricating the joint surface and preventing or dispersing the force acting on the surface of the cartilage, protecting the bone ends.

The characteristics of the articular cartilage layer are a transparent tissue layer that is both hard, tough and elastic. Articular cartilage is composed of two main components: cartilage cells and ground substance. Cartilage cells are incapable of reproduction and regeneration after adulthood and therefore there are no new cells to replace dead cells.

The matrix has many different components such as: water, proteoglycans and collagen fibers. Proteoglycans contain a protein core and glycosaminoglycan chains on the side and are mainly chondroitin sulfate and keratan sulfate. The proteoglycan bodies are connected to hyaluronic acid. Other glycosaminoglycans and proteins associated with this structure ensure the stability and durability of cartilage. In the matrix, the most important role is collagen type 2 (UC-II), accounting for 85 - 90%.

Articular cartilage has no blood vessels or nerves passing through it, so it is nourished by osmosis through the subchondral bone tissue, synovial membrane and synovial fluid. Therefore, cartilage is very susceptible to silent degeneration over the years with almost no warning signs. Statistics show that about 50% of people over 65 years old have X-ray images of cartilage degeneration - arthrosis and most people over 75 years old have at least one degenerative joint.

Medical advice

It should be noted that you should only choose one of the non-steroidal anti-inflammatory drugs. You should not combine two or more drugs in the same group because combining many types will increase the risk of complications but the treatment effect will not increase.

Some of the main causes of cartilage degeneration are most often mentioned as aging. Because, in adults, cartilage cells do not have the ability to reproduce and regenerate, on the other hand, as age increases, along with the aging of the body, cartilage cells also gradually reduce the function of synthesizing basic substances.

In addition, there are many favorable factors that cause damage to articular cartilage such as: trauma or microtrauma plays an important role in changing the cartilage surface. Major trauma causes fractures, dislocations with cartilage damage or redistribution of pressure on the articular cartilage surface.

Some endocrine diseases, metabolic disorders, joint diseases or blood diseases that affect cartilage degeneration are often acromegaly, simple goiter, postmenopausal women, congenital joint defects, infectious arthritis (acute rheumatism), chronic arthritis, gout, osteodystrophy, coagulation disorders, bleeding (Hemophylia). In addition, there may be family factors (genetics) or more commonly due to specific occupations.

People who are or have a history of heavy labor, porters, and miners have a higher rate of osteoarthritis than people who do light work.

Some typical symptoms

Pain increases with movement and decreases with rest. Dull pain, increasing in episodes when carrying heavy loads, incorrect posture, fatigue, nervous tension, weather changes, and most notably, the disease often recurs. Pain often appears early in weight-bearing joints (knee, ankle, wrist, lumbar spine, cervical spine). There are few or no signs of inflammation.

There may be joint effusion, which is common in the knee joint. Limited movement, especially early in the morning when waking up, typically in the knee joint. Signs of crackling when moving (especially in the knee joint). If the disease occurs for a long time, it can cause joint deformities, most commonly in the elderly, the spine, causing hunchback, scoliosis, and back muscle stiffness. In the case of lumbar spine degeneration, it can cause sciatica, thigh or calf muscle atrophy. If cervical spine degeneration causes neck and shoulder pain, numbness in the hands. In some cases, it can cause muscle atrophy due to lack of movement.

How to treat osteoarthritis?

There are some general principles in the treatment of osteoarthritis: symptomatic treatment of pain and maintenance treatment. Painkillers should be used but side effects on the digestive system (stomach) and cardiovascular system should be minimized. Painkillers can be anti-inflammatory analgesics, simple analgesics, and antispasmodic drugs. Maintenance treatment includes analgesics and drugs that change cartilage structures. The most commonly used type is non-steroidal anti-inflammatory drugs. This is a group of many drugs with anti-inflammatory, analgesic and antipyretic effects. When using small doses of these anti-inflammatory analgesics, the risk of side effects on the digestive tract will be reduced.

Classic anti-inflammatory drugs or anti-inflammatory painkillers that inhibit COX1 and COX2 can be prescribed to treat osteoarthritis. However, selective COX2 inhibitors have a lower risk of causing complications of inflammation, ulcers, bleeding or perforation of the stomach and duodenum than COX1. It should be noted that only one of the non-steroidal anti-inflammatory painkillers should be chosen, and two or more drugs of the same group should not be combined because combining many types will increase the risk of complications but the treatment effect will not increase. In addition, when using these drugs, it is necessary to combine additional drugs to protect the stomach lining, proton pump inhibitors (omeprazole 20mg/day) or misoprostol (200mg/2 times/day).

Using drugs to regenerate articular cartilage is very necessary. Therefore, people apply Glucosamine sulfate in the treatment of cartilage degeneration. This drug has the effect of increasing the synthesis of cartilage proglycan and glucosaminoglycan essences, increasing the elasticity of cartilage essence, changing the structure of articular cartilage. In addition, Glucosamine sulfate combined with chondroitin sulfate is considered a nutritional supplement, which can be used separately or in combination with drugs to increase the effectiveness of treatment...

Patients who do not respond to medical treatment or have a significant impact on joint function may be candidates for surgical intervention, depending on the type of joint that can be treated.

According to Health & Life - NT