OSTEOATHRITIS (OA) is a common joint degenerative disease that causes a heavy burden on patients, families and society. The standardized OA diagnosis and treatment are of great significance to clinical work and social development. Guide update was led by the Chinese Medical Society’s Orthopedic Science Branch, the orthopedic arthritis academic group of the Orthopedician Branch of the Chinese Medical Association, the National Elderly Disease Clinical Medicine Research Center (Xiangya Hospital) and the editorial department of the Chinese Orthopedic Magazine. Granding of Recommentations Assessment, Development and Evaluation (Grade) grading system and international practical guidelines (REPORTING ITEMS In Healthca) RE, RIGHT) Select 15 clinical issues that orthopedics are most concerned about, Eventually, 30 evidence -based medical recommendations are formed to improve the scientificity of OA diagnosis and ultimately improve the quality of medical services centered on patients.
Clarify diagnosis and comprehensive evaluation: OA diagnosis and evaluation related recommendations
OA is common in those with age ≥40 years, women, obesity (or overweight), or a history of trauma. The most common clinical manifestations are joint pain and joint activity. Clarifying the diagnosis is an important prerequisite for the formulation of a disease treatment plan. For OA suspected patients, the guidelines are recommended to prefer X -ray examinations. If necessary, CT, MRI, and ultrasound can be performed to further clarify the degeneration site and degree of degeneration and conduct a differential diagnosis. It also pointed out that diseases that need to be identified with OA include: arthritis, infectious arthritis, gout, pseudo -gout, and joint injury of autoimmune diseases.Laboratory examination is not a necessary basis for diagnosis of OA, but if the patient’s clinical manifestations are not typical or cannot exclude other diagnosis, you can consider choosing a appropriate laboratory examination for identifying diagnosis.
After diagnosis of OA, a comprehensive illness assessment of patients needs to be performed in order to formulate targeted treatment plans for patients. Guide pointed out that the disease evaluation of OA patients should include a variety of diseases, pain degree, and merging diseases. It is not difficult to see from the OA diagnosis and evaluation flow diagram. Clear diagnosis and comprehensive evaluation are an important prerequisite for OA treatment.
Stepping, individualized treatment: OA treatment related recommendations
In terms of treatment, the guidelines that the treatment of OA should be based on the principles of ladderization and individualized therapy to achieve the purpose of reducing pain, improving or recovering joint function, improving the quality of life of patients, delaying disease progress, and corrected malformations. Specific therapy includes basic treatment, drug treatment, repair and reconstruction treatment.
1) Basic treatment
In OA’s stepped treatment, the guide recommends the preferred basic treatment. For example, health education, exercise therapy, physical therapy and action assistance.
In exercise treatment, aerobic exercise and water exercise can effectively improve the pain symptoms and physical function of patients with knee and hip joint OA; hand exercise exercise can effectively alleviate the pain and joint stiffness of patients OA patients. Knee joint OA can consider using physical therapy such as interference current electrical stimulation therapy and pulse ultrasound therapy to relieve patients with pain symptoms.
2) Drug treatment
Local topical non -steroidal anti -inflammatory drugs (NSAIDS) can be used as first -line therapy drugs for knee OA pain, especially for patients with gastrointestinal diseases, cardiovascular diseases or weakness. Patients with persistent symptoms of pain or medium -weight OA pain are recommended to take oral NSAIDS, but they need to be alert to their gastrointestinal tract and cardiovascular adverse incidents.
The guide said that OA is not recommended to use strong opioid medicine analgesic, and it is necessary to use weak opioid analgesic such as Qu Maodo. For patients with long -term, chronic, extensive pain and (or), patients with depression can use anti -anxiety drugs such as Rostein. Compared with the treatment of glucocorticoids in the joint cavity, the sodium of the arthrine injection can only relieve pain in the short term, but the safety is high, and the guidelines are recommended as appropriate. In addition, Chinese medicine and acupuncture can also be used to treat OA.
The efficacy of joint cavity injection
Evidence overview: Glucocorticoids are suitable for the acute aggravation of knee pain, especially Knee OA patients accompanied by effusion. Its effect is rapid, the short -term relieving pain effect is significant, but the long -term improvement of the pain and function of pain and function is not obvious, and repeatedly applying the risk of accelerating the loss of joint cartilage in the application of hormones. It is recommended to use the injecting glucocorticoids in the joint cavity. And no more than 2 to 3 times a year, and the injection interval should not be shorter than 3 to 6 months. In addition, except for patient OA patients with severe pain in the fingers, the joints of the joints are generally not considered to treat the hand OA. For patients with diabetes, especially those with poor blood glucose control, they should inform the joint cavity injection of glucocorticoids to temporarily increase the risk of blood sugar, and it is recommended that this type of patient monitor blood sugar levels within 3 d after injection.
Sodium glass can improve joint function, short -term relieving pain and reduce the amount of analgesic drugs, and has high safety. It is suitable for OA patients with gastrointestinal and (or) cardiovascular risk factors, but it is in The role of cartilage protection and delaying the disease is still controversial. It is recommended to apply as appropriate according to the individual conditions of the patient. Growth factor and platelet plasma can improve local inflammatory response, but its mechanism, efficacy, and safety need more long -term follow -up, high -quality random control test (RCT) to provide more evidence support. In addition, the clinical trials of stem cell therapy OA have also been carried out in China.
3) Repair
Regarding repairing the treatment, first of all, it is necessary to understand that arthroscopy surgery is effective in the knee joint OA with only pain symptoms, and there is no significant difference between the medium and long -term efficacy and conservative treatment. The knee joint OA with the symptoms of twisted locks can be used to improve the symptoms of arthroscopy cleansing; other intervention measures are invalid, and patients with shoulder joints due to age, activity or personal wishes are not suitable for shoulder joints. Mirror Qingli.
In addition, the tibia stock room OA with poor knee joint force, especially patients with young and middle -aged and large activity, can choose tibial high -level bone interceptation, femoral bone cutting, or fibula proximal bone interception surgery ; The mild hip joint OA caused by dysplasia of the acetabular acetic can be selected.
4) Reconstruction
Artificial joint replacement is suitable for severe OA patients with obvious efficacy of other intervention measures. However, the specific situation, subjective willingness and expectations of the patient should also be considered.
Other simplicity of the joints of the joints of the shaped shares of other treatment effects, the guideline recommendation selection of the joints of the shares of the shares; the tibia stock single room OA and the force line of 5 ° ~ 10 °, the complete ligament, the flexion and the contracture of the flexion not exceeding 15 °, it is recommended to be recommended Choose a single settling replacement.
OA, as a joint degenerative disease, has an overall prevalence of primary OA among people over the age of 40 in my country. And with the intensification of aging, the prevalence of OA still has an upward trend. In this regard, the medical organization has released multiple guidelines/expert consensus in recent years, including the “Consensus Experts of Clinical Drug Therapy of orthopedic arthritis” and “Suggestions for the Management Expert of Chronic Diseases of osteoarthritis” to guide and standardize clinical diagnosis and treatment. With the release of more guidelines and research, I hope to improve the health of OA patients more.
For OA patients, under the premise of clear diagnosis, comprehensive disease assessment is also required. Based on the principle of step -level and individualized therapy, basic treatment, combined with physical therapy, repair and reconstruction treatment, etc. plan.
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Post time: May-11-2023