When it comes to exercise, many people of the aunty generation are much more diligent than young people. Many people after retirement into a variety of sports, square dancing, climbing, running ......
Although the movement is diligent, but many people feel more and more pain in the knee, to the hospital diagnosed with " osteoarthritis of the knee joint". ".
Osteoarthritis of the knee is no stranger to us all, commonly found in middle-aged and older people over 40 years of age, with the majority of women patients. As long as you look carefully, you will find a lot of such people around us, and their main symptoms are swelling of the knee joints, pain, limited activities, and severe deformity of the knee joints, which affects the quality of life very much.
So what are the conservative treatments for osteoarthritis of the knee?
Nonsteroidal anti-inflammatory drugs (NSAIDs) are common anti-inflammatory drugs that can control the progression of osteoarthritis in the knee and reduce the pain caused by inflammation.
However, long-term use of NSAIDs can cause serious complications such as upper gastrointestinal ulcers and bleeding, making it intolerable for many patients with osteoarthritis of the knee who have coexisting upper gastrointestinal tract pathology.
Therefore, it is recommended that NSAIDs be taken together with proton pump inhibitors (for the treatment of peptic ulcers). For patients who cannot tolerate them, other conservative treatments are recommended.
Aminosugar was extracted from crustacean surgery by French scientists in 1823 and has been well-studied since. In the human body, aminosaccharides are also widely found in connective tissues such as bone, cartilage, valves, glomerular basement membranes, and the conjunctiva of the eye.
Aminosaccharides are the main building blocks of articular cartilage and are lost with age. Aminosugar supplementation is believed to have preventive, cartilage-protecting, anti-inflammatory, and pain-relieving effects on osteoarthritis of the knee, and is widely used clinically in the treatment of osteoarthritis of the knee.
The latest opinion of American scholars is that the mechanism of action of glucosamine is unclear, the lack of appropriate controls in the study of treatment outcomes, and the fact that many of the studies were funded by drug companies, did not make it clear that it was effective in the treatment of osteoarthritis.
However, European scholars believe that these conclusions are due in part to the variety and ineffectiveness of glucosamine used in the United States, and believe that only prescription crystalline glucosamine sulfate is clinically useful, which is consistent with the prevailing view in China. The choice of prescription crystalline glucosamine sulfate is significant for symptomatic relief of mild to moderate osteoarthritis of the knee and improvement in exercise capacity.
Hyaluronic acid, also known as sodium hyaluronate, is an important component of synovial fluid, which determines its viscoelasticity, and also lubricates the joints, cushions the joint surfaces from the stresses of movement, and regulates the function of intra-articular cells.
It has been found that with age, the content of hyaluronic acid in the knee joints decreases, which is related to the decrease in hyaluronic acid secretion and metabolic abnormalities.
Along with the decrease in hyaluronic acid, its corresponding lubrication of the joints, cushioning stress and other roles are reduced, which is associated with the occurrence of osteoarthritis of the knee. In the 1960s, hyaluronic acid came into being after scholars proposed viscoelastic supplementation for the treatment of osteoarthritis.
The mechanism of intra-articular injection of hyaluronic acid is still unclear, and should be related to limiting the spread of inflammation, inhibiting the release of inflammatory factors, inhibiting the activity of some enzymes, relieving pain, improving joint function, and slowing down the progression of osteoarthritis.
While hyaluronic acid injections into the joint cavity are not suitable for patients with severe knee osteoarthritis and patients with acute exudative phase of inflammation, and a few patients may not have relief or even aggravation of their symptoms after using it, its efficacy in the treatment of mild-to-moderate arthritis is still relatively significant.
The hormone here refers to glucocorticoids, which are secreted by the zona fasciculata of the adrenal cortex in the human body and are mainly cortisol, which regulates the metabolism of glucose, fat, and protein in the body, and has a powerful role in suppressing the immune response, anti-inflammatory, anti-toxicity, and anti-shock.
The latest opinion is that joint cavity injections of long-acting glucocorticoids (tretinoin, etc.) can help relieve joint pain, reduce the inflammatory response, and improve joint function and quality of life.
If there is exudate in the knee joint cavity, it should be aspirated and then injected with 40-80mg, which is more effective when combined with oral pain medication. It is important to note that glucocorticoid injections into the joint cavity are not recommended for long-term repeated application, and should not be injected more than 3 times per year.
Platelet-rich plasma (PRP), is a plasma mixture rich in a high concentration of platelets obtained from peripheral blood after centrifugation, separation and extraction.
The concept of PRP was first reported in the journal Nature in 1954, after which it was discovered that PRP has a large amount of platelet growth factor, which can promote cell growth, and after the 1990s PRP was widely utilized in clinical treatments such as orthopedics.
There have been many studies showing that PRP can promote articular cartilage regeneration, meniscus injury repair, and ligament reconstruction after injection into the joint cavity, as well as provide good pain relief.
Although the latest opinion is that there is a lack of uniformity and variability in the collection of PRP and the use of the technique previously reported for the treatment of osteoarthritis of the knee, the validity and scientific validity of this new technique remains to be tested.
Stem cells are a class of cells that are capable of self-replication and self-renewal, and under certain conditions can be differentiated into cells with multiple functions. Bone marrow mesenchymal stem cells (BMSCs) are most abundant in bone marrow tissues, easy to separate, and can proliferate and differentiate in vitro.
Therefore, some scholars believe that cartilage defects in osteoarthritis of the knee can be repaired by tissue engineering, and they have nutritional, anti-inflammatory, and anti-immune properties, which can be directly used in the treatment of osteoarthritis.
As with PRP, the latest opinion is that there is a lack of uniformity and variability in the collection and treatment techniques of BMSCs, and that their therapeutic efficacy needs to be confirmed by more case studies.
References
1. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee [J]. and Knee[J]. Arthritis Care & Research, 2020, 72(2).
2. Bruyère O, Cooper C , Reginster J Y . A consensus statement on the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) algorithm for the management of knee osteoarthritis-From evidence-based medicine to the real-life setting.[J]. Seminars in Arthritis & Rheumatism, 2016, 45( 4):S3-S11.
This article
Written by Dr. Chao Chen, Team Zhang Guoqiang
Reviewed by Dr. Zhang Guoqiang