Although the exercise is very diligent, many people feel that their knees are getting more and more painful, and they are diagnosed as "knee osteoarthritis" after going to the hospital for examination.
Knee osteoarthritis is believed to be familiar to everyone. Common in middle-aged and elderly people over 40 years old, mostly female patients. As long as you observe carefully, you will find that there are many such people around us. Their main symptoms are swelling, pain and limited knee movement. In severe cases, there will be knee joint deformity, which will greatly affect the quality of life.
So what are the conservative treatments for osteoarthritis?
Non-steroidal anti-inflammatory drugs are common anti-inflammatory painkillers in life, which can control the development of osteoarthritis and alleviate the pain caused by inflammation.
However, long-term use of non-steroidal anti-inflammatory drugs will cause serious complications such as upper gastrointestinal ulcer and bleeding, which makes many patients with osteoarthritis complicated with upper gastrointestinal diseases unbearable.
Therefore, it is suggested that proton pump inhibitors (used to treat digestive tract ulcers) should be taken together with NSAIDs. For intolerant patients, other conservative treatment methods are recommended.
Aminoglycan was extracted from crustacean surgery by French scientists in 1823, and then it was fully studied. In human body, glucosamine also exists widely in connective tissues, such as bones, cartilage, valves, glomerular basement membrane and conjunctiva.
Aminoglycan is the main component of articular cartilage. With the increase of age, aminoglycan is constantly lost. It is considered that amino sugar supplementation has the functions of preventing, protecting and repairing cartilage, anti-inflammation and analgesia, and is widely used in the clinical treatment of osteoarthritis.
The latest view of American scholars is that the mechanism of action of glucosamine is not clear, the research of treatment results lacks corresponding control, and many research funds are funded by drug manufacturers, which fails to clarify its effectiveness in treatment.
However, European scholars believe that the above conclusion is partly due to the variety and ineffectiveness of glucosamine used in the United States, and only prescription crystallized glucosamine sulfate has clinical efficacy, which is consistent with the mainstream view in China. Choosing prescription crystalline glucosamine sulfate has a significant effect on relieving symptoms and improving exercise ability in patients with mild to moderate osteoarthritis.
Hyaluronic acid, also known as sodium hyaluronate, is an important component of joint synovial fluid, which determines its viscoelasticity. At the same time, it also has the functions of lubricating joints, buffering the stress on the surface of joints during exercise and regulating the function of cells in joints.
It was found that with the increase of age, the content of hyaluronic acid in knee joint decreased gradually, which was related to the decrease of hyaluronic acid secretion and abnormal metabolism.
With the decrease of hyaluronic acid, its corresponding functions of lubricating joints and buffering pressure decrease, which is related to the occurrence of osteoarthritis. In 1960s, hyaluronic acid came into being after scholars put forward viscoelastic supplement method to treat osteoarthritis.
The mechanism of intra-articular injection of hyaluronic acid is unclear, which 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 delaying the progress of osteoarthritis.
Although intra-articular injection of hyaluronic acid is not suitable for patients with severe knee arthritis and acute exudation of inflammation, the symptoms of a few patients may not be relieved or even aggravated after use, but its curative effect on mild and moderate arthritis is still remarkable.
The hormone here refers to glucocorticoid, which is secreted by the fascicular zone in the adrenal cortex of human body, mainly cortisol, which has the functions of regulating the metabolism of sugar, fat and protein in the body, and has powerful functions of inhibiting immune response, anti-inflammation, anti-toxicity and anti-shock.
The latest view is that long-acting glucocorticoid (triamcinolone acetonide et al.) is injected into the joint. ) helps to relieve joint pain, reduce inflammatory reaction and improve joint function and quality of life.
If there is joint fluid oozing out of the knee joint cavity, it should be sucked out first, and then injected with 40-80mg, which is better with oral analgesic drugs. It should be noted that intra-articular injection of glucocorticoid is not recommended for long-term repeated application, and the number of injections should not exceed 3 times a year.
Platelet-rich plasma (PRP) refers to a plasma mixture rich in high concentration of platelets obtained by centrifugation, separation and extraction of peripheral blood.
The concept of PRP was first published in Nature in 1954. Later, it was found that there were a lot of platelet growth factors in PRP, which could promote cell growth. Since 1990s, PRP has been widely used in orthopedics and other clinical treatments.
Many previous studies have shown that PRP can promote articular cartilage regeneration, promote the repair of half-moon injury and ligament reconstruction after intra-articular injection, and has good analgesic effect.
Although the latest point of view is that there is a great difference between the collection of PRP and the use of technology in the previously reported methods for the treatment of knee osteoarthritis, the effectiveness and scientificity of this new technology still need time to test.
Stem cells are a kind of cells with self-replication and self-renewal ability, which can differentiate into multifunctional cells under certain conditions. Bone marrow mesenchymal stem cells (BMSCs) are the most abundant cells in bone marrow, which are easy to separate, proliferate and differentiate in vitro.
Therefore, some scholars believe that the cartilage defect of osteoarthritis can be repaired by tissue engineering, and it has the characteristics of nutrition, anti-inflammation and anti-immunity, and can be directly used for the treatment of osteoarthritis.
Like PRP, the latest view is that the collection and processing technology of bone marrow mesenchymal stem cells lacks uniform standards and varies greatly, and its processing effect needs more case studies to confirm.
refer to
1, 20 19 American College of Rheumatology/Arthritis Foundation Guidelines on the Treatment of Osteoarthritis of Hands, Hips and Knees [J]. Arthritis care and nursing. Research, 2020, 72(2).
2. Bruyère O, Cooper C, Reginster J Y. Consensus statement on the treatment algorithm of knee osteoarthritis by the European Society of Osteoporosis and Osteoarthritis (ESCEO)-from evidence-based medicine to real life environment. [J]。 Arthritis and arthritis seminar. Rheumatism, 2016,45 (4): S3-s11.
This article
Team Zhang Guoqiang-Written by Dr. Chen Chao.
Director Zhang Guoqiang approved it.