A brief discussion on your misunderstandings about knee osteoarthritis

Knee osteoarthritis is a chronic degenerative bone and joint disease, which is a series of symptoms caused by joint hyperplasia, degeneration and damage to articular cartilage. Among the joints in the human body, the knee joint not only supports the weight of the whole body, but also has to stand, squat, jump, run and walk. Because the knee joint moves very frequently, it is most susceptible to knee strain. Therefore, knee osteoarthritis is the most common disease among middle-aged and elderly people [1-2].

There are two types of knee osteoarthritis: primary and secondary. Primary is closely related to the patient's age and is more common in the elderly over 50 years old. Secondary is mostly due to trauma (knee, patella, meniscus, knee dislocation, etc.), joint deformity (genu varum, valgus), joint disease (inflammatory joint disease, endocrine disorder, ischemic necrosis) and other factors, causing the knee joint to undergo severe degenerative changes prematurely.

There are many causes of knee osteoarthritis:

Chronic strain: Long-term improper posture, uneven weight bearing, excessive weight, etc. can lead to soft tissue damage in the knee joint.

Bone density: As people age, the amount of organic matter in their bodies decreases while the amount of inorganic matter increases. When the subchondral trabeculae become thinner and stiffer, their tolerance to pressure decreases. Therefore, people with osteoporosis are more likely to develop osteoarthritis[3].

Obesity: Obesity is also a factor that aggravates the disease. Weight gain is directly proportional to the incidence of knee osteoarthritis, while weight loss can reduce the incidence of knee osteoarthritis[4].

Trauma and force bearing: Frequent knee joint injuries, such as fractures, cartilage and ligament injuries. When the joint is in an unstable state under abnormal conditions, the unbalanced muscle force and local pressure will accelerate the degeneration of cartilage. Osteoarthritis is not likely to occur during normal joint activities or even after strenuous exercise.

Genetic factors: The joints affected vary among different races. For example, osteoarthritis of the hip and wrist-metacarpal joints is more common in Caucasians, but less common in people of color. Gender also has an impact, and this disease is more common in women.

Clinical manifestations of knee osteoarthritis: long-term and recurrent knee pain, aggravated by exercise and relieved by rest, inconvenient walking, limited extension and flexion of the knee joint, difficulty squatting, obvious pain when going up and down stairs, or stabbing pain when moving suddenly, morning stiffness of the joint, often accompanied by weakness and the tendency to fall, aggravated by cold, weather changes or increased humidity. Knee extension causes pain to a certain extent, and often produces a twisting sound during the extension and flexion of the knee joint. In severe cases, lower limb muscle atrophy may occur, and joint effusion may also occur, complicated by synovitis.

The treatment of knee osteoarthritis is an arduous task. The key lies in early diagnosis, health education for patients and timely targeted graded treatment. A comprehensive treatment plan should be formulated for different patients. Knee osteoarthritis is essentially the degeneration of articular cartilage. This degeneration is irreversible, but its development speed and symptoms can be slowed down through protection and treatment [5]. At present, there are misunderstandings about knee osteoarthritis in the minds of many people:

Myth 1: Young people will not get osteoarthritis:

In fact, osteoarthritis is not limited to the elderly. Secondary osteoarthritis caused by joint trauma and overuse is often unrelated to age. According to surveys, the number of young and middle-aged osteoarthritis patients such as "mountain climbers", "bosozoku", and "high-heeled ladies" has increased significantly in recent years[6].

Myth 2: Osteoarthritis is a minor illness and does not require treatment:

Many patients think that osteoarthritis is a minor illness that will go away just like a cold. In fact, over time, the degeneration of joint cartilage will continue to worsen, or even completely degenerate, eventually leading to severe pain and disability.

Myth 3: No pain means "cured":

Many osteoarthritis patients believe that the treatment goal has been achieved when they feel “pain-free” after treatment. In fact, “pain-free” does not mean that the articular cartilage has not returned to normal, and pain may reappear at any time. If this happens repeatedly, the condition will further deteriorate.

Myth 4: Painkillers can cure osteoarthritis:

All drugs have side effects, and in fact, no drug can delay or reverse the pathological changes of osteoarthritis patients. In particular, painkillers not only irritate the gastrointestinal tract and cause peptic ulcers, but also inhibit cartilage formation and accelerate cartilage damage, making the condition worse.

Myth 5: You have to replace the joint to completely cure it:

Compared with Western medicine alone, TCM can provide some conservative treatments for patients with early-stage osteoarthritis, such as traction, acupuncture, medication, massage, etc., which can effectively relieve knee joint damage, have significant efficacy, and have few toxic side effects, which is a unique advantage [7]. For patients in the middle and late stages and those who are ineffective with conservative treatment, minimally invasive treatment can be considered. It is not recommended to replace the knee joint easily.

So how to prevent osteoarthritis of the knee?

When humans walk upright, their knee joints will be worn out. It is important to learn how to protect joints in daily life. The specific summary is as follows: avoid climbing tall buildings or mountains; remember to bring crutches when climbing; walk sideways down the stairs and hold the handrail; avoid doing exercises that hurt the knees; exercise methods vary from person to person; reduce weight and exert less force; keep warm and avoid wind and cold[8]; seek medical attention as soon as possible if there is any abnormal swelling or pain.

Finally, it is recommended that middle-aged and elderly people should pay special attention to the "expression" of the knee joint. If the knee joint is swollen, red, hot, paroxysmal or persistent pain, stiff or difficulty moving, there is noise in the joint when moving, pain when going up and down stairs, difficulty squatting, knee sprains when walking, knee locking (sudden restriction of movement) and other symptoms, these are all "expressions" of knee joint disease. If the above conditions occur, seek medical attention immediately.

References

[1] Li Zhonglong, Wang Jianjun, Liu Kang. Observation on the short-term efficacy of deep kneading massage in the treatment of knee osteoarthritis in the elderly [J]. Chinese Journal of Rehabilitation Medicine, 2015: 30 (6): 580-4.

[2] Wang Yongyu, Wang Jing, Xue Yan, et al. Correlation between clinical symptoms and anxiety in middle-aged and elderly patients with knee osteoarthritis [J]. Geriatrics and Protection, 2019: 25(5): 568-71.

[3] Zhao Zhihong, Wang Rui, Guo Yu, et al. Study on the correlation between the prevalence of knee osteoarthritis and osteoporosis[J]. Chinese Journal of Orthopaedics, 2019: 39(14): 870-5.

[4] He Qianqian, Zhang Junfeng. Analysis of risk factors for the prevention and treatment of knee osteoarthritis in people over 60 years old with different body mass indexes [J]. Shanxi Medical Journal, 2017: 46(24): 3008-11.

[5] Liu Baohong, Zhao Zhiheng, Jiao Zhaohua. Research progress on the mechanism of action of Duhuo Jisheng decoction on knee osteoarthritis [J]. Global Chinese Medicine, 2018: 11 (9): 1492-1496.

[6] Zhang Yu, Zhang Hua (edited). Knee joints are always painful? Or you may have fallen into these 5 misunderstandings [J]. Elderly Health, 2020.000 (9). 11-11.

[7] Xiong Shixi, Gui Shiqi. 120 cases of knee osteoarthritis treated with comprehensive traditional Chinese medicine therapy [J]. Chinese Journal of Basic Medicine of Traditional Chinese Medicine, 2014: 20(7): 1013,1016.

[8] Zhang Zhijian. What are the symptoms and causes of knee arthritis? [J]. Longevity, 2020.000(2).0074-0074.

Author: Dou Yingxia, attending Chinese medicine physician, graduated from Chengdu University of Traditional Chinese Medicine with a major in integrated Chinese and Western medicine, and has been engaged in clinical work in Hongya County Traditional Chinese Medicine Hospital for more than ten years.