هشاشة العظام في الركبة: نظرة عامة, عوامل الخطر والعلاج

نظرة عامة:

يُعرف الفصال العظمي أيضًا بمرض المفاصل التنكسية. It is the most common form of osteoarthritis and is defined as a long-term noninflammatory condition that is characterized by the destruction of articular cartilage and bone erosions. Women are more affected in osteoarthritis as compared to males and weight bearing joints are the principal joints involved. Osteoarthritis in the knee occurs mostly in females whereas osteoarthritis in hips and spine occurs mostly in males. Osteoarthritis affects only a single joint at a time or it may run an oligoarticular course in which 1 إلى 4 joints are affected at a single time. However large joints affected first.

Risk Factors for Osteoarthritis:

• شيخوخة: As the age of advances the tendency to acquire في العمود الفقري يزيد.
• عوامل وراثية: osteoarthritis is caused by various genetic factors present in the host. It is a hereditary disease and may run in families.
• Mechanical stress: mechanical stress like injuries or falls from a height may cause osteoarthritis in the knee.
• داء السكري: داء السكري is a major risk factor for secondary osteoarthritis in the knee.
• Alkaptonuria: Ochronosis like Alkaptonuria is a secondary factor for osteoarthritis.
• داء ترسب الأصبغة الدموية: deposition of deposits of iron like in hemochromatosis may cause osteoarthritis.
• Marked obesity: obesity is a major risk factor for osteoarthritis as it is a major stressor for weight-bearing joints. You should maintain your BMI to prevent the development of osteoarthritis at an early age.

The pattern of Osteoarthritis in Knee:

Osteoarthritis in knee targets the patella and femoral junction and medial tibiofemoral compartment. pseudogout in association with osteoarthritis is most common at the knee. when we examine the osteoarthritis of the knee it is usually bilateral which means it affects both right and left sides of the knee and it is symmetrical in nature.

If the causative factor for osteoarthritis is trauma or major stress it can present in a single knee joint either of the right side of the leg or the left side of the leg. the patient has a jerky gate which is also called antalgic or asymmetric gait. Varus deformity of the knee occurs when osteoarthritis occurs in the knee.

There is a restriction of movements and patients suffer difficulty in extending and flexing knee joints. Course repetitions may be heard on joint movements. Patient resists walking or moving around due to pain and quadriceps muscles are weekend and wasted.

Osteoarthritis in Hip Joint

Hip osteoarthritis most commonly targets the upper aspect of the joint. Hip shows the best correlation between symptoms and radiographic changes in osteoarthritis. Hip pain is maximally Deep in the interior part of the groin and it radiates to buttocks and thighs and anterior aspect of the shin.

Clinical Features of Osteoarthritis in Knee:

• الم المفاصل: There is pain on moving joints as the articulating cartilage is destroyed as a result of the inflammatory process and Bony surfaces rub against each other.
• تقييد حرية التنقل: movement is restricted due to fear of pain on movement.
• Coarse crepitations: as the Bony surfaces rubbing against each other course repetitions which are palpable sounds can be heard over the joint surfaces.
• التيبس الصباحي: هناك صلابة صباح أقل من 15 minutes which improves over the day.
• Weaknesses and wasting of muscles: The patient restricts his movement due to fear of pain on moving the joint surface so the muscles near the joint are weekend and wasted.
• Bony spurs: bone Spurs are also called osteophytes. These are small bone growths and are formed as a result of the destruction and remodeling of bone and joint surfaces.
• Asymmetrical gait: the patient has an asymmetrical gate which is also called Antalgic Gate. Whenever the patient moves around there is a jerky asymmetrical gait.

How to Diagnose Osteoarthritis in the Knee?

Osteoarthritis in the knee is usually diagnosed clinically. Your doctor may take your complete history of the beginning of disease and signs and symptoms you suffer. He will perform your clinical examination to reach the proper diagnosis. Many tests are available for diagnostic uncertainty which of them are

• فحص دم شامل: complete blood count of the patient is normal
• عامل الروماتويد: Rheumatoid factor is absent
• ESR: erythrocytes sedimentation rate is in normal limits
• CRP: C reactive protein is in normal limits
• Aspiration of joint fluid: aspiration of joint fluid shows no bacteria. The Synovial fluid is normal inconsistency and sterile in nature
• منزل: antinuclear antibody is absent
• أشعة X المفاصل: it is the most important Diagnostic test for osteoarthritis. X-ray of joints shows asymmetrical joint space narrowing, osteophytes or Bony spur formation over the articulating surfaces, التهاب, and destruction of articulating cartilage, Bone Cyst formation, subchondral bone. There is no ankylosis i.e fusion of joints.

Treatment for Osteoarthritis in Knee

1- Pharmacologic Treatment:

• أسيتامينوفين: Acetaminophen is the first initial drug for treating osteoarthritis. It is one of the best initial analgesics.
• أدوية مضادة للإلتهاب خالية من الستيرود: NSAIDS all oral, intravenous, and topical can be used. It helps to relieve pain and inflammation over the joint surfaces.
• Intraarticular steroids: intra-articular steroids are applied inside the joint surfaces if medical treatment does not give complete control over pain.
• Intraarticular hyaluronan injection: Intra-articular hyaluronan injection is only given in knee osteoarthritis.
• Joint replacement: Orthopedic surgery and joint arthroplasty are done if the disease is severe and is refractory to medical therapy.

2- Non-Pharmacological Treatment:

• Weight loss prevents the formation of osteoarthritis
• maintaining an optimal BMI
• regular exercise and strength training exercise for 30 minutes a day for five times a week
• patient education about the disease, علاجها, and prevention
• quadriceps strength training exercises in knee osteoarthritis

متى طلب المساعدة الطبية?

Take medical help when osteoarthritis in the knee is causing severe pain and joint disability. Your Doctor after discussing with you the causes, signs, والأعراض, may tell you to get the proper treatment for treating osteoarthritis in the knee.

If the treatment is started earlier in the disease course then the complications of osteoarthritis can be prevented. However when the disease is complicated the medical treatment may not reverse the complications and progression of the disease as medical treatment aims for the symptomatic management of patients only.