膝关节骨关节炎

1、OSTEOARTHRITIS OSTEOARTHRITIS OF THE KNEEOF THE KNEEBACKGROUNDBACKGROUNDOsteoarthritis : Osteoarthritis :n nMost common causes of functional Most common causes of functional disability and severe paindisability and severe painn nThe prevalence of arthritic symptoms The prevalence of arthritic symptoms among adults is more than 50% among adults is more than 50% BACKGROUNDBACKGROUNDOsteoarthritis: Osteoarthritis:n nBegining with damage and progressive Begining with damage and progressive degradati

2、on of articular hyaline cartilage degradation of articular hyaline cartilage structure and function structure and function n nCartilage thickness loss Cartilage thickness loss n nRemodeling and attrition of subarticular boneRemodeling and attrition of subarticular bonen nGrowth of osteophytesGrowth of osteophytesn nSynovitis, ligamentous laxity, and periarticular Synovitis, ligamentous laxity, and periarticular muscle weakness muscle weakness n nJoint tilting and malalignment Joint tilting and m

3、alalignment Normal and arthritic kneeNormal and arthritic kneeEPIDEMIOLOGYEPIDEMIOLOGY risk factorsrisk factors AgeAge Obesity Obesity Work-related bending and heavy physical workload Work-related bending and heavy physical workload Recreational and physical sporting activities Recreational and physical sporting activities Hyaluronic acid serum levels Hyaluronic acid serum levels Knee injury Knee injury Congenital conditionsCongenital conditions Systemic metabolic diseasesSystemic metabolic dise

4、ases Endocrine diseasesEndocrine diseases Bone dysplasiasBone dysplasias Calcium crystal deposition diseasesCalcium crystal deposition diseasesCLASSIFICATIONCLASSIFICATIONn nPrimary (idiopathic) Primary (idiopathic) articular degeneration occurs in the absence of articular degeneration occurs in the absence of an obvious underlying abnormality an obvious underlying abnormality n nSecondary Secondary result from some risk factors(injury ,repetitive result from some risk factors(injury ,repetitive

5、 motion such as found in certain occupations motion such as found in certain occupations ,congenital conditions , systemic metabolic ,congenital conditions , systemic metabolic diseases,etc.)diseases,etc.)DIAGNOSISDIAGNOSISDiagnostic criteria for osteoarthritis of the knee Diagnostic criteria for osteoarthritis of the knee (proposed by the American College of Rheumatology, (proposed by the American College of Rheumatology, ACR) ACR) n n First: presenting with painFirst: presenting with pain n n

6、Second:meeting at least five of the following criteria: Second:meeting at least five of the following criteria: n nPatient older than 50 years of agePatient older than 50 years of agen nLess than 30 minutes of morning stiffnessLess than 30 minutes of morning stiffnessn nCrepitus (noisy, grating sound) on active motionCrepitus (noisy, grating sound) on active motionn nBony tendernessBony tendernessn nBony enlargementBony enlargementn nNo palpable warmth of synoviumNo palpable warmth of synoviumn

7、nErythrocyte sedimentation rate (ESR) 40 mm/hrErythrocyte sedimentation rate (ESR) 40 mm/hrn nRheumatoid factor 1:40Rheumatoid factor 1:40n nNoninflammatory synovial fluidNoninflammatory synovial fluidDIAGNOSISDIAGNOSIS X-rayX-ray MRIMRIDIAGNOSISDIAGNOSISMolecular biomarkers Molecular biomarkers sC2C (serum cartilage type II collagen cleavage by sC2C (serum cartilage type II collagen cleavage by collagenase )collagenase ) sCPII (serum cartilage type II procollagen carboxy sCPII (serum cartilage

8、type II procollagen carboxy propeptide)propeptide) sHA(serum hyaluronic acid)sHA(serum hyaluronic acid) uNTX (urine N-terminal crosslinking telopeptide of type uNTX (urine N-terminal crosslinking telopeptide of type I collagen )I collagen ) uCTX-II (urine cartilage type II collagen C-telopeptide )uCTX-II (urine cartilage type II collagen C-telopeptide ) uCTX-II(urine cartilage type II collagen C-telopeptideuCTX-II(urine cartilage type II collagen C-telopeptiden nRelationships between biomarkers

9、of joint metabolism Relationships between biomarkers of joint metabolism and cartilage, bone, synovial metabolism may reflect and cartilage, bone, synovial metabolism may reflect early changes in cartilage structure w/o knee painearly changes in cartilage structure w/o knee painEVALUATION SYSTEMEVALUATION SYSTEM Knee injury and Osteoarthritis Outcome Knee injury and Osteoarthritis Outcome Score (KOOS) Score (KOOS) Likert scale Likert scale SF-36 SF-36 Western Ontario and McMaster Western Ontario and McMaster osteoarthritis (WOMAC) scale osteoarthritis (WOMAC) scale VAS scoringVAS scoringEVALUATION SYSTEMEVALUATION SYSTEM Kellgren and Lawrence criteria (radiographic criteria)Kellgren and Lawrence criteria (radiographic criteria)TREATMENTTREATMENTA number of therapies, including A number of therapies, including ExerciseExercise

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