骨关节炎的诊治与研究进展

骨关节炎(osteoarthritis,OA)是影响人类健康最常见的关节疾患之一,人群发病率约为2%～6%,是导致50岁以上人群功能残疾、造成经济损失和影响社会发展的主要疾病之一.骨关节炎具有临床、病理和影像学多重定义;在其疾病发生与发展过程中,在全身因素和局部因素综合作用下,关节软骨发生生化、结构和代谢改变,最终出现关节软骨软化、破溃和局部剥脱以及关节边缘骨与软骨赘生物形成等病理改变,并引起相应临床症状;骨关节炎相关的滑膜炎症是软骨基质降解产物引起的继发性改变,滑膜炎性病变在骨关节炎的发生中不是旁观者,而是关节结构破坏的参与者,促进了骨关节炎的病程进展.骨关节炎的治疗目标是控制疼痛、改善关节功能和生活质量,尽可能避免治疗的毒副作用.目前,骨关节炎缺乏治愈的手段.但是,针对患者设计的个体化治疗方案可以减轻疼痛、保持或改善关节活动度,减缓关节功能的受损.应重视对患者的教育和康复治疗,特异性COX-Ⅱ抑制剂减少了胃肠道副反应事件的发生.当内科保守治疗无效,而日常活动进行性受限时,应该考虑关节镜清理、截骨术和关节置换手术等外科治疗.软骨移植、氨基葡萄糖、针对炎性因子或细胞内与炎症相关的信号分子的生物治疗手段为骨关节炎的治疗开辟了新的研究方向.

The advances in diagnosis, treatment and research of osteoarthritis

Objective Osteoarthrtis (OA) is a disease with a truly formidable impact, as the most common form of arthritis, it accounts for more dependency in walking, stair climbing, and other lower extremity tasks than any other disease, especially in the elderly. The prevalence of OA in population is about 2-6 % . Like many diseases, OA has a multiple of definitions including clinical, pathologic and radiologic ones. Both systemic and local factors affect the likelihood that a joint will develop OA. Although the actual cause of osteoarthritis is unknown, a considerable amount of is known about the changes in the biochemistry, structure and metabolism of the joint cartilage in the disease. Whatever the etiology, the softening, ulceration, and focal disintegration of the articular cartilage and the formation of excrescenses of bone and cartilage at the joint margins (osteophyte) are the changes that ultimately characterize the disease and lead to its symptoms. The goals of the contemporary management of the patient with OA include control of pain and improvement in function and health-related quality of life, with avoidence, if possible, of toxic effects of therapy. Although there is no known cure for OA, treatment designed for the individual patient can reduce pain, maintained and/or improve joint mobility, and limit functional impairment. Patients education and rehabilatation are integral parts of the treatment plan for patients with OA. Cyclooxygenase 2 (COX-2)-specific inhibitors can decrease the risk for a serious upper gastro intestinal adverse events. Patients with severe symptomatic OA who have pain that has failed to respond to medical therapy and who have progressive limitation in activities of daily livings should be referred to surgeon for evaluation of arthroscopic debridement, osteotomy or total joint arthroplasty. New directions of research on osteoarthritis include glucosamine, autologous chondrocyte transplantation, inflammatory cytokines inhibitors and biological effectors targeted toward signal transducers related with inflammatory.