{"id":1142,"date":"2023-04-07T19:00:08","date_gmt":"2023-04-07T12:00:08","guid":{"rendered":"https:\/\/bsvothanhtoan.com\/?post_type=bai-giang&p=1142"},"modified":"2023-04-16T08:55:48","modified_gmt":"2023-04-16T01:55:48","slug":"thoai-hoa-khop","status":"publish","type":"bai-giang","link":"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/thoai-hoa-khop\/","title":{"rendered":"Osteoarthritis"},"content":{"rendered":"

DEFINE<\/h2>\n

Osteoarthritis is a degenerative degenerative disease of the joints, first manifested in the articular cartilage, then there are changes in the joint surface and the formation of bone spurs, finally leading to joint deformity. Mild synovitis is a secondary manifestation of degenerative changes in articular cartilage.<\/p>\n

Epidemiology<\/h2>\n

Osteoarthritis is the most common disease in the joints, in the elderly, both men and women. About 50% people over 65 have pictures X-ray<\/a> Acute degenerative joint disease, in people over 75 years of age with X-ray images of degeneration in at least one joint.<\/p>\n

Most patients with osteoarthritis have no clinical symptoms, only 5 - 15% patients have clinical symptoms, then it is called degenerative joint disease.<\/p>\n

Occupations are associated with higher rates of osteoarthritis, porters and miners have higher rates of disease than those who do light work.<\/p>\n

Between the ages of 45 and 55, the incidence is equal in men and women, but after the age of 55 the disease is more common in women than in men.<\/p>\n

PHARMACOLOGY<\/h2>\n

Normal cartilage structure<\/h3>\n

The cartilage structure consists of three main regions: the surface area is mainly composed of chondrocytes that protect the middle and deep regions of the cartilage. The main components of cartilage include water, proteoglycan, collagen fibers.<\/p>\n

Proteoglycans<\/a> It is abundant in the medial region of articular cartilage, containing a protein core and adjacent glycosaminoglycan chains and mainly chondroitin sulfate and keratan sulfate. The proteoglycan bodies bind to hyaluronic acid, other glycosaminoglycans and proteins associated with this structure to ensure the stability and stability of the cartilage.<\/p>\n

Collagen fibers gather in the deep areas of articular cartilage, which are also important structural and functional components of cartilage. The main collagen in cartilage, articular cartilage is collagen type II, in addition, there are collagen types I, IX and XI.<\/p>\n

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Figure 28.1.<\/strong>Normal Cartilage Structure<\/figcaption><\/figure>\n

Pathogenesis of osteoarthritis<\/h3>\n

Many theories explain cartilage degeneration in osteoarthritis. But mainly the mechanistic theory when there is a mechanical overload that changes the metabolism of the chondrocytes, forming proteolytic enzymes that break down the basic substances of the cartilage. The first pathological phenomenon is small fractures of various sizes; then cause degeneration and gradual loss of articular cartilage, change the structure of joints and form bone spurs.<\/p>\n

\"C\u00e1c
Figure 28.2. <\/strong>The proinflammatory cytokines Interleukine 1 (IL-1) and TNF-\u03b1 have the ability to induce chondrocytes to secrete metaloproteinases such as collagenase and stromeolysine that enhance cartilage breakdown and result in irreversible cartilage destruction. dress<\/figcaption><\/figure>\n

In the early stages, chondrocytes show hypertrophy, increased secretion of cytokines such as Interleukin I (IL-1); element caseation<\/a> Tumor (TNF\u03b1) and other growth factors, enzymes that digest basic substances such as collagenases, gelatinase, stromeolysin, other enzymes such as lysosyme and cathepsin. IL-1 and TNF\u03b1 induce cartilage degeneration by stimulating the secretion of enzymes that destroy collagen and proteoglycans, and by inhibiting synthesis of cartilage matrix proteins.<\/p>\n

\"Giai
Figure 28.3. <\/strong>Early stage of osteoarthritis. Subchondral bone becomes thinner as a result of increased remodeling. Simultaneously, the loss of cancellous bone causes the trabeculae to become thinner and
\nstick-like<\/figcaption><\/figure>
\".
Figure 28.4. <\/strong>Late stage of osteoarthritis. The subchondral bone plate is thick, but the spongy bone is still lacking. Calcified cartilage begins to enter the articular cartilage, creating a denser mineralized plate, reducing the thickness of the non-mineralized cartilage layer and chondroitin loss, subchondral bone sclerosis.<\/figcaption><\/figure><\/p>\n

The enzymes collagenases, gelatinase, and stromeolysin are inhibited by a protein of small molecular weight, called a metaloproteinase reorganization inhibitor. The balance between stimulants and inhibitors of enzyme activity ensures normal cartilage metabolism. When increased enzyme activity stimulating factor leads to cartilage degeneration. The process of osteoarthritis is uncontrolled, because when there is a change in cartilage structure, the mechanical impact on the joint also changes, leading to heavier overloads, releasing more degenerative enzymes and continuing as Thus, the degradation process continues.<\/p>\n

Risk factor<\/h3>\n