Unit9-B.docx

Text B OsteoarthritisIntroduction to osteoarthritis 骨关节炎概论Osteoarthritis is a type of arthritis that is caused by the breakdown and eventual loss of the cartilage of one or more joints. Cartilage is a protein substance that serves as a “cushion” between the bones of the joints. Osteoarthritis is also known as degenerative arthritis. Among the over 100 different types of arthritis conditions, osteoarthritis is the most common，affecting over 20 million people in the United States. Osteoarthritis occurs more frequently as we age. Before age 45, osteoarthritis occurs more frequently in males. After age 55 years, it occurs more frequently in females. In the United States, all races appear equally affected. A higher incidence of osteoarthritis exists in the Japanese population, while South African blacks, East Indians，and Southern Chinese have lower rates. 骨性关节炎是一种由一个或多个关节软骨破坏和损伤引起的关节炎。软骨是一种能在关节的骨头之间充当“缓冲”作用的蛋白质。骨性关节炎又称为退行性关节炎。在100余种不同类型的关节炎中，骨关节炎是最常见的，它影响着超过2000万的美国人。随着年龄的增长，骨关节炎的发生率增高。在45岁以前，骨关节炎在男性中更为常见。55岁以后，女性多发。在美国，所有种族都受到同样的影响。骨关节炎在日本发病率较高，南非黑人、东印度人和中国南部人群发病率较低。Osteoarthritis commonly affects the hands, feet, spine, and large weight-bearing joints, such as the hips and knees. Most cases of osteoarthritis have no known cause and are referred to as primary osteoarthritis. When the cause of the osteoarthritis is known, the condition is referred to as secondary osteoarthritis. Osteoarthritis is sometimes abbreviated OA.What causes osteoarthritis ?骨关节炎通常累及手、脚、脊柱和大的负重关节，如髋关节和膝关节。大多数骨关节炎没有明确的病因，被称为原发性骨关节炎。有明确病因的骨关节炎被称为继发性骨关节炎，有时也被简称为骨关节炎。是什么原因导致骨性关节炎？Primary osteoarthritis, osteoarthritis not resulting from injury or disease, is mostly a result of natural aging of the joint( Fig. 9-2). With aging, the water content of the cartilage increases, and the protein makeup of cartilage degenerates. Eventually，cartilage begins to degenerate by flaking or forming tiny crevasses. In advanced osteoarthritis, there is a total loss of the cartilage cushion between the bones of the joints. Repetitive use of the worn joints over the years can irritate and inflame the cartilage, causing joint pain and swelling. Loss of the cartilage cushion causes friction between the bones, leading to pain and limitation of joint mobility. Inflammation of the cartilage can also stimulate new bone outgrowths (spurs，also referred to as osteophytes) to form around the joints. Osteoarthritis occasionally can develop in multiple members of the same family, implying a hereditary (genetic) basis for this condition. 原发性骨关节炎是指无损伤或疾病导致的骨关节炎，主要是由关节的自然老化导致（图9-2）。随着年龄的增加，软骨由少量水分和退化的蛋白质组成。最终，软骨开始退化、剥落或形成微小的裂隙。在骨关节炎发病初期，关节软骨垫之间出现损失。长期磨损关节、重复使用可能会刺激软骨，导致关节疼痛和肿胀。软骨垫的丢失会导致骨头之间的摩擦，导致关节活动时疼痛和关节受限。软骨的炎症也会刺激新骨的形成（副产物，也被称为骨赘）在关节形成。骨关节炎有时可以在同一个家族的多个成员中发病，这意味骨关节炎有遗传（基因）倾向。Secondary osteoarthritis is a form of osteoarthritis that is caused by another disease or condition. Conditions that can lead to secondary osteoarthritis include obesity, repeated trauma or surgery to the joint structures, abnormal joints at birth ( congenital abnormalities )，gout， diabetes, and other hormone disorders.继发性骨关节炎是由另一种疾病或致病条件引起的骨关节炎的一种形式。可导致继发性骨关节炎的病因包括肥胖、反复创伤或手术后关节结构改变、先天关节畸形（先天性异常）、痛风、糖尿病和某些激素异常。Obesity causes osteoarthritis by increasing the mechanical stress on the joint and therefore on the cartilage. In fact, next to aging, obesity is the most significant risk factor for osteoarthritis of the knees. The early development of os teoarthritis of the knees among weight lifters is believed to be in part due to their high body weight. Repeated trauma to joint tissues (ligaments， bones, and cartilage) is believed to lead to early osteoarthritis of the knees in soccer players and army military personnel. Interestingly, studies have not found an increased risk of osteoarthritis in long-distance runners.肥胖会导致骨关节炎，增加关节承受力、磨损软骨。事实上，在衰老的过程中，肥胖是膝关节骨性关节炎最重要的危险因素。举重运动员超重是导致膝关节骨性关节炎发病早期的部分病因。足球运动员和军人膝关节骨性关节炎发病早期与关节组织（韧带、骨和软骨）的反复创伤有关。有趣的是，研究目前并没有发现长跑运动员发生骨关节炎的风险增加。Crystal deposits in the cartilage can cause cartilage degeneration and osteoarthritis. Uric acid crystals cause arthritis in gout, while calcium pyrophosphate crystals cause arthritis in pseudogout.晶体沉积在软骨中会引起软骨退变和骨关节炎。例如尿酸结晶可引起关节炎、痛风，焦磷酸钙晶体可引起假性痛风关节炎。Some people are born with abnormally formed joints (congenital abnormalities) that are vulnerable to mechanical wear, causing early degeneration and loss of joint cartilage. Osteoarthritis of the hip joints is commonly related to structural abnormalities of these joints that had been present since birth.一部分人是天生畸形关节（先天性异常），因此容易受到机械磨损，导致关节软骨早期退变和损失。髋关节骨性关节炎通常与出生时关节结构异常有关Hormone disturbances，such as diabetes and growth hormone disorders，are also associated with early cartilage wear and secondary osteoarthritis.激素紊乱如糖尿病、生长激素紊乱，也与早期的软骨磨损和继发性骨关节炎有关。What are osteoarthritis symptoms and signs ?骨关节炎的症状和体征是什么？Osteoarthritis is a disease of the joints. Unlike many other forms of arthritis that are systemic illnesses (conditions that affect multiple areas of the body or the entire body)，such as rheumatoid arthritis and systemic lupus, osteoarthritis does not affect other organs of the body. The most common symptom of osteoarthritis is pain in the affected joint( s) after repetitive use. Joint pain of osteoarthritis is usually worse later in the day. There can be swelling, warmth，and creaking of the affected joints. Pain and stiffness of the joints can also occur after long periods of inactivity (for example，sitting in a theater). In severe osteoarthritis, complete loss of the cartilage cushion causes friction between bones，causing pain even at rest or pain with limited motion. 骨性关节炎是关节的一种疾病。与某些其他形式的关节炎不一样，如类风湿关节炎和系统性红斑狼疮是全身性疾病（影响机体或机体的多个脏器），而骨关节炎不影响身体其他器官。骨关节炎最常见的症状是反复活动后的关节疼痛。骨关节炎的关节痛在白天更为严重，关节可出现肿胀、发热和吱吱作响的症状。长时间不活动也可出现关节的疼痛和僵硬（例如，坐在一个剧院里）。在严重的骨关节炎中，软骨垫的完全丧失会导致骨头之间的摩擦，从而引起疼痛，甚至在休息或减少运动后仍有疼痛。Symptoms of osteoarthritis vary greatly from patient to patient. Some patients can be debilitated by their symptoms. On the other hand, others may have remarkably few symptoms in spite of dramatic degeneration of the joints apparent on X-rays. Symptoms also can be intermittent. It is not unusual for patients with osteoarthritis of the finger joints of the hands and knees to have years of pain-free intervals between symptoms.骨关节炎的症状存在个体差异。尽管X-射线提示关节明显退化，但有些患者症状并不典型，另一些患者可能有显著症状。症状也可间歇性发作。膝关节骨性关节炎患者中，有多年疼痛症状的手和膝关节疼痛间隔的时间是不同的。Osteoarthritis of the knees is often associated with excess upper body weight, with obesity, or a history of repeated injury and/or joint surgery. Progressive cartilage degeneration of the knee joints can lead to deformity and outward curvature of the knees，which is referred to as being “bowlegged”. People with osteoarthritis of the weight-bearing joints ( such as the knees) can develop a limp. The limping can worsen as more cartilage degenerates. In some patients, the pain，limping，and joint dysfunction may not respond to medications or other conservative measures. Therefore, severe osteoarthritis of the knees is one of the most common reasons for total knee replacement surgical procedures in the United States.膝关节骨性关节炎常伴有超重、肥胖或反复损伤和/或关节手术的病史。膝关节软骨进行性退变可导致畸形和膝盖向外弯曲，称为“罗圈腿”。负重关节（如膝关节）骨性关节炎可导致跛行，跛行可进行性加重软骨退化。在一些患者中，药物或其他保守措施对疼痛、跛行和关节功能障碍无明显疗效。因此，在美国严重的膝关节骨性关节炎是全膝关节置换手术最常见的原因之一。Osteoarthritis of the cervical spine or lumbar spine causes pain in the neck or low back. Bony spurs, called osteophytes，that form along the arthritic spine can irritate spinal nerves, causing severe pain that can radiate from the spine as well as numbness and tingling of the affected parts of the body.颈椎或腰椎骨关节炎会导致颈部或背部疼痛。骨刺，也称为骨赘，沿脊柱关节形成会刺激脊神经引起剧烈的疼痛，也可从脊椎向身体其他部位放射导致麻木、刺痛。Osteoarthritis causes the formation of hard，bony enlargements of the small joints of the fingers. 骨关节炎可引起手指小关节僵硬，骨质增生形成。Classic bony enlargement of the small joint at the end of the fingers is called a Heberdens node, named after a famous British doctor. 在手指末端的小关节处形成的经典骨质增生被称为赫伯登节点，以英国著名医生的名字命名。The bony deformity is a result of the bone spurs from the osteoarthritis in that joint. 骨畸形是由骨关节炎导致的。Another common bony knob ( node) occurs at the middle joint of the fingers in many patients with osteoarthritis and is called a Bouchards node. Dr. Bouchard was a famous French doctor who also studied arthritis patients in the late 1800s.另一个常见的骨旋钮（节点）发生许多骨关节炎患者手指中间和一个被称为Bouchard的节点。在19世纪末期一位著名法国医生布沙尔博士还研究了类风湿性关节炎。 Heberdens and Bouchards nodes may not be painful, but they are often associated with limitation of motion of the joint. 赫伯登和布沙尔节点可能无疼痛感，但它们往往与关节运动受限有关。The characteristic appearances of these finger nodes can be helpful in diagnosing osteoarthritis. 这些手指节点的特征出现对诊断骨性关节炎有帮助。Osteoarthritis of the joint at the base of the big toe of the foot leads to the formation of a bunion. 第一足趾关节底部的骨关节炎可导致囊肿形成。Osteoarthritis of the fingers and the toes may have a genetic basis and can be found in numerous female members of some families. 手指和脚趾的骨关节炎可以具有遗传倾向，可发生在一些家族的女性成员中。 How is osteoarthritis diagnosed ? 骨性关节炎如何诊断？There is no blood test for the diagnosis of osteoarthritis. Blood tests are performed to exclude diseases that can cause secondary osteoarthritis, as well as to exclude other arthritis conditions that can mimic osteoarthritis. 血液检测不能确诊骨关节炎而是为了排除能引起继发性骨关节炎的疾病，以及排除与骨关节炎相似的其他关节炎状况。X-rays of the affected joints can be used to diagnose osteoarthritis. 受累关节X射线检查可用于诊断骨关节炎。The common X-ray findings of osteoarthritis include loss of joint cartilage, narrowing of the joint space between adjacent bones, and bone spur formation. 骨关节炎常见的X线表现为关节软骨缺失、相邻骨关节间隙变窄、骨形成。Simple X-ray testing can also be very helpful to exclude other causes of pain in a particular joint as well as assisting the decision-making as to when surgical intervention might be considered. 简单的X线检查对排除其他原因的疼痛非常有价值，尤其对联合、协助诊断、评估手术风险和预后是非常有帮助的。Arthrocentesis is a procedure to remove joint fluid that is often performed in the doctors office. During arthrocentesis, a sterile needle is used to remove joint fluid for analysis. 关节穿刺术是一项诊疗室进行的利用消毒针抽取关节液进行冲洗、分析的操作。Joint fluid analysis is useful in excluding gout，infection, and other causes of arthritis. 关节液分析对除痛风、感染和其他原因的关节炎是有用的。Removal of joint fluid and injection of corticosteroids into the joints during arthrocentesis can help relieve pain，swelling，and inflammation. 抽取关节液、将糖皮质激素注入关节腔可帮助缓解疼痛、肿胀和炎症。Arthroscopy is a surgical technique whereby a doctor inserts a viewing tube into the joint space. Abnormalities of and damage to the cartilage and ligaments can be detected and sometimes repaired through the arthroscope. 关节镜检查是医生在关节腔内插入可视导管进行操作的一项外科手术技术。通过关节镜可检测和修复异常软骨和韧带损伤。If successful, patients can recover from the arthroscopic surgery much more quickly than from open joint surgery. 手术成功患者术后恢复远快于开放式关节手术。Finally, a careful analysis of the location, duration, and character of the joint symptoms and the appearance of the joints helps the doctor in diagnosing osteoarthritis. Bony enlargement of the joints from spur formations is characteristic of osteoarthritis. Therefore，the presence of Heberdens nodes，Bouchards nodes, and bunions of the feet can indicate to the doctor a diagnosis of osteoarthritis.最后，对有关节症状的部位、病程、特征进行细致的分析，结合关节的外观有助于诊断骨性关节炎。骨关节的骨质增生是骨关节炎的特征，因此赫伯登的节点、Bouchard节点及脚拇趾囊肿对医生诊断骨关节炎有提示作用。What is the treatment for osteoarthritis ? 如何诊断骨性关节炎？Aside from weight reduction and avoiding activities that exert excessive stress on the joint cartilage, there is no specific treatment to halt cartilage degeneration or to repair damaged cartilage in osteoarthritis. 除了减轻体重外还应避免关节增加负重，在骨关节炎中软骨退变或修复受损软骨的治疗是没有特效的。The goal of treatment in osteoarthritis is to reduce joint pain and inflammation while improving and maintaining joint function. 骨性关节炎的治疗目标是减少关节的疼痛和炎症，同时改善和保持关节功能。Some patients with osteoarthritis have minimal or no pain and may not need treatment. Others may benefit from conservative measures such as rest，exercise, diet control with weight reduction，physical therapy and/or occupational therapy，and mechanical support devices, such as knee braces. 某些骨性关节炎患者无论疼痛与否，可能不需要治疗。一部分人可能受益于保守治疗措施，例如休息，运动，饮食控制与减肥，物理治疗和或职业治疗，和物理治疗设备，如护膝。These measures are particularly important when large, weight-bearing joints are involved, such as the hips or knees. In fact， even modest weight reduction can help to decrease symptoms of osteoarthritis of the large joints, such as the knees and hips. 这些措施是尤其对负重关节有帮助，诸如臀部和膝盖。事实上，即使是适度减肥也能减轻膝关节和髋关节等关节的骨性关节炎症状。Medications are used to complement the physical measures described above. Medication may be used topically，taken orally, or injected into the joints to decrease joint inflammation and pain. 药物仅是补充上述物理治疗措施。药物可外用、口服或注射到关节以减少关节的炎症和疼痛。When conservative measures fail to control pain and improve joint function, surgery can be considered. 当保守的措施无法控制疼痛，改善关节功能，可以考虑手术治疗。Resting sore joints decreases stress on the joints and relieves pain and swelling. Patients are asked to simply decrease the intensity and/or frequency of the activities that consistently cause joint pain.休息可减轻关节压力，缓解疼痛和肿胀。持续性关节疼痛时，可要求患者仅仅降低活动的强度和频率。Exercise usually does not aggravate osteoarthritis when performed at levels that do not cause joint pain. 运动通常不会加重骨关节炎，不加重关节疼痛的程度。Exercise is helpful for relief of symptoms of osteoarthritis in several ways, including strengthening the muscular support around the joints. 运动有助于缓解骨关节炎的症状，包括加强关节周围肌肉的支持。It also prevents the joints from “freezing up” and improves and maintains joint mobility. 还可以防止关节“冻结”，提高和保持关节的灵活性。Finally, it helps with weight reduction and promotes endurance. 最后，运动有助于减轻体重，促进耐力。Applying local heat before and cold packs after exercise can help relieve pain and inflammation. 在运动会后使用局部加热和冷敷有助于缓解疼痛和炎症。Swimming is particularly well suited for patients with osteoarthritis because it allows patients to exercise with minimal impact stress to the joints. 游泳特别适合骨关节炎患者，因为它对患者关节活动影响最小Other popular exercises include walking, stationary cycling，and light weight training.其他比较流行的运动包括散步、固定骑行以及减轻体重的训练。Physical therapists can provide support devices, such as splints, canes, walkers, and braces. These devices can be helpful in reducing stress on the joints. 物理治疗师可以提供支持的设备，如夹板、拐杖、助行器，和支架。这些器件可以有助于减轻关节周围的应力。Occupational therapists can assess the demands of daily activities and suggest additional devices that may help people at work or home.执业治疗师可以评估日常活动的需求并建议和帮助人们在工作场所或家中合理使用辅助器械。Finger splints can support individual joints of the fingers. 手指夹板可以支撑手指各个关节。Paraffin wax dips, warm water soaks, and nighttime cotton gloves can help ease hand symptoms. 石蜡温水浸泡和夜间使用棉手套可帮助缓解手部症状。Spine symptoms can improve with a neck collar, lumbar corset, or a firm mattress, depending on what areas are involved.改善颈部症状的颈托、改善腰部症状的束身衣和硬床垫，改善身体各个部位症状的辅助器械都有涉及。In many patients with osteoarthritis, mi Id pain relievers such as aspirin and acetaminophen (Tylenol) may be sufficient treatment. Studies have shown that acetaminophen given in adequate doses can often be equally as effective as prescription anti-inflammatory medications in relieving pain in osteoarthritis of the knees. 大多数骨关节炎患者可能运用足量的MI ID止痛药如阿司匹林和对乙酰氨基酚（扑热息痛）治疗骨关节炎。有研究表明，经常使用适当剂量的对乙酰氨基酚和使用处方消炎药对缓解膝关节骨性关节炎的疼痛效果相同。Since acetaminophen has fewer gastrointestinal side effects than NSAIDS (see below)，especially among elderly people, acetaminophen Ls generally the preferred initial drug given to patients with osteoarthritis. 由于对乙酰氨基酚与NSAIDs相比，胃肠道副作用较小（见下文），尤其是老年人，对乙酰氨基酚LS一般作为老年骨关节炎患者的首选药物。Medicine to relax muscles in spasm might also be given temporarily. Pain-relieving creams applied to the skin over the joints can provide relief of minor arthritis pain. Examples include capsaicin ( ArthriCare,Zostrix)，salycin ( Aspercreme) ,methyl salicylate ( Ben-Gay,Icy Hot)，and menthol (Flexall). 放松肌肉痉挛的药物也可临时缓解症状。缓解关节疼痛的药膏也可减轻轻微的关节炎疼痛。例如包括辣椒素（Arthricare，Zostrix）、salycin（水杨酸三乙醇胺乳膏剂）、水杨酸甲酯（Ben-Gay,Icy Hot）、薄荷醇（flexall）。New topical treatments include an anti-inflammatory lotion, diclofenac (Voltaren Gel) and diclofenac patch (Flector Patch)，which are used for the relief of the pain of osteoarthritis. 新的局部治疗也可缓解骨关节炎的疼痛，包括消炎洗剂、双氯芬酸（扶他林乳膏剂）和双氯芬酸贴片（Flector Patch）。Nonsteroidal anti-inflammatory drugs ( NSAIDs) are medications that are used to reduce pain and inflammation in the joints. Examples of NSAIDs include aspirin (Ecotrin)，ibuprofen (Motrin)，nabumetone (Relafen)，and naproxen (Naprosyn). 非甾体类抗炎药（NSAIDs）是一种减轻关节疼痛和炎症的药物。非甾体抗炎药包括阿司匹林（Ecotrin），布洛芬（Motrin），萘丁美酮（瑞力芬），萘普生（药）。It is sometimes possible to use NSAIDs temporarily and then discontinue them for periods of time without recurrent symptoms, thereby decreasing the risk of side effects. 有时可以在使用非甾体类抗炎药后暂时停药，停药期间患者的症状并没有复发，所以可以用该方法降低药物的副作用。The most common side effects of NSAIDs involve gastrointestinal distress, such as stomach upset, cramping diarrhea, ulcers, and even bleeding. The risk of these and other side effects increases in the elderly. 非甾体类抗炎药最常见的副作用包括胃肠道不适，如胃部不适、腹痛、腹泻、溃疡，甚至出血。老年人发生上述副作用和其他副作用的风险增加。Newer NSAIDs called COX-2 inhibitors have been designed that have less toxicity to the stomach and bowels. Because osteoarthritis symptoms vary and can be intermittent ,these medicines might be given only when joint pains occur or prior to activities that have traditionally brought on symptoms. 新型非甾体抗炎药COX-2抑制剂已研制成功，其对胃、肠毒性较小。由于骨关节炎症状可间歇性发作，这些药物与传统药物比较，可仅仅在关节疼痛发生前或活动前使用。Some studies, but not all, have suggested that alternative treatment with the food supplements glucosamine and chondroitin can relieve symptoms of pain and stiffness for some people with osteoarthritis. 一部分研究建议用葡糖胺和软骨素等食品补充剂替代治疗可缓解某些骨关节炎患者的疼痛和僵硬症状。These supplements are available in pharmacies and health-food stores without a prescription, although there is no certainty about the purity of the products or the dose of the active ingredients because they are not monitored by the U. S. FDA. 这些补充剂在药店和保健食品店不需要处方就可以买到，它们没有确定的产品纯度或活性成分的剂量，因为它们没有被美国食品药品管理局监控。The National Institutes of Health studied glucosamine in the treatment of the pain of oste