Diagnosis
An individual may not notice symptoms in the early stages of OA.
If a person has knee pain, the doctor will ask about personal and family medical histories. They will then perform a full physical examination and order diagnostic tests.
The doctor will also ask:
- when and where the person is experiencing pain and stiffness
- how this affects their daily life
- whether they are taking any medications
The doctor will examine the joints, test their overall range of motion, and check for damage. They will pay close attention to any areas that are tender, painful, or swollen.
MRI scans and joint fluid tests can help detect early signs of OA. The doctor may perform a joint aspiration, which involves removing some fluid with a needle and sending it to a laboratory for testing.
X-rays can also show damage to the joint.
Blood tests can help to rule out other diseases, such as gout and rheumatoid arthritis.
诊断
在OA的早期阶段，可能不会感到任何症状。
如果有膝盖疼痛，医生会询问有关个人史和家庭史，然后进行全面的体格检查和临床检查。
医生还会询问：
- 何时何地出现疼痛和僵硬
- 是否影响日常生活
- 是否正在服用药物
医生会检查关节及其运动范围，并检查是否损伤，观察发软、疼痛或肿胀的部位。
MRI扫描和关节液检查可以帮助OA的早期诊断。 医生会进行关节腔穿刺术，抽取积液并进行实验室检查。
X射线可显示受损关节。
血液检查可以帮助排除其他疾病，例如痛风和类风湿关节炎。
Treatment
Treatment options depend on the stage of OA and how quickly the condition is progressing.
Stage 1
Any symptoms are usually minor, and acetaminophens or other over-the-counter (OTC) medications can often relieve the pain.
Performing certain exercises can help to build strength and mobility.
Some sources recommend taking supplements, such as glucosamine and chondroitin. However, the AAOS have concluded that there is not enough evidence to show that supplements help.
Stage 2
Treatments can include:
- taking pain relievers
- attending physical therapy sessions to build or maintain strength and flexibility
- wearing a knee brace designed to relieve pressure on the joints' surfaces
- wearing shoe inserts to relieve stress on the knee
At this stage, people with OA of the knee may need to change their daily activities to avoid pain.
Stage 3
Treatments can include:
- taking OTC pain relievers, such as acetaminophen
- taking prescription pain relievers, including oxycodone or codeine
- receiving injections of corticosteroids or hyaluronic acid
A doctor will administer three to five hyaluronic acid injections over 3–5 weeks. It can take time for results to show, but relief can last for 6 months.
The AAOS have questioned the use of corticosteroid and hyaluronic acid injections. The drugs can be costly, and long-term use of corticosteroids can lead to adverse effects.
Stage 4
At this stage, the cartilage has either significantly diminished or disappeared completely.
The person may need surgery to replace or realign the joint.
治疗
治疗方案取决于OA的阶段以及病情进展的速度。
第一阶段
症状通常都很轻微，对乙酰氨基酚或其他非处方(OTC)药物通常可以缓解疼痛。
进行适当锻炼可以帮助增强力量和活动能力。
有人建议服用补充剂，例如氨基葡萄糖和软骨素。但是，美国骨科医师学会(AAOS)的结论是，没有足够的证据表明补充剂有帮助。
第二阶段
治疗方法包括：
- 服用止痛药
- 进行物理治疗以建立或保持力量和灵活性
- 佩戴减轻关节表面压力的护膝
- 用足垫以减轻膝盖压力
在此阶段，膝关节骨性关节炎患者需要改变日常活动以避免疼痛。
第三阶段
治疗方法可以包括:
- 服用非处方止痛药，如对乙酰氨基酚
- 服用处方止痛药，包括羟考酮或可待因
- 接受皮质类固醇或透明质酸注射
在3-5周内注射3-5次透明质酸，结果显示可能需要一段时间，但缓解可能持续6个月。
美国骨科医师学会(AAOS)对皮质类固醇和透明质酸注射液的使用提出了质疑，这些药物价格较昂贵，长期使用皮质类固醇会导致不良反应。
第四阶段
在这个阶段，软骨要么明显减少，要么完全消失。
患者可能需要手术来更换或重新调整关节。