Arthritis Care and Research

The current consensus in the global clinical community is that except for a few secondary arthritis such as infectious and traumatic arthritis, which can be clinically cured through targeted treatment, more than 90% of primary osteoarthritis and rheumatoid arthritis cannot be completely cured. However, through individualized layered care and cutting-edge intervention methods, it is possible to reduce the frequency of pain attacks by more than 80% and delay joint replacement by 10-15 years. It is by no means an incurable disease that "can only be treated by taking painkillers and walking less until joint replacement" as popular perception.

Last week I just treated a 38-year-old Internet programmer who had been diagnosed with knee arthritis for three years. I searched for "nursing experiences" on the Internet for half a night and set rules for myself: take ibuprofen when it hurts, take the elevator and never take the stairs. I have persisted for more than two years. Recently, the pain is so severe that I can't even stand for a half-hour meeting. When I came to take an MRI, I found that the cartilage wear has not increased, but the quadriceps have shrunk by two centimeters - the joint cannot be stabilized, and the pain is of course getting worse and worse.

In fact, until now, rheumatology and rehabilitation departments do not have completely unified standards for the daily care of arthritis. The two groups have been arguing for almost ten years: one group advocates that "the life span of joints is fixed, so use them sparingly." The other group says that "muscles are the protective umbrella of joints. The more immobile they are, the more useless they will be." To be honest, both of them are right, but the applicable scenarios are completely different. For example, if you are currently in the acute attack stage, your knee is swollen and shiny, the skin temperature is several degrees higher than the other side, and walking is difficult. At this time, you have to carry it to practice silent squats and climb stairs. But if the redness and swelling have gone away, and there is a dull pain only after walking for a long time, and you still lie down every day and use a wheelchair when going out, then within half a year, the thigh muscles will become loose. Originally, the muscles can help the joints share half of the pressure, but now the pressure is all piled up. Of course, cartilage wears out faster. At this time, you have to follow the "athletic" plan. Start with straight leg raises in a lying position, and slowly transition to silent squats against the wall. Once the thigh muscles are strengthened and the joints are stabilized, the pain will naturally be relieved. I once had a 62-year-old patient who was originally scheduled for joint replacement. He practiced quadriceps exercises at home for 8 months. Now he picks up his grandson from school every day and climbs the third floor without taking a break. He canceled the surgery appointment directly.

The first thing many people ask when they come to the clinic is "Doctor, will it help if I take aminoglucose?" ”, I really can’t give you a one-size-fits-all answer to this question right now. In the updated guidelines of the American College of Rheumatology in 2023, glucosamine was directly classified into the category of "unclear benefits and routine use is not recommended." In their European and American cohort study, patients who took glucosamine and the placebo group who took starch tablets had no difference of 3% in pain relief and cartilage wear rate, which is basically useless. However, the data from a 1,200-person East Asian population cohort study just released by the Japanese Orthopedic Association in 2024 are different. Patients with mild knee arthritis aged 40-60 continued to take medicinal glucosamine with a purity of more than 80% for 12 months. The loss of cartilage thickness was 32% slower than the placebo group, and the pain score was also 27% lower. So our current clinical advice is generally, if you have mild to moderate arthritis and want to take it, you can try it. Just buy the OTC drug that costs more than ten yuan at the pharmacy. Don’t touch the compound IQ tax that costs hundreds of yuan in health food stores. If you feel the pain is really relieved after taking it for 3 months, continue taking it. If you don’t feel it at all, stop. Don’t waste money by taking it.

The research on arthritis in recent years has actually progressed much faster than everyone thought. The hottest direction is the regulation of joint microenvironment. To put it bluntly, when we deal with arthritis, we either relieve the pain when it hurts, or replace the joint when it is worn out. This is equivalent to temporarily watering the crops or directly replanting when the crops are dry. Now we directly adjust the pH of the soil, add probiotics and nutrients, so that the crops can grow slowly. Platelet-rich plasma (PRP) injection, which is now maturely used in clinical practice, is to draw your own venous blood, concentrate the repair factors in it and inject it into the joint cavity to "fertilize" the cartilage. I followed up a 42-year-old amateur badminton coach last year. His cartilage was 40% worn out. He originally planned to stop playing. He received PRP three times according to the course of treatment. Now he can still play amateur singles twice a week, and he can smash smashes when he is in good condition. Of course, this is not a magic medicine. If your cartilage has worn out by more than 70%, the joint space is almost gone, and the effectiveness of PRP is less than 20%, it is better to save money to prepare for joint replacement. There is also mesenchymal stem cell injection, which is currently undergoing Phase III clinical trials. Current public trial data shows that for patients with moderate osteoarthritis, the cartilage regeneration rate can reach 47% 2 years after injection. If it is successfully approved and popularized, arthritis joint replacement may not be necessary in the future.

Oh, by the way, there is another thing I told you in the outpatient department: just apply hot compress to the joints when there is nothing wrong. Last week, there was a patient who was in so much pain that he couldn't sleep during an acute attack. He applied a hot water bottle for two hours at home. The next day, he was so swollen that he couldn't walk, so he was carried here by his family. Remember, as long as the joint is red and swollen and the skin temperature is higher than the other side, you must apply cold compress for 15 minutes each time, 3-4 times a day. Only the chronic stage where the joint is usually cold, the pain is a dull pain, and there is no obvious redness and swelling is suitable for warm care such as hot compress, moxibustion, and electric heating.

In fact, arthritis is not as scary as everyone thinks, and there is no one-size-fits-all care plan. If you have to use other people’s experiences online to apply to yourself, you will most likely end up in a trap. I have seen a girl in her 20s wearing clothes every day and having arthritis worse than her 50-year-old aunt. I have also seen a 70-year-old man doing Tai Chi every day, and his joints are more flexible than many young men who have been sedentary. To put it bluntly, you need to understand the temperament of your joints, don't act blindly, and don't break the pot as soon as you hear "it can't be cured." Research is progressing very fast now. Maybe in another three to five years, cartilage regeneration will be as simple as filling a tooth. If you take good care of it now, it will be profitable to delay the replacement of your joints for a day.