The Treatment of Modern Western - Biblio.nhat-nam.ru

53OSTEOARTHRITISAlso called degenerative joint disease, osteoarthrosis, andhypertrophic osteoarthritis, osteoarthritis (OA) is a joint diseasecharacterized by loss of articular cartilage and hypertrophyof the bone producing osteophytes or bone spurs. It is themost common articular disorder. Osteoarthritis typicallybegins asymptomatically in the 20s and 30s and is extremelycommon by age 70. Almost all persons by age 40 have somepathological changes in weight-bearing joints, although relativelyfew have symptoms. Although men and women areequally affected by this disease, onset tends to be earlier inmales.Osteoarthritis is divided into two broad categories: primary(i.e., idiopathic) and secondary. Primary generalized OA typicallyinvolves the distal and proximal interphalangeal joints,the first carpo-metacarpal joint, the intervertebral disks andzygapophyseal joints in the cervical and lumbar vertebrae,the first metatarso-phalangeal joint, hip, and knee.Secondary OA appears to result from conditions changingthe microenvironment of the chondrocytes. These includecongenital joint abnormalities, genetic defects, infectious,metabolic, endocrine, and neuropathic diseases, diseases thatalter normal structure and function of the hyaline cartilage,and trauma to the hyaline cartilage or surrounding tissue.This trauma also include micro-trauma due to prolongedrepetition of specific movements and overuse.Pain is the earliest symptom of this disease. It is usually worsenedby exercise and relieved by rest. Morning stiffness followsinactivity but lasts less than 15-30 minutes and lessenswith movement. As OA progresses, joint mobility diminishes,tenderness and crepitus appear, and flexion contracturesmay develop. Proliferation of cartilage, bone, ligament, tendon,capsules, and synovium, along with varying amounts ofjoint effusion, ultimately produces the joint enlargementcharacteristic of this disease.The Western medical diagnosis of osteoarthritis is based onsigns and symptoms and on x-ray. X-ray generally revealsnarrowing of the joint space, increased density of the subchondralbone, osteophyte formation at the periphery of thejoints, and pseudocysts in the subchondral marrow. ESR isnormal or only moderately increased. Blood studies help ruleout other diseases with similar symptoms, such as rheumatoidarthritis and gout. The Western medical treatment ofOA involves lifestyle and activity counseling, such as theavoidance of soft, deep chairs by those with osteoarthritis ofthe hip, exercise and stretching, and the symptomatic use ofanalgesics, such as NSAIDs. Muscle relaxants may be temporarilyprescribed to relieve pain arising from musclestrained attempting to support OA joints. However, drugtherapy comprises only 15% of a total treatment programand is the least important aspect of optimum management.Adjunctive treatments include transcutaneous electricalstimulation (TENS) and local rubs such as with capsaicin, acapsicum derivative. Surgery, including laminectomy,osteotomy, and total joint replacement, may be used whenconservative therapy fails.CHINESE DISEASE CATEGORIZATION: Osteoarthritisfalls within the general category of bi zheng, impedimentconditions, in Chinese medicine. It is also called feng shibing, literally, wind dampness disease but often translated asrheumatic disease, and li jie feng, wind visiting the joints.DISEASE CAUSES: External contraction of wind, cold,damp evils and bodily weakness due to former heaven naturalendowment insufficiency and/or agingDISEASE MECHANISMS: Due to habitual bodily vacuityweakness, the defensive exterior may fail in its duty. Ifwind, cold, and/or damp evils take advantage of this vacuityto invade the body and flow to the joints, they may impedeand obstruct the qi and blood in the local area, thus causing