骨性關節炎之臨床診斷

Clinical Diagnosis of Osteoarthritis

鄭國安(Quo-An Cheng) ； 林永福(Yeong-Fwu Lin)

《中華民國物理治療學會雜誌》 16卷1期 (1991/03) Pp. 19-24

https://doi.org/10.29616/JPTAROC.199103.0003

摘要

骨性關節炎(Osteoarthritis)可分為原發性和續發性兩大類，原發性關節炎在40歲以前是很少見的。隨著年齡的增加，原發性關節炎的症狀之頻率和嚴重性均會跟著增加。如果一個年青人患有厲害的關節炎，就必須考慮其他的因素。骨性關節炎之診斷，必須綜合各項檢查的結果，才不容易産生誤診，這些可分爲病人之病徵(Symptoms)和醫生檢查所得之徵侯(Signs)，放射線學之檢查，骨骼掃瞄(Bone scan)，紅外線攝影，以及各種理學檢查(Laboratory finding)而証實。

關鍵字

骨性關節炎

並列摘要

Osteoarthritis is the most common of the various articular disorders affecting man. Although pathologic evidence of degenerative change in joints may occur as early as the second decade of life. Symptoms are relatively uncommon before 40 years of age. However, it is not an inevitable aging process. Many research has demonstrated significant difference between the aging process and osteoarthritis. osteoarthritis can occur in virtually any joint of the body. Fortunately, painful symptoms develop in only about half of these patients. The most commonly involved joints are those that bear weight, such as the hips, knees and spine.
Clinical diagnosis of osteoarthritis is not as simple as it seems and requires evaluation of many aspects such as clinical symptoms and signs, roentgenologic studies, bone scan, thermography and laboratory findings.
The clinical symptoms has an insidious onset. The cardinal symptoms of the disease is pain. It is described as deep and poorly localized. Joint stiffness is localized to involve joints and usually of short duration. In the presence of advanced disease, the patient may complain of a feeling of crepitus as the joint is moved. Ultimately, a decreased range of motion and loss of mobility occur as the joint stiffness developed. This may lead to joint enlargement and deformity. Both deformity and sublaxation are seen in late stages of the disease owing to cartilage loss, collapse of subchondral bone, formation of bone cysts and gross bony overgrowth. The first roentgenologic manifestation of osteoarthritis is joint space narrowing owing to the thinning of the articular cartilage. Osteophyte are the most prominent roentgenoloraphic feature of the disease. Osteophytogenesis is a biomechanical attempt to develop a more favorable distribution of load across the joint. Degenerative cysts are a hallmark of osteoarthritis. Sclerosis of the subchondral bone is described as eburnation.
The bone scan is useful in assessing the extent and severity of osteoarthritis. Thermograpy provides a pictorial image of surface temperature. Osteoarthritis joints with concomitant synovitis may appear warmer than adjacent skin but is indistinguishable from rheumatoid disease.
Laboratory finding in osteoarthritis are not pathognomonic. Nevertheless, test of body fluid such as urine, blood and synovial fluid serve to exclude other metabolic disorders. Synovial fluid in primary osteoarthritis is generally consider as non inflammatory, however, a mild but significant pleocytosis and elevation of fluid protein imply a mild synovitis. The viscosity of synovial fluid and mucin clot test provides additional information regarding to oeteoarthritis.

並列關鍵字

Osteoarthritis