Background and Purpose
Degenerative arthritis is a disease in which the number of patients visit medical institutions is increasing every year. According to Health Insurance Review and Assessment Service(HIRA) statistics in 2022, the number of patients who received Korean medicine treatment for degenerative arthritis was 303,523, taking into account that the number of patients who received Korean medicine treatment for arthropathy was 349,749. Between 2020 and 2022, the number of patients receiving Korean medicine treatment for degenerative arthritis is approximately 300,000, showing a consistent trend, with an increase in the elderly population and elderly deaths. It is expected that the number of patients receiving treatment will continue to increase due to socio-demographic changes.
As the Korean medicine clinical practice guideline(CPG) for the present was made in 2020, focusing only on KOA, further development of the CPG for other common degenerative arthritis of hip and phalangeal joint, is needed. Consequently, this study aims to create a Korean medicine CPG regarding degenerative arthritis of hip and phalangeal joint that is intended to present guidance on various korean medicine treatment direction including acupuncture or herbal medicine that could be widely used among korean medicine clinic, hospital and so on; the korean medical service system in the field.
Overview of disease
Inflammation and pain, caused by spontaneous injury to the bone and ligaments around the joints, are the most common complaints of degenerative arthritis that occur when the cartilage that protects the joints gradually wears away or has a degenerative condition. In addition, degenerative arthritis is characterized by spontaneous injury or degenerative changes in the articular cartilage that covers the joints. Within the disease progression, excess bone is formed around the joints which is called osteophyte. When synovial tissue that covers the joints has a inflammatory condition, full of fluids in the joints result in pain, swelling, edema, stiffness causing limitations in movement. Degenerative arthritis occurs usually in the knee and hip joints where are weight-bearing, followed by phalangeal joints and neck.
According to the Korean Standard Classification of Diseases(KCD) major classification system, degenerative arthritis of hip joint is categorized for M160(Primary coxarthrosis, bilateral), M1905(Primary arthrosis of other joints, pelvis and femur), M1985(Other specified arthrosis, pelvis and femur), and M1995(Arthrosis, unspecified, pelvis and femur). Additionally, degenerative arthritis of phalangeal joint may be classified as M180(Primary arthrosis of first carpometacarpal joints, bilateral), M1904(Primary arthrosis of other joints, hand), M1984(Other specified arthrosis, hand), and M1994(Arthrosis, unspecified, hand).
Degenerative arthritis is diagnosed by symptoms, physical examination, and imaging investigations such as X-Ray, CT, Magnetic Resonance Imaging(MRI), and Bone scan. The treatments include the conservative treatment and the operation, for the conservative treatment there are medications, physical therapy, therapeutic exercise, pharmaceutical injection and so forth. When there is no effectiveness in the conservative treatment anymore or a patient with severe functional impairment, arthroplasty is mainly recommended.
In korean medicine, degenerative arthritis of hip and phalangeal joint can be considered to be classified as 痹症(Bijung). According to the symptoms and pattern identification of degenerative arthritis patients of hip and phalangeal joint patients, various korean medicine treatments are applied; such as acupuncture, electroacupuncture, ear acupuncture, moxibustion, cupping, pharmacoacupuncture, thread-embedding, chuna, etc. The most widely used prescriptions as follows: daeganghwaltang, Sopunghwalhyeoltang, Daebangpungtang, Youngseonjaetongyeum, Bangpungtongseongsan, and so on.
