What are the symptoms of osteoarthritis?

As we all know, bone marrow is very important in our body. If there is a disease in the bone marrow, it is very complicated and difficult to treat. Among various bone marrow diseases, osteomyelitis is the most common one. In fact, this disease is mainly caused by bacterial infection. Generally speaking, we can detect this disease in time through the symptoms of osteomyelitis.

Osteomyelitis is an infection and destruction of bone that can be caused by aerobic or anaerobic bacteria, mycobacteria, and fungi. Osteomyelitis often occurs in the long bones, the feet of diabetic patients, or at the site of penetrating bone injury caused by trauma or surgery. The most common site in children is the metaphysis of well-vascularized long bones, such as the tibia or femur.

Osteomyelitis refers to an inflammatory disease caused by purulent bacteria infecting the bone marrow, cortical bone and periosteum. Most of them are caused by blood-borne infections, but also by trauma or surgical infections. Most of them are caused by purulent bacteria and toxins from furuncles or other lesions entering the blood and reaching the bone tissue. The ends of the bones of the limbs are most susceptible to invasion, especially the hip joint. Clinically, repeated attacks are common, which seriously affect physical and mental health and work ability. Acute osteomyelitis presents with high fever and local pain at the onset, and when it turns into chronic osteomyelitis, there will be ulceration, pus discharge, dead bone or cavity formation. Severely ill patients are often in danger of their lives, and sometimes amputation is the only emergency measure that has to be taken, causing the patient to become disabled for life.

Differential Diagnosis

Clinically, it is necessary to differentiate the type of osteomyelitis from diseases with similar clinical manifestations:

1. Hematogenous osteomyelitis is clinically divided into three main types:

(1) Acute hematogenous osteomyelitis is characterized by systemic symptoms, no changes in X-ray examination within 10 days of onset, and most cases have no history of previous attacks.

(2) Subacute hematogenous osteomyelitis is characterized by the absence of systemic toxicity symptoms, the presence of X-ray changes at the onset of the disease, a course of more than 10 days, and no history of previous attacks.

(3) Chronic hematogenous osteomyelitis is characterized by systemic symptoms that may or may not occur depending on the course of the disease, common X-ray changes, and a history of previous infectious attacks.

2. Diseases that need to be differentiated from acute osteomyelitis

From a systemic point of view, it should be differentiated from acute rheumatic fever and acute leukemia. From local and X-ray findings, it should be differentiated from osteosarcoma, Ewing sarcoma, and bone histiocytosis:

(1) Osteosarcoma usually occurs in children aged 10 to 20 years old in the bones of the limbs, mostly in the epiphysis of the long bones; occasionally in the diaphysis. Compared with osteomyelitis, the scope of bone destruction and periosteal reaction is more limited, but sometimes X-ray differentiation is difficult; differentiation through CT, MRI and biopsy is necessary.

(2) Ewing sarcoma is often difficult to distinguish from osteomyelitis. Ewing sarcoma occurs in the bone shafts of the limbs; sometimes there is severe pain, accompanied by fever and local heat; the erythrocyte sedimentation rate is elevated; the white blood cell count is elevated; and the CRP is positive, indicating an inflammatory reaction. On X-ray, the early stage is mainly characterized by periosteal reaction, with a lack of changes in the bone marrow, making diagnosis difficult. Compared with osteomyelitis, periosteal reaction is regular and mostly presents an onion-skin-like periosteal reaction, which is a characteristic. Biopsy is necessary to confirm the diagnosis.

(3) Bone histiocytosis shows various X-ray images depending on the site of disease. When it occurs in the long tubular bones of the limbs, there is a high degree of bone destruction and significant periosteal reaction. Because there are mild inflammatory symptoms both locally and systemically, compared with osteomyelitis, the range of bone destruction and periosteal reaction in bone histiocytosis are limited; if viewed from the dead bone, sometimes no sclerosis image is seen.

(4) Osteoid osteoma is sometimes difficult to distinguish from osteomyelitis. On X-ray, it often occurs in the long tubular bones (i.e., occurs above or below the center). X-rays show a high degree of periosteal reaction and cortical hypertrophy. If observed carefully, the bone translucent image of the lesion can be seen.