Osteoarthritis (OA) is a degenerative joint disorder; prevalence increases with age.
The most commonly affected joints are the knee, hip, hands, and lumbar and cervical spine.
Presents with joint pain and stiffness that is typically worse with activity.
Radiographs show loss of joint space, subchondral sclerosis, and osteophytes.
Treatments are non-pharmacological and pharmacological.
Joint replacement surgery is effective for controlling the pain of OA in advanced disease.
Osteoarthritis (OA) is the result of mechanical and biological events that destabilise the normal process of degradation and synthesis of articular cartilage chondrocytes, extracellular matrix, and subchondral bone. It involves the entire joint, including the articular cartilage, subchondral bone, pericapsular muscles, capsule, and synovium. The condition leads to loss of cartilage, sclerosis and eburnation of the subchondral bone, osteophytes, and subchondral cysts. It is clinically characterised by joint pain, stiffness, and functional limitation.
History and exam
Key diagnostic factors
- presence of risk factors
- functional difficulties
- knee, hip, hand, or spine involvement
- bony deformities
- limited range of motion
Other diagnostic factors
- shoulder, elbow, wrist, or ankle involvement
- antalgic gait
- age >50 years
- female sex
- genetic factors
- knee malalignment
- physically demanding occupation/sport
- post trauma/injury
- high bone mineral density
1st investigations to order
- x-ray of affected joints
- serum CRP
- serum erythrocyte sedimentation rate (ESR)
Investigations to consider
- rheumatoid factor (RF)
- anti-cyclic citrullinated peptide (anti-CCP) antibody
- MRI of affected joints
- ultrasound scan
joint pain: medical management
persistent pain despite multiple treatment modalities or with severe disability
Fadi Badlissi, MD, MSc
Harvard Medical School
Director of the Musculoskeletal Medicine Unit
Department of Orthopedics & Division of Rheumatology
Beth Israel Deaconess Medical Center
FB declares that he has no competing interests.
David Hunter, MD
Assistant Professor of Medicine
Boston University Clinical Epidemiology Research and Training Unit
Boston University School of Medicine
DH declares that he has no competing interests.
David L. Scott, MD, FRCP
Professor of Clinical Rheumatology
Department of Rheumatology
- Guideline for the management of osteoarthritis of the hand, hip, and knee
- VA/DoD clinical practice guideline for the non-surgical management of hip and knee osteoarthritis
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