Osteoarthritis (OA) is a common and frequently debilitating joint disorder; prevalence increases with age.
The most commonly affected joints are the knee, hip, hands, feet, 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 nonpharmacologic and pharmacologic.
Joint replacement surgery is effective for controlling the pain of OA in advanced disease.
OA is the result of mechanical and biologic events that destabilize 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 characterized by joint pain, stiffness, and functional limitation.
History and exam
Key diagnostic 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
- joint anatomy and/or malalignment
- physically demanding occupation/sport
- post trauma/injury
- high bone mineral density
1st investigations to order
- history and physical exam
Investigations to consider
- x-ray of affected joints
- serum CRP
- serum erythrocyte sedimentation rate (ESR)
- rheumatoid factor (RF)
- anticyclic 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
- Management of osteoarthritis of the hip
- Treatment for shoulder OA with intact rotator cuff and severe glenoid retroversion: appropriate use criteria
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