Osteoarthritis

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 24 Apr 2025

Last updated: 13 Dec 2024

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.

Definition

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.[1][2]

History and exam

Key diagnostic factors

pain
functional difficulties
knee, hip, hand, or spine involvement
bony deformities
limited range of motion
malalignment

Full details

Other diagnostic factors

tenderness
crepitus
stiffness
shoulder, elbow, wrist, or ankle involvement
effusion
antalgic gait

Full details

Risk factors

age >50 years
female sex
obesity
genetic factors
joint anatomy and/or malalignment
physically demanding occupation/sport
post trauma/injury
high bone mineral density

Full details

Diagnostic tests

1st tests to order

history and physical exam

Full details

Tests 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
CT

Full details

Treatment algorithm

ACUTE

joint pain: medical management

ONGOING

persistent pain despite multiple treatment modalities or with severe disability

Contributors

Authors

Fadi Badlissi, MD, MSc

Assistant Professor

Harvard Medical School

Attending Physician

Director of the Musculoskeletal Medicine Unit

Department of Orthopedics & Division of Rheumatology

Beth Israel Deaconess Medical Center

Boston

Disclosures

FB has received reimbursement from ANI Pharmaceutical for attending an advisory board meeting.

Peer reviewers

Amanda E. Nelson, MD, MSCR, RhMSUS

Associate Professor

University of North Carolina at Chapel Hill

Disclosures

AN serves on the OARSI Board of Directors, is an Associate Editor of Osteoarthritis and Cartilage, is medical advisor to the Osteoarthritis Action Alliance, and has received grant funding from NIH/NIAMS and the CDC.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Kolasinski SL, Neogi T, Hochberg MC, et al. 2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee. Arthritis Care Res (Hoboken). 2020 Feb;72(2):149-62.Full text Abstract

National Institute for Health and Care Excellence. Osteoarthritis in over 16s: diagnosis and management. Oct 2022 [internet publication].Full text

Bruyère O, Honvo G, Veronese N, et al. An updated algorithm recommendation for the management of knee osteoarthritis from the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO). Semin Arthritis Rheum. 2019 Dec;49(3):337-50.Full text Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

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Osteoarthritis

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic tests

1st tests to order

Tests to consider

Treatment algorithm

joint pain: medical management

persistent pain despite multiple treatment modalities or with severe disability

Contributors

Authors

Fadi Badlissi, MD, MSc

Disclosures

Peer reviewers

Amanda E. Nelson, MD, MSCR, RhMSUS

Disclosures

References

Key articles

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials

Guidelines

Patient information

Videos

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice