Last reviewed: 23 Dec 2020
Last updated: 06 May 2020
Summary
Definition
History and exam
Key diagnostic factors
- pain
- functional difficulties
- knee, hip, hand, or spine involvement
- bony deformities
- limited range of motion
- malalignment
Other diagnostic factors
- tenderness
- crepitus
- stiffness
- shoulder, elbow, wrist, or ankle involvement
- effusion
- antalgic gait
Risk factors
- age >50 years
- female sex
- obesity
- genetic factors
- knee malalignment
- physically demanding occupation/sport
- high bone mineral density
Diagnostic investigations
1st investigations to order
- x-ray of affected joints
- serum CRP
- serum erythrocyte sedimentation rate (ESR)
Investigations to consider
- rheumatoid factor (RF)
- anticyclic citrullinated peptide (anti-CCP) antibody
- MRI of affected joints
Treatment algorithm
Contributors
Authors

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
MA
Disclosures
FB has received an honorarium as an advisory board member for Fidia Pharmaceuticals.
Peer reviewers
Assistant Professor of Medicine
Boston University Clinical Epidemiology Research and Training Unit
Boston University School of Medicine
Boston
MA
Disclosures
DH declares that he has no competing interests.
Professor of Clinical Rheumatology
Department of Rheumatology
King’s College
London
UK
Disclosures
Not disclosed.
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