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
- joint anatomy and/or malalignment
- physically demanding occupation/sport
- post trauma/injury
- high bone mineral density
Diagnostic tests
1st tests to order
- history and physical exam
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
Treatment algorithm
joint pain: medical management
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
MA
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
NC
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.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
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.
Differentials
- Bursitis
- Gout
- Pseudogout
More DifferentialsGuidelines
- Management of osteoarthritis of the hip
- APA clinical practice guideline for psychological and other nonpharmacological treatment of chronic musculoskeletal pain in adults
More GuidelinesPatient information
Osteoarthritis: what is it?
Osteoarthritis: what are the treatment options?
More Patient informationVideos
Hip exam
Knee exam
More videos
Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer