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Osteoarthritis is the mechanical degradation of a joint with degeneration of the articular cartilage, periarticular bone remodelling and inflammation.  

Risk factors

  • Primary osteoarthritis risk factors
    • Increasing age
    • Obesity
    • Family history
    • Female gender
    • Sports activities
  • Secondary osteoarthritis causes
    • Pre-existing joint damage: trauma, RA, gout, spondyloarthropathy, septic arthritis, Paget’s disease, avascular necrosis
    • Metabolic disease: chondrocalcinosis, haemochromatosis, acromegaly
    • Systemic disease: haemophilia (haemarthrosis), neuropathy, haemoglobinopathy

Clinical features

Symptoms

  • Joint pain: worse on exercise and relieved by rest, morning pain <30 minutes
  • Commonly affected joints: knees, hips, interphalangeal joints of fingers, carpometacarpal joint of thumb

Signs

  • Crepitus
  • Pain on movement
  • Reduced range of movement
  • May be bony swellings (osteophytes), joint instability, joint effusions
  • Characteristic hand deformities: Heberden’s nodes, Bouchard’s nodes, squaring of carpometacarpal joint of thumb

Investigations

  • X-Rays 
  • Bloods: FBC, CRP/ESR
    • Only useful for ruling out inflammatory and infectious causes (inflammatory markers not raised in osteoarthritis)

Management

  • Conservative: exercise, physiotherapy, weight loss, mobility aids, supportive footwear
  • Analgesia
    • Topical analgesia (e.g. capsaicin, NSAIDs)
    • Add paracetamol
    • Add NSAID
    • Add opioid
  • Intra-articular corticosteroid injections
  • Joint replacement aims to reduce pain and improve mobility

Questions for you

What are the classical features of osteoarthritis on an X-ray?

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What are the possible complications of joint replacement?

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What is capsaicin? How does it work? What is a common adverse effect?

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Try some OSCE stations!

  1. Knee osteoarthritis exam
  2. Hip exam
  3. Foot and ankle exam
  4. Hand and wrist exam
  5. Find lots more here
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