Osteoarthritis

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)

A patient presents to ED with chest pain and this trace. What would you do?

Interpretation management

Covered in OSCE Stations

Management

• Conservative: exercise, physiotherapy, weight loss, mobility aids, supportive footwear
• Analgesia: topical NSAID, then oral NSAID if required
• Intra-articular corticosteroid injections
• Joint replacement aims to reduce pain and improve mobility

Reference: NICE ‘NG226 Osteoarthritis in over 16s: diagnosis and management’ 2022

Questions for you

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