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

• Joint examination 
• 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