Osteoarthritis

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Background

Risk Factors

  • Age
  • Female versus male sex
  • Obesity
  • Lack of osteoporosis
  • Occupation
  • Previous injury
  • Muscle weakness
  • Genetic elements

Clinical Features

PIP (Bouchard's nodes) and DIP (Heberden's node) inflamation.
Most commonly affected joints.
  • Commonly affected joints
    • Cervical and lumbar spine
    • First carpometacarpal joint
    • Proximal interphalangeal joint
    • Distal interphalangeal joint
    • Hip
    • Knee
    • Subtalar joint
    • First metatarsophalangeal joint
  • Uncommonly affected joints
    • Shoulder
    • Wrist
    • Elbow
    • Metacarpophalangeal joint

Differential Diagnosis

Monoarticular arthritis

Algorithm for Monoarticular arthralgia

Polyarthritis

Algorithm for Polyarticular arthralgia

Evaluation

OA of left knee
OA and osteopenia of the carpal joint and 1st carpometacarpel joint
  • Greater than 50 years of age
  • Morning stiffness for less than 30 minutes
  • Crepitus on active motion of the knee
  • Bony tenderness
  • Bony enlargement
  • No palpable warmth

Management

Nonpharmacological

  • Weight loss
  • Ice/warm packs
  • Physical therapy
  • Occupational therapy
  • Exercise

Pharmacological [1]

AAOS Decision Tool for Knee OA

Surgical

  • Arthroscopy for removal of meniscal tears or loose foreign bodies
    • No additional benefit compared to PT and medical therapy in routine OA [2]
  • Osteotomy in young patients with misalignment of knee or hip joint
  • Arthroplasty
    • If all other modalities are ineffective
    • Prothetic knee/hip/shoulder usually has 10-15 year viability
    • Infection, Pulmonary embolism are biggest risks
  • Joint fusion
    • Relieves pain but prevents motion
    • May be used in small foot/ankle bones or after failed arthroplasties

Disposition

  • Discharge with PCP follow-up

See Also

External Links

References

  1. Jordan JM, et al. Prevalence of knee symptoms and radiographic and symptomatic knee osteoarthritis in African Americans and Caucasians: the Johnston County Osteoarthritis Project. J Rheumatol. 2007 Jan. 34(1):172-80.
  2. Kirkley A, et al. A randomized trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med. 2008 Sep 11. 359(11):1097-107