Overview
Definition
A degenerative joint disease characterized by the breakdown of articular cartilage, subchondral bone changes, and osteophyte formation.
Epidemiology
The most common joint disease worldwide. Prevalence increases significantly with age and obesity.
Etiology & Risk Factors
- 'Wear and tear' on weight-bearing joints (knees, hips) and hands over time.
- Risk factors: Advancing age, obesity, prior joint trauma, genetics, repetitive occupational stress.
Clinical Symptoms
- Joint pain that worsens with use and weight-bearing, and improves with rest
- Morning stiffness is brief (usually < 30 minutes)
- Commonly affects: Knees, Hips, Spine, and Hands (DIP and PIP joints, First CMC joint)
- Heberden's nodes (osteophytes at DIP joints) and Bouchard's nodes (at PIP joints)
- Crepitus (grinding/crackling sensation in the joint)
Clinical Approach
Diagnosis
- Clinical diagnosis based on history and physical exam in patients >45 years old
- X-ray (Diagnostic hallmark): Asymmetric joint space narrowing, subchondral sclerosis, subchondral cysts, and Osteophytes (bone spurs)
- Labs: Normal (ESR, CRP, RF, and ANA are typically negative)
Management
- First-line Lifestyle: Weight loss (most effective intervention for knee/hip OA) and physical therapy/exercise
- Pharmacotherapy: Topical NSAIDs (Diclofenac), Oral NSAIDs, Acetaminophen, Intra-articular Corticosteroid injections
- Definitive: Total Joint Arthroplasty (Replacement) for severe, debilitating pain refractory to conservative measures
Complications
- Chronic pain leading to significantly reduced mobility and quality of life
- Increased risk of falls in the elderly