Osteoarthritis

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

• Acute osteoarthritis
• Avascular necrosis
• Crystal-induced (Gout, Pseudogout)
• Gonococcal septic arthritis
• Nongonococcal septic arthritis
• Lyme disease
• Malignancy
• Reactive poststreptococcal arthritis
• Trauma-induced arthritis

Polyarthritis

Algorithm for Polyarticular arthralgia

• Fibromyalgia
• Juvenile idiopathic arthritis
• Lyme disease
• Osteoarthritis
• Psoriatic arthritis
• Reactive poststreptococcal arthritis
• Rheumatoid arthritis
• Rheumatic fever
• Serum sickness
• Systemic lupus erythematosus
• Serum sickness–like reactions
• Viral arthritis

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

• Topical capsaicin
• Topical NSAIDs
• Oral NSAIDs
• Tylenol
• Steroid injections
• Tramadol

AAOS Decision Tool for Knee OA

• Refer to this helpful tool from the American Academy of Orthopedic Surgeons for management and disposition options
• Link to knee osteoarthritis tool

Surgical

• Arthroscopy for removal of meniscal tears or loose foreign bodies
  • No additional benefit compared to PT and medical therapy in routine OA
• 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

• Home with primary care follow up

See Also

• Arthritis

References

Authors

Ann Huang, Bobak Zonnoor, Ross Donaldson, Kevin Lu, Michael O'Brien, MD, Claire, Neil Young, Daniel Ostermayer