Osteoarthritis

The answer first

Osteoarthritis (OA) is the most common form of arthritis, characterised by joint pain, stiffness, reduced function, and variable structural changes including articular cartilage loss, subchondral bone alteration (sclerosis, cysts, osteophytes), synovitis, and joint capsule thickening. The FRACP candidate must defend the clinical diagnosis (no imaging required in typical presentations: persistent use-related joint pain, age 45 years or older, morning stiffness less than 30 minutes, crepitus), the first-line therapy ladder (education, exercise, weight loss if overweight, topical NSAID before oral), and the indications for joint replacement (persistent pain despite conservative therapy, functional limitation, sleep disturbance, reduced quality of life). ^{[1] [3]}

The answer-first synthesis is: make a clinical diagnosis, address modifiable risk factors (weight, muscle strength, joint loading), institute non-pharmacological therapy first (exercise, weight loss, biomechanical interventions), add topical or oral pharmacological therapy for symptom control, reserve intra-articular therapy and surgery for refractory cases, and integrate patient education and self-management. ^{[1] [4]}

References10ShowHide

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2. [2]Kolasinski SL, Neogi T, Hochberg MC et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee Arthritis & rheumatology (Hoboken, N.J.), 2020.PMID 31908163
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9. [9]McAlindon TE, LaValley MP, Harvey WF et al. Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain in Patients With Knee Osteoarthritis: A Randomized Clinical Trial JAMA, 2017.PMID 28510679
10. [10]Weng Q, Goh SL, Wu J et al. Comparative efficacy of exercise therapy and oral non-steroidal anti-inflammatory drugs and paracetamol for knee or hip osteoarthritis: a network meta-analysis of randomised controlled trials British journal of sports medicine, 2023.PMID 36593092