Summary

Osteoarthritis (OA) is the most common joint disease worldwide, characterised by cartilage loss, bony remodelling (osteophytes, subchondral sclerosis), synovitis, and structural joint changes. It is a major cause of pain and disability, especially in older adults. The knee, hip, hand (DIPs, CMC), and spine are most commonly affected. Management is holistic, with emphasis on exercise, weight loss, and analgesia. Joint replacement surgery offers excellent outcomes for end-stage disease.

Key Facts

• Definition: Degenerative joint disease with cartilage loss and bony changes
• Prevalence: ~10% of adults over 60 have symptomatic OA
• Risk Factors: Age, obesity, previous joint injury, female sex
• Most Commonly Affected Joints: Knee, hip, hand (DIP, PIP, 1st CMC), spine
• First-Line Treatment: Exercise, weight loss, physiotherapy
• Surgery: Joint replacement for end-stage disease

Clinical Pearls

"Activity-Related Pain": OA pain is typically worse with use ("mechanical") and better with rest. Pain at rest or at night is a red flag for inflammatory arthritis or other pathology.

X-Ray Changes Don't Correlate with Symptoms: Many people with severe radiographic OA have minimal symptoms, and vice versa. Treat the patient, not the X-ray.

Core Treatments Are Non-Pharmacological: NICE emphasises exercise, weight loss, and information/support as first-line. Medications are adjuncts, not first-line.

Why This Matters Clinically

OA is extremely prevalent and a leading cause of disability. Effective management reduces pain, improves function, and can delay or avoid surgery. Holistic, patient-centred care is key.

Structured Approach

Look:

• Joint swelling, deformity
• Bony enlargement
• Muscle wasting (quadriceps in knee OA)
• Gait abnormality

Feel:

• Tenderness (joint line, periarticular)
• Bony enlargement (osteophytes)
• Effusion (patellar tap, bulge sign)
• Temperature (should NOT be hot in OA)

Move:

• Range of motion (active and passive)
• Crepitus (palpable grinding with movement)
• Fixed flexion deformity

Joint-Specific Findings

Natural History

OA is a slowly progressive condition. Symptoms may fluctuate over time. Not everyone with OA will progress to needing surgery. Weight management and exercise can slow progression.

Outcomes

Prognostic Factors

Worse Prognosis:

• Obesity
• Malalignment
• Muscle weakness
• Multiple affected joints
• Inflammatory phenotype
• Poor coping strategies

Key Guidelines

1. NICE CG177: Osteoarthritis (Care and Management) (2022) — Core treatments, stepped care approach.

2. OARSI Recommendations (2019) — International guidelines on management.

Landmark Studies

TOPKAT Trial (2020) — TKR vs non-operative treatment

• RCT comparing total knee replacement with non-operative management
• Key finding: TKR provided greater pain relief and function improvement
• Clinical Impact: Confirms benefits of TKR in appropriate patients

Evidence Strength

What is Osteoarthritis?

Osteoarthritis (OA) is the most common type of arthritis. It happens when the cartilage that cushions your joints wears down over time, causing pain, stiffness, and sometimes swelling. It most often affects the knees, hips, hands, and spine.

Why does it matter?

OA can cause significant pain and make it harder to do everyday activities like walking, climbing stairs, or opening jars. However, with the right treatment, most people can manage their symptoms well and stay active.

How is it treated?

The most important treatments are:

1. Exercise: Strengthening and stretching exercises help support your joints and reduce pain. Walking, swimming, and cycling are good options.

2. Weight loss: Even a small amount of weight loss (5-10%) can significantly reduce knee pain if you're overweight.

3. Pain relief:

   • Topical creams (anti-inflammatory gel) applied to the joint
   • Paracetamol for mild pain
   • Anti-inflammatory tablets (NSAIDs) for short periods if needed

4. Physiotherapy: A physiotherapist can guide you with exercises and provide walking aids if needed.

5. Injections: Steroid injections into the joint can provide temporary relief.

6. Surgery: If other treatments don't work and your quality of life is significantly affected, joint replacement surgery (hip or knee) is very effective.

What to expect

• OA is a long-term condition, but symptoms often fluctuate
• Staying active is one of the best things you can do
• Most people can manage well without surgery
• If surgery is needed, outcomes are usually excellent

When to seek help

See a doctor if:

• Pain is not improving with self-care
• You have sudden severe pain or swelling
• You notice a red, hot, swollen joint (could be infection or gout)
• Pain is stopping you from sleeping or doing daily activities