Osteoarthritis is the most common form of arthritis, caused by the breakdown of joint cartilage with changes in the bone underneath. It most often affects the knees, hips, hands and spine in older adults.
Key symptoms
- Joint pain that worsens with use and improves with rest
- Morning stiffness lasting less than 30 minutes
- Reduced range of motion
- Grinding or cracking in the joint
What you find on exam
- Bony enlargement; Heberden and Bouchard nodes in the hands
- Crepitus and limited motion
- Mild effusion without warmth
- Joint deformity such as bowed legs
Tests
- Clinical diagnosis in adults over 45 with typical symptoms
- X-ray: joint space narrowing, osteophytes, subchondral sclerosis and cysts
- Normal ESR and CRP; joint fluid with a low white cell count if tapped
Treatment basics
- Exercise, weight loss and physical therapy
- Topical NSAIDs such as diclofenac gel, then oral NSAIDs
- Acetaminophen for mild pain
- Joint steroid injections for flares
- Joint replacement for severe disease
Red flags
- Hot, red, swollen joint (rule out infection or gout)
- Night pain, fever or weight loss
- Rapid loss of function
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.