OSTEOARTHRITIS

A degenerative joint disease with damage to articular cartilage usually caused by inorganic calcium deposit. It
is the commonest form of joint disease. The pathological changes in osteoarthritis are irreversible.

Causes/risk factors

  • Previous injury
  • Overweight
  • Age

Clinical features

  • May involve any joint; most commonly the hip, spine, and knees, usually not symmetrical
  • Restriction of movement, pain on moving the joint but tends to be absent at rest, limp in case of lower limbs
  • Deformity, moderate tenderness
  • Improvement with rest, deterioration with physical activity, and cold and wet weather conditions
  • Joints are usually not swollen or warm but there may be some accumulation of (clear) articular fluid

Differential diagnosis

  • Gout; gouty arthritis
  • Rheumatoid arthritis

Investigations

  • Normal blood count and ESR
  • X-ray: Of the joint(s)

Management

Goals of treatment

  • Pain relief
  • Optimisation of function
  • Minimise progression

General measures

  • Weight reduction
  • Encourage activity and regular exercise
  • Use of appropriate foot wear and walking aids
  • Paracetamol 1 g every 8 hours

In acute exacerbation, or severe pain

  • NSAID (ibuprofen, or diclofenac)
    • Limit use to brief periods
  • Diclofenac 1% gel if available
  • Intra-articular steroids e.g. triamcinolone (specialist only), maximum 4 times/year