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General Medicine

Osteoarthritis

Patrick Wakefield Joyner, MD, MS Reviewed 06/2019
 


BASICS

DESCRIPTION

  • Progressive loss of articular cartilage with reactive changes at joint margins and in subchondral bone

  • Primary osteoarthritis (OA)

    • Idiopathic: categorized by clinical features (localiz...

DIAGNOSIS

HISTORY

  • Distinguish OA from other types of arthritis by:

    • Absence of systemic findings

    • Minimal articular inflammation

    • Distribution of involved joints (e.g., distal and proximal interphalangeal jo...

TREATMENT

GENERAL MEASURES

  • Weight management combined with exercise/physical therapy demonstrates most improvement in patients with OA.

  • Physical therapy to maintain or regain joint motion and muscle str...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Patient Monitoring

  • Regularly assess range of motion and functional status.

  • Monitor for GI blood loss and cardiac, renal, and mental status in older patients on NSAI...

REFERENCES

1
Gersing AS, Schwaiger BJ, Nevitt MC, et al. Is weight loss associated with less progression of changes in knee articular cartilage among obese and overweight patients as assessed with MR i...

ADDITIONAL READING

  • Hall M, Castelein B, Wittoek R, et al. Diet-induced weight loss alone or combined with exercise in overweight or obese people with knee osteoarthritis: a systematic review and meta-...

CODES

ICD10

  • M19.90 Unspecified osteoarthritis, unspecified site

  • M19.91 Primary osteoarthritis, unspecified site

  • M19.93 Secondary osteoarthritis, unspecified site

  • M19.92 Post-traumatic osteoarthritis, unsp...

CLINICAL PEARLS

  • Patients with OA typically have morning stiffness lasting for <15 minutes.

  • OA most commonly affects the hips, knees, and hands (PIP and DIP joints).

  • If used, intra-articular steroid i...

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FIG. 108.1. Degenerative joint disease of the knee. Large areas of erosion of articular cartilage are present on the patellar facet and on the condyles of the femur. These erosions occupy principally the central portions of the joint surfaces and spare the marginal regions. The cartilage at the eroded edges is fi illated. The irregular elevations at the periphery of the surfaces are osteophytes.
FIG. 108.1. Degenerative joint disease of the knee. Large areas of erosion of articular cartilage are present on the patellar facet and on ...
FIG. 108.8. Heberden node. The articular cartilage has completely disappeared from the surfaces of the distal interphalangeal joint. Bony osteophytes, directed toward the base of the finger, are present on the dorsal and palmar aspects of both articulating surfaces. Advanced osteoarthritic changes also are present in the proximal interphalangeal joint and form a so-called Bouchard node. (Hematoxylin and eosin stain, original magnification 320.)
FIG. 108.8. Heberden node. The articular cartilage has completely disappeared from the surfaces of the distal interphalangeal joint. Bony o...
Osteoarthritis
Osteoarthritis
Figure 10-5 INFLAMMATORY VERSUS DEGENERATIVE ARTHRITIS.A. Inflammatory Arthritis (Rheumatoid Arthritis). The most prominent feature is the uniform bicompartmental loss of joint space. B. Degenerative Arthritis (Degenerative Joint Disease). In contrast, selective loss of a single compartment joint space in a non-uniform manner is apparent.COMMENT: This is an important differential feature between inflammatory and degenerative joint changes.
Figure 10-5 INFLAMMATORY VERSUS DEGENERATIVE ARTHRITIS.A. Inflammatory Arthritis (Rheumatoid Arthritis). The most prominent feature is the ...
Figure 10-46 DEGENERATIVE JOINT DISEASE: KNEE. A. Recumbent. B. Erect. Observe the loss of lateral joint space not seen on the recumbent film (arrow).
Figure 10-46 DEGENERATIVE JOINT DISEASE: KNEE. A. Recumbent. B. Erect. Observe the loss of lateral joint space not seen on the recumbent fi...
Figure 10.27. Degenerative joint disease of fingers: Bouchard's nodes on proximal interphalangeal (PIP) joint, Heberden's nodes on distal interphalangeal (DIP) joint. Look for the company of other finger or of thumb osteoarthritis.
Figure 10.27. Degenerative joint disease of fingers: Bouchard's nodes on proximal interphalangeal (PIP) joint, Heberden's nodes on distal i...
FIG. 65.9. "Whittling" of the middle phalanx and expansion of the base of the distal phalanx—the "pencil-in-cup" deformity.
FIG. 65.9. "Whittling" of the middle phalanx and expansion of the base of the distal phalanx—the "pencil-in-cup" deformity.
Left Hand and Wrist with Osteoarthritis Unlabeled
Left Hand and Wrist with Osteoarthritis Unlabeled
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