🔑 Key Learning

  • Degenerative joint disease typically affecting adults > 45
  • Commonly affects knees, hips, hands (especially DIPJs and CMCJs)
  • Presents with activity-related pain and minimal morning stiffness
  • X-ray shows LOSS: Loss of joint space, Osteophytes, Subchondral sclerosis, Subchondral cysts
  • 1st line: topical NSAIDs; joint replacement if function significantly impaired

🧬 Pathophysiology

  • Progressive degeneration of articular cartilage with bone remodelling
  • Inflammation is minimal, differentiating OA from inflammatory arthropathies
  • In the hands:
    • DIPJs and 1st CMCJs most commonly affected
    • In contrast to RA, which tends to spare DIPJs

đź‘€ Clinical Features

Symptoms

  • Age > 45
  • Gradual onset of activity-related joint pain
  • No or minimal morning stiffness
  • Pain relieved by rest

Examination

  • Hands:
    • Heberden’s nodes (DIPJ)
    • Bouchard’s nodes (PIPJ)
    • Squaring of thumb base (CMCJ)
    • Thenar wasting
  • Knees:
    • Crepitus, bony swelling, effusion
  • Hips:
    • Groin pain, reduced internal rotation

🧪 Investigations

🩻 X-ray Findings – 'LOSS'

  • L – Loss of joint space
  • O – Osteophyte formation
  • S – Subchondral sclerosis
  • S – Subchondral cysts

Other investigations (e.g. CRP, ESR) usually normal

đź’Š Management

NICE Analgesia Ladder

  1. Topical NSAIDs
  2. Oral NSAIDs 
    • If topical treatment is inadequate
    • Use lowest effective dose, shortest duration
    • Consider co-prescribing PPI
  3. Paracetamol or codeine
    • Short-term use only if NSAIDs contraindicated or ineffective
    • Avoid strong opioids

đź’‰ Intra-articular Steroid Injections

  • For flares or when oral/topical agents insufficient
  • Can provide relief for 2–10 weeks

🦿 Further Management

  • Physiotherapy
  • Weight loss
  • Walking aids if needed
  • Referral to T&O for joint replacement:
    • Indications: Symptoms persist > 3 months despite conservative management and functional impact

đź“ť Exam Clues & Clinchers

  • Heberden’s nodes = DIPJ OA
  • Squaring of the thumb base = 1st CMCJ OA
  • Crepitus, no morning stiffness, gradual progression = OA not RA
  • X-ray showing LOSS = classic OA features
  • Topical NSAIDs -> PO NSAIDS -> PCM/Codeine

đź”— Useful Links and References