Osteoarthritis

Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management | References

Definition

Osteoarthritis (OA) is a degenerative joint disease characterised by the breakdown of cartilage and underlying bone, leading to pain, stiffness, and functional impairment.

Aetiology

Osteoarthritis is caused by a combination of genetic, mechanical, and biochemical factors. Key aetiological factors include:

• Ageing
• Joint injury or overuse
• Obesity
• Genetic predisposition
• Muscle weakness
• Other joint conditions, such as rheumatoid arthritis or gout

Pathophysiology

The pathophysiology of osteoarthritis involves:

• Degeneration of articular cartilage
• Subchondral bone sclerosis
• Formation of osteophytes (bone spurs)
• Synovial inflammation
• Thickening of the joint capsule

Risk Factors

• Advanced age
• Female gender
• Obesity
• Previous joint injuries
• Repetitive stress on the joints
• Genetic factors
• Congenital or developmental abnormalities

Signs and Symptoms

The signs and symptoms of osteoarthritis include:

• Joint pain, particularly with movement and weight-bearing
• Stiffness, especially in the morning or after periods of inactivity
• Swelling and tenderness around the affected joints
• Decreased range of motion
• Crepitus (a grating sensation) during joint movement
• Joint deformity in advanced cases

Investigations

Specific investigations to diagnose osteoarthritis include:

• Clinical examination: Physical assessment of joint pain, swelling, and range of motion.
• Imaging studies:
  • X-rays: To identify joint space narrowing, osteophytes, and subchondral sclerosis.
  • MRI: To assess cartilage integrity and detect early changes in the joint structure.
• Blood tests: Generally used to rule out other conditions, such as rheumatoid arthritis.

Management

Primary Care Management

• Education and self-management: Educating patients about the disease and encouraging weight loss, if necessary, to reduce joint stress.
• Exercise and physiotherapy: Regular, low-impact exercises to maintain joint mobility and muscle strength.
• Pain management: Analgesics such as paracetamol or NSAIDs for pain relief.
• Topical treatments: Topical NSAIDs or capsaicin cream for local pain relief.
• Supportive devices: Use of braces, orthotics, or walking aids to support affected joints.

Specialist Management

• Intra-articular injections: Corticosteroid or hyaluronic acid injections for temporary pain relief.
• Surgical intervention:
  • Arthroscopy: Minimally invasive surgery to clean out the joint.
  • Osteotomy: Surgical realignment of bones to relieve pressure on the joint.
  • Joint replacement: Total or partial joint replacement for severely damaged joints.
• Advanced pain management: Referral to pain management specialists for chronic pain not relieved by conventional treatments.

References

1. NHS (2024) Osteoarthritis. Available at: https://www.nhs.uk/conditions/osteoarthritis/ (Accessed: 24 June 2024).
2. National Institute for Health and Care Excellence (2024) Osteoarthritis: Care and management. Available at: https://www.nice.org.uk/guidance/cg177 (Accessed: 24 June 2024).
3. British Medical Journal (2024) Osteoarthritis: clinical features, diagnosis, and management. Available at: https://www.bmj.com/content/350/bmj.h273 (Accessed: 24 June 2024).
4. Arthritis Research UK (2024) Osteoarthritis. Available at: https://www.versusarthritis.org/about-arthritis/conditions/osteoarthritis/ (Accessed: 24 June 2024).

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