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ESSENTIALS OF DIAGNOSIS

  • Joint pain exacerbated by activity and relieved with rest.

  • Brief, self-limited morning stiffness.

  • Absence of constitutional symptoms.

  • Examination notable for increased bony prominence at the joint margin, crepitus or a grating sensation, and tenderness over the joint line.

  • Diagnosis supported by radiographic features of joint-space narrowing and spur (or osteophyte) formation.

General Considerations

An estimated 54 million adult Americans have been informed by a doctor that they have arthritis, gout, lupus, rheumatoid arthritis, or fibromyalgia. Among this group, osteoarthritis is the leading cause of arthritis. Joint pain is a frequent symptom that often prompts a patient with osteoarthritis to seek medical attention. Consequently, osteoarthritis is a prominent consideration in the differential diagnosis of joint pain. The challenge for clinicians is to correctly identify the cause of a patient’s pain and to initiate appropriate therapy, both pharmacologic and nonpharmacologic approaches.

Synonymous with degenerative joint disease, osteoarthritis is characterized by joint pain related to use, self-limited stiffness upon awakening in the morning, an audible grating sound or crepitus on palpation, the presence of tenderness over the affected joint line, and frequently diminished range of motion in use of the affected part of the body.

Characteristic sites of involvement in the peripheral skeleton include the hand (distal interphalangeal [DIP] joint, proximal interphalangeal [PIP] joint, and first carpometacarpal joint) (Figure 39–1), knee (Figure 39–2), and hip (Figure 39–3). Involvement of the finger joints is so characteristic that eponyms have been assigned to osteoarthritic involvement at the DIP and PIP joints, labeled Heberden’s nodes and Bouchard nodes, respectively. Constitutional symptoms are absent. As such, the affected patient generally feels well, globally, aside from the localized symptoms arising from the involved osteoarthritic joint. The diagnosis of osteoarthritis can usually be made easily and confidently based on the history and examination alone. When necessary, the bedside diagnosis of osteoarthritis can be supported by plain radiography.

Figure 39–1.

Radiograph of a hand showing osteoarthritis of the distal interphalangeal (DIP), proximal interphalangeal (PIP), and first carpometacarpal (CMC) joints. Note the joint-space narrowing of the DIP and PIP joints compared to the metacarpophalangeal joints, as well as the bony sclerosis (eburnation) of all joints involved by the osteoarthritis process.

Figure 39–2.

Knee osteoarthritis with medial joint-space narrowing and osteophytes.

Figure 39–3.

Right hip osteoarthritis. Note the joint-space narrowing of the superior portion of the involved joint, compared to the same portion of the opposite joint.

Epidemiology

At the population level, osteoarthritis results in substantial morbidity and disability, particularly among the elderly. Osteoarthritis is the leading indication for joint arthroplasty surgery performed in ...

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