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Key Features

Essentials of Diagnosis

  • A degenerative disorder with minimal articular inflammation

  • No systemic symptoms

  • Pain relieved by rest; morning stiffness brief

  • Radiographic findings

    • Narrowed joint space

    • Osteophytes

    • Increased subchondral bone density

    • Bony cysts

General Considerations

  • Degeneration of cartilage and hypertrophy of bone at the articular margins

  • Inflammation is usually minimal


  • Most commonly affects some or all of the following

    • Distal interphalangeal (DIP) joints and, less commonly, proximal interphalangeal (PIP) joints

    • Carpometacarpal joints of the thumbs

    • Hip

    • Knee

    • Metatarsophalangeal joint of the big toe

    • Cervical and lumbar spine


  • May occur in any joint as a sequela to articular injury

  • Causes of articular injury that lead to secondary degenerative arthritis include

    • Trauma

    • Gout

    • Rheumatoid arthritis

    • Hyperparathyroidism

    • Hemochromatosis

    • Charcot joint


  • The most common form of joint disease

  • 90% of all people have radiographic features of osteoarthritis in weight-bearing joints by age 40

  • Patient sex is also a risk factor; osteoarthritis develops in women more frequently than in men

  • Obesity is a risk factor for knee and hand (and probably hip) osteoarthritis

Clinical Findings

Symptoms and Signs

  • Insidious onset

  • Pain is made worse by activity or weight bearing and relieved by rest

  • Bony enlargement of the interphalangeal joints is occasionally prominent

    • DIP (Heberden nodes)

    • PIP (Bouchard nodes)

  • Crepitus may often be felt over the knee

  • Joint effusion and other articular signs of inflammation are mild

  • Because articular inflammation is minimal and systemic manifestations are absent, degenerative joint disease should seldom be confused with other arthritides

  • The distribution of joint involvement in the hands also helps distinguish osteoarthritis from rheumatoid arthritis

    • Osteoarthritis primarily affects the DIP and PIP joints and spares the wrist and metacarpophalangeal joints (except at the thumb)

    • Rheumatoid arthritis involves the wrists and metacarpophalangeal joints and spares the DIP joints

  • No systemic manifestations

Differential Diagnosis

  • Rheumatoid arthritis

  • Seronegative spondyloarthropathy, eg, psoriatic arthritis

  • Gout

  • Chondrocalcinosis, eg, pseudogout, Wilson disease

  • Other bone disease, eg, osteoporosis, metastatic cancer, plasma cell myeloma


Laboratory Tests

  • No laboratory evidence of inflammation such as elevated erythrocyte sedimentation rate

  • Synovial fluid is noninflammatory (Table 20–2)

Table 20–2.Examination of joint fluid.

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