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  • Joint pain brought on and exacerbated by activity and relieved with rest.
  • Stiffness that is self-limited upon awakening in the morning or when rising from a seated position after an extended period of inactivity.
  • Absence of prominent constitutional symptoms.
  • Examination notable for increased bony prominence at the joint margins, crepitus or a grating sensation upon joint manipulation, and tenderness over the joint line of the symptomatic joint.
  • Diagnosis supported by radiographic features of joint-space narrowing and spur (or osteophyte) formation.

Osteoarthritis is the leading cause of arthritis in the adult American population and affects an estimated 27 million people in the United States. Joint pain is a frequent symptom that often prompts a patient to seek medical attention; osteoarthritis figures prominently in the differential diagnosis. The challenge for clinicians is to identify correctly the cause of the patient’s pain and to initiate appropriate therapy, both pharmacologic and nonpharmacologic. Synonymous with degenerative joint disease, osteoarthritis is characterized by joint pain related to use, self-limited morning stiffness, an audible grating sound or crepitus on palpation, the presence of tenderness over the affected joint on palpation, and frequently reduction in joint range of motion.

Characteristic sites of involvement in the peripheral skeleton include the hand (distal interphalangeal [DIP] joint, proximal interphalangeal [PIP] joint, and first carpometacarpal joint) (Figure 43–1), knee (Figure 43–2), and hip (Figure 43–3). Constitutional symptoms are absent. The diagnosis of osteoarthritis can usually be made easily and confidently based on the history and examination alone. The bedside diagnosis of osteoarthritis can be supported by plain radiography.

Figure 43–1.

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 43–2.

Knee osteoarthritis with medial joint-space narrowing and osteophytes.

Figure 43–3.

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.

At the population level, osteoarthritis results in substantial morbidity and disability, particularly among the elderly. It is the leading indication for several hundred thousand knee and hip replacement surgeries performed each year in the United States. Therefore, much effort has been invested in improving the understanding of the epidemiology of this disorder, including identifying the risk factors that predispose persons to osteoarthritis, especially ones that are reversible or modifiable.

Several factors heighten the risk of incident osteoarthritis, including age, gender, joint injury, and obesity. Although the clinical manifestations of osteoarthritis can begin as early as the fourth ...

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