Osteoarthritis Clinical Presentation

Updated: Oct 10, 2017
  • Author: Carlos J Lozada, MD; Chief Editor: Herbert S Diamond, MD  more...
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Presentation

History

The progression of osteoarthritis is characteristically slow, occurring over several years or decades. Over this period, the patient can become less and less active and thus more susceptible to morbidities related to decreasing physical activity (including potential weight gain).

Early in the disease process, the joints may appear normal. However, the patient’s gait may be antalgic if weight-bearing joints are involved.

Pain is usually the initial source of morbidity in osteoarthritis, with the disease’s primary symptom being deep, achy joint pain exacerbated by extensive use. Also, reduced range of motion and crepitus are frequently present. Stiffness during rest (gelling) may develop, with morning joint stiffness usually lasting for less than 30 minutes.

Initially, pain can be relieved by rest and may respond to simple analgesics. However, joints may become unstable as the osteoarthritis progresses; therefore, the pain may become more prominent (even during rest) and may not respond to medications.

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Physical Examination

Physical examination findings in patients with osteoarthritis are mostly limited to the affected joints. [64, 65, 66] Reduced range of motion and crepitus are frequently present.

Malalignment with a bony enlargement may occur. Most cases of osteoarthritis do not involve erythema or warmth over the affected joint(s); however, a bland effusion may be present. Limitation of joint motion or muscle atrophy around a more severely affected joint may occur.

Osteoarthritis of the hand most often affects the distal interphalangeal (DIP) joints but also typically involves the proximal interphalangeal (PIP) joints and the joints at the base of the thumb. Heberden nodes, which represent palpable osteophytes in the DIP joints, are more characteristic in women than in men. Inflammatory changes are typically absent or at least not pronounced.

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Progression of Osteoarthritis

The etiopathogenesis of osteoarthritis has been divided into three stages, as follows:

  • Stage 1 – Proteolytic breakdown of the cartilage matrix occurs
  • Stage 2 – Fibrillation and erosion of the cartilage surface develop, with subsequent release of proteoglycan and collagen fragments into the synovial fluid
  • Stage 3 – Breakdown products of cartilage induce a chronic inflammatory response in the synovium, which in turn contributes to further cartilage breakdown

Several systems have been advocated for use in the grading of focal cartilage change; however, a simple description of the extent of disease (ie, surface, partial-thickness, or full-thickness irregularity with or without underlying subchondral bone change) is generally sufficient and prevents the confusion that may occur with numeric grading systems. Such systems are in any case intended more for research purposes than for clinical use.

Certain diseases are often categorized as subsets of primary osteoarthritis. These include primary generalized osteoarthritis (PGOA), erosive osteoarthritis, and chondromalacia patellae.

Hand osteoarthritis has been classified as follows:

  • Erosive
  • Thumb base
  • Interphalangeal (with or without nodes)
  • Widespread hand

Marshall et al report that thumb base osteoarthritis tends to be most prevalent symptomatic form of hand osteoarthritis, followed by interphalangeal joint osteoarthritis. Erosive and generalized hand osteoarthritis were found in older populations and predominantly in women. Over time, erosive osteoarthritis tends to have the poorest characteristics and leads to the most disability. [67]

For more information, see Progression of Osteoarthritis.

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