MANUAL MINORS
Osteoarthritis (OA) is a degenerative joint disease characterised by the progressive breakdown of articular cartilage, leading to pain, stiffness, and limited movement.
As the cartilage wears away, bones can rub against each other, causing inflammation and further joint damage. It is more common in older adults and primarily affects weight-bearing joints, such as the knees, hips, and spine.
Diagnosis
The diagnosis is based on a clinical history of chronic joint pain that worsens with use and improves with rest. Physical examination reveals limited movement, crepitus, and in advanced cases, joint deformities. X-rays show joint space narrowing, subchondral sclerosis, and the formation of osteophytes (bone spurs).
In some cases, MRI can be used to assess cartilage condition, or ultrasound may be employed to identify joint effusions.
Differential Diagnosis
Condition | Distinctive Features |
|---|---|
Rheumatoid arthritis | Symmetrical polyarthritis, positive serological tests (RF, anti-CCP), systemic signs like fatigue and fever. |
Gouty arthritis | Acute onset, presence of urate crystals in synovial fluid, acute attack in a joint like the big toe. |
Traumatic arthritis | History of acute trauma, rapid onset of pain, signs of inflammation associated with the injury. |
Septic arthritis | Severe pain, fever, positive synovial fluid culture, increased white blood cells. |
Patellar chondromalacia | Anterior knee pain, especially when climbing stairs or after prolonged sitting. |
Emergency Management
Emergency department management of osteoarthritis focuses on pain and inflammation relief. Patients may benefit from analgesics, such as NSAIDs. In cases of acute exacerbation, intra-articular corticosteroid injections may be considered.
If significant joint effusion is present, arthrocentesis may be performed to relieve pain and rule out other causes. Temporary immobilisation of the affected joint can be useful in cases of severe pain.
Definitive Treatment
Definitive treatment includes conservative measures such as weight loss, muscle strengthening exercises, physiotherapy, and the use of orthotic devices to reduce the load on the affected joint. In advanced cases, when conservative treatment is insufficient, surgical intervention such as osteotomy or total joint replacement (arthroplasty) may be necessary.
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