Clinical manifestations and diagnosis of osteoarthritis
- Michael Doherty, MA, MD, FRCP, FHEA
Michael Doherty, MA, MD, FRCP, FHEA
- Professor of Rheumatology and Head of Rheumatology, Orthopaedics and Dermatology
- School of Medicine
- University of Nottingham
- Abhishek Abhishek, MBBS, MD, MRCP, PhD
Abhishek Abhishek, MBBS, MD, MRCP, PhD
- Clinical Associate Professor of Rheumatology
- School of Medicine
- University of Nottingham
- Nottingham, UK
- Honorary Consultant Rheumatologist
- Queen's Medical Centre
- Nottingham University Hospitals NHS Trust
- Nottingham, UK
Osteoarthritis (OA) is the commonest form of arthritis and possesses marked variability of disease expression. Although most patients present with joint pain and functional limitations , the age of disease onset, sequence of joint involvement, and disease progression varies from person to person. OA ranges from an asymptomatic, incidental finding on clinical and/or radiographic examination to a rapidly progressive disabling disorder eventually culminating in “joint failure.”
The clinical features and approach to the diagnosis of OA will be reviewed here. The pathogenesis, epidemiology, and treatment of OA are discussed separately. (See "Pathogenesis of osteoarthritis" and "Risk factors for and possible causes of osteoarthritis" and "Initial pharmacologic therapy of osteoarthritis" and "Treatment of osteoarthritis resistant to initial pharmacologic therapy".)
The primary symptoms of osteoarthritis (OA) are joint pain, stiffness, and locomotor restriction. Symptoms usually present in just one or a few joints in a middle-aged or older person. Other manifestations in patients with OA include sequelae such as muscle weakness and poor balance  and comorbidities like fibromyalgia [3-6].
Symptoms and signs — The following symptoms and signs may be observed in patients with OA:
●Pain – Pain in OA is worse with joint use (usage-related pain) and relieved by rest. It is often the most frequent symptom and generally progresses through three stages :
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- CLINICAL MANIFESTATIONS
- Symptoms and signs
- Joint distribution
- - Single- or multiple-joint osteoarthritis
- - Generalized osteoarthritis
- Synovial fluid
- Osteoarthritis with calcium pyrophosphate deposition
- CHARACTERISTICS OF SPECIFIC JOINT INVOLVEMENT
- - Nodal osteoarthritis
- - Erosive osteoarthritis
- Facet joint
- First metatarsophalangeal joint
- DIFFERENTIAL DIAGNOSIS
- Clinical diagnosis
- When to consider additional testing
- CLASSIFICATION CRITERIA