Diagnosis and classification of osteoarthritis
- Kenneth C Kalunian, MD
Kenneth C Kalunian, MD
- Professor of Medicine
- University of California, San Diego School of Medicine
Osteoarthritis (OA) was previously thought to be a normal consequence of aging, thereby leading to the term degenerative joint disease. However, it is now realized that OA results from a complex interplay of multiple factors, including joint integrity, genetic predisposition, local inflammation, mechanical forces, and cellular and biochemical processes. (See "Pathogenesis of osteoarthritis".)
The diagnosis of OA is complicated by multiple factors. These include a lack of specific physical or laboratory findings and discrepancies between symptoms and the results of radiographic examinations. As a result, OA is frequently diagnosed by an overall clinical impression based upon the patient's age and history, findings on physical examination, and radiographic findings.
In an attempt to overcome these difficulties, a standardization of the definition, classification, and diagnosis of OA has been attempted using traditional diagnostic criteria and decision trees. These criteria were formulated according to the affected anatomic areas, and include the knee, hand, and hip.
The classification and diagnosis of OA is discussed here, beginning with a review of the different types of OA. The risk factors for and possible causes of OA and the clinical manifestations of this disorder are presented elsewhere. (See "Risk factors for and possible causes of osteoarthritis" and "Clinical manifestations of osteoarthritis".)
TYPES OF OSTEOARTHRITIS
Osteoarthritis (OA) has traditionally been subdivided by etiology into either idiopathic or secondary forms:
- Claessens AA, Schouten JS, van den Ouweland FA, Valkenburg HA. Do clinical findings associate with radiographic osteoarthritis of the knee? Ann Rheum Dis 1990; 49:771.
- Peat G, Thomas E, Duncan R, et al. Estimating the probability of radiographic osteoarthritis in the older patient with knee pain. Arthritis Rheum 2007; 57:794.
- Doi K, Martel W. Monarticular erosive osteoarthritis: a possible source of confusion with infectious arthritis. J Clin Rheumatol 1995; 1:242.
- Altman R, Asch E, Bloch D, et al. Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Arthritis Rheum 1986; 29:1039.
- Wu CW, Morrell MR, Heinze E, et al. Validation of American College of Rheumatology classification criteria for knee osteoarthritis using arthroscopically defined cartilage damage scores. Semin Arthritis Rheum 2005; 35:197.
- Altman R, Alarcón G, Appelrouth D, et al. The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hand. Arthritis Rheum 1990; 33:1601.
- Altman R, Alarcón G, Appelrouth D, et al. The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hip. Arthritis Rheum 1991; 34:505.
- Rosenberg ZS, Shankman S, Steiner GC, et al. Rapid destructive osteoarthritis: clinical, radiographic, and pathologic features. Radiology 1992; 182:213.
- Boutry N, Paul C, Leroy X, et al. Rapidly destructive osteoarthritis of the hip: MR imaging findings. AJR Am J Roentgenol 2002; 179:657.
- Laroche M, Moineuse C, Durroux R, et al. Can ischemic hip disease cause rapidly destructive hip osteoarthritis? A case report. Joint Bone Spine 2002; 69:76.
- Watanabe W, Itoi E, Yamada S. Early MRI findings of rapidly destructive coxarthrosis. Skeletal Radiol 2002; 31:35.
- Masuhara K, Nakai T, Yamaguchi K, et al. Significant increases in serum and plasma concentrations of matrix metalloproteinases 3 and 9 in patients with rapidly destructive osteoarthritis of the hip. Arthritis Rheum 2002; 46:2625.
- Garnero P, Charni N, Juillet F, et al. Increased urinary type II collagen helical and C telopeptide levels are independently associated with a rapidly destructive hip osteoarthritis. Ann Rheum Dis 2006; 65:1639.
- TYPES OF OSTEOARTHRITIS
- Idiopathic osteoarthritis
- Secondary osteoarthritis
- Joint involvement
- Diagnosis: Summary and recommendations
- DIFFERENTIAL DIAGNOSIS
- Calcium pyrophosphate crystal deposition disease
- Rheumatoid arthritis
- Infectious monoarticular disease
- OSTEOARTHRITIS OF THE KNEE
- Classic clinical criteria
- Classification trees
- Summary and recommendations
- OSTEOARTHRITIS OF THE HAND
- OSTEOARTHRITIS OF THE HIP
- Classification trees
- Rapidly destructive hip osteoarthritis
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS