Arthritis - osteoarthritis, generalised and regional
Description
- Whole-joint disease - cartilage loss + subchondral bone remodelling + osteophytes + synovitis + capsular thickening + periarticular muscle weakness
- Not "wear and tear" and not non-inflammatory - low-grade synovitis is present and drives symptoms
- The commonest joint disease and the leading cause of chronic pain and disability in older Australians
Clinical features
- Pain on use, relieved by rest; later, rest and night pain
- Morning stiffness <30 min, gelling after inactivity
- Crepitus, bony swelling, restricted range, deformity, instability, muscle wasting
- Absence of prolonged morning stiffness and of soft-tissue synovitis distinguishes it from inflammatory arthritis
Patterns
| Pattern | Joints | Note |
|---|---|---|
| Nodal generalised OA | DIPJs (Heberden), PIPJs (Bouchard), 1st CMCJ | F>>M, familial, post-menopausal; spares MCPJs |
| Knee | Medial tibiofemoral > patellofemoral | *The joint most associated with obesity*; varus deformity |
| Hip | Superior pole | Groin pain, dec internal rotation first |
| Spine | Facet joints, discs | Radiculopathy, spinal stenosis |
| Erosive/inflammatory OA | IPJs | Marked inflammation, "gull-wing" central erosions on X-ray |
- *Involvement of MCPJs, wrists, elbows, shoulders or ankles is NOT typical primary OA* - look for a secondary cause (haemochromatosis, CPPD, prior trauma, avascular necrosis)
6 more sections, plus exam facts
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