Osteoarthritis is the most common arthropathic issue and is a leading cause of pain and disability worldwide. For example, a study suggests that symptomatic knee osteoarthritis occurs in 15% of adults more than 55 years old, increasing to around 80% in those over 75 years.

It is characterized by the constant loss of articular cartilage and remodeling of the underlying bone. This article will look at the clinical features, pathophysiology, management, and overall physiology of osteoarthritis.

Clinical Features

The most commonly affected areas by osteoarthritis are the small joints like the hands and feet, the hip joint, and the knee joint.

Patients typically present with insidious, chronic, and gradually worsening symptoms. OA’s clinical features include pain and stiffness in joints, which worsens if the patient keeps on working and feels relieved by rest.

On examination, inspect for deformity; some common characteristic findings depend on the joint affected, such as Bouchard nodes, Heberden nodes in the hands, and fixed flexion deformity or varus malalignment in the knees.

*Joint pain and stiffness that improves with activity are characteristically seen in inflammatory arthropathies.


Osteoarthritis was treated as a ‘wear and tear’ disease which occurs as we age. However, recent research suggests otherwise.

The pathogenesis of OA involves

  • Stiffness
  • The degradation of cartilage.
  • The remodeling of bone is due to an active response of chondrocytes in the cartilage and the inflammatory cells in the surrounding tissues.

The release of enzymes breaks down collagen and proteoglycans, which destroys the articular cartilage. The exposure of the underlying bone results in sclerosis, followed by reactive remodeling changes that lead to the formation of osteophytes and bone cysts. As a result, the joint space is progressively lost over time.

Risk Factors

Osteoarthritis has a multifactorial etiology and can be primary (with no obvious cause) or secondary (infiltrative disease, trauma, or connective tissue diseases).

Risk factors for primary osteoarthritis include obesity, advancing age, female gender, and manual labor occupations.


The diagnosis of osteoarthritis depends on which body area is affected. However, some universal conditions include inflammatory arthropathies, crystal arthropathies, septic arthritis, fractures, bursitis, or malignancy.

Joint specific differential diagnoses for osteoarthritis:

  • Hand– rheumatoid arthritis, De Quervain’s tenosynovitis, gout
  • Hip – radiculopathy, trochanteric bursitis, spinal stenosis, or iliotibial band syndrome
  • Knee– meniscal, referred hip pain, ligament tears, or chondromalacia patellae


The management of OA involves options ranging from conservative and medical to surgical.


Patients should be educated well by the doctors about their disease and its progression, including advice on joint protection and emphasizing the importance of strengthening and exercise. Overweight Patients should also be advised on weight loss.

Some non-pharmacological options that can be offered include local heat or ice packs, joint support, and physiotherapy.


Simple analgesics and topical NSAIDs are the most commonly prescribed medical management for OA, alongside the conservative measures.

There is a varying success with the use of intra-articular steroid injections. Therefore, these injections are commonly administered in the outpatient clinic in cases where the presence of pain remains despite oral analgesics.


If conservative and medical interventions fail, surgical intervention may be considered, especially if joint symptoms substantially impact their quality of life.

Surgical management and its effectiveness will depend on the site affected. Options include:

  • Osteotomy
  • Arthrodesis
  • Arthroplasty

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