Osteoarthritis

The commonest type of arthritis

Common in old age mainly over 60 but earlier age could be affected

Joints involved mainly from top to bottom

• Cervical spine
• Lumbar spine
• Hips
• First metacarpophalangeal joint
• Distal interphalangeal joints
• Knee joint
• First metatarsophalangeal- Great toe
• Ankle

Symptoms

Symmetrical arthritis

Pain worse on starting movements

Pain relieved with rest

Joint stiffness

Pain worse end of the day and in cold weather

Signs

Bony swelling

Restricted joint movement

Joint deformity

No systemic manifestations

Radial deviation of distal phalanx of the hand

Heberden’s nodes

Bouchard’s nodes

Diagnosis

Clinical  and radiological

X-ray shows

• Osteophyte formation
• Joint space narrowing
• Bone deformity

Management

Non-pharmacological

Patient education and reassurance

Graduated exercise program

Corrected modifiable risk factors such as obesity and overuse etc

Rest during active bouts of pain

Use of heat—Hot water bottle/ warm bath

Weight reduction if overweight through dietary modification and exercise

Physiotherapy- postural aid, etc

Occupational therapy- walking aids etc

Pharmacological therapy

Panadol

NSAIDs

Cox -2 inhibitors

Intraarticular steroid injection

Complimentary therapy

Glucosamine

Intraarticular Hylan injection

Others

Surgery- Joint replacement