Pathophysiology

  • Degeneration of the articular cartilage, and remodelling of bone
  • In the hand - the CMCs and DIPJs are affected more than the PIPJs (in contrast to RA where DIPJs are spared).

  

Clinical features

  • Symptoms:
    • Age normally > 45
    • Activity -related joint pain in one or a couple of joints
    • Symptoms progress gradually over months to years
    • There is no significant morning stiffness (more suggestive of an inflammatory arthropathy)
  • Examination findings:
    • Bony deformities - Heberden’s nodes, Bouchard’s nodes,
    • Squaring of the CMC, wasting of the thenar muscles
    • Joint tenderness and swelling, effusions in knee
    • Crepitus 

  

Investigations: XR shows LOSS

  • L – loss of joint space
  • O – osteophytes
  • S – subchondral sclerosis
  • S - subchondral cysts

 

Management

  • NICE: "Advise on the use of simple analgesia" as follows:
    • 1st line: Topical NSAID
      • Knee arthritis - suggest topical NSAID such as ibuprofen 5% gel
      • Consider a topical NSAID for other joint OA
    • 2nd line: Oral NSAID: If topical NSAID is ineffective, consider oral NSAID, depending on risk factors, contraindications and adverse effects
      • Use the lowest dose for the shortest time, and consider co-prescribing a PPI
    • 3rd line: Paracetamol/codeine: Advise on paracetamol or codeine for infrequent, short-term pain management if all other treatments are contraindicated, not tolerated or ineffective. 
      • Do NOT prescribed strong opioids
  • Further management:
    • Intra-articular steroid injections if other drug treatments are ineffective or unsuitable 
      • Provide short‑term relief for 2–10 weeks.
    • Referral to T&O: Consider referral to orthopaedic surgery, for consideration of joint replacement, if non-surgical management is ineffective after 3 months.