Osteoarthritis
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"osteoarthritis"[MeSH Terms] AND treatment
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osteoarthritis symptoms diagnosis management NICE guideline
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https://www.nice.org.uk/guidance/ng226/chapter/Recommendatio…
Osteoarthritis (OA) is a chronic joint disorder in which joint tissues fail to repair adequately after stress, causing cartilage and bone changes that may result in pain, stiffness, and reduced function. X-ray changes do not always match how much pain a person feels. Goldman-Cecil Medicine, p. 2763.
Common features
- Pain that worsens with activity or use
- Brief stiffness after rest, usually less than 30 minutes in the morning
- Reduced movement, creaking or grinding sensation
- Bony enlargement or deformity in later disease
- Often affects knees, hips, hands, spine, and the base of the thumb
Risk factors
Older age, previous joint injury, obesity, repetitive heavy joint loading, abnormal joint alignment, family history, and some metabolic or inflammatory joint diseases.
Diagnosis
For people aged 45 or over, OA can usually be diagnosed clinically when activity-related joint pain occurs with absent or brief morning stiffness. Imaging is not routinely needed unless symptoms are atypical or another diagnosis is suspected, according to NICE diagnostic guidance.
Management
The foundation is:
- Regular therapeutic exercise: strengthening, aerobic, and mobility work.
- Weight reduction if appropriate, especially for knee or hip OA.
- Education, pacing of activity, sleep support, and assistive devices when needed.
For pain, NICE OA recommendations advise:
- Topical NSAIDs first for knee OA.
- Oral NSAIDs only when suitable, at the lowest effective dose for the shortest time, with attention to stomach, kidney, liver, and cardiovascular risks.
- Avoid routine paracetamol or weak opioids.
- Do not use hyaluronan injections routinely.
- Consider joint replacement when symptoms remain severe despite non-surgical treatment and substantially limit quality of life.
Seek prompt medical review for
A hot, very swollen joint, fever, rapidly worsening deformity, significant injury, prolonged morning stiffness, unexplained weight loss, or severe sudden pain. These can suggest infection, fracture, gout, or inflammatory arthritis rather than uncomplicated OA.
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