Osteoarthritis (OA) is a degenerative condition of the joint that results primarily from breakdown of cartilage but can also affect adjoining bone, joint (synovial) lining and muscles. While any joint can be affected, the most commonly affected joints are the base of the thumb, hips, knees and low back. The most classic symptom is joint pain that is worse with use and gets better with rest. Other symptoms can include joint swelling, crepitus (crunching feeling or sound) or instability. The greatest risk for OA is advanced age although prior injury, body habitus, ethnicity, joint malalignment and muscle weakness can all contribute to the development of OA. The diagnosis of OA centers on a thorough history and physical exam. X-Rays may be needed to further elucidate the diagnosis or determine the severity. In some cases, a sample of the joint fluid may be required to rule out other conditions such as infection or gout. The management of OA centers around symptom control and restoration of function. Most patients with OA will benefit from weight loss. Similarly, many patients will benefit from physical therapy to stretch and strengthen muscles around the affected joint. However, when these modalities are not medications may be added to reduce pain and swelling. Typically, initial pharmacotherapy involves nonsteroidal anti-inflammatory medications (NSAIDs) such as ibuprofen either orally or topical as well as the analgesic acetaminophen. When this does not adequately control the pain, joint injections may be considered and some patients ultimately need joint replacement.
Gelber AC. In The Clinic: Osteoarthritis. Ann Intern Med. 2014 Jul 1; 161 (1)