Osteoarthritis Complete Guide: Symptoms, X-Ray Grades & Modern Treatment Options

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Below is a **complete, concise but fully comprehensive one-place reference** for **Osteoarthritis (OA)** following your preferred medical-content structure. --- # **OSTEOARTHRITIS (OA) — COMPLETE GUIDE** ## **1. Definition** Osteoarthritis is a **chronic, progressive degenerative joint disease** characterized by **loss of articular cartilage**, **subchondral bone remodeling**, **osteophyte formation**, and **synovial low-grade inflammation**, leading to **pain, stiffness, reduced function**, and structural deformity. --- ## **2. Pathophysiology (Mechanism)** * **Cartilage degradation:** Imbalance of anabolic vs catabolic enzymes (↑MMPs, ADAMTS → cartilage breakdown). * **Chondrocyte dysfunction:** Senescent chondrocytes → reduced proteoglycan / collagen synthesis. * **Subchondral sclerosis:** Microfractures → thickened subchondral bone. * **Osteophyte formation:** Due to growth factor (TGF-β, BMP) stimulation. * **Synovitis:** Mild inflammation with macrophages; NOT autoimmune. * **Joint space narrowing → altered biomechanics → worsening degeneration.** --- ## **3. Causes & Risk Factors** ### **Primary OA** * Age-related degeneration (most common) * Genetics (COL2A1) * Obesity (↑ mechanical load + inflammatory adipokines) * Female sex * Joint malalignment (genu varum/valgum) ### **Secondary OA** * Trauma (ACL tears, meniscal injury) * Inflammatory arthritis (e.g., RA) * Metabolic: Hemochromatosis, Wilson disease, ochronosis * Endocrine: Diabetes, acromegaly, hypothyroidism * Neuropathic joints (Charcot) * Avascular necrosis --- ## **4. Clinical Features** ### **Symptoms** * **Pain** worse with activity, relieved by rest * **Morning stiffness < 30 minutes** * **Crepitus** * **Reduced range of motion** * **Functional limitation** ### **Characteristic Joint Involvement** * **Knee OA:** Joint line tenderness, effusion, varus deformity * **Hip OA:** Groin pain, difficulty wearing shoes, internal rotation ↓ earliest sign * **Hand OA:** * **Heberden’s nodes** (DIP) * **Bouchard’s nodes** (PIP) * 1st CMC joint involvement * **Spine OA:** Facet joint pain, stiffness --- ## **5. Diagnosis** OA is diagnosed clinically + X-ray; MRI only if atypical. ### **Key Investigations** * **X-ray (most important):** * **Joint space narrowing (asymmetric)** * **Osteophytes** * **Subchondral sclerosis** * **Subchondral cysts** * **Blood tests:** Typically normal * ESR/CRP normal * RF/Anti-CCP negative (helps rule out RA) ### **Kellgren–Lawrence (KL) X-Ray Grading** | Grade | Radiographic Features | | ----- | -------------------------------------------------------------- | | **0** | Normal | | **1** | Doubtful joint space narrowing, minute osteophytes | | **2** | Definite osteophytes, possible joint space narrowing | | **3** | Moderate narrowing, multiple osteophytes, sclerosis, deformity | | **4** | Severe narrowing, large osteophytes, severe deformity | --- ## **6. Differential Diagnosis** * Rheumatoid arthritis * Gout / CPPD (pseudogout) * Avascular necrosis * Meniscal tear (knee) * Trochanteric bursitis (hip pain mimic) --- # **7. Management — Modern, Evidence-Based Approach** ## **A. Non-Pharmacologic (First-Line)** * **Weight loss:** Most effective intervention * **Physiotherapy:** Quadriceps strengthening, hip abductors * **Aerobic exercise & low-impact activity:** Cycling, swimming * **Activity modification** * **Assistive devices:** Cane, walker * **Bracing:** Unloader braces for medial knee OA * **Thermal therapy:** Hot/cold packs --- ## **B. Pharmacologic Therapy** ### **1. NSAIDs (Most effective for symptomatic relief)** * Oral: Ibuprofen, naproxen, diclofenac * Topical: Diclofenac gel (preferred in elderly) * **Risks:** GI bleed, renal dysfunction, CV risk ### **2. Paracetamol** * Limited efficacy; use if NSAIDs contraindicated. ### **3. Duloxetine** * Useful in chronic OA pain, especially knee OA. ### **4. Intra-articular Treatments** * **Corticosteroid injections:** Short-term relief (4–8 weeks) * **Hyaluronic acid (viscosupplementation):** Mixed evidence; selective use * **PRP (Platelet-Rich Plasma):** Emerging evidence for early OA, not standard but used clinically ### **5. Topical Capsaicin** * Good for hand OA. ### **6. Avoid** * Opioids (except palliative short-term) --- ## **C. Surgical Management** ### **Indications** * Severe pain not controlled with maximal therapy * Functional limitation * Radiographic grade 3–4 OA ### **Procedures** * **Total Knee Replacement (TKR)** — most common * **Total Hip Replacement (THR)** — excellent long-term outcomes * **Osteotomy** (for younger pts with malalignment) * **Arthroscopic lavage/debridement** — **NOT recommended** for routine OA --- # **8. Drug-Wise Quick Reference (Mechanism, Dosing, AE, Monitoring)** ### **NSAIDs** * **Mechanism:** COX-1/COX-2 inhibition → ↓ prostaglandins → ↓ pain/inflammation * **Dosing:** * Ibuprofen 400–600 mg TID * Naproxen 250–500 mg BID * **AE:** Gastritis, ulcers, AKI, fluid retention, ↑ CV risk * **Contra:** CKD, ulcers, heart failure * **Monitoring:** BP, renal function, occult GI bleed --- ### **Duloxetine** * **MOA:** SNRI → enhances descending inhibitory pain pathways * **Dose:** 30–60 mg/day * **AE:** Nausea, dry mouth, insomnia * **Contra:** MAOI use, severe liver disease * **Monitoring:** BP, mood changes --- ### **Intra-articular Steroids** * **MOA:** Strong local anti-inflammatory * **Drugs:** Triamcinolone 20–40 mg * **AE:** Flare pain, infection risk, cartilage degeneration if repeated frequently * **Limit:** ≤ 3–4 injections/year --- # **9. Patient Counselling Points** * OA is chronic but **manageable** * Maintain daily **exercise & weight control** * Choose low-impact activities * NSAIDs should be taken **with food** * Avoid long-term self-medication * Joint replacement is **highly successful** in advanced disease --- If you want, I can also generate: ✅ **25 hard NEET PG MCQs (HTML + CSS + JS in one file)** ✅ **SEO-friendly tags for this topic** Just tell me: **“Give MCQs”** or **“Give tags.”**