Osteoarthritis Initial Assessment

History 

The cardinal features of osteoarthritis are pain, stiffness, decreased movement, inflammation, crepitus, and the absence of systemic signs and symptoms like fever.  

Osteoarthritis pain is usually aggravated by activities and relieved by rest. It is not common to occur at night or during rest but may be experienced by patients after several hours of using joints, in advanced osteoarthritis, and in an acute inflammatory flare. Stiffness occurs in the morning lasting for a few minutes but <30 minutes, after a period of rest, or in the evening which usually resolves within 10 minutes of activity.

Physical Examination 

A normal physical examination does not rule out osteoarthritis. Features that suggest the diagnosis of osteoarthritis include tenderness usually over the joint, crepitus on joint movement, limited range of motion, bony enlargement of the finger joints (eg Heberden’s or Bouchard’s nodes), pain on passive range of motion or joint compression, deformity (eg angulation in the hand joints, varus, valgus), joint instability, and periarticular muscle weakness (ie quadriceps muscle).

Diagnosis or Diagnostic Criteria 

A complete and thorough clinical assessment of the patient helps establish the diagnosis, severity of the disease, and risk profile. Clinical diagnosis is based on history and physical exam, with laboratory and radiologic investigations requested to exclude other diagnoses.

Diagnostic Criteria of Osteoarthritis by the American College of Rheumatology (ACR)

Osteoarthritis of the Hand

Hand pain, aching, or stiffness plus at least three of the following features:

• Hard tissue enlargement on ≥2 of selected joints (first carpometacarpal [CMC], bilateral second or third distal interphalangeal [DIP], or second and third proximal interphalangeal [PIP] joints)
• Hard tissue enlargement of ≥2 DIP joints
• <3 swollen metacarpophalangeal joints
• Deformity of at least one of the selected joints (first CMC, bilateral second or third DIP, or second and third PIP joints) 

It has a sensitivity of 94% and a specificity of 87%. 

Osteoarthritis of the Knee (Clinical and Radiographic Features) 

Knee pain plus one of the following features: 

• Patient >50 years old
• Stiffness for <30 minutes
• Crepitus
• Presence of osteophytes on X-ray 

It has a sensitivity of 91% and a specificity of 86%.

Osteoarthritis of the Hip 

Hip pain plus at least two of the following features:

• Erythrocyte sedimentation rate (ESR) of <20 mm/hour
• Presence of femoral and acetabular osteophytes on X-ray
• Presence of superior, axial, and/or medial joint space narrowing on X-ray 

It has a sensitivity of 89% and a specificity of 91%.