Osteoarthritis:

• mainly due to: trauma, gradual wear & tear, avascular necrosis, haemochromatosis/haemophillia (results in bleeding into joint = inflammatory process = cartilage destruction) & hyperparathyroidism (results in increased osteoclast activity = decreased bone density & increased calcium in the blood)
• hand joints effected: DIP (=heberden’s nodes), PIP (=bouchard’s nodes), 1st carpometacarpal (sublux/squaring of thumb base)
• large joints effected: hips, knees & lumbar/cervical spine
• X-ray findings (4 to remember): 1. joint space narrowing = decreased cartilage = decreased chondroctyes Þcartilage fissures Þmicrofractures in bone which leads to 2. boney cysts, followed by bone repair which results in 3. subchondral sclerosis & 4. osteophytes
• symptoms: joint pain (during activity, relieved by rest, worst at end of day), stiffness/gelling following inactivity, asymmetric joint involvement, locking due to loose bodies, crepitus, decreased range of movement
• tests: bloods (normal infective & inflammatory markers), synovial fluid is usually normal, check for haemochromatosis (increased iron) & hyperparathyroid (increased parathyroid hormone)
• treatment: analgesia, reduce weight (lifestyle advice), exercise/physio, surgery (e.g. joint replacement) & occupational health support
• N.B. when assessing joint pain remember these causes: monoarthritis (=septic arthritis, gout, pseudogout, OA) & polyarthritis (=reactive arthritis, RA)

	Bilateral hip OA + R sided femoral head collapse
	Knee OA