Snapshot A 56-year-old woman presents to her primary care physician with pain in her hands. The pain began approximately 1 year prior to presentation and has progressively worsened. She describes the pain being worse in the evening and improves in the morning. She has also noticed swelling in her knuckles. On physical exam, there is bone deformity noted on the distal and proximal interphalangeal joints, as well as tenderness upon palpation of the affected joints. Introduction Clinical definition a degenerative disorder affecting the articular cartilage Epidemiology incidence most common articular disease demographics more common in women and the elderly risk factors modifiable login to view 3 more bullets non-modifiable login to view 3 more bullets Pathogenesis not completely understood but is more complex than "wear and tear" of the joint and inflammation appears to be involved chondrocytes attempt to proliferate and synthesize proteoglycans when it is injured login to view 1 more bullet inflammatory processes appear to promote proteolytic articular degeneration mediated by chondrocytes login to view 1 more bullet eventually portions of the articular cartilage and subchondral bone is sloughed off into the joint space (synovial space) forming loose bodies (joint mice) subchondral bone becomes exposed and rubs on the adjacent bone, resulting in bone eburnation (polished ivory) osteophytes (bony outgrowths) develop due to bone remodeling can be appreciated in the login to view 2 more bullets late stage osteoarthritis is characterized by loss of chondrocytes and degraded extracellular matrix Prognosis favorable with joint replacement Biology and Anatomy Articular cartilage greatly decreases friction with movement and resists tension and compressive forces composed of type II collagen and proteoglycans which are synthesized and secreted by chondrocytes chondrocytes maintain cartilage with its anabolic and catabolic activities Presentation Symptoms pain worsens with use and improves with rest commonly involves the hands, hips, and knees Physical exam joint tenderness decreased range of motion bony swelling swelling of the distal interphalangeal (Herberden nodes) swelling of the proximal interphalangeal (Bouchard nodes) Imaging Radiography indication may be used to confirm the diagnosis and determine disease progression and severity findings joint space narrowing osteophytes joint mice subchondral sclerosis Studies Labs c-reative protein (CRP) and erythrocyte sedimentation rate (ESR) levels are normal Diagnostic criteria typically a clinical diagnosis Differential Rheumatoid arthritis Arthralgia Bursitis localized tenderness to palpation without radiographic changes treat with NSAIDs Tendonitis greater trochanter pain syndrome iliotibial band dysfunction gluteus medius/minimus Treatment Conservative exercise and weight loss indication login to view 1 more bullet Medical topical or oral nonsteroidal antiinflammatory drugs (NSAIDs) indication login to view 1 more bullet Operative orthopedic surgery indication login to view 1 more bullet Complications Pain Bone deformity Functional impairment