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Last reviewed: 21 Apr 2025
Last updated: 20 Nov 2024

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • pain
  • functional difficulties
  • knee, hip, hand, or spine involvement
  • bony deformities
  • limited range of motion
  • malalignment
Full details

Other diagnostic factors

  • tenderness
  • crepitus
  • stiffness
  • shoulder, elbow, wrist, or ankle involvement
  • effusion
  • antalgic gait
Full details

Risk factors

  • age >50 years
  • female sex
  • obesity
  • genetic factors
  • joint anatomy and/or malalignment
  • physically demanding occupation/sport
  • post trauma/injury
  • high bone mineral density
Full details

Diagnostic investigations

1st investigations to order

  • history and physical examination
Full details

Investigations to consider

  • x-ray of affected joints
  • serum CRP
  • serum erythrocyte sedimentation rate (ESR)
  • rheumatoid factor (RF)
  • anti-cyclic citrullinated peptide (anti-CCP) antibody
  • MRI of affected joints
  • ultrasound scan
  • CT
Full details

Treatment algorithm

ACUTE

joint pain: medical management

ONGOING

persistent pain despite multiple treatment modalities or with severe disability

Contributors

Authors

Fadi Badlissi, MD, MSc
Fadi Badlissi

Assistant Professor

Harvard Medical School

Attending Physician

Director of the Musculoskeletal Medicine Unit

Department of Orthopedics & Division of Rheumatology

Beth Israel Deaconess Medical Center

Boston

MA

Disclosures

FB has received reimbursement from ANI Pharmaceutical for attending an advisory board meeting.

Peer reviewers

Amanda E. Nelson, MD, MSCR, RhMSUS

Associate Professor

University of North Carolina at Chapel Hill

NC

Disclosures

AN serves on the OARSI Board of Directors, is an Associate Editor of Osteoarthritis and Cartilage, is medical advisor to the Osteoarthritis Action Alliance, and has received grant funding from NIH/NIAMS and the CDC.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Kolasinski SL, Neogi T, Hochberg MC, et al. 2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee. Arthritis Care Res (Hoboken). 2020 Feb;72(2):149-62.Full text  Abstract

National Institute for Health and Care Excellence. Osteoarthritis in over 16s: diagnosis and management. Oct 2022 [internet publication].Full text

Bruyère O, Honvo G, Veronese N, et al. An updated algorithm recommendation for the management of knee osteoarthritis from the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO). Semin Arthritis Rheum. 2019 Dec;49(3):337-50.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available here.

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