Osteoarthritis (Degenerative Joint Disease): Causes, Symptoms & Management

Osteoarthritis (OA) is the most common arthritis — progressive loss of articular cartilage with bone remodeling, osteophytes, and synovial inflammation.

Risk Factors

• Modifiable: Obesity (↑ load + adipokines), joint injury, occupational repetition, muscle weakness.
• Non-modifiable: Age, female sex, genetics, malalignment, race.

Symptoms

• Pain (worse with activity, better with rest — later constant).
• Stiffness (<30 min morning, after inactivity).
• Crepitus, bony enlargement (Heberden’s/Bouchard’s nodes), effusion.
• Functional limitation (stairs, grip, walking).

Management Pyramid (Base → Apex)

1. Core (all patients): Education, weight loss (if BMI>25), exercise (aerobic + strength + neuromuscular), assistive devices (cane, brace).
2. Adjunctive: Topical NSAIDs (knee/hand), oral NSAIDs (lowest dose, shortest time, PPI if GI risk), duloxetine.
3. Injections: Corticosteroid (flare), hyaluronic acid (controversial), PRP (emerging).
4. Surgery: Arthroscopy (mechanical symptoms only), osteotomy (young, malaligned), joint replacement (end-stage, failed conservative).

Self-Management Essentials

• Daily movement (walking, cycling, water exercise).
• Quadriceps/glute strengthening for knee/hip OA.
• Heat for stiffness, ice for acute flare.
• Pacing activities; good footwear.

OA is manageable. Early, consistent non-pharmacologic care delays progression and surgery.