Pain is most frequent clinical feature of osteoarthritis.The pain of osteoarthritis is often felt as a deep ache and is localized to the involved joint. The pain is aggravated by joint use and relieved by rest initially. As the disease progesses, it may become persistent.
Night pain, interfering with sleep, is seen particularly in advanced osteoarthrits of the hip.
Stiffness of the involved joint is another clinical feature. Stiffness usally comes in osteoarthritis when disease has progressed. This is in contrast to Rheumatoid Arthritis where the stiffness is prominent feature in the early stage too. The stiffness is more pronounced after a period of inactivity.
Systemic manifestations i.e symptoms involving whole body are not a feature of primary OA.
Articular cartilage is an aneural structure. that means it cannot cause the pain. Therefore other structures are responsible for joint pain.
It may be due to stretching of nerve endings in the periosteum covering osteophytes. Or it may arise from microfractures in subchondral bone or from meullary hypertension caused by distoration of blood flow by thickened subchondral trabeculae.
Joint instability leading to stretching of the joint capsule, and muscle spasm also may be sources of pain.
Joint pain may be de to synovitis or inflammation of synovium.In the earlier stages, even in the patient with chronic joint pain, synovial inflammation may be absent.
the joint may reveal localized tenderness and bony or soft tissue swelling. Bony crepitus (the sensation of bone rubbing against bone) is characteristic. Synovial effusions, if present, are usually not large.
Palpation may reveal some warmth over the joint. Periarticular muscle atrophy may be due to disuse or to reflex inhibition of muscle contraction.
In the advanced stages of osteoarthritis there may be gross deformity, bony hypertrophy, subluxation, and marked loss of joint motion.
In contrast to the popular notion, osteoarthritis is not always progressive. In many patients the disease stabilizs, in some, regression of joint pain and even of radiographic changes occurs.
Though the diagnosis of OA is often straightforward, it is important to ensure that joint pain in a patient with radiographic evidence of OA is not due to some other cause, such as
- Rheumatism -e.g. Anserine bursitis at the knee, trochanteric bursitis at the hip
- Radiculopathy, referral of pain from another joint
- Entrapment neuropathy,
- Vascular disease (claudication),
- Other type of arthritis such as crystal-induced synovitis or septic arthritis.
These are all common pitfalls in the diagnosis of OA.
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About Dr Arun Pal Singh
