“Wear and tear” - nothing to do from immune system
- Cartilage flakes off
- Fragments of cartilage triggers slight inflammatory reaction
- Bone form cysts as tries to remodel
Affects weight bearing joints
Causes/Factors
- Age
- Occupation
- Athlete (doing something to accelerate wear)
Signs
- Heberen’s nodes (DIP joint)
- Bouchard’s nodes (PIP joint)
- Crepitus over joint
- Inflammation around the joint
Symptoms
- Increasing pain over months/yeras
- Siffness and reduced range of movement
- Referred pain to the joint below
- Reduced power due to muscle wastage from reduced use)
No systemic features or early morning stiffness. This is seen in RA
Diagnostic Tests
- Clinical examination
- XR AP + lateral of affected joint
- Loss of joint space
- Osteophyte formation (bony spurs protrude out)
- Sclerosis (underlying Bone becomes hard)
- Subchondrial cyst
- Normal CRP and antibodies
- Does not affect other organs
Management
Conservative:
- analgesia - Paracetamol (+ Codeine if bad). NSAIDs for a short period of time
- intraarticular steroids give short term improvement when there is a painful joint effusion
Systemic steroids are not used
Surgical:
- total joint replacement
- this lasts about 20 years
Complications/red Flags
- Total hip replacement dislocation