Osteoarthritis (OA) (degenerative joint disease) is joint degeneration with loss of articular cartilage, with no to minimal inflammation. It is the most common form of arthritis. Risk increases with age; OA affects at least 1 joint in 80% of people age >70.
Clinically, there is an insidious onset of joint stiffness; deep, aching joint pain, which worsens with repetitive motion; decreased range of motion; crepitus; and joint effu-sions and swelling. Osteophytes may cause nerve compression. X-ray studies show narrowing of the joint space due to loss of cartilage; osteosclerosis and bone cysts; and osteophytes (osteophytic lipping).
The pathogenesis involves both biomechanical factors (aging or wear and tear of articular cartilage) and biochemical factors (chondrocyte injury and abnormal colla-gen activity). Predisposing factors include obesity, previous joint injury, ochronosis, diabetes, and hemarthrosis.
OA affects weight-bearing joints (knees, hips, and spine), often with asymmetrical involvement.
• There is degeneration and loss of articular cartilage with eburnation (exposed bone becomes polished) and subchondral bone sclerosis.
• The changes may include subchondral bone cysts, loose bodies (joint mice), which are free-floating fragments of cartilage and bone, and osteophytes (bone spurs), which are reactive bony outgrowths.
• Heberden nodes are osteophytes at the distal interphalangeal (DIP) joints, while Bouchard nodes are osteophytes at the proximal interphalangeal (PIP) joints.
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