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Osteoarthritis – Symptoms and Signs

Key Points

  • The main symptoms associated with osteoarthritis are stiff and painful joints.
  • The main signs are an altered range of motion, crepitus, and joint tenderness.
  • Please seek help from a health professional to make the correct diagnosis.

Osteoarthritis is a joint disease. Unlike many other forms of arthritis that are systemic illnesses, such as rheumatoid arthritis, scleroderma, and lupus, osteoarthritis does not affect other organs of the body. However, recent data have suggested an increased risk of cardiovascular disease in people with osteoarthritis. Therefore, an accurate assessment of the person as a whole is required in patients with osteoarthritis.

Symptoms of osteoarthritis vary greatly from person to person. Some people can be debilitated by their symptoms whereas others may have remarkably few symptoms in spite of the dramatic degeneration of their joints shown on X-rays. Symptoms can also be intermittent. It is not unusual for patients with osteoarthritis of the hands and knees to have years of pain-free intervals between symptomatic episodes.

The severity of symptoms in osteoarthritis is greatly influenced by a person’s attitudes, anxiety, depression or daily activities.

The symptoms and signs of osteoarthritis will also vary depending on the joint affected. The main symptoms associated with OA are stiff and painful joints. Theses do usually impact on your day-to-day function. The main signs relate to an altered range of motion, crepitus, and tenderness of the joint.

Pain

The characteristic pain of osteoarthritis begins gradually, progressing slowly over many years. Once established, pain may behave like a roller coaster, with bad spells followed by periods of relative relief. However, there are some patients who report feeling acute pain and joint swelling as the first signs and symptoms related to osteoarthritis.

Pain usually comes from deep within the joint. It is generally described as an aching, sharp or burning pain. It is also often described as mechanical; that is, it is worse with activity such as when there is weight or resistance put on the joint/s affected (for example, walking or climbing of stairs and therefore putting pressure on the knee joint). The pain is usually relieved after resting for a few minutes.

Sometimes the activity-related pain will persist after long period of activity (playing sports, hiking, doing housework, or other repeated activities of daily living) and towards the end of the day. Some people with OA say that cold and humid weather may increase their pain.

As the disease advances and the structure of the joint is badly damaged, the pain may occur even when the joint is at rest, and it can keep a sufferer awake at night.

The pain of osteoarthritis usually occurs in the area of the affected joint; however, in some cases, the pain may be referred to other areas. For example, the pain of osteoarthritis of the hip may actually be felt in the knee. Although it has long been thought that this pain originated in the joint itself, recently published studies have suggested that in some cases the pain might  also originate in, or “amplify” at, the central nervous system or peripheral nerves.

Stiffness

The joint stiffness associated with osteoarthritis usually follows periods of inactivity. Usually it is at its worst in the morning on the first rising from bed – lasting less than 30 minutes – and can also be troublesome after resting during the day. Moving the joint or doing some exercise for a few minutes can help shake off the stiffness associated with osteoarthritis. Usually the stiffness lasts for 2-3 minutes and is described as ‘gelling’.

Long-lasting (for over 1 hour)  morning joint stiffness is less typical of osteoarthritis and should be discussed with a health professional.

Reduction in the normal range of motion within the joint

As the condition causes more symptoms, the joint may become less movable and eventually it may not be possible to fully straighten or bend it.

Tenderness

Joints affected by osteoarthritis may be tender to the touch, even in the absence of obvious signs of inflammation.

Crepitus

The crunching, creaking, crackling, grating, or grinding sounds and sensation on movement of the joint is called ‘crepitus’. The causes of these sensations are unknown;  they might be related to a roughening of the normally smooth cartilage surfaces inside the joint.

Swelling

Later in the course of OA, swelling of the joint may develop. This can either be soft in consistency (due to extra synovial fluid) or firm (due to bony enlargement at the joint – most commonly seen in the joints of the fingers).

The soft joint swelling from fluid is called an ‘effusion’. An effusion results from the accumulation of excess fluid in the joint space. Potentially this swelling will be warm, but if the joint is red or hot his is unusual for osteoarthritis and you should have this checked by a doctor as it is more suggestive of other conditions.

Bony growths called osteophytes or bone spurs commonly develop in the joints at the ends or middle of the fingers (called then Heberden’s or Bouchard’s nodes), among others. These bony protuberances can be felt under the skin near joints, and typically enlarge over time.

Muscle weakness

In more advanced osteoarthritis, muscles may become weaker because of insufficient use. In some joints (such as the knee), the ligaments, which surround and support the joint, stretch so that the joint becomes unstable. This is one of the late signs of osteoarthritis once can potentially improve with available therapies such as physiotherapy and exercise programmes.

Symptoms in specific joints

Osteoarthritis does not affect all joints equally. The condition most commonly affects the hand, knee, hip and spine, but other joints can be affected.

Furthermore, osteoarthritis often has an symmetric pattern, affecting joints on either side of the body to a different extent.

Knees

Osteoarthritis is particularly debilitating in the weight-bearing joints of the knees. Osteoarthritis of the knees is often associated with obesity or a history of repeated injury and/or joint surgery. Advanced osteoarthritis of the knee may be associated with changes in the alignment of the knee, including a bow-legged or a knock-kneed appearance.

Osteoarthritis of the knee may also cause a Baker’s cyst, a collection of joint fluid in the hollow at the back of the knee. The rupture of a Baker’s cyst is usually painful and can be difficult to differentiate from a blood clot in the leg (deep vein thrombosis).

Bakers Cyst

Patients with osteoarthritis of the weight-bearing joints (like the knees) sometimes develop a limp, which can worsen as the joint degenerates. Although painful, the arthritic knee usually retains reasonable flexibility. The pain of knee osteoarthritis is often made worse during activities such as walking, squatting, getting in or out of a chair, and climbing stairs.

Spine

Osteoarthritis may affect the cartilage in the discs that form cushions between the bones of the spine (otherwise known as degenerative disc disease), the moving joints of the spine itself, or both. Osteoarthritis typically affects the most flexible regions of the spine, including the vertebrae (the individual bones that make up the spine) in the lower neck. lower chest, and lower back. Osteoarthritis in any of these locations can cause pain, muscle spasms, and diminished mobility.

Osteoarthritis of the spine can lead to complications. Bony outgrowths of the vertebrae in the lower spine may press on the nerves within the spinal canal, causing low back pain and pain in the legs that is worsened by exercise, and also numbness and tingling of the affected parts of the body. Osteoarthritis of the lower spine may also cause the normally aligned vertebrae to slip out of alignment.

When the spine is affected in the neck, narrowing of the spinal canal can cause damage to the spinal cord, resulting in arm or leg weakness, difficulty in walking, or loss control of bowel or bladder. Any of these complications can be serious and you should seek medical attention if you suspect you have any of these symptoms.

Hands

Osteoarthritis of the fingers occurs most often in older women and may be inherited within families. Osteoarthritis causes the formation of hard bony enlargements (nodes) of the small joints of the fingers. The characteristic appearances of these finger nodes can be helpful in diagnosing osteoarthritis.

Heberdens-NodesOsteoarthritis may cause enlargements of the last joints on the fingers (the distal interphalangeal or DIP joints) called Heberden’s nodes. The bony deformity is a result of the bone and cartilage spurs (osteophytes) from the osteoarthritis in that joint. Osteoarthritis may also cause enlargements of the middle joints of the finger (the proximal interphalangeal or PIP joints) called Bouchard’s nodes. Osteoarthritis also frequently damages the base of the thumb, which may give the hand a squared appearance. Gelatinous cysts, which sometimes go away on their own, may also form in the finger joints.

Hips

Osteoarthritis frequently strikes the weight-bearing joints in one or both hips. Pain develops slowly, usually in the groin and on the outside of the hips, or sometimes in the buttocks. The pain may also radiate to the knee, making the diagnosis less clear. Those with osteoarthritis of the hip often have a restricted range of motion (particularly when trying to rotate the hip) and walk with a limp, because they slightly turn the affected leg to avoid pain. The pain of hip osteoarthritis is often made worse during activities such as walking, getting in and out of the car, and putting socks or stockings on.

Shoulder

Osteoarthritis is less common in the shoulder area than in other joints. Osteoarthritis may cause vague shoulder discomfort, bony outgrowths that irritate or even tear the surrounding tendons, and, occasionally, marked pain and restriction of movement. It may develop in the shoulder joint  itself (called the glenohumeral joint). In such cases it is most often associated with a previous injury, and patients gradually develop pain and stiffness in the back of the shoulder. Osteoarthritis also can develop in the joint between the shoulder blade and collarbone, the acromioclavicular (AC) joint.

Feet

Osteoarthritis often affects the feet. Inflammation of the joint at the base of the big toe may cause a bunion or stiffness of the joint and may make it difficult to walk.

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