Osteoarthritis Rheumatology


• Osteoarthritis (OA ) is degenerative disease more common in older adults
• Approximately one millon people affected
• Morning stiffness less than 30 minutes
• Pain exacerbated with movement
• Rare systemic involvement


• Minimal joint inflammation
• Bony enlargement of the affected joint
• Pain and/or deformity in the distal and proximal interphalangeal joints (DIP and PIP)
(see figures 1A and 1B)
• Radiographic findings: narrowing joint space; osteophyte formation; sharpened articular margins; dense subchondral bone (absence of radiographic findings does not exclude the diagnosis)


• Nodes: bony enlargements of the affected joints
• BOUCHARD nodes occur at the PIP joint (think of a BUTCHER grasping the knife using his PIP joint
as he chops meat; see Fig. 1A)
• HEBERDEN nodes occur at the DIP joint (think of a gardener picking HERBS using his DIP joints)
• Limited range of motion
• Crepitus on motion


Heberden nodes occur at the DIP joint (Think of a gardener flexing his DIP joints while picking herbs)



• Nonpharmacological: weight reduction; exercise; and joint protection.
• Initial pharmacological treatment: acetaminophen and capsaicin, (.025%)
• Moderate pain: Non steroidal anti-inflammatory agents (NSAIDS).
• Severe pain: steroid injections( ie. 40mg Triamcinolone) into the most severely affected joint;
Hyaluronic acid-like product joint injections
• Surgical intervention: joint replacements for moderate to severe pain and functional impairment


February 09, 2006