Joint pain and osteoarthritis: Signs and symptoms
Recognising joint pain and osteoarthritis
Osteoarthritis is a progressive condition1 that can lead to significant physical2 and psychosocial3 impact for patients.
Here we review the signs and symptoms of osteoarthritis to help you identify this disorder.
Signs and symptoms of osteoarthritis
Osteoarthritis most commonly affects the knees, hips and hands.4–7
Osteoarthritis is characterised by:4,7–9
- Activity-related joint pain/stiffness
- Morning joint stiffness or stiffness after activity that normally resolves in 20–30 minutes
- Possible swelling
- Possible crepitus – a crackling, grating or crunching sound that occurs with joint movement
- Impaired function
Knee pain most commonly develops slowly but can also have a sudden onset, and may be aggravated by climbing stairs or rising from a chair.9
A diagnosis of osteoarthritis in your patients may be made based on their symptomatic history and presentation of disease-related signs on clinical examination.4,10,11 In patients older than 50 years, presence of the following symptoms and signs may be indicative of osteoarthritis:
- Knee pain*†
- Short-lived morning stiffness*‡
- Functional limitation*
- Restricted movement*
- Bony enlargement*‡
- Bone margin tenderness‡
- No palpable warmth‡
To help inform your diagnosis, consider asking your patients the following questions:
- Where exactly is your pain? Is it one joint or any several joints affected?
- How long has the joint been troubling you?
- Describe the pain. Is it sharp? Or a dull ache? Does it feel sore? Or stiff?
- Is there any swelling or tenderness in the joint?
- Do you notice any noises when you move the joint?
- Is the pain present all the time or does it just occur when you move, or perform any particular activity?
- Does the joint feel stiff in the morning? If so, does this stiffness ease off once you start moving? How long does it take to improve?
- Does the pain ease after you have rested? Or does resting make the joint stiff?
- Have you lost any mobility in the joint? Can you still use it in the same way as you always could?
*Necessary according to the European League Against Rheumatism (EULAR) guidelines.†Necessary according to the American College of Rheumatology (ACR) guidelines.‡Three or more in addition to knee pain according to the ACR guidelines.
Patients should be referred to a physician if they report:12
- Persistent symptoms of osteoarthritis
- Symptoms of gout including redness and heat in the joint
- Swelling, warmth and stiffness after an injury
Whilst not necessary for initial diagnosis of osteoarthritis, plain radiography may be considered (in combination with clinical diagnostic criteria) for the diagnosis of atypical cases and/or morphological assessment.9–11
Classical radiographical features of osteoarthritis include focal, non-uniform joint space narrowing; osteophytes; subchondral bone sclerosis and subchondral ‘cysts’. 9–11
Plain radiography alone is not considered sufficient to make a diagnosis of osteoarthritis9 due to a poor correlation between disease symptoms and radiographic changes4 – particularly in early disease.11