Osteoarthritis Diagnosis: Avoiding the Pitfalls

Osteoarthritis Diagnosis: Avoiding the Pitfalls

A common pitfall in the diagnosis of osteoarthritis (OA) is misinterpretation of the patient’s symptoms and signs. Erroneous diagnosis may result from misinterpretation of the patient’s pain, of deformities caused by diseases other than OA, of radiologic findings, and of laboratory results.

Correct diagnosis of osteoarthritis (OA) is important, misdiagnosis often leads to omission of appropriate treatment or institution of unnecessary treatment. It also may create stress for the patient.

A common pitfall in the diagnosis of OA is misinterpretation of the patient’s symptoms and signs. Pain is the predominant symptoms and signs. Pain is the predominant symptoms and signs. Pain is the predominant symptom in patients with OA, and OA pain has typical characteristics. However, pain may arise not only from intra-articular structures but also from periarticular muscle spasm or soft tissue rheumatism. Differentiation of articular pain from periarticular pain is important, because the latter often may be managed successfully by local injection and physical therapy, without systemic medication.

The Clinical Picture

OA can affect any joint in the body; those most frequently affected are the spine, knees, hips, interphalangeal joints of the hands, and first metatarsophalangeal (MTP) joints. In most persons with symotomatic OA of peripheral joints, more than one joint is affected. Of  500 patients with symptomatic  OA in peripheral joints, only 6% had symptoms confined to a single joint. The most frequently involved joints were the knees (41% of affected joints), hands (30%), and Hips (19%).

In patients with hip OA, there may be a congential or developmental abnormality of that joint. In contrast, congenital or developmental abnormalities seldom are a basis for knee OA, in which a history of previous trauma, menisectomy, obesity, and some repetitive vocational activities are dominant risk factors. Spine OA, which most often affects the lumbar and cervical regions, typically is not associated with a history of trauma. Although OA may involve any diarthrodial joint in the body, in the absence of trauma or of a developmental or congenital abnormality, it is uncommon in the elbows, glenuhumeral joints, ankles and wrists.

No one would be surprised if OA developed in a knee with hyperextension and varus angulation resulting from catastrophic acute trauma, such as a vigorous below the knee tackle of a football player, which disrupts the integrity of the joint by damaging ligaments, articular cartilage, the meniscus, and subchondral bone.

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