Degenerative joint disease characterised by cartilage loss, subchondral changes, osteophytes.
History taking
- • Activity-related pain, morning stiffness <30 min, crepitus, swelling, instability
- • Effect on stairs, squatting, walking distance
- • Prior injury, occupation, BMI
Examination
- • Antalgic gait, varus/valgus deformity, quadriceps wasting, effusion
- • Tenderness over joint line, crepitus, reduced ROM
Red flags
- • Hot swollen joint with fever — exclude septic arthritis
- • Locking — meniscal injury
- • Recent trauma with deformity
Differential diagnosis
- • Rheumatoid arthritis, gout, septic arthritis, meniscal/ligament injury, referred hip pain
Recommended investigations
- • Standing AP and lateral knee X-ray (Kellgren-Lawrence grading)
- • Bloods if inflammatory cause suspected (CBC, ESR, CRP, RF, anti-CCP, uric acid)
Diagnosis
- • Clinical + radiographic
Initial treatment / management
- • Weight loss, quadriceps strengthening, low-impact exercise
- • Topical NSAIDs, then oral NSAIDs
- • Intra-articular steroid for acute flare; viscosupplementation in selected
- • Total knee replacement when conservative fails
Prescription examples
- • Topical Diclofenac gel — apply to knee TDS
- • Tab Naproxen 500 mg PO BD x 7–14 d (with PPI)
- • Tab Paracetamol 1 g PO QID PRN
- • Glucosamine-Chondroitin — limited evidence
Follow-up advice
- • Review in 4–6 weeks, monitor functional improvement
Patient counselling
- • Weight loss most effective non-pharmacological intervention
- • Activity modification: avoid stairs, squatting
- • Walking aids if needed
Referral criteria
- • Failed conservative therapy, severe disability — orthopaedics for joint replacement
Clinical pearls
- • Lose 1 kg → 4 kg less load on knees per step
- • Avoid repeated steroid injections (>3–4 per year)
References
- • OARSI Guidelines for Knee OA 2019
- • NICE NG226: Osteoarthritis in over 16s
Educational outpatient guide — verify against local guidelines before clinical use.
