Degenerative joint disease with cartilage loss, osteophytes and joint-space narrowing; commonest in knees, hips, hands.
Risk factors
- • Age >50, female, obesity
- • Prior joint injury, occupation
- • Family history
History taking
- • Pain worse with activity, better with rest
- • Morning stiffness <30 min
- • Crepitus, instability
Examination
- • Bouchard / Heberden nodes
- • Joint-line tenderness, crepitus, ↓ROM
Red flags
- • Haemodynamic instability
- • Rapid deterioration
- • Severe pain or new neurological deficit
Differential diagnosis
- • See differentials section per chief complaint
Recommended investigations
- • Usually clinical
- • X-ray: joint space narrowing, osteophytes, subchondral cysts
Diagnosis
- • Clinical diagnosis supported by targeted investigations
Initial treatment / management
- • Exercise + weight loss are cornerstone
- • Topical NSAID first-line for hand/knee
Drug therapy
- • Paracetamol 1 g QDS
- • Topical diclofenac gel
- • Oral NSAID with PPI if needed
- • Intra-articular steroid for flares
Lifestyle advice
- • Quadriceps strengthening
- • Low-impact aerobic exercise
- • Footwear, walking aids
Follow-up advice
- • Review in 2–4 weeks or earlier if worsening
- • Monitor response to therapy and adverse effects
Patient counselling
- • Explain diagnosis and natural course in lay terms
- • Red-flag symptoms warranting urgent return
- • Adherence to medications and follow-up
Referral criteria
- • Orthopaedics if persistent severe pain or functional limitation
References
- • Harrison's Principles of Internal Medicine, 21e
- • NICE / WHO guidelines (current edition)
Educational outpatient guide — verify against local guidelines before clinical use.
