Osteoarthritis (OA), or degenerative joint disease (DJD), is the most common form of arthritis.
Given that osteoarthritis is not primarily an inflammatory process, as might be suggested by the suffix "itis", some authors prefer the term osteoarthrosis instead. To differentiate OA from its erosive namesake, the condition is sometimes called non-erosive osteoarthritis.
Primary osteoarthritis is the less common variant and is characterized by the absence of an antecedent insult. There is a strong genetic component 5 with the disease primarily affecting middle-aged women.
Key radiographic features are joint space narrowing (JSN), sclerosis, and osteophytosis. If all three of these findings are not present, another diagnosis should be considered.
Joint space narrowing
- characteristically asymmetric
- least specific: present in many other pathological processes
- sclerotic changes occur at joint margins
- frequently seen unless severe osteoporosis is present
- i.e. development of osteophytes
- common DJD finding
- will also be diminished in the setting of osteoporosis
- some osteophytes carry eponymous names, as discussed below
It affects the distal interphalangeal joints (Heberden nodes), the proximal interphalangeal joints (Bouchard nodes), (mnemonic H-D, B-P) and the base of the thumb in a bilaterally symmetric fashion. If it is not bilaterally symmetric, the diagnosis of primary osteoarthritis should be questioned.
- several joints may exhibit degenerative erosions 1
- temporomandibular joint (TMJ)
- acromioclavicular joint (ACJ)
- sacroiliac joints (SIJ)
- symphysis pubis
- also known as a geode
- cystic formations that occur around joints in a variety of disorders, including , rheumatoid arthritis, calcium pyrophosphate dihydrate crystal deposition disease (CPPD) and avascular necrosis.
Treatment and prognosis
Simple analgesia is the mainstay of treatment for most patients.
There is increasing evidence that the condition erosive osteoarthritis (EOA) is a severe form of 'normal' osteoarthritis and not a discrete disease entity, and that therefore a subset of patients may progress from the non-erosive to the erosive form 6.
- 1. Brant WE, Helms CA. Fundamentals of diagnostic radiology. Lippincott Williams & Wilkins. (2007) ISBN:0781765188. Read it at Google Books - Find it at Amazon
- 2. Jacobson JA, Girish G, Jiang Y et-al. Radiographic evaluation of arthritis: degenerative joint disease and variations. Radiology. 2008;248 (3): 737-47. Radiology (full text) - doi:10.1148/radiol.2483062112 - Pubmed citation
- 3. Lane NE, Kremer LB. Radiographic indices for osteoarthritis. Rheum. Dis. Clin. North Am. 1995;21 (2): 379-94. Pubmed citation
- 4. Lane NE, Nevitt MC, Genant HK et-al. Reliability of new indices of radiographic osteoarthritis of the hand and hip and lumbar disc degeneration. J. Rheumatol. 1994;20 (11): 1911-8. Pubmed citation
- 5. Genetics in Osteoarthritis. (2008) Current Genomics. 9 (8): 542. doi:10.2174/138920208786847953 - Pubmed
- 6. Marshall M, Nicholls E, Kwok WY, Peat G, Kloppenburg M, van der Windt D, Myers H, Dziedzic K. Erosive osteoarthritis: a more severe form of radiographic hand osteoarthritis rather than a distinct entity?. (2015) Annals of the rheumatic diseases. 74 (1): 136-41. doi:10.1136/annrheumdis-2013-203948 - Pubmed
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