Age of onset |
Usually after age 40 |
Commonly affected joints |
Cervical and lumbar spine |
First carpometacarpal joint |
Proximal interphalangeal joint |
Distal interphalangeal joint |
Hip |
Knee |
Subtalar joint |
First metatarsophalangeal joint |
Uncommonly affected joints |
Shoulder |
Wrist |
Elbow |
Metacarpophalangeal joint |
Symptoms |
Pain without significant swelling or other inflammatory characteristics |
Stiffness, if present, worse after effort; may be described as evening stiffness |
Findings on physical examination |
Crepitus |
Bony enlargement |
Decreased range of motion |
Malalignment |
Tenderness to palpation |
Synovial fluid analysis |
Clear fluid |
WBC <2000/mm3 |
Normal viscosity |
Radiographic features |
Joint space narrowing |
Subchondral sclerosis |
Marginal osteophytes |
Subchondral cysts |
Patterns of presentation |
Monoarticular in young adult |
Pauciarticular, large-joint in middle age |
Polyarticular generalized |
Rapidly progressive |
Secondary to trauma, congenital abnormality, or systemic disease |
Prognosis |
Variable, generally slowly progressive |