GPAtlas🧭 When to suspect
Osteoarthritis (OA) is the most common form of arthritis, and the knee is one of the most frequently affected joints.
• It is a leading cause of pain and disability in older adults, and is overwhelmingly managed in primary care.
• It is a whole-joint "wear and repair" process involving cartilage loss, bony remodelling and low-grade synovial change.
• The degree of damage on X-ray correlates poorly with how much pain a person has.
The diagnosis is clinical. Under NICE NG226, diagnose knee osteoarthritis without imaging in a person who:
• Is 45 or over
• Has activity-related joint pain
• Has either no morning joint-related stiffness or morning stiffness lasting no longer than 30 minutes
Imaging is not needed to confirm the diagnosis and should be reserved for atypical features.
Clinically:
• Recognise the mechanical pattern (pain worse with use, eased by rest)
• Never miss an inflammatory or septic mimic
Raise suspicion in those with:
• Increasing age
• Overweight or obesity (the main modifiable risk factor)
• Previous joint injury or surgery (e.g. meniscectomy, anterior cruciate ligament rupture)
• Occupations involving heavy lifting or repetitive kneeling/squatting
• A family history of OA
• Women, in whom knee OA is more common
| Points towards osteoarthritis |
|---|
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• Age ≥ 45 with gradual-onset, activity-related pain (worse with use, better with rest) |
|
• No morning stiffness, or stiffness ≤ 30 minutes |
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• Crepitus, bony swelling and restricted movement |
|
• Functional limitation (stairs, walking, kneeling) without systemic illness |
| Atypical features – reconsider the diagnosis |
|---|
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• Hot, red, swollen, acutely painful joint – think septic or crystal arthritis |
|
• Prolonged morning stiffness > 30 minutes, or pain worse at rest and easing with movement – think inflammatory arthritis |
|
• Rapidly worsening pain, function or deformity, or marked systemic upset |
|
• Rest/night pain with weight loss or a history of cancer (bone pathology), or true locking (meniscal tear or loose body) |
Source: NICE NG226
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