Last updated: July 3, 2023

Summarytoggle arrow icon

Osteoarthritis is a disabling joint disease characterized by degeneration of the joint complex (articular cartilage, subchondral bone, and synovium) that can have various causes, most notably advanced age and overuse. It mainly affects weight-bearing joints and joints that are heavily used, such as the hip, knee, hands, and vertebrae. Despite the widespread view that osteoarthritis is a condition caused exclusively by degenerative “wear and tear” of the joints, newer research indicates that there are various causes, including preexisting joint abnormalities, genetics, local inflammation, mechanical forces, and biochemical processes that are promoted by proinflammatory mediators and proteases. Major risk factors for osteoarthritis include advanced age, obesity, previous injuries, and asymmetrically stressed joints. In early-stage osteoarthritis, patients typically report a reduced range of motion, joint stiffness, and pain that is aggravated with heavy use. As the disease advances, persistent pain may also be present during the night and/or at rest. The diagnosis is predominantly based on clinical features and supported by radiological findings, as classic radiographic features of osteoarthritis do not always correlate with the patient's clinical symptoms or appearance. If lifestyle changes (e.g., moderate exercise, weight loss) fail to improve symptoms, pharmacotherapy is typically used for the management of active osteoarthritis. If these measures do not improve the patient's quality of life, surgical procedures such as arthroplasty may be necessary.

See also “Osteoarthritis of the hip and knee” for more specific information.

Epidemiologytoggle arrow icon

Epidemiological data refers to the US, unless otherwise specified.

Etiologytoggle arrow icon

Classificationtoggle arrow icon

Osteoarthritis can be classified according to the underlying cause: [2]

Pathophysiologytoggle arrow icon

Chronic mechanical stress on the joints and age-related decrease in proteoglycans cartilage loses elasticity and becomes friable → degeneration and inflammation of cartilage ; joint space narrowing and thickening and sclerosis of the subchondral bone [3][4]

Clinical featurestoggle arrow icon

Common clinical findings [5][6][7][8]

Joint-specific findings [5]

In contrast to rheumatoid arthritis, osteoarthritis can affect the distal interphalangeal joints.

Diagnosticstoggle arrow icon


  • Osteoarthritis is a clinical diagnosis
    • Consider the diagnosis in patients ≥ 45 years of age with typical clinical features. [7]
    • There are no specific diagnostic criteria. [9]
  • If there is clinical doubt, consider imaging and additional testing to:
    • Support the clinical diagnosis with radiological evidence of joint degeneration [1]
    • Rule out differential diagnoses [7][10]
  • Invasive procedures are not routinely recommended, but may be helpful in select circumstances, for example:
    • Uncertain diagnosis
    • Assessing cartilage damage
    • Ruling out septic arthritis
    • Procedures with dual diagnostic and therapeutic purposes.

Osteoarthritis is often diagnosed based on the patient's history and the presence of typical clinical features. Radiographic signs often do not correlate with the patient's reported symptoms or clinical findings; therefore, imaging is usually used to support the diagnosis.

Imaging [7][10]

The presence of at least one of the radiological signs of osteoarthritis, in addition to typical clinical features, supports the diagnosis of osteoarthritis.

First-line modality: plain radiography of affected joints

  • Indications
  • Consideration: Multiple views are typically more accurate than a single view.

Other imaging modalities

Other modalities may be indicated if the diagnosis remains uncertain after radiography.

Radiological signs of osteoarthritis [1]

  • Irregular joint space narrowing
  • Subchondral sclerosis: a dense area of bone (visible on x-ray) just below the cartilage zone of a joint that forms as a result of a compressive load on the joint
  • Osteophytes (bone spurs): spurs or densifications that develop on the edges of the joint, increasing its surface area
  • Subchondral cyst: a fluid-filled cyst that develops on the surface of a joint due to local bone necrosis induced by the joint stress caused by osteoarthritis

Further investigations

Differential diagnosestoggle arrow icon

See “Differential diagnoses of inflammatory arthritis.”

The differential diagnoses listed here are not exhaustive.

Treatmenttoggle arrow icon

Treatment recommendations are consistent with the 2019 American College of Rheumatology (ACR) management guidelines for osteoarthritis of the hand, hip, and knee. [12]

Approach [12][13]

  • Follow a stepwise approach to treatment: Start with nonpharmacological management, followed by pharmacological and/or surgical treatment if needed.
  • Individualize treatment based on patient preferences, comorbidities, treatment goals, and available resources.
  • Consider referral to physical therapy or occupational therapy.

Nonpharmacological management

Pharmacotherapy [12][13]

Pharmacotherapy for osteoarthritis should be consistent with the WHO pain ladder. See “Treatment of pain” for dosages and important considerations.

Pharmacotherapy should only be used as a short-term treatment in symptomatic patients; long-term therapy is associated with many adverse effects.

Surgical management [16][17]


Surgery is typically indicated if conservative measures fail.

Perioperative considerations

After total joint replacement, patients should receive aspirin or an anticoagulant (e.g., a direct oral anticoagulant or low molecular weight heparin) for VTE prophylaxis. [22]

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Referencestoggle arrow icon

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  2. Altman R, Asch E, Bloch D, et al. Development of criteria for the classification and reporting of osteoarthritis: Classification of osteoarthritis of the knee. Arthritis & Rheumatism. 1986; 29 (8): p.1039-1049.doi: 10.1002/art.1780290816 . | Open in Read by QxMD
  3. Liu-Bryan R, Terkeltaub R. Emerging regulators of the inflammatory process in osteoarthritis. Nat Rev Rheumatol. 2014.doi: 10.1038/nrrheum.2014.162 . | Open in Read by QxMD
  4. Lane NE, Brandt K, Hawker G et al . OARSI-FDA initiative: defining the disease state of osteoarthritis. Osteoarthritis Cartilage. 2011.doi: 10.1016/j.joca.2010.09.013 . | Open in Read by QxMD
  5. Marshall M, Watt FE, Vincent TL, Dziedzic K. Hand osteoarthritis: clinical phenotypes, molecular mechanisms and disease management. Nature Reviews Rheumatology. 2018; 14 (11): p.641-656.doi: 10.1038/s41584-018-0095-4 . | Open in Read by QxMD
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  8. Michael JW-P, Schlüter-Brust KU, Eysel P. The Epidemiology, Etiology, Diagnosis, and Treatment of Osteoarthritis of the Knee. Deutsches Aerzteblatt Online. 2010; 107 (9): p.152-162.doi: 10.3238/arztebl.2010.0152 . | Open in Read by QxMD
  9. Aggarwal R, Ringold S, Khanna D, et al. Distinctions between diagnostic and classification criteria?. Arthritis Care Res (Hoboken). 2015; 67 (7): p.891-7.doi: 10.1002/acr.22583 . | Open in Read by QxMD
  10. Wenham CYJ, Grainger AJ, Conaghan PG. The role of imaging modalities in the diagnosis, differential diagnosis and clinical assessment of peripheral joint osteoarthritis. Osteoarthritis and Cartilage. 2014; 22 (10): p.1692-1702.doi: 10.1016/j.joca.2014.06.005 . | Open in Read by QxMD
  11. Bhavsar TB, Sibbitt WL, Band PA, et al. Improvement in diagnostic and therapeutic arthrocentesis via constant compression. Clin Rheumatol. 2017; 37 (8): p.2251-2259.doi: 10.1007/s10067-017-3836-x . | Open in Read by QxMD
  12. Kolasinski SL, Neogi T, Hochberg MC, et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Care Res (Hoboken). 2020; 72 (2): p.149-162.doi: 10.1002/acr.24131 . | Open in Read by QxMD
  13. Paterson KL, Gates L. Clinical Assessment and Management of Foot and Ankle Osteoarthritis: A Review of Current Evidence and Focus on Pharmacological Treatment. Drugs Aging. 2019; 36 (3): p.203-211.doi: 10.1007/s40266-019-00639-y . | Open in Read by QxMD
  14. Wang C, Schmid CH, Iversen MD, et al. Comparative Effectiveness of Tai Chi Versus Physical Therapy for Knee Osteoarthritis. Ann Intern Med. 2016; 165 (2): p.77-86.doi: 10.7326/m15-2143 . | Open in Read by QxMD
  15. Messier SP, Resnik AE, Beavers DP, et al. Intentional Weight Loss in Overweight and Obese Patients With Knee Osteoarthritis: Is More Better?. Arthritis Care & Research. 2018; 70 (11): p.1569-1575.doi: 10.1002/acr.23608 . | Open in Read by QxMD
  16. Katz JN, Earp BE, Gomoll AH. Surgical management of osteoarthritis. Arthritis Care & Research. 2010; 62 (9): p.1220-1228.doi: 10.1002/acr.20231 . | Open in Read by QxMD
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  21. Surgical Management of Osteoarthritis of the Knee Evidence Based Clinical Practice Guideline. Updated: September 4, 2015. Accessed: June 17, 2022.
  22. Anderson DR et al.. American Society of Hematology 2019 guidelines for management of venous thromboembolism: prevention of venous thromboembolism in surgical hospitalized patients. Blood Adv. 2019; 3 (23): p.3898-3944.doi: 10.1182/bloodadvances.2019000975 . | Open in Read by QxMD
  23. Sollecito TP, Abt E, Lockhart PB, et al. The use of prophylactic antibiotics prior to dental procedures in patients with prosthetic joints. J Am Dent Assoc. 2015; 146 (1): p.11-16.e8.doi: 10.1016/j.adaj.2014.11.012 . | Open in Read by QxMD

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