CLINICAL down stairs, pain in weight-bearingjoints when

CLINICAL FEATURESJoint pain from OA is activity-related. Pain comes on either duringor just after joint use and then gradually resolves. Examples includeknee or hip pain with going up or down stairs, pain in weight-bearingjoints when walking, and, for hand OA, pain when cooking. Early indisease, pain is episodic, triggered often by a day or two of overactiveuse of a diseased joint, such as a person with knee OA taking a long runand noticing a few days of pain thereafter. As disease progresses, thepain becomes continuous and even begins to be bothersome at night.Stiffness of the affected joint may be prominent, but morning stiffnessis usually brief (1000/µL, inflammatoryarthritis or gout or pseudogout is likely, the latter two being alsoidentified by the presence of crystals.X-rays are indicated to evaluate chronic hand pain and hip painthought to be due to OA, as the diagnosis is often unclear withoutconfirming radiographs. For knee pain, x-rays should be obtained ifsymptoms or signs are not typical of OA or if knee pain persists afterinauguration of effective treatment. In OA, radiographic findings correlate poorly with the presence and severity of pain.Further, radiographs may be normal in early disease as they are insensitiveto cartilage loss and other early findings.Although MRI may reveal the extent of pathology in an osteoarthriticjoint, it is not indicated as part of the diagnostic workup.Findings such as meniscal tears and cartilage and bone lesions occur inmost patients with OA in the knee, but almost never warrant a changein therapy.PrognosisThe prognosis in patients with osteoarthritis depends on the joints involved and on the severity of the condition. No proven disease-modifying or structure-modifying drugs for osteoarthritis are currently known; consequently, pharmacologic treatment is directed at symptom relief.A systematic review found the following clinical features to be associated with more rapid progression of knee osteoarthritis  :• Older age• Higher BMI• Varus deformity• Multiple involved jointsPatients with osteoarthritis who have undergone joint replacement have a good prognosis, with success rates for hip and knee arthroplasty .NONPHARMACOTHERAPYBecause OA is a mechanically driven disease, the mainstay of treatmentinvolves altering loading across the painful joint and improvingthe function of joint protectors, so they can better distributeload across the joint. Ways of lessening focal load across the jointinclude:1. avoiding activities that overload the joint, as evidenced by their 2231causing pain;2. improving the strength and conditioning of muscles that bridgethe joint, so as to optimize their function; and3. unloading the joint, either by redistributing load within the jointwith a brace or a splint or by unloading the joint during weightbearing with a cane or a crutch.The simplest effective treatment for many patients is to avoidactivities that precipitate pain.tal knee replacement