Conditions

Osteoarthritis

Mechanism: An active process of the whole joint: cartilage loss with a reaction of the underlying bone, the capsule and the synovium. It is not simple wear from use; load, predisposition, age and low-grade inflammation all contribute.
Recognition: Start-up pain and stiffness after rest resolving within half an hour, pain increasing with load, and a capsular pattern with its own order per joint. Crepitus and bony widening come later.
Course: Imaging and complaints correlate weakly, in both directions. Exercise therapy and education are the basis of treatment for every affected joint, and that remains so regardless of what the radiograph shows.
What the guideline recommends: The handbook puts exercise therapy, education and weight management first, with medication and joint replacement as later steps. Movement does not worsen the osteoarthritis; that misconception is itself a treatment target.

Structures