Osteoarthritis (OA) / degenerative joint disease

Typical symptoms:

Mechanical pain, morning stiffness <30 min, reduced proprioception and strength. Sites: knee, hip, CMC1 joint of the hand (base of the thumb), DIP/PIP joints of the fingers, facet joints of the spine.

Physical and rehabilitation medicine (physiatry) assesses:

pain, contractures, reduced endurance and walking speed, and the risk of falls; it plans and carries out the diagnostic work-up, treatment and long-term follow-up.

Treatment:

includes education and self-management; an activity diary.

Exercise:

strengthening 2–3×/week (especially the quadriceps/hip abductors), range-of-motion (ROM), neuromuscular/proprioceptive and aerobic exercise (brisk walking/cycle ergometer/swimming); water-based programmes

Body weight:

aim for 5–10% weight loss in knee/hip OA.

Aids/orthoses:

walking stick on the opposite side, orthoses, CMC1 orthosis, insoles as needed.

Physical modalities:

heat/cold, TENS and others

Medication:

topical NSAIDs first; oral NSAIDs with gastrointestinal/renal caution; duloxetine (knee OA, with centralised pain); topical capsaicin; short-term intra-articular corticosteroid for synovitis. Hyaluronate/PRP – selectively

Procedures:

radiofrequency ablation of the genicular nerves (selected patients with knee OA).

Surgery:

mechanical locking, progression of deformity or severe functional limitation despite optimal conservative treatment for ≥3–6 months.

Caution/contraindications:

osteoporosis (adjust the load), active synovial irritation (avoid more strenuous activities), cervical/lumbar OA – no forceful manipulation; comorbidities (CVD, CKD) when choosing pain relief.