骨关节炎的临床表表和诊断 uptodate.docxVIP

Clinical manifestations and diagnosis of osteoarthritisAuthors:Michael Doherty, MA, MD, FRCP, FHEAAbhishek Abhishek, MBBS, MD, MRCP, PhDSection Editor:David Hunter, MD, PhDDeputy Editor:Monica Ramirez Curtis, MD, MPHContributor DisclosuresAll topics are updated as new evidence becomes available and our?peer review process?is complete.Literature review current through:?Nov 2016.?|?This topic last updated:?Aug 01, 2016.INTRODUCTION?—?Osteoarthritis (OA) is the commonest form of arthritis and possesses marked variability of disease expression. Although most patients present with joint pain and functional limitations [1], the age of disease onset, sequence of joint involvement, and disease progression varies from person to person. OA ranges from an asymptomatic, incidental finding on clinical?and/orradiographic examination to a rapidly progressive disabling disorder eventually culminating in “joint failure.”The clinical features and approach to the diagnosis of OA will be reviewed here. The pathogenesis, epidemiology, and treatment of OA are discussed separately. (See?Pathogenesis of osteoarthritisand?Risk factors for and possible causes of osteoarthritis?and?Initial pharmacologic therapy of osteoarthritis?and?Treatment of osteoarthritis resistant to initial pharmacologic therapy.)CLINICAL MANIFESTATIONS?—?The primary symptoms of osteoarthritis (OA) are joint pain, stiffness, and locomotor restriction. Symptoms usually present in just one or a few joints in a middle-aged or older person. Other manifestations in patients with OA include sequelae such as muscle weakness and poor balance [2] and comorbidities like fibromyalgia [3-6].Symptoms and signs?—?The following symptoms and signs may be observed in patients with OA:●Pain?–?Pain in OA is worse with joint use (usage-related pain) and relieved by rest. It is often the most frequent symptom and generally progresses through three stages [7]:?Stage 1 – Predictable, sharp pain usually brought on by a mechanical insult that