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1、ClinicalmanifestationsanddiagnosisofosteoarthritisAuthors:MichaelDoherty,MA,MD,FRCP,FHEAAbhishekAbhishek,MBBS,MD,MRCP,PhDSectionEditor:DavidHunter,MD,PhDDeputyEditor:MonicaRamirezCurtis,MD,MPHContributorDisclosuresAlltopicsareupdatedasnewevidencebecomesavailableandour peerr
2、eviewprocess iscomplete.Literaturereviewcurrentthrough: Nov2016.
3、 Thistopiclastupdated: Aug01,2016.INTRODUCTION — Osteoarthritis(OA)isthecommonestformofarthritisandpossessesmarkedvariabilityofdiseaseexpression.Althoughmostpatientspresentwithjointpainandfunctionallimitation
4、s[1],theageofdiseaseonset,sequenceofjointinvolvement,anddiseaseprogressionvariesfrompersontoperson.OArangesfromanasymptomatic,incidentalfindingonclinical and/orradiographicexaminationtoarapidlyprogressivedisablingdisordereventuallyculminatingin“jointfailure.”Theclinicalfeat
5、uresandapproachtothediagnosisofOAwillbereviewedhere.Thepathogenesis,epidemiology,andtreatmentofOAarediscussedseparately.(See "Pathogenesisofosteoarthritis"and "Riskfactorsforandpossiblecausesofosteoarthritis" and "Initialpharmacologictherapyofosteoarthritis" and "Treatmento
6、fosteoarthritisresistanttoinitialpharmacologictherapy".)CLINICALMANIFESTATIONS — Theprimarysymptomsofosteoarthritis(OA)arejointpain,stiffness,andlocomotorrestriction.Symptomsusuallypresentinjustoneorafewjointsinamiddle-agedorolderperson.OthermanifestationsinpatientswithOAin
7、cludesequelaesuchasmuscleweaknessandpoorbalance[2]andcomorbiditieslikefibromyalgia[3-6].Symptomsandsigns — ThefollowingsymptomsandsignsmaybeobservedinpatientswithOA:●Pain – PaininOAisworsewithjointuse(usage-relatedpain)andrelievedbyrest.Itisoftenthemostfrequentsymptomandgen
8、erallyprogressesthroughthreestages[7]:•Stage1–Predictable,sharppainusuallybroughtonbyamechanicalinsultthateventuallylimitshigh-impactactivitieswithrelativelymodesteffectonfunction.•Stage2–Painbecomesmoreconstantandstartstoaffectdailyactivities.Theremaybeunpredictableepisode
9、sofstiffness.•Stage3–Constant dull/aching painpunctuatedbyepisodesofoftenunpredict