Adults
Osteoarthritis
Use-related pain, brief stiffness and bony enlargement with normal inflammatory markers. Diagnose clinically.
What to look for
- Pain with use, morning stiffness under 30 minutes
- Bony enlargement (Heberden and Bouchard nodes), crepitus, reduced range of motion
- Normal ESR/CRP. Imaging is not needed for a typical presentation.
What to do
- Exercise and weight loss for knee and hip OA carry strong recommendations. The 2026 ACR update adds a conditional recommendation for a GLP-1 receptor agonist, with diet and exercise, in knee OA with obesity.
- Topical NSAIDs for knee and hand OA (often tried before oral NSAIDs), oral NSAIDs if the risk profile allows, and intra-articular glucocorticoids for knee or hip (ultrasound-guided for the hip). Duloxetine and acetaminophen are conditional options. PT, OT, braces, hand orthoses and canes help many patients.
- The 2026 update strongly recommends against glucosamine or chondroitin, platelet-rich plasma, stem cell injections, hydroxychloroquine and bisphosphonates for OA, and conditionally against hyaluronic acid injections and opioids.
Refer if
- Young-onset OA, an atypical joint pattern (MCP, wrist, shoulder) or rapid progression, so CPPD, hemochromatosis or inflammatory arthritis can be excluded
- Joint swelling with features of inflammatory arthritis
- Erosive hand OA, where the 2026 update now conditionally recommends methotrexate
About this urgency level
Common in referral queues. Many can be managed in primary care with the guidance below, though some rheumatology practices are happy to see them. A pre-referral e-consult can help decide.
Timeframes are typical targets. Local pathways, capacity and clinical judgment come first.