Osteoarthritis

Symptoms:
1. Pain that worsens with activity and improves with rest
2. Unilateral joint involvement, commonly affecting the knee or hip
3. Crepitus (a grinding sensation) in the joint
4. Absence of systemic symptoms

Diagnosis:
i. Clinical Examination: Identifying tenderness, swelling, and crepitus in the joint.
Imaging: X-rays showing joint space narrowing, osteophytes, and subchondral sclerosis.

Management:

First-Line Treatment:

. Paracetamol: Initial medication for pain relief.
. Exercise and Physiotherapy: Strengthening muscles around the joint and improving flexibility.
. Weight Loss: To reduce stress on weight-bearing joints.

Second-Line Treatment:
. Topical NSAIDs: Applied directly to the skin over the painful joint to minimize systemic side effects.

Third-Line Treatment:
. Oral NSAIDs: Consider if pain persists despite the use of paracetamol and topical NSAIDs. NSAIDs like celecoxib should be paired with a proton pump inhibitor (PPI) to prevent gastric ulcers.

Fourth-Line Treatment:
. Opioids: Used only if other medications are not effective in managing pain, due to the risk of addiction and side effects.

Last Resort:
. Surgery: Options include joint replacement or other surgical interventions, considered when conservative treatments fail and pain severely impacts quality of life.