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Arthritis

Ankle OA—primarily post-traumatic—diagnosis, staging, and consideration of ankle replacement versus fusion for end-stage disease.

Overview

Juvenile arthritis is a diagnosis of exclusion requiring a broad differential diagnosis [1]. Early referral to a pediatric rheumatologist has greatly improved long-term outcomes for juvenile arthritis [1]. The use of targeted biologic medications has reduced the need for surgical intervention in juvenile arthritis [1]. Proper indication for autologous osteochondral grafting relies on identifying and simultaneously correcting malalignment and/or traumatic changes in affected joints [4].

Reverse shoulder arthroplasty is a safe and effective procedure for the treatment of rheumatoid arthritis patients [5]. Reverse shoulder arthroplasty for rheumatoid arthritis has a low risk of complications [5]. Reverse shoulder arthroplasty for rheumatoid arthritis has a low rate of revision [5]. The effectiveness of reverse shoulder arthroplasty for rheumatoid arthritis is independent of the radiologic presentation and stage of the disease [5]. Reaming the glenoid flat for reverse total shoulder arthroplasty without bone-grafting in patients with severe glenoid bone loss produced excellent prosthetic survival [62]. Clinical results for reverse total shoulder arthroplasty without bone-grafting in patients with severe glenoid bone loss were maintained at a minimum 5-year follow-up [62].

The optimal treatment of glenohumeral arthritis in patients ≤ 50 years of age remains controversial [7]. There are many treatment options to consider for glenohumeral arthritis in patients ≤ 50 years of age to respond to the variety of clinical presentations and anatomic pathologies [7]. Patients with rheumatoid arthritis may be at an increased risk of complications and revision surgery following primary total hip arthroplasty [8]. Patients with rheumatoid arthritis can expect reduced pain and improved functional outcomes similar to those with osteoarthritis following primary total hip arthroplasty [8]. Incorporating the 2023 AAOS hip osteoarthritis management guidelines into clinical practice may optimize patient treatment outcomes [49].

Anatomy & Pathophysiology

Osseous Alignment and Biochemistry

In the majority of patients with ankle osteoarthritis, the average tibiotalar alignment is varus regardless of the underlying etiology [79]. Correcting altered biomechanics associated with asymmetric arthritis improves functional outcomes in ankle arthritis [24]. Key biochemical markers of early ankle osteoarthritis include aggrecan, BMP-7, and BMP-2 [89].

Ligamentous and Soft Tissue Pathology

Persistent biomechanical alterations after ACL reconstruction are associated with significant changes in cartilage T1r and T2 at 1 year postreconstruction [95]. Anatomical and pathomechanical aspects of post-traumatic anterior ankle bands differ from accessory fascicles of the antero-inferior tibiofibular ligament, despite similar diagnostic and treatment approaches [86].

Classification

Juvenile Arthritis: This diagnosis is one of exclusion, necessitating a broad differential diagnosis [1].

Rheumatoid Arthritis: Revised diagnostic criteria aim to achieve uniformity in patient classification [15]. Destructive seronegative rheumatoid arthritis is a rare inflammatory subtype that carries devastating consequences despite negative serology [14]. Synoviocyte detachment is a crucial histological feature, with correlations existing between synovial pathology types and clinical characteristics [52]. Differential gene expression compared with osteoarthritis indicates potential targets for molecular diagnosis [80].

Osteoarthritis: Bone metabolism biomarkers possess diagnostic value in distinguishing arthritis subtypes and correlate with inflammatory markers [9]. Understanding subchondral vascular physiology is key to better MRI classification of osteoarthritis and other bone diseases [27]. Patient history and physical examination findings may guide physicians to predict structural joint abnormalities as signs of osteoarthritis following ankle sprain [6].

Shoulder Classification: Inter-rater reliability for classifying arthritic shoulders using the Walch et al. system shows only fair agreement among experienced shoulder surgeons [65].

Hip Classification: The Tönnis classification of hip osteoarthritis is widely utilized but has conflicting data regarding reliability, with interobserver agreement ranging from slight to substantial depending on the study population and observer expertise [68].

General Cartilage Grading: A universal and definitive grading system for cartilage lesions is necessary, and measurement devices are needed for objective cartilage grading in questionable cases [72].

Historical Context: The 1950 revision of "The Arthropathies" added value through extensive rewriting, clearer illustrations, and updated terminology [25].

Other Considerations: Discordance exists between self-reported diagnosed arthritis and recent musculoskeletal signs or symptoms in older women [2]. Proper indication for autologous osteochondral grafting relies on identifying and simultaneously correcting malalignment and/or traumatic changes in affected joints [4].

Clinical Presentation

Juvenile arthritis is a diagnosis of exclusion requiring a broad differential diagnosis [1]. Early referral to a pediatric rheumatologist and the use of targeted biologic medications have greatly improved long-term outcomes and reduced the need for surgical intervention in juvenile arthritis [1].

Palindromic rheumatism requires ruling out other arthritic disorders and observing a protracted, non-destructive course over time [3]. In contrast, some women who reported diagnosed arthritis did not have recent musculoskeletal signs or symptoms [2], while other women with musculoskeletal signs and symptoms did not report diagnosed arthritis [2].

Patient history and physical examination findings may guide physicians to predict structural joint abnormalities as signs of osteoarthritis after ankle sprain [6]. Although many OA-related biomarkers are currently available, none can be considered a surrogate marker of clinical and imaging features for the diagnosis or prognosis of the disease at this time [12]. Bone metabolism biomarkers have diagnostic value in distinguishing arthritis subtypes [9] and correlate with inflammatory markers [9].

In patients with suspected inflammatory arthritis, routine ultrasound use in newly referred patients seems to be associated with significantly earlier diagnosis and DMARD initiation [13]. Synovial-fluid acid phosphatase activity was higher in patients with rheumatoid and other inflammatory arthritides compared to noninflammatory arthritides [42], and this activity may have diagnostic value in differential diagnosis [42].

Destructive seronegative (rheumatoid) arthritis is a rare sub-type of inflammatory arthritis which, despite being seronegative, can have devastating disease consequences [14]. Chronic post-rheumatic-fever arthritis (Jaccoud's arthritis) is characterized by periarticular fibrosis and the absence of chronic synovitis [45]. The articular lesion in Jaccoud's arthritis is distinctly different from rheumatoid arthritis [45].

The diagnosis of familial Mediterranean fever is clinical, based on the association of monoarticular arthritis with recurrent fever and abdominal pain [33]. There are no specific laboratory aids for the diagnosis of familial Mediterranean fever [33]. Joint involvement in familial Mediterranean fever is typically transient [19], but permanent joint damage can occur, particularly in older children at onset [19].

The diagnosis of septic knee arthritis must be suspected at the early stage of the disease [35]. Diagnostic joint aspiration must be immediately performed when septic knee arthritis is suspected [35]. Cross-specialty collaboration is important to ensure timely identification and treatment of culture-negative septic glenohumeral arthritis to maximally salvage joint tissue and functional capacity [46].

Early diagnosis and prompt treatment are essential to prevent joint destruction and maintain function in patients with osteoarticular tuberculosis (OAT) [36]. Physicians should be aware of Charcot joint disease presentation in patients with insensate joints to avoid overtreatment [38]. The presence of bone and cartilage debris ground into the synovial membrane is a significant pathological finding indicative of early neuropathic joints [47]. Bone and cartilage debris in the synovial membrane often appears before clinical or roentgenographic evidence is demonstrable [47], but it is not absolutely specific as it can occur in advanced degenerative arthritis [47].

The optimal treatment of glenohumeral arthritis in patients ≤ 50 years of age remains controversial [7]. There are many treatment options to consider when responding to the variety of clinical presentations and anatomic pathologies in glenohumeral arthritis in patients ≤ 50 years of age [7]. Understanding the basic science of cartilage and the changes that occur in osteoarthritis is imperative to develop novel strategies to diagnose and treat this disorder [40]. Serum biochemical changes may play a role in worsening knee joint health but are not associated with poor symptom development related to post-traumatic osteoarthritis (PTOA) at 12 months post-ACLR [41].

Investigations

Plain radiography: Radiographs and MRI scans exhibit substantial limitations and inconsistency between raters when evaluating common markers of hip osteoarthritis [43]. Machine learning algorithms can predict the rate of future rapid cartilage loss from a single plain radiograph, a prediction validated on an independent dataset [77]. Patient history and physical examination findings may guide physicians to predict structural joint abnormalities as signs of osteoarthritis after ankle sprain [6].

MRI: Clinical magnetic resonance imaging is the method of choice for the non-invasive evaluation of articular cartilage defects and for the follow-up of cartilage repair procedures [81]. MRI serves as a noninvasive tool that overcomes the shortcomings of radiography by detecting preclinical disease and subtle early abnormalities [51]. It is evolving as a complete answer to cartilage-imaging requirements for lesion description, treatment planning, and outcome measurement [51]. Magnetic resonance imaging has created an important role for reproducible, noninvasive, and objective evaluation and monitoring of cartilage in the setting of trauma, degenerative arthritides, and surgical treatment for cartilage injury [54]. Understanding subchondral vascular physiology will be key to better MRI classification and prevention, control, prognosis and treatment of osteoarthritis and other bone diseases [27].

CT: The study reveals a higher incidence of osteoarthritis before and after the Latarjet procedure than reported in the literature, likely attributed to the use of computed tomography imaging [60].

Laboratory: Bone metabolism biomarkers have diagnostic value in distinguishing arthritis subtypes and correlate with inflammatory markers in various types of arthritis [9]. Many OA-related biomarkers are currently available, but none can be considered a surrogate marker of clinical and imaging features for the diagnosis or prognosis of the disease at this time [12].

Other Considerations: Juvenile arthritis is a diagnosis of exclusion requiring a broad differential diagnosis [1]. Early referral to a pediatric rheumatologist has improved long-term outcomes and reduced the need for surgical intervention in juvenile arthritis [1]. The use of targeted biologic medications has improved long-term outcomes and reduced the need for surgical intervention in juvenile arthritis [1]. Some women who reported diagnosed arthritis did not have recent musculoskeletal signs or symptoms [2], while some women with musculoskeletal signs and symptoms did not report diagnosed arthritis [2]. The final diagnosis of palindromic rheumatism requires ruling out other arthritic disorders and observing a protracted, non-destructive course over time [3]. Routine ultrasound use in newly referred patients with suspected inflammatory arthritis is associated with significantly earlier diagnosis and DMARD initiation [13]. This is the first study to assess the prevalence of ultrasound features of osteoarthritis in a population-based sample [78]. Calcitonin presents a promising agent for the treatment of both osteoarthritis and rheumatoid arthritis, with potential that seems greater in OA [83].

Treatment

Non-Operative

Juvenile arthritis requires early referral to a pediatric rheumatologist and the use of targeted biologic medications to improve long-term outcomes and reduce the need for surgical intervention [1]. Diagnosis is a diagnosis of exclusion requiring a broad differential diagnosis [1]. For methotrexate-resistant rheumatoid arthritis, tofacitinib is efficacious and well tolerated up to 24 weeks [16]. The therapeutic efficacy of tumor necrosis factor alpha drugs in rheumatoid arthritis is primarily influenced by prior response to DMARD treatment [44]. Intra-articular TNFi therapy appears to have equal efficacy to intra-articular steroids, though the optimal dose and frequency of injections is yet unknown [57].

Current non-surgical managements for osteoarthritis do not change the clinical course or arrest disease progression [34]. Extensive randomized controlled trial studies show that various moderate exercises can improve symptoms and prognosis of osteoarthritis in clinical settings [39]. Hydrotherapy is a noninvasive, non-interventional, reasonably priced therapeutic option with few side effects for the concomitant treatment of osteoarthritis of the hip or knee [70]. Biological treatments for osteoarthritis must meet three crucial milestones: safety, reasonable cost, and improved effectiveness compared with alternatives [48]. For patients with ankle osteoarthritis, PRP injections did not improve ankle symptoms and function over 52 weeks compared with placebo injections [22].

The symptomatic treatment effect of intra-articular mesenchymal stem cells for knee osteoarthritis is dose dependent, and the efficacy of SVF injections supports its use as a treatment option [37]. Based on high-level evidence studies, single intraarticular injection of MSCs is a safe, reliable, and effective treatment option for Kellgren-Lawrence grade I—III knee osteoarthritis [53]. Physical therapy management of osteochondritis dissecans can incorporate a full spectrum of conservative, nonoperative, and postoperative care [58]. Nonoperative treatment is almost always initiated for primary and posttraumatic arthritis of the elbow, although surgical treatment may be indicated in cases refractory to conservative management [50]. Initial treatment for atlantoaxial osteoarthritis is conservative, with as many as two-thirds of patients improving [55]. Nonoperative modalities should be utilized before surgical options for shoulder osteoarthritis, particularly for patients with moderate-to-mild disease [64]. Treatment options for hallux rigidus and osteoarthrosis of the first metatarsophalangeal joint range from non-operative measures to various surgical procedures [66]. The handbook on diagnosis and nonsurgical management of osteoarthritis offers an overview of epidemiology, evaluation methods, and non-operative treatment [69].

Operative

Indications: Joint replacement is indicated for end-stage osteoarthritis [34]. Surgery is indicated for atlantoaxial osteoarthritis for incapacitating pain recalcitrant to nonoperative management [55]. Proper indication for autologous osteochondral grafting relies on identifying and simultaneously correcting malalignment and/or traumatic changes in affected joints [4]. Treatment selection for hallux rigidus and osteoarthrosis of the first metatarsophalangeal joint depends on disease stage and patient factors [66]. Patients with established scaphoid non-union should be advised that osteoarthritis will most likely develop [63].

Surgical Approach / Technique: Reverse shoulder arthroplasty is a safe and effective procedure for the treatment of RA patients, with a low risk of complications and low rate of revision, regardless of the radiologic presentation and stage of the disease [5]. The optimal treatment of glenohumeral arthritis in patients ≤ 50 years of age remains controversial, with many treatment options to consider for variety in clinical presentations and anatomic pathologies [7]. Surgical management for end-stage ankle OA currently focuses on ankle arthrodesis and total ankle arthroplasty, with specific indications for one procedure over the other being the topic of much debate [18]. In the early stages of ankle OA, only periarticular osteotomies have enough evidence to recommend use in cases with malalignment [28]. Ankle arthrodesis and ankle replacement can produce satisfactory functional results if correctly indicated in the final stages of ankle OA [28]. Proximal-row carpectomy should be considered after conservative measures fail, as mild degenerative arthritis is not a contraindication and progressive degenerative arthritis of the radial capitate articulation did not occur [21].

Implant Selection: Patients with rheumatoid arthritis can expect reduced pain and improved functional outcomes similar to those with osteoarthritis following primary THA, although they may be at an increased risk of complications and revision surgery [8]. Surgical treatment for end-stage ankle OA resulted in satisfactory clinical outcomes in patients aged ≥75 years, with improvements comparable to those in younger patients [17]. Surgical treatments like arthroplasty are considered effective for severe cases of shoulder osteoarthritis [64].

Complications

Other Considerations: Discordance exists between self-reported diagnosed arthritis and the presence of recent musculoskeletal signs or symptoms in older women [2]. Palindromic rheumatism requires ruling out other arthritic disorders and observing a protracted, non-destructive course over time for final diagnosis [3]. Long-term knee instability causes proliferative and degenerative changes and persistent pain [23]. Permanent joint damage can occur in familial Mediterranean fever, particularly in older children at onset, despite typically transient joint involvement [19]. Progressive cervical rheumatoid disease can result in the recurrence of long-tract symptoms due to further subaxial subluxation distal to the original fusion site [32]. The occurrence of arthritis of the implanted surfaces in bipolar fresh osteochondral allografts for glenohumeral post-traumatic arthritis is a cause of concern, although it is unrelated to the clinical result [90]. Arthrosis of the glenohumeral joint after arthroscopic Bankart repair rarely causes more than minor subjective symptoms or a minor objectively perceived disadvantage during 13 years' follow-up [29].

Rheumatoid Arthritis Outcomes: Reverse shoulder arthroplasty (RSA) in rheumatoid arthritis patients carries a low risk of complications and a low rate of revision [5]. Patients with rheumatoid arthritis may be at an increased risk of complications and revision surgery compared to those with osteoarthritis following primary total hip arthroplasty [8].

Geriatric Shoulder Arthroplasty: Complication and revision rates after reverse or anatomic total shoulder arthroplasty are comparably low at short-term follow-up in patients 75 years or older with primary glenohumeral arthritis and an intact rotator cuff [20].

Recovery

Light activity (weeks): Evidence does not specify a week range for light activity or return to desk work.

Full activity (months): Evidence does not specify a month range for full activity or return to sport.

Complete recovery / outcome plateau (months): Postoperative improvements in clinical and MRI outcomes after autologous osteochondral transfer (AOT) are maintained through a mean follow-up of 4 years [10].

Rehabilitation protocol: Evidence does not specify PT phasing, immobilisation duration, or weight-bearing progression.

Functional milestones: Discordance exists between self-reported diagnosed arthritis and the presence of recent musculoskeletal signs or symptoms in older women [2]. Palindromic rheumatism is characterized by a protracted, non-destructive course over time, requiring the ruling out of other arthritic disorders for final diagnosis [3]. Long-term knee instability causes proliferative and degenerative changes and persistent pain [23]. Arthrosis of the glenohumeral joint after arthroscopic Bankart repair rarely causes more than minor subjective symptoms or objectively perceived disadvantage during 13 years' follow-up [29].

Other Considerations: Reverse shoulder arthroplasty (RSA) is a safe and effective procedure for rheumatoid arthritis patients, with low complication and revision rates regardless of radiologic presentation or disease stage [5]. Patients aged 75 years or older with primary glenohumeral arthritis and an intact rotator cuff show similar clinical improvement after reverse or anatomic total shoulder arthroplasty [20]. Complication and revision rates for shoulder arthroplasty in patients aged 75 years or older are comparably low at short-term follow-up [20]. Short-term functional and radiographic outcomes for total shoulder arthroplasty (TSA) and total shoulder surface replacement (TSSR) are comparable [61]. Surface replacement arthroplasty provides good long-term symptomatic and functional results for glenohumeral arthropathy in patients younger than 50 years in 81.6% of cases [75]. Correcting altered biomechanics associated with asymmetric ankle arthritis via supramalleolar osteotomies improves functional outcomes [24]. Platelet-rich plasma (PRP) injection may beneficially improve pain and functional scores for ankle osteoarthritis in the short term [76]. Joint preservation procedures for young, active patients with osteoarthritis show satisfactory short-term outcomes but have yet to demonstrate the ability to halt arthritic progression [96]. Rotational acetabular osteotomy (RAO) demonstrates good survival rates at a median follow-up of 14 years for patients at the preosteoarthritis stage and initial stage of developmental dysplasia of the hip [26]. Synovectomy in rheumatoid patients arrests inflammatory disease changes in approximately 67% of knees, although radiographic changes of degenerative joint disease may progress [30]. End results of synovectomy of the knee in rheumatoid patients are better if the stage of disease in the knee is not advanced at the time of surgery [92]. Systemic deterioration after knee synovectomy in rheumatoid patients does not necessarily cancel out the gain from the procedure [92]. Long-term functional and symptomatic results of surgical synovectomy of digital joints in rheumatoid disease are better in patients with mild systemic disease, no roentgenographic lesions, and incipient rather than late-stage mechanical derangement [74]. Untreated focal chondral defects (FCDs) of the knee increase the risk for progression of cartilage damage, though radiographically evident osteoarthritis was not demonstrated within 2 years of follow-up in reviewed studies [31]. Progressive cervical rheumatoid disease can result in the recurrence of long-tract symptoms due to subaxial subluxation distal to the original fusion site [32]. The majority of clinical improvement in early inflammatory arthritis treated with subcutaneous methotrexate occurs rapidly within the first 6 weeks, with significantly less change observed between weeks 6 and 12 [87]. Stiffening of subchondral cancellous bone by 38% from normal to early arthritic condition is accompanied by a trabecular contiguity change from 0.7 to 0.8 [98].

Key Evidence

  • [L4] While some women who reported diagnosed arthritis did not have recent musculoskeletal signs or symptoms, others with the signs and symptoms did not report diagnosed arthritis. (10.1186/s12891-016-1349-4)
  • [Paper] Proper indication relies on identifying and simultaneously correcting malalignment and/or traumatic changes in affected joints. (10.1016/j.injury.2008.01.041)
  • [L4] RSA is a safe and effective procedure for the treatment of RA patients, with a low risk of complications and low rate of revision, regardless of the radiologic presentation and stage of the disease. (10.1016/j.jse.2021.01.033)
  • [Paper] These findings may guide physicians to predict structural joint abnormalities as signs of osteoarthritis. (10.1055/s-0043-109554)
  • [L5] The optimal treatment of glenohumeral arthritis in patients ≤ 50 years of age remains controversial, and there are many treatment options to consider when responding to the variety of clinical presentations and anatomic pathologies. (10.1016/j.jse.2023.01.009)
  • [L3] Although patients with rheumatoid arthritis may be at an increased risk of complications and revision surgery, patients can expect reduced pain and improved functional outcomes similar to those with osteoarthritis following primary THA. (10.5435/jaaos-d-24-00656)
  • [L4] This study highlights the diagnostic value of bone metabolism markers in distinguishing arthritis subtypes, revealing their correlation with inflammatory markers. (10.1186/s12891-026-09523-4)
  • [L4] Postoperative improvements in clinical and MRI outcomes after AOT at the early term follow-up were maintained through a mean follow-up of 4 years. (10.1177/23259671251356267)
  • [L5] Short-term results in children are no less favorable than in adults, and the danger of abnormal growth from rheumatoid inflammation is an indication for synovectomy, especially in children with unilateral knee involvement. (10.2106/00004623-197153040-00001)
  • [L5] Although many OA-related biomarkers are currently available, none can be considered as a surrogate marker of clinical and imaging features for the diagnosis or prognosis of the disease at this time. (10.1186/1471-2474-16-s1-s2)
  • [L2] In patients with suspected inflammatory arthritis, routine US use in newly referred patients seems to be associated with significantly earlier diagnosis and DMARD initiation. (10.1186/s12891-017-1850-4)
  • [L4] This report highlights a rare sub-type of inflammatory arthritis which, despite being seronegative, can have devastating disease consequences. (10.1186/s12891-016-1067-y)
  • [L5] The revised criteria are hoped to aid in obtaining more uniformity in the classification of patients with rheumatoid arthritis and should be reviewed in two or three years. (10.2106/00004623-195941040-00023)
  • [L1] Tofacitinib is efficacious and well tolerated in patients with MTX-resistant RA up to a period of 24 weeks. (10.1186/1471-2474-14-298)
  • [L3] Surgical treatment for end-stage ankle OA resulted in satisfactory clinical outcomes in patients aged ≥75 years, with improvements comparable to those in younger patients. (10.1186/s13018-023-03734-4)
  • [L5] Surgical management for end-stage ankle OA currently focuses on ankle arthrodesis and total ankle arthroplasty, with specific indications for one procedure over the other being the topic of much debate. (10.5435/jaaos-d-23-00743)
  • [L4] While joint involvement is typically transient, this report emphasizes that permanent joint damage can occur, particularly in older children at onset. (10.2106/00004623-197557020-00023)
  • [L3] Complication and revision rates are comparably low at short-term follow-up. (10.1016/j.jse.2023.10.021)
  • [L4] It should be considered after conservative measures fail, as mild degenerative arthritis is not a contraindication and progressive degenerative arthritis of the radial capitate articulation did not occur. (10.2106/00004623-197759040-00004)
  • [L1] For patients with ankle osteoarthritis, PRP injections did not improve ankle symptoms and function over 52 weeks compared with placebo injections. (10.1177/03635465231182438)
  • [L5] Clinical studies demonstrate that correcting the altered biomechanics associated with asymmetric arthritis improves functional outcomes. (10.5435/jaaos-d-12-00124)
  • [L5] This is a careful revision of the second edition of The Arthropathies, which adds greatly to the value of the book through extensive rewriting, clearer illustrations, and updated terminology. (10.2106/00004623-195032030-00045)
  • [L3] The RAO cohort with a median follow-up period of 14 years demonstrated good survival rates in patients at the preosteoarthritis stage and in patients at the initial stage of DDH. (10.1016/j.arth.2025.06.021)
  • [L4] Understanding subchondral vascular physiology will be key to better MRI classification and prevention, control, prognosis and treatment of osteoarthritis and other bone diseases. (10.1530/eor-23-0002)
  • [L5] In the early stages, only periarticular osteotomies have enough evidence to recommend in ankle OA with malalignment, while both ankle arthrodesis and ankle replacement can produce satisfactory functional results if correctly indicated in the final stages of the disease. (10.1530/eor-21-0117)
  • [L4] Arthrosis rarely causes more than minor subjective symptoms or a minor objectively perceived disadvantage during 13 years' follow-up. (10.1016/j.jse.2011.04.023)
  • [L3] While radiographic changes of degenerative joint disease may progress, inflammatory disease changes are arrested in about 67 per cent of the knees. (10.2106/00004623-198668020-00004)
  • [L3] Patients with untreated FCDs of the knee joint are more likely to experience a progression of cartilage damage, although the studies included in this review did not demonstrate the development of radiographically evident OA within 2 years of follow-up. (10.1177/2325967118801931)
  • [L4] The progressive nature of cervical rheumatoid disease resulted in the recurrence of long-tract symptoms in three patients due to further subaxial subluxation distal to the original fusion site. (10.2106/00004623-198163080-00003)
  • [L4] The diagnosis is clinical, based on the association of monoarticular arthritis with recurrent fever and abdominal pain, as there are no specific laboratory aids. (10.2106/00004623-196547080-00016)
  • [L5] Current non-surgical managements for osteoarthritis do not change the clinical course or arrest disease progression, while joint replacement is indicated for end-stage disease. (10.1530/eor-2025-0050)
  • [L4] The diagnosis of septic knee arthritis must be suspected at the early stage of the disease, and diagnostic joint aspiration must be immediately performed when the diagnosis is suspected. (10.1007/s00167-006-0224-5)
  • [L4] Early diagnosis and prompt treatment are essential to prevent joint destruction and maintain function in patients with OAT. (10.1186/s12891-025-08400-w)
  • [L1] The symptomatic treatment effect was found to be dose dependent, and the efficacy of SVF injections, in combination with its safety and ease of use, supports its use as a treatment option for symptomatic knee osteoarthritis. (10.1177/2325967120s00127)
  • [Case_report] Physicians should be aware of this presentation in patients with insensate joints to avoid overtreatment. (10.2106/00004623-199274090-00017)
  • [L2] Extensive randomized controlled trial studies show that various moderate exercises can improve symptoms and prognosis of osteoarthritis in clinical settings. (10.1530/eor-22-0119)
  • [L5] Understanding the basic science of cartilage and the changes that occur in osteoarthritis is imperative to develop novel strategies to diagnose and treat this disorder. (10.1016/j.csm.2004.08.007)
  • [L2] Serum biochemical changes may play a role in worsening knee joint health but not poor symptom development related to PTOA. (10.1177/2325967123s00035)
  • [L4] Synovial-fluid acid phosphatase activity was higher in patients with rheumatoid and other inflammatory arthritides compared to noninflammatory arthritides, suggesting the test may have diagnostic value in differential diagnosis. (10.2106/00004623-196446080-00008)
  • [L3] Radiographs and MRI scans had substantial limitations and inconsistency between raters in evaluating common markers of hip osteoarthritis. (10.1177/03635465231167866)
  • [L1] The main factor influencing therapeutic efficacy is the prior response to DMARD treatment. (10.1186/1471-2474-9-52)
  • [Case_report] The patient's articular lesion was distinctly different from rheumatoid arthritis, characterized by periarticular fibrosis and the absence of chronic synovitis, consistent with chronic post-rheumatic-fever arthritis (Jaccoud's arthritis). (10.2106/00004623-198466070-00027)
  • [Case_report] In these cases, cross-specialty collaboration is important to ensure timely identification and treatment of septic arthritis to maximally salvage joint tissue and functional capacity. (10.1016/j.xrrt.2024.04.005)
  • [L4] The presence of bone and cartilage debris ground into the synovial membrane is a significant pathological finding indicative of early neuropathic joints, often appearing before clinical or roentgenographic evidence is demonstrable, though it is not absolutely specific as it can occur in advanced degenerative arthritis. (10.2106/00004623-194830030-00006)
  • [L5] Biological treatments for osteoarthritis must meet three crucial milestones: safety, reasonable cost, and improved effectiveness compared with alternatives. (10.1016/j.arthro.2019.04.020)
  • [L5] Incorporating the 2023 AAOS hip OA management guidelines into clinical practice may optimize patient treatment outcomes. (10.5435/jaaos-d-24-00427)
  • [L5] Nonoperative treatment is almost always initiated although surgical treatment may be indicated in cases refractory to conservative management. (10.1155/2013/473259)
  • [L5] MRI is evolving as a complete answer to cartilage-imaging requirements for lesion description, treatment planning, and outcome measurement, serving as a noninvasive tool that overcomes the shortcomings of radiography by detecting preclinical disease and subtle early abnormalities. (10.2106/jbjs.rvw.15.00093)
  • [L4] The study aims to explore the correlation between synovial pathology types and clinical characteristics in rheumatoid arthritis and to investigate related risk factors for synovial pathological changes. (10.1186/s12891-024-07935-8)
  • [L2] Based on high-level evidence studies, single intraarticular injection of MSCs is a safe, reliable, and effective treatment option for Kellgren-Lawrence grade I—III knee osteoarthritis. (10.1186/s40634-023-00665-1)
  • [L5] Magnetic resonance imaging has created an undeniably important role for reproducible, noninvasive, and objective evaluation and monitoring of cartilage in the setting of trauma, degenerative arthritides, and surgical treatment for cartilage injury. (10.1177/0363546505281938)
  • [L4] Initial treatment is conservative, with as many as two-thirds of patients improving, while surgery is indicated for incapacitating pain recalcitrant to nonoperative management. (10.5435/jaaos-d-24-00513)
  • [L1] Intra-articular TNFi therapy appears to have equal efficacy to IA steroids, though the optimal dose and frequency of injections is yet unknown. (10.1186/s12891-021-04651-5)
  • [Paper] Physical therapy management of osteochondritis dissecans can incorporate a full spectrum of conservative, nonoperative, and postoperative care. (10.1016/j.csm.2014.01.001)
  • [L4] One-stage spacer implantation + two-stage arthroplasty is the current standard surgical option with a high success rate and low reinfection rate, while one-stage arthroplasty is a new treatment option with unique advantages but limitations in surgical indications. (10.1186/s42836-025-00305-2)
  • [L3] The study reveals a higher incidence of osteoarthritis than reported in the literature, likely attributed to the imaging method employed. (10.1016/j.jse.2024.09.037)
  • [L3] Short-term functional and radiographic outcomes were comparable for TSA and TSSR. (10.1016/j.jse.2016.07.029)
  • [L4] For the studied indication, reaming the glenoid flat produced excellent prosthetic survival with clinical results maintained at a minimum 5-year follow-up. (10.2106/jbjs.20.01042)
  • [L4] Patients with established scaphoid non-union should be advised that osteoarthritis will most likely develop. (10.2106/00004623-198567030-00013)
  • [L5] The article provides an overview of available treatments for shoulder osteoarthritis, noting that nonoperative modalities should be utilized before surgical options, particularly for patients with moderate-to-mild disease, while surgical treatments like arthroplasty are considered effective for severe cases. (10.1155/2013/370231)
  • [L4] Only fair agreement was found among experienced shoulder surgeons when classifying arthritic shoulders using the classification system of Walch et al. (10.1016/j.jse.2007.12.006)
  • [L5] Treatment options range from non-operative measures to various surgical procedures including cheilectomy, arthroplasty, and arthrodesis, with selection depending on disease stage and patient factors. (10.2106/00004623-199806000-00015)
  • [L5] The Tönnis classification is widely utilized but has conflicting data regarding its reliability, with interobserver agreement ranging from slight to substantial depending on the study population and observer expertise. (10.1097/01.blo.0000534679.75870.5f)
  • [L5] The handbook is an excellent source of information on the essential facts about osteoarthritis, offering an impressive overview of epidemiology, evaluation methods, and non-operative treatment, and is strongly recommended for orthopaedic surgeons. (10.2106/00004623-199802000-00026)
  • [L2] The results will contribute to establishing hydrotherapy as a noninvasive, non-interventional, reasonably priced, therapeutic option with few side effects, in the concomitant treatment of osteoarthritis of the hip or knee. (10.1186/1471-2474-10-104)
  • [L4] A universal and definitive grading system for lesions is necessary, and measurement devices are needed for objective cartilage grading in questionable cases. (10.1007/s00402-009-0868-y)
  • [L4] Long-term functional and symptomatic results are better in patients with mild systemic disease, with no roentgenographic lesions, and with an incipient rather than a late stage of mechanical derangement. (10.2106/00004623-197153060-00001)
  • [L4] CSRA provides good long-term symptomatic and functional results in the treatment of glenohumeral arthropathy in patients aged younger than 50 years in 81.6% of the patients. (10.1016/j.jse.2014.11.035)
  • [L1] PRP may beneficially improve pain and functional scores for ankle OA in a short-term period. (10.1186/s13018-023-03828-z)
  • [L3] We demonstrate prediction of future rapid cartilage loss from a single plain radiograph with validation on an independent dataset. (10.1177/2325967120s00530)
  • [L4] This is the first study to assess prevalence of ultrasound features of OA in a population-based sample. (10.1186/1471-2474-15-162)
  • [L4] The differential expression of genes in RA compared with OA indicates potential targets for molecular diagnosis and treatment. (10.1186/s12891-022-05277-x)
  • [Paper] Clinical magnetic resonance imaging (MRI) is the method of choice for the non-invasive evaluation of articular cartilage defects and the follow-up of cartilage repair procedures. (10.1016/j.injury.2008.01.043)
  • [L1] Given these effects, CT presents a promising agent for the treatment of both diseases, although the potential seems to be greater in OA. (10.1530/eor-23-0133)
  • [L4] The authors comment that anterior ankle arthroscopy is valuable but emphasize the need to differentiate post-traumatic bands from accessory fascicles of the antero-inferior tibiofibular ligament, noting that anatomical and pathomechanical aspects differ despite similar diagnostic and treatment approaches. (10.1007/s00167-012-2155-7)
  • [L3] The study found that the majority of the clinical improvement in early inflammatory arthritis treated with subcutaneous methotrexate occurs rapidly within the first 6 weeks, with significantly less change observed between weeks 6 and 12. (10.1186/s12891-016-1213-6)
  • [L3] The study identified different key markers of ankle osteoarthritis, specifically aggrecan, BMP-7, and BMP-2, which offer starting points for new ways in diagnostics and interventional strategies. (10.1155/2014/434802)
  • [L5] Although unrelated to the clinical result, the occurrence of arthritis of the implanted surfaces is cause of concern. (10.1007/s00167-011-1793-5)
  • [L4] Follow-up five to seventeen years after sixty-six synovectomies of the knee in forty-nine rheumatoid patients substantiates that end results are better if the stage of the disease in the knee is not advanced at the time of surgery, and that systemic deterioration after operation does not necessarily cancel out the gain from synovectomy. (10.2106/00004623-197456030-00009)
  • [L2] Persistent biomechanical alterations after ACL reconstruction are related to significant changes in cartilage T1r and T2 at 1 year postreconstruction. (10.1177/2325967116644421)
  • [L4] Early results indicate satisfactory short-term outcomes, though these procedures have yet to show they can halt arthritic progression. (10.1155/2012/160923)
  • [L4] The stiffening of 38 percent from a normal to an early arthritic condition was accompanied by a trabecular contiguity change from 0.7 to 0.8. (10.2106/00004623-197456020-00010)

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b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.