What is the standard approach to diagnosing OA and grading its severity?

• A. History and Physical with Kellgren-Lawrence grading
• B. Laboratory testing
• C. MRI only
• D. Arthroscopy as initial test

Answer: (A)

OA is diagnosed primarily through the patient’s history and a focused physical exam. Typical OA symptoms include joint pain that worsens with use, activity-related stiffness that is usually brief, and functional limitations. On examination, you may find crepitus, limited or painful range of motion, bony enlargement, and sometimes deformity or effusion, depending on the joint involved. To gauge how advanced the disease is, radiographs are used and interpreted with the Kellgren-Lawrence grading system. This scale ranges from no radiographic features of OA to severe disease, based on findings such as osteophytes, joint space narrowing, subchondral sclerosis, and deformity. The radiographic grade provides a standardized way to quantify structural severity and helps guide management and prognosis.

Laboratory tests aren’t needed to diagnose OA and are mainly used to rule out inflammatory or infectious causes if the clinical picture suggests them. MRI offers greater sensitivity for soft-tissue and early cartilage changes but isn’t required for routine diagnosis or grading of OA. Arthroscopy isn’t used as an initial diagnostic test for OA; it’s reserved for addressing specific intra-articular pathology or certain surgical decisions.