What is Degenerative Joint Disease (DJD)?

What is Degenerative Joint Disease (DJD)?

Degenerative Joint Disease (DJD), also known as osteoarthritis, is a chronic progressive disorder characterized by degradation and loss of articular cartilage, changes in subchondral bone, and alterations in other joint tissues including the synovial membrane and ligaments. 1

Pathophysiology and Characteristics

DJD represents a breakdown of joint cartilage and underlying bone that results in:

• Joint pain, stiffness, and potential disability 1
• Loss of cartilage with subchondral bone changes 1
• Abnormalities in synovial membrane and ligaments 1
• Progressive morphologic changes in the affected joint 2

The condition is characterized radiographically by loss of joint space, osteophytes (bone spurs), subchondral cysts, erosions, flattening of joint surfaces, and bony resorption 2.

Epidemiology and Risk Factors

• DJD is the most common form of arthritis, with incidence increasing with age in both genders 1, 2
• Mechanical, biochemical, and genetic factors are well-established risk factors 1
• The condition can occur at any age but is more prevalent in older populations 2, 3
• DJD causes up to one-third of all total hip arthroplasties in patients under 60 years of age, emphasizing its significant impact 1

Clinical Presentation

Patients with DJD typically present with:

• Pain that worsens with joint use 4
• Joint stiffness, particularly after periods of rest 1, 3
• Limitation in activities of daily living 1
• Reduction in quality of life 1
• Mechanical symptoms such as clicking, catching, or crepitus 1, 3

The natural history involves fluctuating symptoms with periods of remission and activity, eventually reaching a "burnout phase" in many cases 5, 3.

Diagnostic Approach

Initial evaluation should focus on:

• Radiography as the first-line imaging study, which can reveal osteoarthritis, osteochondral abnormalities, joint space narrowing, and osteophytes 1
• Synovial fluid analysis showing non-inflammatory effusions (clear fluid with good viscosity and <2000 WBC/mm³) when effusion is present 4
• Advanced imaging (MRI or CT) reserved for specific indications such as evaluating cartilage integrity, soft tissue involvement, or surgical planning 1

Management Principles

Conservative Treatment (First-Line)

Conservative management forms the cornerstone of treatment for the vast majority of DJD cases 5:

• Structured exercise therapy focusing on strengthening and range of motion is as effective as pharmacologic interventions 6, 7
• Weight reduction for patients with BMI >25 significantly reduces joint pain and improves function 7
• NSAIDs at the minimum effective dose for the shortest duration, with ibuprofen 1200 mg daily carrying the lowest GI risk 7
• Activity modification to reduce mechanical stress while maintaining overall activity 8, 7

Critical Treatment Caveat

Arthroscopic surgery is explicitly NOT recommended for degenerative knee disease, even when mechanical symptoms or meniscal tears are present 1, 8. High-quality evidence demonstrates:

• Less than 15% of patients experience small, temporary improvements at 3 months that completely disappear by 1 year 1, 8
• No clinically meaningful long-term benefit over conservative treatment for pain or function 1, 8
• Recovery burden includes 2-6 weeks of limited function and potential complications 1

Advanced Interventions

When conservative management fails after 6-12 months:

• Intra-articular corticosteroid injections may provide temporary relief if significant effusion limits exercise participation 7
• Joint replacement surgery should be considered for end-stage disease with severe functional impairment 6, 2
• Surgical reconstruction is reserved for patients who have lost mandibular or joint function secondary to end-stage disease 2

Important Clinical Pitfalls

• Do not rush to surgery based on imaging findings alone—radiographic changes often do not correlate with symptom severity 1, 8
• Do not interpret clicking, catching, or intermittent "locking" as surgical indications—these mechanical symptoms respond equally well to conservative treatment 1, 8
• Avoid multiple corticosteroid injections, as they may compromise tissue integrity and affect future surgical outcomes 6
• Screen for systemic diseases that can cause secondary DJD, including hemochromatosis, hyperparathyroidism, acromegaly, and diabetes 4