Altman listed a variety of criteria for the diagnosis of idiopathic osteoarthritis of the knee. The diagnosis can be made based on clinical and laboratory data. The author is from the University of Miami and Miami Veterans Administration Medical Center.
Patient selection:
(1) presence of knee pain
(2) absence of a condition predisposing to degenerative arthritis (see Table I, page 33)
Parameters:
(1) age in years
(2) duration of stiffness in the affected knee joint
(3) crepitus
(4) bony tenderness
(5) bony enlargement
(6) palpable warmth
(7) erythrocyte sedimentation rate (ESR)
(8) rheumatoid factor titer
(9) synovial fluid analysis
|
Parameter |
Finding |
Points |
|
age of the patient in years |
<= 50 years |
0 |
|
|
> 50 years |
1 |
|
duration of knee stiffness |
>= 30 minutes |
0 |
|
|
< 30 minutes |
1 |
|
crepitus |
absent |
0 |
|
|
present |
1 |
|
bony tenderness |
absent |
0 |
|
|
present |
1 |
|
bony enlargement |
absent |
0 |
|
|
present |
1 |
|
palpable warmth |
present |
0 |
|
|
absent |
1 |
|
ESR |
>= 40 mm in first hour |
0 |
|
|
< 40 mm in first hour |
1 |
|
rheumatoid factor titer |
>= 1:40 |
0 |
|
|
< 1:40 |
1 |
|
synovial fluid analysis |
0 findings |
0 |
|
|
1 or more findings |
1 |
where:
• The synovial fluid findings in osteoarthritis are (1) clear, (2) viscous, (3) WBC count < 2,000 per µL.
total score =
= SUM(points for all 9 parameters)
Interpretation:
• minimum score: 0
• maximum score: 9
• A score of 5 or more indicates that the patient has osteoarthritis.
Performance:
• The sensitivity for 5 of 9 criteria is 91% and the specificity is 86%.
Specialty: Surgery, orthopedic, Immunology/Rheumatology
ICD-10: ,
