Degenerative Joint Disease: Risk Factors and How to Diagnose It in Clinic

Before a patient reaches an operating table, degenerative joint disease has usually been building for years through a combination of factors a referring doctor can screen for in a single consultation. Dr. Ishwar Bohra, Senior Director of the Joint Replacement Programme at BLK-Max Super Speciality Hospital, New Delhi, laid out that screening process for doctors across Africa in a Jivo Healthcare masterclass, working from the same clinical tests and X-ray grading he uses in his own practice.

Who develops it, and why

Age is the dominant factor, and women are more susceptible after 45 because of the hormonal changes that follow. Obesity adds mechanical load to weight-bearing joints. A previous knee injury, metabolic bone disease that produces malalignment, repetitive high-impact activity in physically demanding work, and muscle weakness that fails to keep cartilage surfaces properly separated all raise the risk independently, and Dr. Bohra noted they frequently compound each other in the same patient.

Tests that take minutes in an outpatient clinic

Four simple manoeuvres cover most of what a general practitioner needs before referring a patient onward: valgus and varus stress testing for ligament laxity, the Lachman test for the anterior and posterior cruciate ligaments, the McMurray test for meniscal tears, and a duck-waddle test to assess stability across the hip, knee and ankle. Dr. Bohra described these as standard office-practice tests, not specialist procedures, meaning the initial workup does not require imaging or a referral to start.

Reading the X-ray

A plain X-ray, graded by the Kellgren-Lawrence system, separates patients into three practical groups. At one end, the X-ray shows no meaningful joint change and no surgical intervention is warranted. In the middle, moderate change is compatible with continued rehabilitation. At the other end, an X-ray showing severe, diffuse joint change rules out medical management entirely and moves the conversation straight to surgery. Dr. Bohra called this staging step, on its own, enough to guide the next referral decision in most cases.

A question worth asking every patient: vitamin D

Asked directly during the session whether vitamin D deficiency contributes to osteoarthritis, Dr. Bohra said the link is real and frequently missed. Vitamin D regulates the calcium, magnesium and phosphorus that give bone its strength; when levels are low, the subchondral bone beneath the cartilage weakens, the cartilage above it wears faster, and the joint becomes malaligned. He recommends testing for and correcting vitamin D deficiency as soon as it is suspected, rather than waiting for it to show up as arthritis years later.