Sandhivata, commonly equated with osteoarthritis, is classified as a Vatavyādhi affecting the joints (sandhis) in Ayurvedic medicine. A thorough understanding of its diagnosis requires collating classical descriptions of nidāna (etiology), saṃprāpti (pathogenesis), and lakṣaṇa (clinical features), along with differential diagnosis (vyavacchedaka nidāna) and the sāma/nirāma vāta classification. This review analyzes authoritative texts (Caraka, Suśruta, Mādhava) and relevant studies to outline these aspects. Classical ślokas note that aggravated Vāta in joints causes swelling and pain: “वातपूर्णदृतिस्पर्शः शोथः संधिगतेऽनिले प्रसारणाकुञ्चनयोः प्रवृत्तिश्च सवेदना”[1]. Key etiological factors include excessive exertion, trauma, and tissue depletion. Clinical signs (e.g. joint śotha, crepitus, and śula) are corroborated by both Caraka and Suśruta[1][2]. Differentially, Sandhivata must be distinguished from traumas (upaghāta vata), Amavāta (rheumatoid arthritis), and reactive osteoarthritis[3]. Assessment of sāma (with āma) vs. nirāma (without āma) Vāta is emphasized for guiding management[4]. This integrated diagnostic framework bridges classical and modern understanding of joint degeneration.