Osteoarthritis Diagnosis

  • Diagnosis

    Osteoarthritis is characterized by chronic and often disabling pain and stiffness of one or more joints, particularly those of the fingers, spine, hips, knees, and feet Figure 01. Osteoarthritis is the most common form of arthritis and was once called degenerative joint disease. Most people who are affected by osteoarthritis are middle-aged or older.

    Click to enlarge: Osteoarthritis: Common pain sites

    Figure 01. Osteoarthritis: Common pain sites

    Cartilage is the tissue that cushions the joints. In osteoarthritis, this tissue becomes cracked and pitted and no longer allows smooth movement of the joint. When cartilage wears away in a weight-bearing joint such as the hip or knee, it can produce severe pain, deformity, and loss of mobility.

    While there is no medication that can slow or prevent osteoarthritis, there are medications that can ease the pain and increase your joint mobility. In addition, there are many forms of self-care techniques you can use to help with the pain, including controlling your weight, exercising regularly, getting plenty of rest, and applying heat and cold to the joints to relieve stiffness.

    Because there is no absolute cure for the condition, you will have to take your medications regularly and use self-care techniques every day. Depending on the severity of your osteoarthritis, you may have difficult days where your normal activities are disrupted by stiffness and aches. Yet arthritis doesn't have to keep you from doing the things you enjoy. By learning what you can do to control symptoms, you can continue to lead an active and healthy life.

    Osteoarthritis occurs when the tissue that cushions the ends of the bones in a joint (cartilage) degenerates Figure 02. Cartilage keeps the joint flexible and provides protection between the bones. When the cartilage breaks down, the bones rub against each other, resulting in pain and loss of movement. Bony spurs may form around the joint, causing pain and inflammation. The exact causes for why the cartilage breaks down is unclear.

    Click to enlarge: Osteoarthritis of the hip

    Figure 02. Osteoarthritis of the hip

    The symptoms of osteoarthritis usually come on slowly. Joint pain, often described as a deep ache, is the most common symptom Table 01. Early in the disease, the pain does not usually last longer than a couple of hours. It may occur only after physical work or exercise. The pain subsides once you rest the joint. Occasionally, pain caused by osteoarthritis occurs someplace other than in the affected joint—a condition known as “referred pain.” For example, people with osteoarthritis of the neck often experience referred pain in the shoulder.

    As the disease progresses, the pain may persist for longer stretches of time. Not everyone with osteoarthritis experiences pain; in fact, only one-third of people whose x-rays show evidence of osteoarthritis report having joint pain or other symptoms of the disease.

    Osteoarthritis commonly causes stiffness, particularly during activity and in the morning after you get out of bed. The stiffness usually lasts less than 20 minutes. You may also experience brief stiffness after inactivity, such as riding in a car or sitting in a movie theater. The short duration of stiffness distinguishes osteoarthritis from rheumatoid arthritis, which is characterized by longer periods of stiffness usually during the morning hours.

    As osteoarthritis progresses, your range of movement (or flexibility) in the affected joint may become more limited. You may find it increasingly difficult, for example, to open a jar, sew on buttons, or turn your neck to look over your shoulder while driving. You may also notice a crunching feeling or a grating sound when you move the affected joint--the result of the roughened cartilage on the surface of the bones rubbing together.

    When osteoarthritis affects your hands, bony knobs called nodes may develop on your joints, giving your fingers and thumbs a gnarled appearance Figure 03. Nodes that appear on the joint closest to your fingernail are known as Heberden's nodes; those that appear on the middle joint are called Bouchard's nodes. The affected finger and thumb joints may feel painful or stiff at first, although the pain usually subsides within time. For some people, the pain is gone in as early as a few months, and for others it make take a couple of years. However, the bony knobs will remain. Heberden's nodes and Bouchard's nodes usually take years to develop, although they can sometimes appear within a period of weeks or months.

    Click to enlarge: Heberden's nodes

    Figure 03. Heberden's nodes

    Swelling, especially in the knee joints, can also occur with osteoarthritis.

    Table 1.  Symptoms of Osteoarthritis

    Steady or intermittent pain in a joint (although not everyone with osteoarthritis feels pain)
    Joint stiffness upon standing or getting out of bed
    Swelling in a joint
    Appearance of bony knobs, or nodes, on fingernail or thumb joints
    A crunching feeling or sound of bone rubbing on bone when you bend a joint.

    Although the precise causes of osteoarthritis are not known, age, gender, obesity, heredity, trauma, or overuse can increase your risk of developing the disease.

    • Age. The incidence of osteoarthritis increases dramatically after age 40 in women and after age 50 in men. By age 65, half of all people have x-ray evidence of the disease in at least one joint, although their symptoms may be very mild. Not all people whose osteoarthritis shows up on an x-ray have symptoms of the disease.
    • Gender. More women than men develop osteoarthritis; particularly osteoarthritis of the hand and, to a lesser extent, osteoarthritis of the knee. Men are slightly more likely, however, to develop osteoarthritis of the hip.
    • Obesity. Studies have shown that women who are obese are more likely to develop osteoarthritis of the knee than those of normal weight. Researchers have found a weaker connection between obesity and osteoarthritis of the hip. Some studies suggest that obesity may also contribute to osteoarthritis of the hand, but this link remains controversial.
    • Repetitive joint use and/or major trauma to a joint. Osteoarthritis, particularly of the knee, is more common in people whose jobs or hobbies require repetitive bending or other continuous “wear and tear” of a joint. Jackhammer operators, cotton mill and shipyard workers, and coal miners, for example, have all been found to be at an increased risk of developing osteoarthritis. In addition, ballet dancers are especially prone to osteoarthritis of the ankle, and baseball pitchers to osteoarthritis of the elbow. The connection between regular, intense exercise, such as long-distance running, and osteoarthritis of the knee is less clear, however. X-rays of the knees of long-distance runners often show osteoarthritis has developed, even though the runners do not complain of any pain. On the other hand, people who have developed osteoarthritis in the knees, who also participate in more recreational, and therefore less regular and intense sports, tend to suffer from pain.
    • Severe trauma to a joint. A fracture, whether as a result of a sport or other injury, can harm the joint in such a way that the cartilage is damaged. Damaging your cartilage can accelerate osteoarthritis. If you have had a fracture of the rounded bony part of the ankle, for example, you are at very high risk of developing osteoarthritis of the ankle.
    • Heredity. Some forms of osteoarthritis, especially that of the fingers, appear to run in families.

    Your health care professional will give you a thorough physical exam, and ask you about your history of symptoms. The diagnosis will be confirmed with x-rays. After you describe your medical history, you will be asked about your symptoms, including when and how they started. You should let the doctor know how your symptoms are affecting your work and daily life. Your doctor will also need to know about any other medical conditions you may have and about any medications you're taking, including over-the-counter drugs and herbal supplements. During your physical examination, your health care professional will check your general health as well as joints that are bothering you. He or she will also examine your reflexes and muscle strength, and will observe how well you are able to walk, bend, and make other routine motions with your joints.

    X-rays are considered the best, most accurate tests for diagnosing osteoarthritis. X-rays can show cartilage loss and bone damage--evidence of the disease. However, x-rays often do not reveal the disease in its earliest stage, before much cartilage has been damaged.

    Your health care professional may also order a diagnostic procedure known as a “joint aspiration” (arthrocentesis). For this procedure, which can be done right in your doctor's office, you will be given a local anesthesia to numb the affected joint. The doctor will insert and needle into the space within the joint, and will draw fluid from the joint (known as synovial fluid). Your doctor will send a sample to the lab to test for white cells and bacteria and perhaps other tests to see if your joint swelling is caused by arthritis, infection, or another cause. Sometimes the removal of this fluid lowers the pressure within the joint and helps to ease the pain. Sometimes steroids are injected to replace some of the fluid that was removed, which can also ease pain.

    Maintain a healthy weight to avoid putting additional pressure on your joints.

    Exercise regularly to keep your joint muscles and bones strong.

    Avoid repetitive movements (such as climbing many flights of stairs) or risky activities that may lead to joint injury. High impact exercise, like running, are not recommended if you have osteoarthritis in your knees or hips.

  • Prevention and Screening

    Maintain a healthy weight to avoid putting additional pressure on your joints.

    Exercise regularly to keep your joint muscles and bones strong.

    Avoid repetitive movements (such as climbing many flights of stairs) or risky activities that may lead to joint injury. High impact exercise, like running, are not recommended if you have osteoarthritis in your knees or hips.

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