How Osteoarthritis Is Diagnosed

An accurate diagnosis of osteoarthritis ensures proper treatment

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Woman being evaluated for osteoarthritis. kristian sekulic/E+/Getty Images

Early, accurate diagnosis of osteoarthritis is necessary so that appropriate treatment options can be considered. Your medical history, physical examination, and imaging studies help diagnose osteoarthritis. During the physical exam, your doctor will check for joint swelling and range of motion. Imaging studies (x-rays) look for joint abnormalities and loss of cartilage. Your doctor will also make assessments using blood tests to assess your general health and rule out other possible causes for joint problems.

Self-Checks/At-Home Testing

Many people expect to have aches and pains as they age. Stiffness in the morning, joint pain, and reduced range of motion of said joints, are easy to simply chalk up to getting older.

And if you're young, arthritis may not even enter your mind. You may chalk stiffness up to hitting the gym too hard, or joint pain to working out in the yard.

But anytime joint pain doesn't go away after a few days, or keeps coming back intermittently over the course of several months, you should consider arthritis. This is especially true if you have injured that joint at any point in time, have a job that requires repetitive motion, or if you are overweight as this puts extra strain on the joints.

Joint pain and stiffness, pain that's worse in the morning or while moving or exercising can be a tip-off that osteoarthritis has set in. Mild pain and stiffness is easy to ignore, but should be brought to your doctor's attention.

No matter your age, paying attention to your body is the first step in getting a correct, and early, diagnosis.

Labs and Tests

Two of the best diagnostic tools a doctor has are her ears. Taking a thorough medical history and discussion of the symptoms with you, in addition to labs and imaging, is very important for arriving at a diagnosis.

Medical History

Your medical history tells the doctor about the onset of osteoarthritis symptoms, past treatments or surgeries, a family history of the disease, or other significant details about your condition.

Typically, at the first appointment with your doctor, you will be asked to fill out an extensive questionnaire about your medical history. You will also be asked about the symptoms you are experiencing including when they commonly occur and what makes the symptoms worse or better.

Questions To Expect at Your First Appointment

  • Where does it hurt and how much?
  • How long have you been having these symptoms?
  • Is there a pattern?
  • Are your joints stiff in the morning?
  • Do you feel the pain with certain activities and exercises, and which ones?
  • Have you changed the way you stand or walk due to the pain?
  • Do you have any other symptoms that are more general?

Be prepared in advance. Write down or record the information to bring with you so you won't leave out important clues. While you may think that these things should already be in the medical record, it is best to recap them when are being seen for a specific problem. Past surgeries and injuries, including any recent injuries, are important to discuss during your examination.

Routine Lab Tests

Routine laboratory tests such as complete blood count and urinalysis are usually normal when you have osteoarthritis, so their value is in ruling out other types of arthritis, especially inflammatory types of arthritis, or establishing a baseline for monitoring treatment.

Synovial fluid analysis also helps rule out other conditions. During this test, a sterile needle is used to draw a small amount of synovial fluid from your joint. This fluid is then analyzed for blood cells, bacteria, and more. Although it sounds unnerving, the process itself is fairly quick and procedure only mildly painful. Your doctor may give a local anesthetic to help numb the area first.

Physical Examination

During the physical examination, your doctor will assess each of your joints for pain, tenderness, and range of motion. Determining the pattern of affected joints has significance and can often distinguish between rheumatoid arthritis and osteoarthritis (for example, one knee or both knees affected).

She will also be doing a full general exam to assess your heart, lungs, liver, and kidneys.

During the Physical Exam

The physical examination looks for evidence of:

  • Mild to moderate firm swelling around the joint
  • Crepitus on movement. This is that crunching feeling, like the sound of bone rubbing on bone. If you have a "noisy knee" that is crepitus.
  • Limited range of motion, the joint can't flex as far as it once did.
  • Pain with movement of the joint (especially towards the end of its range of motion)
  • Joint tenderness
  • Mild inflammation and warmth over the joint

Other physical evidence that points to osteoarthritis includes:

  • Weakness of muscles surrounding the affected joint
  • Tenderness of structures surrounding the joint
  • Joint instability (with advanced osteoarthritis)
  • Joint deformity, such as bony enlargement (with advanced osteoarthritis)
  • Bony lumps, especially on the fingers
  • Unequal leg lengths
  • Altered walking gait

Also, from your initial physical examination, you establish a baseline with your doctor. When your doctor repeats the physical examination on follow-up visits, changes for better or worse will be evident.

It is wise to keep a log of your symptoms so you can discuss them fully with your doctor on follow-up examinations.

American College of Rheumatology Criteria

The American College of Rheumatology has established clinical criteria for diagnosing primary osteoarthritis of the hand, hips, and knees.

Osteoarthritis of the Hand

  • Hand pain, aching, or stiffness
  • Hard tissue enlargement of two or more of 10 selected joints
  • Fewer than three swollen MCP (metacarpophalangeal) joints
  • Hard tissue enlargement of two or more DIP (distal interphalangeal) joints or deformity of two or more of 10 selected joints

The 10 selected joints include:

  • Second and third DIP joints of both hands
  • Second and third PIP (proximal interphalangeal) joints of both hands
  • First CMC (carpometacarpal) joints of both hands

Osteoarthritis of the Hip

  • Hip pain
  • Femoral and/or acetabular osteophytes evident on x-ray or sedimentation rate less than or equal to 20 mm/hour
  • Joint space narrowing evident on x-ray

Internal hip rotation of less than or equal to 15 degrees, morning stiffness in the hip lasting less than or equal to one hour, and age of 50 years or older are additional criteria which are useful for diagnosing osteoarthritis of the hip.

Osteoarthritis of the Knee

  • Knee pain
  • At least three of the following 6 criteria: 50 years of age or older, stiffness lasting less than 30 minutes, crepitus, bony tenderness, bony enlargement, no warmth to the touch

Laboratory findings which are useful in assessing knee osteoarthritis include sedimentation rate less than 40 mm/hour, rheumatoid factor less than 1:40, and synovial fluid examination showing clear, viscous fluid with a white blood cell count less than 2,000/mm3.

Imaging

X-rays are typically used to confirm the diagnosis of osteoarthritis. X-rays can reveal osteophytes at the joint margins, joint space narrowing, and subchondral bone sclerosis. Subchondral bone is the layer of bone which is just below the cartilage.

While MRI (magnetic resonance imaging) is a more sensitive imaging method, it is used less often than x-rays due to cost and availability. MRI scans show cartilage, bone, and ligaments.

X-rays alone may give your physician the information he needs to treat your osteoarthritis appropriately, so you may not have an MRI done. In some cases, though, MRIs are done to give a more detailed picture of what is happening in the joint. MRIs can also be used to rule out osteoarthritis, or diagnose other types of arthritis.

Don't be afraid to ask your doctor why he is ordering an MRI. It's important to have an active voice in the decisions being made about your health care.

Differential Diagnoses

When diagnosing osteoarthritis, the doctor must first differentiate osteoarthritis from other types of arthritis. It is also important to determine whether a patient has primary osteoarthritis or a secondary form of osteoarthritis associated with another disease or condition.

Other issues that have symptoms similar to osteoarthritis include:

Blood tests can often be used to diagnose, or rule out, these health problems. In the majority of cases, though, diagnosing osteoarthritis is fairly straightforward.

A Word from Verywell

It is the doctor's job to be the diagnostician but it clearly is helpful if the patient understands why tests are being performed and what the results mean. If a patient understands the process from early symptoms to diagnosis to treatment plan, the patient will likely be more compliant and the outcome of treatment will likely be more successful.

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