Symptomatic vs. Radiographic Osteoarthritis

Osteoarthritis studies often refer to symptomatic osteoarthritis or radiographic osteoarthritis. What do these medical terms mean? Can you have one without the other?

Symptomatic Osteoarthritis

Symptomatic osteoarthritis means that the person with osteoarthritis is experiencing symptoms, such as joint pain, aching, and stiffness. Your symptoms are probably what made you go to your healthcare provider in the first place or to describe your symptoms during a check-up or exam for another complaint. When your practitioner hears these symptoms, she will suspect osteoarthritis and do further examinations, tests, and probably an X-ray to make a diagnosis.

The primary symptom of osteoarthritis is joint pain that worsens during activity and improves with rest.

Other common symptoms of osteoarthritis include:

• Joint instability, especially of the knees and first carpometacarpal joints
• Early morning stiffness lasting less than 30 minutes
• Stiffness following periods of inactivity

Physical examination may also detect swelling, deformities, bony enlargements or protrusions such as Heberden's nodes and Bouchard's nodes, crepitus, and limited range of motion. Muscle spasms and tendon contractures are other possible clinical findings.

Radiographic Osteoarthritis

The diagnosis of radiographic primary osteoarthritis involves the following observed on X-ray:

• Nonuniform joint space loss
• Osteophyte formation
• Cyst formation
• Subchondral sclerosis

Early X-rays may reveal minimal, nonuniform joint space narrowing. As osteoarthritis progresses, subluxations (partial dislocation of a bone) may occur, subchondral cysts may develop, and osteophytes may form.

Subchondral sclerosis or subchondral bone formation occurs as cartilage loss increases. In the advanced stage of the disease, X-rays may reveal a bone-on-bone situation and a collapse of the joint may occur.

These may be incidental findings seen when you are X-rayed for a different reason, such as having just broken a bone. Or, they may be found when you have an X-ray of your joint after presenting to your healthcare provider with the symptoms of osteoarthritis.

Significance

It is possible to have symptomatic osteoarthritis without radiographic osteoarthritis — and vice versa. For example, up to 60% of people with radiographic knee osteoarthritis may not complain of pain. The lack of symptoms may correlate with the radiographic findings, meaning that less severe radiographic findings appear to be associated with less severe symptoms.

However, those with radiographic knee osteoarthritis who lack frequent or intense pain may still experience weakness of their quadricep muscles and difficulty performing activities of daily living. This suggests that radiographic osteoarthritis without pain still can significantly impact joint function.

Bottom Line

With osteoarthritis, there can be a discrepancy between symptoms and joint damage observed on X-rays. You can have symptoms without joint damage seen on the X-ray. But you may also have X-ray findings of osteoarthritis without any major symptoms. This can be a surprise when you were getting an X-ray for a non-related reason. However, it is also true that severe symptoms do tend to be associated with advanced radiographic findings. When your condition is really bad, it's probably bad in both places.