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How to diagnose osteoarthritis

Osteoarthritis affects more than 8 million people in the UK and is one of the most common types of arthritis. The condition is caused by the inflammation and eventual loss of cartilage in the joints, especially in the hands, hips, knees, lower back and hands. Cartilage is the protective surface at the ends of the bones in the joints, which allows the joints to move smoothly.

How to diagnose osteoarthritis

Who is likely to have osteoarthritis?

Osteoarthritis is most likely to occur in adults aged 40 onwards. Young people can be affected as a result of a traumatic injury or from experiencing other joint-related conditions such as rheumatoid arthritis or gout. It can take several years of osteoarthritis to appear following an injury.

Women are more likely to develop osteoarthritis than men. The condition can also affect those who are obese as being overweight causes a strain on weight-bearing joints, such as the knees and hips.

How do you know if you have osteoarthritis?

The main joints in the body feel painful and stiff. If the skin feels warm or appears red around a joint, it is an indication of inflammation. Osteoarthritis is usually diagnosed based on the symptoms and physical signs that are examined by a specialist. The doctor will look for tender joints, creaking sounds, swelling, excess fluid, reduced movement and muscle thinning.

What is the difference between osteoporosis and osteoarthritis?

These are two quite different conditions. Osteoporosis involves the thinning of the bone, which makes it fragile and prone to fracture. This occurs when the bone loses minerals, such as calcium, faster than the body can replace them and leads to a loss of bone density. With the bones becoming thinner, even a minor bump can cause a fracture. Osteoarthritis is a disease in which the damage occurs in the ends of the joints and does not affect the bone density.

How is osteoarthritis diagnosed?

Blood tests do not detect osteoarthritis but can rule out any other types of arthritis. The most useful test to determine the condition is an X-ray, which shows the narrowing of space between the bones, bone spurs, or if any calcium has settled in the joints. An X-ray cannot, however, show the level of pain or disability that osteoarthritis causes in each individual.

Can osteoarthritis be cured and how is it treated?

There is no cure for osteoarthritis but treatments are available to manage the symptoms. Treatment of arthritis includes lifestyle changes, physical therapy, exercise and medication, such as over the counter anti-inflammatories.

Some individuals may benefit from corticosteroid injections to ease the pain of affected joints if painkillers do not work. The injections are normally only applied once every four months, with one single shot.

In rare cases, where other therapies have been ineffective or joints have been severely damaged, surgery may be beneficial. Surgery can involve smoothing the surfaces of the joints or alternatively use an artificial joint to replace the worn-out joint. Joint replacement surgery is most likely to be carried out on the hip or knee.

Can osteoarthritis spread to other joints?

Unlike other types of arthritis, osteoarthritis will not spread through the body. However, more pressure may be put on other joints to compensate, potentially damaging those that were not previously affected. Making lifestyle changes can greatly reduce the risk of the condition getting worse. Losing weight and regular exercise can help.

Orthopaedic surgery in London

Mr Ian Holloway is a leading consultant orthopaedic surgeon in London, who specialises in hip and knee replacement surgery. He trained in London and was a senior trainee at the Royal National Orthopaedic Hospital. Mr Holloway completed two specialist hip and knee fellowships in Sydney and Melbourne, Australia. He undertakes revision hip replacement for cases with significant bone loss and for periprosthetic fractures. He built his experience on the Bone Tumour Unit at Stanmore and treats pati.

How to diagnose osteoarthritis

By Mr Ian Holloway
Orthopaedic surgery

Mr Ian Holloway is a leading consultant orthopaedic surgeon in London, who specialises in hip and knee replacement surgery. He trained in London and was a senior trainee at the Royal National Orthopaedic Hospital.

Mr Holloway completed two specialist hip and knee fellowships in Sydney and Melbourne, Australia. He undertakes revision hip replacement for cases with significant bone loss and for periprosthetic fractures. He built his experience on the Bone Tumour Unit at Stanmore and treats patients with metastatic bone disease with an emphasis on early symptom control and aggressive rehabilitation.

Mr Holloway is a national and international speaker on enhanced recovery after hip and knee replacement. He has publications in the medical literature on hip and knee surgery and is also on the teaching faculty of a number of orthopaedic training courses.

He is Deputy Training Programme Director for higher surgical trainees in the North West Thames region and is Clinical Lead for orthopaedics at the London North West Healthcare NHS Trust. He is a reviewer for the Bone and Joint Journal.

Overall assessment of their patients

Osteoarthritis is the most common form of arthritis. The joint most commonly affected, is the knee joint. OA of the knee generally affects people aged 50 and older. However, previous injuries, extreme sports, misalignment of the lower extremities or being overweight may cause osteoarthritis to develop at a younger age.

How to diagnose osteoarthritis

An osteoarthritis diagnosis (OA) may make you want to find our more about your condition. The joint most commonly affected by osteoarthritis, is the knee joint, but the progression of osteoarthritis is the same for all joints. OA generally affects people aged 50 and older. However, previous injuries, extreme sports, misalignment of the lower extremities or being overweight may cause osteoarthritis to develop in the hips, knees and feet at a younger age.

How to diagnose osteoarthritis

Osteoarthritis affects all the main components of the joint, which are:

  • the cartilage
  • the synovium (also called the synovial membrane)
  • the underlying (also called the subchondral) bone

How to diagnose osteoarthritisOsteoarthritis in the knee joint

The cartilage is the smooth tissue at the ends of the bones, which allows the bones to slide over each other without any friction and also acts like a cushion between the bones.

The synovium (or synovial membrane) is a soft flexible layer of tissue which lines the inside of the joint – covering every part of the inside of the joint except where there is joint cartilage. The synovium produces a fluid, called synovial fluid, which provides lubrication and supplies vital nutrients and oxygen to the cartilage.

An osteoarthritis diagnosis is made when the cartilage and synovium break down and deteriorate, gradually leading to damage of the underlying (subchondral) bone. This results in pain, stiffness and eventually leads to the loss of normal function since both boney ends of the joint will be rubbing on each other. The process is gradual and happens over a period of years.

Stages 1 – 4 of osteoarthritis diagnosis

How to diagnose osteoarthritisThere are four stages of osteoarthritis

Stage 1 – minor osteoarthritis

At this stage in the development of osteoarthritis the patient may experience some crepitus (crackling or gritty feeling in the joint). There is only slight damage to the cartilage. The patient may have no pain or discomfort, and the joint will look normal on an X-ray.

Stage 2 – mild osteoarthritis

Osteoarthritis moves into stage 2 when the patient starts to notice symptoms of pain and stiffness. On X-ray, there will be evidence of “wear and tear” damage and small osteophytes will be visible. At this point the cartilage will be thinning, but the space between the bones will be normal. In stage 2 there is not yet bone rubbing on bone, and the synovial fluid is not yet affected.

Stage 3 – moderate osteoarthritis

In stage 3 there is an increase in cartilage damage and the gap between the two boney ends will show signs of narrowing. X-rays will show significant cartilage loss. Normal activities such as walking, running, climbing stairs, moving and bending the joint become painful and the joint feels stiff. There will also be early signs of joint inflammation, which will make the joint feel warm and swollen.

The warmth, tenderness and swelling is due to the progression of the arthritis process, and is called synovitis. (Synovitis means inflammation of the synovium.) The synovium becomes inflamed and produces more synovial fluid causing swelling.

Stage 4 – severe osteoarthritis

As the osteoarthritis progresses, the signs and symptoms become more apparent. The space between the bones continue to narrow and the cartilage degeneration is advanced. At this stage almost no cartilage tissue is visible on X-ray. There will be an increase in stiffness, and the inflammation becomes chronic. As a result of the deterioration of the cartilage and synovium, and lack of normal joint lubrication, the patient will have more bone on bone friction.

Depending on the joints affected, normal everyday activities like walking, climbing stairs or going to the bathroom become very challenging. If the hands or fingers are affected, tasks such as opening jars or bottles, doing up buttons, crafting or tasks become difficult. If the spine is affected, many functional daily activities like rolling or getting out of bed, moving from sitting to standing, getting in and out of a car and many other movements become painful and arduous.

What to do if you have a diagnosis of osteoarthritis?

If you have knee or hip osteoarthritis, check out our knee exercise video and our hip exercise video here. These exercises will help you to perform approved optimal physical therapy exercises in order to strengthen the muscles around the joint, and thereby slow down the progression of your osteoarthritis.

As you can see, the gradual progression of osteoarthritis can lead to pain, stiffness and eventually to severe limitations of your everyday activities. However an osteoarthritis diagnosis need not be a life sentence of pain and deterioration.

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How to diagnose osteoarthritis

How Osteoarthritis Is Diagnosed

The most common ways osteoarthritis is diagnosed include discussing your symptoms with your doctor and undergoing a joint examination. Your doctor may ask questions to see if you fit the profile of a typical osteoarthritis patient (most are over 45) and to check for a range of symptoms associated with osteoarthritis, including:

  • Joint pain
  • Excess fluid
  • Joint instability
  • Reduced motion in joints
  • The sound of bone rubbing on bone or a crunching feeling
  • The formation of bony spurs
  • The thinning of muscles
  • Joint pain that worsens throughout the day

Your doctor may also ask about the duration, location and strength of your joint symptoms or if you are taking any other medications.

4 Tests to Diagnose Osteoarthritis

If your doctor thinks you may have osteoarthritis but is unable to confirm her diagnosis, she may refer you for further tests. Doctors use imaging and lab tests in many cases to rule out the presence of other conditions.

1. X-rays

If you are experiencing joint pain, your doctor may recommend an X-ray for a clearer picture. An X-ray is usually a short procedure (10 minutes or so) that allows doctors to examine the extent of joint damage. It X-ray may show problems caused by osteoarthritis, such as the growth of bony spurs or a narrowing space between bones caused by cartilage loss. An X-ray can also aid a diagnosis by ruling out a fracture or other injury that could lead to joint pain.

If your diagnosis of osteoarthritis is confirmed, the X-ray may be used in the future to help assess how effective your treatment plan is.

2. MRI Scan

In some cases, your doctor may refer you for a magnetic resonance imaging (MRI) scan. Unlike X-rays, these scans can show the soft tissue around the joint. An MRI may be useful in a complicated case where the doctor suspects that another problem is causing your symptoms, such as a torn meniscus or bone damage.

3. Blood Tests

While there is no blood test that can definitively diagnose the presence of osteoarthritis, a blood test can be used to exclude the possibility of other conditions causing osteoarthritis-like symptoms.

Medical professionals cannot detect osteoarthritis directly in the blood stream. However, they can detect rheumatoid arthritis, the other most common type of arthritis, by measuring the levels of antibodies. Since the two forms of arthritis can have some similar symptoms, a blood test helps ensure that you receive the correct diagnosis.

4. Joint Aspiration

Joint aspiration can be used to diagnose knee or shoulder joint problems. A doctor will numb the affected area and then use a needle to withdraw fluid from the joint, and send the fluid to be analyzed. Medical specialists will look for evidence of joint deterioration or crystals. Once again, this test is useful as it can rule out other forms of arthritis.

If you are suffering from joint pain and stiffness, osteoarthritis is diagnosed primarily through a discussion and joint examination with your doctor. You may be referred for further testing, which will rule out other possible causes of persistent joint pain. While osteoarthritis is a problematic condition, how osteoarthritis is diagnosed is relatively straightforward. So, you should not hesitate to visit your doctor if you believe you are suffering from its symptoms.

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Affiliations

  • 1 Department of PM&R, University of Pennsylvania, Penn Medicine Rittenhouse, 1800 Lombard Street, Philadelphia, PA 19146, USA.
  • 2 Department of PM&R, University of Pennsylvania, Penn Medicine Rittenhouse, 1800 Lombard Street, Philadelphia, PA 19146, USA. Electronic address: [email protected]
  • PMID: 32035570
  • DOI: 10.1016/j.mcna.2019.10.007
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Authors

Affiliations

  • 1 Department of PM&R, University of Pennsylvania, Penn Medicine Rittenhouse, 1800 Lombard Street, Philadelphia, PA 19146, USA.
  • 2 Department of PM&R, University of Pennsylvania, Penn Medicine Rittenhouse, 1800 Lombard Street, Philadelphia, PA 19146, USA. Electronic address: [email protected]
  • PMID: 32035570
  • DOI: 10.1016/j.mcna.2019.10.007

Abstract

Osteoarthritis (OA) is a worldwide endemic and debilitating disease. Previously thought to simply be damaged from “wear and tear,” OA is now understood to be a complex interaction of local and systemic factors. This article reviews the pathology, symptoms, diagnosis, and various conservative, surgical, and novel treatments of OA.

Keywords: Arthralgia; Arthritis; Degenerative joint disease; Osteoarthritis.

Conflict of interest statement

Disclosure The authors have nothing to disclose.

The chronic affection of the articulations or arthritis evolves over the years in a more or less rapid way according to the patients. This pathology can induce a significant handicap when it is localized at the level of the knee or the hip. To diagnose the chronic condition, the patient must essentially undergo a clinical examination . (1)

How To Diagnose Osteoarthritis?

The diagnosis of osteoarthritis begins by questioning the symptoms. This state consists of obtaining precious information on the nature and intensity of the pain felt by the patient and the presence of a joint gene. Osteoarthritis is diagnosed after carefully examining the patient.

The doctor will also deepen the analysis of the disease by determining the triggering of the pain. Is the discomfort triggered by pressure or during movement of the affected limb? The diagnosis of osteoarthritis is also made by evaluating the importance of joint stiffness by detecting a sign such as swelling of a joint.

Most patients with osteoarthritis experience arthritis pain that is triggered with exertion. The violent stitches calm down when the ankylosed member is at rest. Note that some arthritis can be accompanied by painful inflammatory flares capable of waking the patient overnight. Inflammatory flares generate morning rust. (2)

Radiological Signs Confirming The Diagnosis Of Osteoarthritis

When osteoarthritis has evolved a lot, the x-ray of the affected area can show erosion of the subchondral bone. This phenomenon is observed in the part where the cartilage has disappeared. The main radiological signs capable of diagnosing the chronic affection are – a pinching of the joint space, the presence of osteophytes which are bony growths located around the joint. Bone condensation and the presence of geodes are all radiological signs that confirm the diagnosis of osteoarthritis.

There are no particular biological signs that can confirm the diagnosis of the joint condition. Generally, radiography is the only examination capable of confirming the presence of osteoarthritis and guaranteeing the follow-up of the pathology. Additional exams can also be performed. Examples are CT, bone scintigraphy, arthrography, MRI, ultrasound or arthroscopy. (3)

Summary Of Procedures For A Diagnosis Of Osteoarthritis

The diagnosis of osteoarthritis takes place in several stages. Doctors start with the interrogation of the pain and discomfort of the joint which appeared gradually. The clinical examination makes it possible to detect the development of the disease in more detail. Confirmation of the diagnosis is made by simple additional examinations. The X-ray can detect the main features of osteoarthritis. (2)

What Is The Best Medicine For Osteoarthritis?

Medicines containing paracetamol are recommended first. In the treatment of osteoarthritis, paracetamol can be taken at a dose of 1 gram, four times a day, but only on medical prescription. Paracetamol is usually well tolerated. However, an overdose can be toxic to the liver. Care must be taken not to exceed the prescribed doses and not to combine several drugs containing paracetamol. If taking oral anticoagulant therapy and taking a dose of four grams of paracetamol daily for four days or more, increased monitoring of anticoagulant therapy may be necessary.

Nonsteroidal Oral Anti-Inflammatory Drugs: Certain nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and ketoprofen, or aspirin can be obtained without a prescription for pain relief, but they should not be used for more than a few days without notice.

Non-Steroidal Anti-Inflammatory Drugs In Gel Form: Certain anti-inflammatory drugs (NSAIDs) in the form of a gel for the local application can be used to relieve arthritis pain in small joints (fingers, knees, etc.). They do not expose to the digestive side effects of oral NSAIDs. The ketoprofen-containing gels are nevertheless likely to cause photosensitivity reactions. The areas treated with the gel must be covered with a garment so as not to be exposed to the sun, even when veiled, for the entire duration of the treatment and during the next 15 days following its cessation.

Opiate And Morphine Pain Relievers: The doctor may prescribe more powerful pain medications: opiate derivatives (codeine, tramadol) alone or in combination with paracetamol, or as a last resort, morphine, and its derivatives.

Intra-Articular Corticosteroid Injections: Glucocorticoids, or corticosteroids, are synthetic products derived from cortisone, a hormone secreted by the adrenal glands. Glucocorticoids are also called corticosteroids. They reduce the characteristic signs of the inflammatory reaction (heat, redness, and swelling). Glucocorticoids are prescription drugs.

Slow-Acting Antiarthritic And Other Drugs: Other drugs are sometimes prescribed to preserve the cartilage: Chondroitin sulfate, glucosamine, diacerein, avocado, and soy. Following the reassessment of their medical service rendered by the health authorities, they are no longer reimbursed by Health Insurance. Some of these substances (glucosamine, chondroitin, etc.) are also present in food supplements. (4) (5)

If you feel stiff and have pain in your joints you should contact a medical center for a diagnosis. There are several joint diseases that can cause similar problems, but osteoarthritis is one of the most common. It is possible to have a fairly good idea of whether you are suffering from osteoarthritis even without consulting a doctor by reading about common symptoms. On the other hand, it is important to get an osteoarthritis diagnosis in order to begin the right kind of treatment.

Who can diagnose osteoarthritis?

The professionals who usually make the first assessment are physiotherapists or general practitioners. Both of these professions work closely with patients with osteoarthritis and are capable of making a diagnosis. If they are uncertain of the assessment, however, they can refer the patient to an orthopedic surgeon. An orthopedic surgeon can make a more thorough examination and assessment.

Osteoarthritis symptoms, joint function and medical history as the basis for a diagnosis

Osteoarthritis is a clinical diagnosis. This means that it should be made based on the medical history, pain level and joint function. It is therefore likely that the patient will be asked to talk about how the condition started, how the joint works and how the pain feels. One question that may be relevant is whether any relatives have osteoarthritis. In addition to this, a clinical examination of the joint and sometimes different types of functional tests will be done. A standard way of doing this kind of functional test is to see how many times the patient can get up from a chair in 30 seconds.

An x-ray is not necessary

The diagnosis used to be made using an x-ray, something which we now know is not necessary. Today, we see osteoarthritis as a combination of structural changes (what is seen on the x-ray) and symptoms. Symptoms can arise long before we can see changes on an x-ray – usually many years before. The idea is that a person with pronounced symptoms should not have to go without treatment just because it is not visible on an x-ray. At the same time, a person with changes that are visible on the x-ray may not know about their disease because they do not have symptoms. Therefore, the diagnosis should be made in view of the need for treatment rather than based on x-ray images.

Despite this, an x-ray may be useful in certain cases, for example to distinguish it from rheumatoid arthritis. Rheumatoid arthritis may, in fact, present symptoms that are similar to people with osteoarthritis. In the event of an unclear diagnosis, another form of imaging can be used, known as MRI (magnetic resonance imaging). The purpose of this is mainly to differentiate from other diseases that affect soft tissues instead of the cartilage tissue, for example meniscus injuries in the knee or injuries to the joint capsule in the hip.

Assessing whether surgery is needed

Once a diagnosis has been made, the patient can start treatment. This should primarily take the form of customized, instructor-led training. If training is too painful, pain-relieving medications can be taken if necessary. If the patient is overweight, weight control may also be necessary to reduce the strain on the joints.

In cases where the basic treatment does not give the desired results, surgery may be appropriate. Whether this is necessary will be decided by an orthopedic surgeon together with the patient. The most common procedure is to replace the affected joint with a prosthetic joint. If a smaller joint is affected, such as a joint in the foot or hand, a stiffening operation may be appropriate.

Desciption

Arthritis— which literally means “inflamed joint” — can affect any joint in the body, including the joints between the 29 bones of the wrist, hand, and fingers. Arthritis of the hand can hurt and keep you from being able to do what you want or need to do. The most common forms of arthritis in the hand are osteoarthritis, post-traumatic arthritis (after an injury), and rheumatoid arthritis. Osteoarthritis is a degenerative joint disease in which the smooth cartilage that covers the bone surfaces at the joints either is injured or wears over time.

Causes

A normal joint is made of two smooth, cartilage-covered bone surfaces that fit well together so that they glide when the bones move. If the smooth surfaces wear out, then they no longer fit together and arthritis develops. Injury, infection, gout, psoriasis, and other conditions can also cause arthritis of the hand.

Signs & Symptoms

The three most common sites where arthritis happens in the hand are (see Figure 1):

  • At the base of the thumb, where the thumb and wrist come together (the trapeziometacarpal or basilar joint)
  • At the joint closest to the fingertip (the distal interphalangeal or DIP joint)
  • At the middle joint of a finger (the proximal interphalangeal or PIP joint)

All forms of hand arthritis can cause stiffness, swelling, pain, and deformity. Osteoarthritis sometimes causes bony nodules at the middle joint of the finger (Bouchard’s nodes) or at the end joint of the finger (Heberden’s nodes) (see Figure 2). Osteoarthritis at the basilar joint can cause swelling, a bump, and a deep, aching pain at the base of the thumb. Weakness of grip and pinch can make it hard to open a jar or turn a key for those with osteoarthritis.

Treatment

The Diagnosis of Osteoarthritis

When diagnosing osteoarthritis, your doctor will ask you about your hands and other joints. Explain how your symptoms affect what you do. Your doctor will check how your hands look and function. X-rays of joints with osteoarthritis can show loss of normal joint space, “bone spurs,” or other changes.

How to Treat Osteoarthritis

The goals in treating osteoarthritis are to relieve pain and restore function. Brief rest — either by changing activities or wearing a splint — can help. Soft, snug sleeves can help support a joint when rigid splints are too restrictive. Heat (for example, paraffin wax and warm compresses) can soothe the joints and help keep them mobile. It is important to keep as much finger motion and function as possible. Hand therapists can teach joint protection exercises and activity modification to help protect joints. Anti-inflammatory medication or a steroid injection into the joint can decrease pain, but neither cures osteoarthritis.

Surgery is considered when the non-surgical options above have not helped. In most cases, you will tell your doctor when you are ready for surgery. The goal is to restore as much function as possible and to minimize your pain. One type of surgery is joint fusion. The worn cartilage is removed and the bones on each side of the joint are fused together, which means that the joint will not move but it will not hurt. Another choice is joint reconstruction, where the rough joint surface is removed and either replaced with your own soft tissue or with an implant. The type of surgery depends on the joint(s) involved, your anatomy, and your activities. Your hand surgeon can help you decide which type of surgery is the best for you.