Track arthritis symptoms before you judge the scan

Track arthritis symptoms during daily tasks

Arthritis symptoms often include stiffness after rest, soreness during use, less motion, and some swelling. A knee may hurt on stairs or while rising. Hip soreness may sit in the groin, buttock, or thigh. Hand soreness may make keys and jars hard to use.

Stiffness that eases with gentle movement often goes with slow joint wear. Long morning stiffness and matching swelling in small joints deserve an exam. Sudden heat, redness, or heavy swelling needs quicker care.

One symptom can't name the cause.

Read the X-ray beside your symptoms

An X-ray shows bones, their position, and the space between them. Less space may mean the smooth cartilage has thinned. The X-ray can support an arthritis diagnosis and show the amount of joint wear.

Large changes on an X-ray may come with little soreness. Small changes may come with trouble walking or sleeping. That is why the exam and the tasks you cannot do still matter.

“Bone on bone” describes the X-ray, but those words alone don't mean you need surgery.

Ask what the X-ray changes

Bring the report, the X-ray pictures, your medicine list, and notes about the ache; show the doctor which motion hurts. Name the task you want to do more easily.

Ask what the X-ray clearly shows, what it only suggests, and what remains unknown. Then ask whether the exam alone would lead to the same first care. A yes means the X-ray supports the choice, while a no means the doctor can explain which finding changed it.

You may need another test, but the exam should guide that choice.

Sources

1. In the Framingham Osteoarthritis Study, 710 people over 50 with NO radiographic evidence of knee osteoarthritis underwent knee MRI: 89% had 'any abnormality'. Osteophytes appeared in 74%, cartilage damage in 69% and bone marrow lesions in 52%. Prevalence of at least one abnormality was 90-97% in painful knees and 86-88% in painLESS knees.

   Guermazi A, et al. — Prevalence of abnormalities in knees detected by MRI in adults without knee osteoarthritis: population based observational study (Framingham Osteoarthritis Study).. BMJ, 2012. DOI: 10.1136/bmj.e5339.

2. A systematic review found the proportion of people with knee pain who have radiographic osteoarthritis ranges from 15% to 76%, and the proportion of people with radiographic knee OA who have pain ranges from 15% to 81%. The authors conclude X-ray results should not be used in isolation when assessing an individual patient with knee pain.

   Bedson J, et al. — The discordance between clinical and radiographic knee osteoarthritis: a systematic search and summary of the literature.. BMC Musculoskelet Disord, 2008. DOI: 10.1186/1471-2474-9-116.

3. The Lancet Seminar on osteoarthritis states that diagnosis is clinically based despite widespread OVERUSE of imaging, that management should focus on core treatments - self-management and education, exercise, and weight loss where relevant - and that surgery should be reserved for people who have not responded appropriately to less invasive methods.

   Hunter DJ, et al. — Osteoarthritis.. Lancet, 2019. DOI: 10.1016/S0140-6736(19)30417-9.

4. The 2010 ACR/EULAR classification criteria define 'definite rheumatoid arthritis' by confirmed synovitis in at least one joint, absence of a better alternative diagnosis, and a total score of 6 or more out of 10 across four domains: number and site of involved joints (0-5), serology (0-3), acute-phase response (0-1) and symptom duration (0-1). This is the formal boundary between inflammatory arthritis and degenerative joint disease.

   Aletaha D, et al. — 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative.. Arthritis Rheum, 2010. DOI: 10.1002/art.27584.