Diagnosing Osteoarthritis and Joint Pain
Osteoarthritis, a common type of arthritis caused by wear and tear on a joint, has a way of creeping up on you.
The slippery cartilage that cushions the ends of your bones may have been thinning for years before you feel the actual pain of bone meeting bone, says Richard Diana, M.D., an orthopedic surgeon and clinical instructor of orthopedics at Yale-New Haven Hospital in Connecticut.
If you’ve been feeling joint pain, however, don’t immediately self-diagnose it as that twinge. Osteoarthritis isn’t the only stalker that threatens aging knees, hips or shoulders. “There are more than 100 kinds of arthritis,” says Diana. Pain, weakness or stiffness may signal other problems, too, such as a gradually fraying muscle, an autoimmune disease like lupus, or an infection like Lyme disease, he adds.
Whatever the cause of your joint pain may be, it’s essential to get it check out by your health care practitioner.
Questions your orthopedist may ask
Osteoarthritis is the most common type of arthritis, but your health care practitioner will order several tests to confirm the cause of your joint pain.
“An orthopedist is like Sherlock Holmes trying to figure out if you have a mechanical problem or osteoarthritis,” Diana says. The clues will emerge during your exam, and you can expect your doctor to ask you these key questions:
1. What is your family history?
- Did either parent have arthritis?
- Do any siblings have joint problems?
2. What is your personal history?
- Did you ever injure your bones or joints as a child? (An early injury is often a setup for osteoarthritis after 50, says Diana.)
- Are you a lifelong jogger or a marathon runner?
3. What does your pain feel like?
- Is it sharp and severe or dull and achy?
- When exactly does the discomfort start, and when does it get worse?
- Does the opposite joint — the other shoulder or knee — hurt as well?
The more explicit your descriptions when answering, the better.
After discussing your history and undergoing physical exam, doctors may need to investigate further, and this might include ordering more tests.
Diagnostic tests for chronic pain
In diagnosing any type of arthritis, your health care practitioner has to consider the possibility of other causes first. He may order several tests, including:
- A complete blood count: This measures the number of different types of blood cells and indicates your general health and the presence of inflammation or infection.
- Erythrocyte sedimentation rate: When inflammation crops up anywhere in your body, red blood cells clump together readily (at a higher rate) than normal. A high "sed rate" is nonspecific — meaning it also increases in many other conditions — but it can be suggestive of an inflammatory arthritis like rheumatoid arthritis and systemic lupus erythematosus, or Lyme disease.
- Antibody blood test: More than 80 percent of people with rheumatoid arthritis have the antibody rheumatoid factor in their blood. More than 95 percent of people with lupus have antinuclear antibody in their bloodstreams.
- Arthrocentesis: This test involves manually removing fluid from a joint via a needle to examine under a microscope. It helps identify infection and determine if the pain is caused by gout, another type of arthritis condition
- Radiography: An X-ray shows doctors a few things, including: how bones of the joint line up; whether the ends are smooth and rounded or have an unevenness, called a bone spur; and if a healthy amount of space remains between the ends of your bones for cushioning. “X-ray is the least expensive, most readily available and valuable tool for detecting moderate osteoarthritis,” Diana says.
- Ultrasonography: An ultrasonography, or ultrasound, uses high-frequency sound waves to create an image of soft tissue, like tendons, muscles, ligaments and nerves. Unlike other imaging techniques, this allows your specialist to actually see these structures as you move the joint.
- Computed tomography scan (CT scan): These computerized X-ray images show vertical and horizontal cross sections of muscle and bone. These “slices” of tissue are much more detailed than standard X-rays.
- MRI. Using powerful magnets and radio waves, a computer generates an image of bones and surrounding soft tissue. Minute details of cartilage degeneration can be seen on an MRI. “It’ll help detect early stages of osteoarthritis that may not yet be evident on an X-ray,” says Diana.
Take the next steps
If you’ve been feeling joint pain, here are practical steps to help manage your initial pain and jump-start plans to see a specialist.
- List your symptoms with as much detail as possible, and tell your doctor about all of it. Diana urges all potential patients and caregivers to mount a prevention plan that will sidestep symptoms and help minimize the pain of osteoarthritis.
- Make an appointment. Start with a family physician who may refer you to a specialist, either an orthopedist or a rheumatologist. Don’t ignore chronic, achy discomfort; early intervention is extremely beneficial to long-term pain management.
- If you’ve been diagnosed with arthritis, get a second opinion. Consulting with a second physician is a smart and essential step, especially if you plan on having invasive surgery, such as a joint resurfacing or a total joint replacement.