Cartilage — the smooth, ultra-lubricated ends that contact as you move your hips, knees, shoulders, fingers and other joints — permits the smooth motion of all of the joints of your body. Over time, as a result of athletic activity, injuries, work and normal use, cartilage can wear down, eventually leading to pain and inflammation that occur due to the release of cell-signaling molecules from the degrading cartilage.
While this inflammation is a sign of significant cartilage wear, your cartilage may have been thinning for years before you start to feel the actual pain of bone meeting bone, says Richard Diana, M.D., an orthopaedic surgeon and clinical instructor of orthopaedics at Yale-New Haven Hospital in Connecticut. However, you shouldn’t assume that any and all joint pain is osteoarthritis — “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.
If you have joint pain that’s severe despite the use of over-the-counter anti-inflammatories like ibuprofen and that pain is limiting your normal day-to-day function, it’s essential to get checked by your primary care practitioner or an orthopaedic doctor. During the process of obtaining a diagnosis, you can expect to undergo testing, questioning and a variety of procedures that’ll help your doctor fully determine what’s causing your pain.
Questions Your Orthopaedist May Ask
If you’re experiencing joint pain, your primary care physician may refer you to a specialist called an orthopaedist. This is a type of doctor who focuses on treating your musculoskeletal system, which encompasses your bones, joints, tendons and ligaments. Orthopaedists often care for people who have osteoarthritis, which is the most common type of arthritis, but keep in mind that your joint pain may not be the result of arthritis and your healthcare practitioner will need to gather some information from you before performing any diagnostic tests. “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:
Family History: What is your family history? Did either parent have arthritis? Do any siblings have joint problems?
Osteoarthritis and many autoimmune joint conditions, such as rheumatoid arthritis or lupus, run in families. If a parent has a particular type of joint condition, there’s a significant chance that you’ll also develop it. Your doctor can evaluate this using radiographs and lab tests. Your physician will also ask you if any of your parents or siblings have needed joint replacements.
Injury and Activity History: What is your personal history with injuries? 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? What types of exercise do you do on a regular basis? What do/did you do for work?
While osteoarthritis can be the result of normal day-to-day wear and tear, injuries you endure while playing sports or working can often start or accelerate this condition or exacerbate joint pain. These injuries may have happened years before your symptom onset. Telling your doctor about any prior surgeries in or around the affected joints is also important.
Pain Sensations: 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? Did these symptoms come on gradually, or were they sudden? Is the pain worse after activity or rest?
While arthritis can present with different symptoms for each person, the timing of symptoms and the number of joints involved can provide important clues about your underlying diagnosis.
Diagnostic Tests for Chronic Joint Pain and Osteoarthritis
In diagnosing any type of arthritis or joint pain, your healthcare practitioner will want to consider the possibility of other causes first. There’s a wide variety of tests they may order to rule out other conditions and diagnose arthritis. These include:
- A complete blood count: This measures the number of different types of blood cells you have. It also 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: Up to 80% of people with rheumatoid arthritis have an antibody called rheumatoid factor in their blood. More than 95% of people with lupus have antinuclear antibody in their bloodstreams.
- Arthrocentesis: This test involves manually removing fluid from a joint using a needle and then examining that fluid under a microscope. It helps identify infection and can determine if the pain is due to 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 tissues like tendons, muscles, ligaments and nerves. Unlike other imaging techniques, this allows your specialist to actually see these structures as you move the joint so they can assess how the joint is performing, along with the extent of the damage to structures other than bone.
- Computed tomography (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. Your doctor can see very small details of cartilage degeneration on an MRI. “It’ll help detect early stages of osteoarthritis that may not yet be evident on an X-ray,” says Diana.
How Do Doctors Treat Osteoarthritis?
Non-operative management is the mainstay for treatment of mild to moderate osteoarthritis. This means that your doctor will want you to try lifestyle and other less-invasive changes to lessen the severity of your arthritis symptoms before pursuing surgery. Your physician is likely to give you home exercises or refer you for physical therapy. Injections of steroids or joint lubrication (hyaluronic acid) solutions are commonly recommended, and your doctor can administer them at three- or six-month intervals without posing any significant risk to your joint.
Preserving muscle mass and your ability to engage in normal activities is essential for preventing symptom progression. While you may need to modify some of your routines to avoid certain activities — like heavy lifting, throwing or running, depending on what joints are involved — low-impact exercises such as swimming, using an elliptical machine, bicycling and walking are often recommended.
If your doctor identifies a problem inside your joint (such as with your meniscus in your knee) or if your arthritic pain progresses to the point that its normal functioning is significantly compromised, you may be a candidate for a surgical procedure. Surgeries for degenerative joint disease mostly fall into two categories: arthroscopy and arthroplasty.
Arthroscopy involves a surgeon inserting a small scope and shaver into your joint through small incisions. This is a very versatile type of surgery that doctors can use to diagnose and manage cartilage tears, ligament injuries, meniscus tears (if your arthritis is in one or both knees) and, in some cases, significant inflammation. It can be particularly useful when X-rays and other types of imaging aren’t comprehensive enough to lead to a diagnosis. The risks of this surgery are rather low due to its minimally invasive nature, and you’re often permitted a full return to normal activities shortly after your procedure.
Arthroplasty, or full joint replacement, is the only true “cure” for osteoarthritis in a specific joint, but this is a major procedure. Because of this, it’s usually reserved for severe cases that significantly limit a joint’s ability to function properly. There are many different types of arthroplasty procedures, each indicated for a different type of joint and type of wear that happens to the joint. Your orthopaedic surgeon will speak to you at length about what procedures are potentially the most useful for the arthritis you have and the ways it’s affected your body.