Osteoarthritis -- Diagnosis

  • Patient Input
  • Physical Examination
  • Health Care Team


    Many people confuse osteoarthritis with rheumatoid arthritis. But the treatments for them differ considerably, so it is important to know which type of arthritis you have. Your doctor is the best person to make an accurate diagnosis but you can help him or her by providing a clear description of your symptoms. The chart below shows the differences between these two common forms of arthritis.


    Rheumatoid arthritis

    Usually begins after age 40 Usually begins between ages 25 and 50
    Usually develops slowly, over several years Often develops suddenly, within weeks or months
    Often begins in joints on only one side of the body Usually affects the same joint on both sides of the body (such as both feet)
    Usually doesn't cause inflammation (redness, warmth, and swelling) in the joint Causes inflammation in the joints
    Affects only some joints; rarely affects the elbows or shoulders Affects many joints, including the elbows and shoulders
    Doesn't cause a general feeling of sickness Often causes a general feeling of sickness, fatigue, weight loss, and fever

    Osteoarthritis cannot necessarily be prevented, but the symptoms can be managed. Seeing a doctor at an early stage and beginning treatment can help slow the progress of the disorder and reduce the damage to your joints. In general, a diagnosis of arthritis is based on information you provide, your medical history, a physical examination, and special tests and/or X-rays. Each of these sources of information helps the doctor determine whether the problem is arthritis and, if so, which type of arthritis it is. In addition, each test and each piece of information helps the doctor rule out diseases other than arthritis.

    If you have arthritis, an accurate diagnosis will ensure that you get appropriate treatment. Such treatment is more likely to be successful if you and your doctor work together as a team to manage the disease. The diagnostic examination is the first step in forming this doctor-patient partnership.

    Patient Input

    To make an accurate diagnosis, your doctor needs as much information as you can provide. It's a good idea to start keeping written records as soon as you notice symptoms. Bring these records with you to your first visit with your doctor. Here is some of the information your doctor needs:

    Where it hurts The location of your arthritis pain can help your doctor determine the type of arthritis you have and, possibly, the cause.

    When it hurts Knowing the time of day when your pain is most severe will help the doctor determine what type of arthritis you have. For example, prolonged pain or stiffness in the morning is often associated with inflammatory types of arthritis.

    When the pain first started This information can help the doctor determine if your arthritis is caused by an injury, an illness, or general wear and tear on your joints. It will also help the doctor evaluate how much damage to your joints or bones has occurred since the disease started.

    If there is any swelling The absence or presence of swelling in your joints can indicate the type of arthritis you have. If the swelling is caused by inflammation, you may have rheumatoid arthritis or another type of inflammatory arthritis. If the swelling is caused by growths of bone (bone spurs), you probably have osteoarthritis.

    Which daily tasks are hard to do This information will help your doctor understand which joints are most affected by the arthritis, providing another clue to the type of arthritis you have.

    If the joint has ever been injured or overused The doctor needs to know how you have used your joints over time. Have you ever done physically strenuous work that included repeated movements of certain joints? What types of exercises, sports, and hobbies have you engaged in? Do you spend or have you spent long periods during an average day moving very little?

    Your family health history In addition to your symptoms, your doctor will ask about any serious illnesses, operations, allergies, or injuries you have had. Because some forms of arthritis tend to run in families, your doctor will ask whether one of your parents, grandparents, or brothers or sisters has had arthritis.

    Any medications you are taking Some medicines that are fine to take alone can cause a harmful reaction when they are taken with another medicine. Before prescribing a drug for your arthritis, your doctor needs to know about any medications you are currently taking regularly—both prescription and over-the-counter ones.

    Allergies to any medications Some people are allergic to certain medicines. This is essential information for your doctor to know before he or she prescribes something for your arthritis.

    The Physical Examination

    Your doctor will feel the affected joints for swelling or for bony growths. He or she may also move or even stretch your sore joints to see if their movement is limited and to listen for crackling sounds.

    Depending on the symptoms you report and on your medical history, the doctor may take X-rays of the affected joints. X-rays can show if a bone is damaged by osteoarthritis and, if so, how badly. The doctor may also want to test a sample of your blood or of fluid withdrawn from inside the affected joints. These tests may help rule out other diseases and determine the type of arthritis that is causing your symptoms. Some types of arthritis become obvious only as they develop over time. If the type of arthritis you have isn't clear immediately, your doctor may recommend more testing or refer you to a specialist.

    The Health Care Team

    The doctor who diagnoses your arthritis is likely to be an internist or a family physician. He or she may refer you to a rheumatologist (a doctor who specializes in treating disorders of the joints). A rheumatologist can help diagnose arthritis by ruling out other disorders and can design a treatment program to help you manage your arthritis. You may be referred to an orthopedic surgeon (a doctor who specializes in surgery on bones) to determine if your joints are damaged to such an extent that surgery is necessary to restore movement.

    The diagnosis is only the first step toward managing osteoarthritis. It is very important, from your first office visit on, that you and your doctor work together as a team. Your team is also likely to include other health care professionals, such as nurses, a physical therapist, and an occupational therapist.

    Physical therapists and nurses can help you learn new ways to perform the daily activities—such as dressing, walking, climbing stairs, and bathing—that your arthritis has made difficult. You will learn how to do these things in ways that put less strain on your joints. A physical therapist will help you strengthen the muscles around your joints to give them support. An occupational therapist can help you make changes in your home that will make it safer and easier for you to get around.

    In general, physical therapists and occupational therapists can do the following:
    • help you improve the range of motion in your affected joint and strengthen the muscles that support it

    • provide you with helpful devices such as canes, crutches, walkers, braces, or shoe inserts

    • fit you with splints that you can use to temporarily rest a sore joint

    • teach you the proper way to use heat and cold to relieve pain and stiffness

    • teach you the basics about using your joints with a minimum of discomfort and exertion

    Other members of your arthritis management team may include psychiatrists, psychologists, and social workers who can help you and your family adjust emotionally to the new circumstances brought on by your illness.

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