Working With Your Health-Care Provider
For the most part, health-care providers diagnose osteoarthritis on the basis of symptoms that are evident during an office visit and on physical examination. The first clue comes from the reason for your visit to your health-care provider in the first place. People with osteoarthritis usually seek help for pain in and around one or more joints. The joint or joints may feel stiff for a short time when you wake in the morning, and the pain may be accompanied by a grinding sensation (crepitus) in the affected joints. Occasionally, your health-care provider diagnoses osteoarthritis after X-rays performed for some other reason show evidence of the disease. This may happen even before symptoms of osteoarthritis begin.
When osteoarthritis involves the spine, it most commonly affects the bones of the neck and lower back. This can cause numbness, tingling, pain or weakness in the extremities. Bones in the spine, called vertebrae, encase the spinal cord, which contains the nerves that allow communication between the brain and the rest of the body. Vertebrae deformed by osteoarthritis may affect the extremities by pressing on the nerves that exit the spinal cord to supply the arms and legs. Enlarged vertebrae may press on the spinal cord itself, causing spinal stenosis. Spinal stenosis may be associated with pain, numbness or weakness in the legs and/or arms depending on what part of the spinal cord is involved.
Finally, bone deformities associated with osteoarthritis can cause individual vertebrae to slip out of place. This displacement may put pressure on the spinal cord and/or nerves that exit the spinal cord, causing symptoms similar to those of spinal stenosis.
Your health-care provider will ask questions about how much your osteoarthritis affects your day-to-day functioning. For example, he or she will want to know the following:
- Have you reduced your activity because of pain?
- Are you having trouble dressing, bathing or preparing meals?
- Does your disease interfere with your enjoyment of a hobby, such as gardening, or family activities?
Your answers to these questions will help to determine how severe your osteoarthritis may be and what degree of treatment you may need. Because osteoarthritis may run in your family, your health-care provider may ask about the appearance of your parents' hands.
After asking about your symptoms in detail and getting a sense of your general health, your health-care provider will examine the joint or joints that are painful to look for tenderness, warmth, swelling and joint enlargement or deformity. This examination may reveal bony lumps at the ends of the fingers (Heberden's nodes) or at the middle joint (Bouchard's nodes).
Researchers use certain criteria in studies of osteoarthritis to help them ensure that the study patients are similar, which makes it possible to compare studies and treatments more directly. At an office visit, your health-care provider will look for findings similar to these criteria, as they are the most typical features of osteoarthritis. For example, your health-care provider may check to see if you meet at least three of the following six features:
- Age older than 50. Osteoarthritis becomes more common as you age.
- Stiffness in the morning for less than 30 minutes. This helps differentiate osteoarthritis from inflammatory joint disorders such as rheumatoid arthritis, which causes morning stiffness that can last an hour or more.
- A grinding sensation. The sensation of bone rubbing against bone during knee movement is called crepitus.
- Tenderness. In osteoarthritis, pain is elicited when you touch the edge of the affected joint.
- Enlarged bones. In osteoarthritis, bones of the affected joint may be larger than normal.
- Absence of warmth. The temperature of the skin over the affected joint is usually normal or only slightly warm in osteoarthritis. But in rheumatoid arthritis or other conditions that have more joint inflammation, skin is often much warmer than normal.
Microscopic examination of joint fluid. Joint fluid (also called synovial fluid) may accumulate in the joint in some forms of arthritis. When present in the knee, it is often called "water on the knee." Fluid accumulation in an osteoarthritic joint may cause the joint to look or feel swollen. Your health-care provider can withdraw a sample of joint fluid (after applying an anesthetic, of course) and test it for signs of inflammation.
Osteoarthritis is characterized by only mild or low-grade inflammation, indicated by a low number of white blood cells in the joint fluid. Joint fluid also may be tested for other signs of inflammation, infection or crystals (such as gout ). These findings are absent in samples of joint fluid when osteoarthritis is the primary problem.
X-rays. When osteoarthritis has been present for months or years, X-rays usually show that the space around the affected joint is narrower than normal and that the shape of the joint is abnormal. The bones in the joint also show some abnormalities, including bone spurs (that is, excess bone), also known as osteophytes. Health-care providers recognize that osteoarthritis can cause symptoms before abnormalities are evident on X-rays. When X-rays reveal minor changes in bone, joint pain may be related to osteoarthritis in its early stages. In addition, X-rays can show osteoarthritic abnormalities in the absence of arthritic pain. For these reasons, health-care providers don't use X-rays exclusively when diagnosing osteoarthritis, nor do they rely entirely on these images to guide treatment.
Blood tests. If your health-care provider suspects that you have arthritis, he or she may order some blood tests. There is no specific blood test to help diagnose osteoarthritis, but certain tests can support the diagnosis of other arthritic disorders (such as gout or rheumatoid arthritis ) or another condition (such as hemochromatosis, a metabolic disorder of iron metabolism) that has led to osteoarthritis.
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