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Osteoarthritis- diagnosis

How is osteoarthritis diagnosed?

Osteoarthritis is diagnosed with a combination of medical history, physical exam, xrays, labs, and possibly other tests.


Medical history

There are several “clues” a physician looks for in differentiating osteoarthritis from other types of arthritis. For example, in osteoarthritis, the pain usually comes on over time, it is worse at night and with use of the joints, and there is minimal stiffness in the morning.

Although these clues are helpful, they may not be true in every person. For example, some people with rheumatoid arthritis may present with similar symptoms. On the other hand, some people with osteoarthritis may have only some or none of these clues.


Physical exam

Although osteoarthritic joints can be warm and swollen, there is usually less swelling in osteoarthritis than some other forms of arthritis like rheumatoid arthritis or gout.

Heberden's nodes
Heberden’s nodes- From operation-pro.de/

Osteoarthritis can lead to joint deformity. Sometimes the two bones in a joint actually fuse and the joint loses its

flexibility. As the body attempts to repair the damage joints, extra bone may form around the joint causing the joint to get larger and sometimes have “bumps”. These bumps are otherwise known as Heberden’s and Bouchard’s nodes.



Hand osteoarthritis
Hand osteoarthritis

In more advanced osteoarthritis, xrays can show narrowing of the space between two bones and even joint damage characteristic of osteoarthritis.




Although there is no blood test for osteoarthritis, labs can be done to rule out other forms of arthritis.


Joint fluid

If there is significant swelling in the joint, examination of the fluid drawn from the joint can help provide another clue. The joint fluid from an osteoarthritic joint has different characteristics from that from a joint with rheumatoid arthritis, infection, or gout.


See also:











Osteoarthritis- The most common type of arthritis

What is osteoarthritis?

Arthritis pain
Arthritis pain

Of the 100-or-so types of arthritis that can affect us, osteoarthritis (OA) is the most common type. OA is caused by “wear and tear” on the joints over time. Much like the tires on a car, the cartilage between joints, which provides cushioning to the joint, wears down over time and with use.

Osteoarthritis is like wear and tear of a tire


When the cushioning between the joints is worn off, the bones rub against each other. This causes pain, stiffness, and swelling in the joint.


Who gets osteoarthritis?

Basically, everyone. As we get older the chance of developing OA increases. Risk factors for developing OA sooner and more severe include obesity, previous joint injury, weak thigh muscles, and genetics (do your mom and grandmother have osteoarthritis?).


What exactly happens in osteoarthritis?

There is usually a rubbery material between the two bones that form a joint called cartilage. Cartilage acts as a cushion between the two bones.  As the bones slide over each other (like bending a joint) or pressed against each other (like walking), cartilage absorbs the impact and prevents bone damage and pain. As cartilage wears off over time, the two bones get closer to each other and eventually start rubbing against each other.

Components of a normal joint
Components of a normal joint

The joints we use the most often- the joints of the hands, knees, hips, and spine- are most likely to be affected by osteoarthritis. However, almost any joint may be affected.


Osteoarthritis symptoms

Symptoms of OA may include:

  • Joint pain
  • Join stiffness
  • Joint deformity
  • Swelling in the joint
  • Grinding noise with movement
  • Decreased range of motion of the joint


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How do I know if I have Osteoarthritis or Rheumatoid Arthritis?

Osteoarthritis and rheumatoid arthritis are both forms of arthritis, and can cause joint tenderness and deformity. This is where their similarity stops, as they are actually very different diseases.


Tire photoOsteoarthritis is a form of mechanical arthritis. It is caused by wear and tear of the cartilage and joint, much like the tires of a car. The more we use our joints, in activities like sports or repetitive movements, the more likely we are to get osteoarthritis.
Osteoarthritis is very common, and its prevalence increases as we get older. In fact, 35% of people over 65 and 80% of people over 75 have at least one arthritic joint.

Osteoarthritis can affect any joint, but it’s mostly seen in large joints like hips and knees. The arthritis pain is usually worse at the end of the day or after a lot of activity. Stiffness in the morning lasts a few minutes.

Rheumatoid arthritis

joints of hands photoRheumatoid arthritis is caused by an overactive immune system. The immune system actually attacks the joint, causing a lot of inflammation which can actually dissolve pieces of the bone. I sometimes think of this as pacman eating away at a joint. It can start at any age. Its prevalence is about 1% in the United States.
Rheumatoid arthritis most commonly affects small joints of hands and feet, but like osteoarthritis, can go to any joint. The pain is usually worse in the morning and after periods of inactivity. Morning stiffness commonly lasts several hours. Pain and stiffness get better as the day progresses.


Here are the differences between the two diseases at a glance:

OsteoarthritisRheumatoid Arthritis
CauseWear and tearAutoimmune
PrevalenceIncreases with ageAbout 1% of population
GenderWomen > MenWomen > Men
Joint sizeUsually large jointsUsually small joints
InflammationUsually littleUsually a lot
TimingPain worse at nightPain worse in morning
Morning stiffnessLess than an hourMore than an hour


Unfortunately, most arthritis is not this simple. For example, you can have osteoarthritis affecting small joints of the hands, or rheumatoid arthritis with not a lot of inflammation.  Or you may have one of more than 100 other types of arthritis. The diagnosis will require a trained physician. If you have arthritis pain, it is a good idea to talk to your physician or see a rheumatologist.