Do I Have Osteoarthritis?

Symptoms and Signs of Osteoarthritis


If you are reading this article, you likely have joint pain and are curious whether this pain is from osteoarthritis (OA) or not. There is no way to know for sure without going to the doctor's office and getting a thorough exam and possibly an X-ray. This article will discuss the typical symptoms of osteoarthritis to help you decide whether OA is a likely cause of your pain.

OA, also known as degenerative joint disease, is a complex multi-factorial process that leads to erosion or “wear and tear” of joints.

OA is typically diagnosed based on a person’s history, physical exam, and radiographic findings. The most common type of OA is idiopathic, meaning that there is no identifiable reason for its onset. This is in contrast to secondary OA that results from an identifiable cause such as trauma. Osteoarthritis must be distinguished from a number of other potential causes of joint pain. Below is a discussion of key clinical features of OA, this discussion is specific for idiopathic OA, which is the most common form.

Symptoms and Diagnosis

The clinical presentation of OA has a number of key features that can help with diagnosis. The first key feature is age. OA is more typical in older patient populations, with the usual onset after age 40. The second key is which joint is painful? OA commonly affects hips, knees, finger joints including the proximal and distal interphalangeal joints (anatomy of hand), as well as the spine.

The elbow and shoulder joints are less commonly affected, but can still certainly have OA.

The most common symptoms of OA are pain and stiffness. Stiffness is often worst in the morning but typically lasts less than 30 minutes. This is an important feature that distinguishes OA from rheumatoid arthritis that involves morning stiffness for OVER 30 minutes, as opposed to less.

Another key feature of OA is that it can cause creaking in the affected joint, the medical term for this is called crepitus. As OA progresses it can cause deformity of the joint with bony enlargement and protrusions or spurs. A key aspect of the symptoms of OA is that they are gradual in onset and often take years to progress. Pain that has a short period of onset, such as days or weeks, with quick progression is unlikely to be OA.

X-rays can be helpful in diagnosing OA. A number of key x-ray features help identify OA. Joint space narrowing results from the erosion of cartilage in the affected joint. With the erosion of cartilage the bones on either end of the joint experience more friction and thicken as a result of the increased stress, on x-rays this appears as more dense white lines and is termed subchondral (meaning below the cartilage) sclerosis. Boney spurs can develop as OA progresses. The last x-ray sign is small cysts in the bone immediately below the cartilage.

Clinical Criteria

That can be a lot of information to digest.

To help with organizing the above information, three separate systems have been developed to identify OA of the knee, hip, and hands. These are the “classic clinical criteria” for each of those sites, and can be helpful in diagnosing OA. As a warning, these are not full proof and are not always 100% accurate.

Classic Clinical Criteria for Osteoarthritis of the Knee

Knee pain plus at least 3 of the following:

  • Greater than 50 years of age
  • Morning stiffness for less than 30 minutes
  • Crepitus on active motion of the knee
  • Bony tenderness
  • Bony enlargement
  • No palpable warmth

Classic Clinical Criteria for Osteoarthritis of the Hand

Hand pain or stiffness plus at least 3 of the following:

  • Hard tissue enlargement of 2 or more of 10 selected joints. The 10 selected joints are the second and third distal interphalangeal (DIP) joints, the second and third proximal interphalangeal (PIP) joints, and the first carpometacarpal (CMC) of both hands
  • Hard enlargement of two or more DIP joints
  • Fewer than three swollen metacarpophalangeal (MCP) joints
  • Deformity of at least 1 of the 10 selected joints

Classic Clinical Criteria for Osteoarthritis of the Hip

Hip pain plus at least two of the following three features:

  • Erythrocyte sedimentation rate (blood test that is a measure of infection) of less than 20 mm/h
  • Radiographic bone spurs
  • Joint space narrowing on X-ray

Again, I must emphasize that the above criteria are not full proof, the only sure way to find out if you have OA is to see a physician. I do hope that the above information is helpful for the readers to decide whether OA should be on their radar as a possible cause for their joint pain.

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