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Patient education: Osteoarthritis symptoms and diagnosis (Beyond the Basics)

Authors
Michael Doherty, MA, MD, FRCP, FHEA
Abhishek Abhishek, MBBS, MD, MRCP, PhD
Section Editor
David Hunter, MD, PhD
Deputy Editor
Monica Ramirez Curtis, MD, MPH
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OSTEOARTHRITIS OVERVIEW

Osteoarthritis (OA) is a common type of arthritis. In OA, the cartilage in the joints (which normally protects bones from rubbing together) wears down, and bone spurs can form (figure 1). Common OA symptoms include pain, stiffness, some loss of joint motion, and changes in the shape of affected joints. Although OA can affect almost any joint, it most often affects the hands, knees, hips, feet, and spine.

OA is a chronic condition that gradually worsens over time; however, there are several measures that may slow its progression and control symptoms. The diagnosis of OA is the first step in ensuring the appropriate treatment of OA.

This article reviews the symptoms and diagnostic tests that may be used for people with OA. Treatment of OA is discussed separately. (See "Patient education: Osteoarthritis treatment (Beyond the Basics)".)

OSTEOARTHRITIS RISK FACTORS

A number of factors can increase the risk of developing osteoarthritis (OA); most people with OA have one or more of these factors (table 1).

Age — Advancing age is one of the strongest risk factors for OA. The condition rarely occurs in people younger than age 40, but at least 80 percent of people over age 55 have some X-ray evidence of the disorder. However, not all people with arthritis on an X-ray have joint pain or other joint problems.

Gender — For unknown reasons, women are between two and three times more likely than men to develop OA.

Obesity — People who are obese are at high risk of developing OA. Weight loss may reduce this risk.

Occupation — OA of the knee has been linked to certain occupations that require frequent squatting and kneeling, including cotton processing, dock work, shipyard work, and carpentry.

OA of the hip has been linked to farm work, construction work, and other activities that require heavy lifting, prolonged standing, or walking several miles each day.

Sports — The risk of OA is increased in those who participate in certain sports that predispose to joint injury. This includes wrestling, boxing, pitching in baseball, cycling, parachuting, gymnastics, soccer, and football; by contrast, noncompetitive running does not appear to increase the risk of OA.

OSTEOARTHRITIS SYMPTOMS

The symptoms of osteoarthritis (OA) usually begin after age 40 and can vary considerably from one person to another (table 1).

Pain — The main symptom of OA is joint pain that is worse with activity and relieved by rest. In severe cases, the pain may also occur at rest or at night. The pain usually occurs near the affected joint; however, in some cases, the pain may be referred to other areas. For example, the pain of OA of the hip may actually be felt in the lower thigh or at the knee.

Stiffness — Morning stiffness is a common symptom of OA. This stiffness usually resolves within 30 minutes of rising, but it may recur throughout the day during periods of inactivity. Some people note a change in symptoms related to the weather.

Swelling (effusion) — OA may cause a type of joint swelling called an effusion, which results from the accumulation of excess fluid in the joint.

Crackling or grating sensation (crepitus) — Movement of a joint affected by OA may cause a crackling or grating sensation called crepitus. This sensation likely occurs because of roughening of the normally smooth surfaces inside the joint.

Bony outgrowths (osteophytes) — OA often causes outgrowths of bone called osteophytes or bone spurs. These bony protuberances can be felt under the skin near joints and typically enlarge over time.

Symptoms in specific joints — OA does not affect all joints equally. The condition most commonly affects the fingers, knees, hips, and spine; it rarely affects the elbow, wrist, and ankle.

OSTEOARTHRITIS DIAGNOSIS

There is no single sign, symptom, or test that can diagnose osteoarthritis (OA). Instead, the diagnosis is based on several factors, including the person's age, history, and symptoms.

For example, knee OA can be usually be diagnosed in a person over the age of 50 if the following are present:

Pain predominantly when weight-bearing and moving the knee

Early morning stiffness lasting for just a short time (less than 30 minutes)

A crackling or grating sensation in the knee when going up and down stairs

Hard bony enlargement of the knees

OA does not cause inflammation (ie, the joint is not warm to the touch). The symptoms of OA generally vary from day to day but progress slowly over years and may level off at some point. Similar symptoms to the above can affect other joints, such as the hands and the hips. As the hip joint is deep inside the body, bony enlargement of this joint is not visible, whereas bony enlargement of finger joints is easy to see. Laboratory tests and imaging studies (such as X-rays) are sometimes done if OA is suspected, particularly if the person's symptoms are atypical, but these tests are not always required to make the diagnosis.

Laboratory tests — Laboratory tests may be used to rule out other diseases when there is a high index of suspicion that symptoms may be caused by something else.

Imaging tests — Imaging is not a routine part of making a diagnosis. It can be helpful when there is lack of clarity around a source of joint pain other than OA. Sometimes imaging is also required prior to joint replacement surgery to help stage and guide the procedure.

Other types of imaging, such as ultrasound and magnetic resonance imaging (MRI), are not necessary to make a diagnosis but may be used if the diagnosis is uncertain.

COURSE OF OSTEOARTHRITIS

Osteoarthritis (OA) generally worsens slowly over time, although it stabilizes in some people. In those whose pain and joint stiffness worsens over time, there is usually intermittent worsening (worsening, then stabilization for a period).

Some people with OA are able to function normally despite pain, while others may have difficulty with even simple tasks as a result of pain. Exercise may help to prevent loss of strength and may decrease the chances of becoming disabled.

OSTEOARTHRITIS TREATMENT

The treatment of osteoarthritis (OA) is discussed in a separate topic review. (See "Patient education: Osteoarthritis treatment (Beyond the Basics)".)

WHERE TO GET MORE INFORMATION

Your healthcare provider is the best source of information for questions and concerns related to your medical problem.

This article will be updated as needed on our web site (www.uptodate.com/patients). Related topics for patients, as well as selected articles written for healthcare professionals, are also available. Some of the most relevant are listed below.

Patient level information — UpToDate offers two types of patient education materials.

The Basics — The Basics patient education pieces answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials.

Patient education: Osteoarthritis (The Basics)
Patient education: Hip replacement (The Basics)
Patient education: Arthritis and exercise (The Basics)
Patient education: Meniscal tear (The Basics)
Patient education: Paget disease of bone (The Basics)

Beyond the Basics — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are best for patients who want in-depth information and are comfortable with some medical jargon.

Patient education: Osteoarthritis treatment (Beyond the Basics)
Patient education: Gout (Beyond the Basics)

Professional level information — Professional level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings. These articles are thorough, long, and complex, and they contain multiple references to the research on which they are based. Professional level articles are best for people who are comfortable with a lot of medical terminology and who want to read the same materials their doctors are reading.

Patient guidelines for weight-resistance training in osteoarthritis
Risk factors for and possible causes of osteoarthritis
Overview of surgical therapy of knee and hip osteoarthritis
Clinical manifestations and diagnosis of osteoarthritis
Management of knee osteoarthritis
Overview of the management of osteoarthritis

The following organizations also provide reliable health information.

National Library of Medicine

(www.nlm.nih.gov/medlineplus/arthritis.html, available in Spanish)

National Institute of Arthritis and Musculoskeletal and Skin Diseases

(301) 496-8188

(www.niams.nih.gov/Health_Info/Arthritis/default.asp)

National Institute on Aging

(www.nia.nih.gov/health/publication/arthritis-advice, available in Spanish)

American College of Rheumatology

(404) 633-3777

(www.rheumatology.org/practice/clinical/patients/information_for_patients)

The Arthritis Foundation

(800) 283-7800

(www.arthritis.org)

My Joint Pain

(www.myjointpain.org.au)

Arthritis Research UK

(http://www.arthritisresearchuk.org/arthritis-information/conditions/osteoarthritis-of-the-knee.aspx)

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ACKNOWLEDGMENT

The editorial staff at UpToDate would like to acknowledge Kenneth Kalunian, MD, who contributed to an earlier version of this topic review.

Literature review current through: Nov 2017. | This topic last updated: Tue Oct 24 00:00:00 GMT 2017.
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