Persistent joint aches, pains, and stiffness may mean osteoarthritis (OA). If a knee, hip, finger, or other joint has begun to be bothersome—for example, sore or swollen after vigorous activity or stiff first thing in the morning—these symptoms should be evaluated. If a joint suddenly becomes painful or is warm or red, prompt evaluation is important to rule out other conditions such as injury, infection or gout (another type of arthritis).

What to expect at an appointment

Early diagnosis of a disease is always best, as this allows appropriate treatment to be started as soon as possible. Tools for early diagnosis of OA are not yet available, although this is an active area of research. Currently, OA is diagnosed after joint pain and stiffness become persistent and characteristic damage or changes in cartilage and bones are seen on an imaging study (x-ray or MRI scan).

A diagnosis of OA often is possible with an evaluation by a primary care physician. If the diagnosis is in question, a rheumatologist (arthritis specialist) or an orthopaedic physician may be consulted or participate in the evaluation.

The main tools used in the diagnosis of OA (Table Below) are a medical history and physical examination combined with imaging studies of the joint and, possibly, blood tests and tests of fluid that is extracted from the joint. These additional tests help to confirm that OA—and not some other condition—is the cause of the symptoms.

How osteoarthritis is diagnosed:

To help your doctor determine the cause of your joint pain, be sure to give the following information:

Symptoms:

• What are the main joint symptoms – pain, swelling, redness, weakness, clicking, catching, or buckling?
• In which joints are the symptoms occurring?
• When did your symptoms start?
• Are the symptoms on and off or constant?
• What activities make your joints hurt?
• How intense is the pain (maybe rate it on a scale of 1 to 10)?
• How would you describe the pain (throbbing, aching, burning, sharp, dull)?

Personal medical/surgical history and family history:

• Have you had any injuries or surgeries?
• Do you have any other medical problems?
• Have any members of your family been diagnosed with arthritis?

Impact of symptoms:

• Are your symptoms limiting your activities in any way?
• What activities are affected?
• Are your symptoms affecting your life and/or work? In what way? How much?

To make a diagnosis of OA, a physician will perform a physical examination, looking for the following:

Joint signs and symptoms:

• Swelling, tenderness, redness, rash, or other abnormalities
• Limited range of motion
• Evidence of joint damage
• Number and pattern of joint involvement

Other pertinent signs or symptoms:

• Muscle weakness, weak reflexes
• Joint function (ability to sit down in and stand up from a chair, walk)

To make a diagnosis of OA, a physician may want to see the joint through images, such as:

Joint X-ray, to:

• Look for changes in or damage to cartilage or bone
• Estimate the degree of joint damage

Joint MRI (magnetic resonance imaging), to:

• Look for subtle changes in or damage to cartilage or bone not visible on x-ray
• Look for damage to tissues around the joint (eg, ligaments), which are not visible on x-ray

To make a diagnosis of OA, a physician may order tests, such as:

Blood tests, to:

• Rule out other infection and other diseases that cause joint pain (such as, rheumatoid arthritis)

Joint fluid tests, to:*

• Rule out other diseases that cause joint pain (such as, gout)

After an evaluation for joint symptoms, it is important to know what your physician determines is the problem. If he does not diagnose OA as the cause of your symptoms, ask what further evaluation is needed.

If the diagnosis is unclear, ask why. There could be many good reasons, including that the disease is still in too early a stage to know for sure that it is OA. If your physician suspects it is OA, ask what should happen next.

Next: It's Osteoarthritis—Now What?