eMedicine Specialties > Physical Medicine and Rehabilitation > Arthritis & Connective Tissue Disorders

Osteoarthritis: Differential Diagnoses & Workup

Author: Todd P Stitik, MD, Professor, Department of Physical Medicine and Rehabilitation; Director, Outpatient Occupational/Musculoskeletal Medicine, UMDNJ-New Jersey School of Medicine
Coauthor(s): Patrick M Foye, MD, FAAPMR, FAAEM, Associate Professor of Physical Medicine and Rehabilitation, Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, Director of Coccyx Pain Service (Tailbone Pain Service: www.TailboneDoctor.com), University of Medicine and Dentistry of New Jersey, New Jersey Medical School; Irim Ciolino, MD, Co-chief Resident, Department of Internal Medicine, New York Medical College/St Vincent's Catholic Medical Center
Contributor Information and Disclosures

Updated: Jan 14, 2010

Differential Diagnoses

Gout
Lyme Disease
Patellofemoral Syndrome
Prepatellar Bursitis
Rheumatoid Arthritis

Other Problems to Be Considered

Crystal deposition disease
Pseudogout
Inflammatory arthritis
Seronegative spondyloarthropathies
Infected joint
Underlying mechanical pain

Workup

Laboratory Studies

  • Research has not yet produced a clinically useful diagnostic test for osteoarthritis (OA), so no laboratory studies can assist in the condition's diagnosis per se.
  • Researchers have looked at monoclonal antibodies, synovial fluid markers, and urinary pyridinium cross-links (ie, breakdown products of cartilage).6 Erythrocyte sedimentation rate (ESR) is not usually elevated, but it may be slightly elevated in cases of erosive inflammatory arthritis.

Imaging Studies

  • Studies on the diagnostic use of magnetic resonance imaging (MRI) in osteoarthritis (OA) of the knee are currently being conducted.7 A study attempted to correlate the clinical features of OA with MRI findings in patients with the condition. A large joint effusion was associated with pain and stiffness. The presence of an osteophyte in the patellofemoral compartment was associated with pain. All other imaging findings, including focal or diffuse cartilaginous abnormalities, subchondral cysts, bone marrow edema, subluxation of the meniscus, meniscal tears, and Baker cysts, were not associated with symptoms.8,9
  • Bone scans10 may be helpful in the early diagnosis of OA of the hand. Bone scans also can help to differentiate joint pain due to OA from pain associated with other disease processes. For example, bone scans typically yield a symmetrical pattern of a very mild increased uptake in a symmetrical manner in OA. In contrast, bone scans are often negative in the early stages of multiple myeloma, a cause of bone pain in older adults that can be confused with OA. Bone scans also can help to differentiate OA from osteomyelitis and bone metastases. Single-photon emission computed tomography scanning (SPECT) helps to differentiate back pain due to degenerative disk disease from back pain due to spondylolysis.
  • Plain radiographs are often negative early in the disease.
  • The Kellgren-Lawrence Grading System, which is the most universally accepted method of classifying radiographic osteoarthritis, uses the following 4 radiographic features:
    • Joint space narrowing
    • Osteophytes
    • Subchondral sclerosis
    • Subchondral cysts

Other Tests

  • Perform diagnostic joint aspiration for synovial fluid analysis to help rule out conditions other than osteoarthritis. The presence of noninflammatory joint fluid helps to distinguish OA from other causes of joint pain. Other findings that aid in the differentiation of OA from other conditions are negative Gram stains and cultures, as well as the absence of crystals when fluid is viewed under a polarized microscope.

Histologic Findings

Cartilage biopsy generally is not performed in the diagnosis of osteoarthritis.

More on Osteoarthritis

Overview: Osteoarthritis
Differential Diagnoses & Workup: Osteoarthritis
Treatment & Medication: Osteoarthritis
Follow-up: Osteoarthritis
Multimedia: Osteoarthritis
References
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Further Reading

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Keywords

osteoarthritis, arthritis, joint pain, arthritis pain, knee pain, knee arthritis, hip arthritis, arthritic, degenerative joint disease, synovial, synovial joint, osteoarthritis knee, osteoarthritis treatment, treatment of osteoarthritis, arthroplasty, joint replacement, osteoarthrosis, synovial joints, osteophytes, synoviocytes, hyaluronic acid, hyaluronate, HA, repetitive joint use, crystal deposition, acromegaly, rheumatoid arthritis, obesity, alkaptonuria, hemochromatosis, Wilson disease, Wilson's disease, hemoglobinopathies, sickle cell disease, thalassemia, Charcot joint, Charcot'sjoint, syringomyelia, tabes dorsalis, diabetes, congenital hip dislocation, slipped capital femoral epiphysis, Paget disease, Paget's disease, avascular necrosis

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Contributor Information and Disclosures

Author

Todd P Stitik, MD, Professor, Department of Physical Medicine and Rehabilitation; Director, Outpatient Occupational/Musculoskeletal Medicine, UMDNJ-New Jersey School of Medicine
Todd P Stitik, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Association of Academic Physiatrists, Phi Beta Kappa, and Physiatric Association of Spine, Sports and Occupational Rehabilitation
Disclosure: Nothing to disclose.

Coauthor(s)

Patrick M Foye, MD, FAAPMR, FAAEM, Associate Professor of Physical Medicine and Rehabilitation, Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, Director of Coccyx Pain Service (Tailbone Pain Service: www.TailboneDoctor.com), University of Medicine and Dentistry of New Jersey, New Jersey Medical School
Patrick M Foye, MD, FAAPMR, FAAEM is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, Association of Academic Physiatrists, and International Spine Intervention Society
Disclosure: Nothing to disclose.

Irim Ciolino, MD, Co-chief Resident, Department of Internal Medicine, New York Medical College/St Vincent's Catholic Medical Center
Irim Ciolino, MD is a member of the following medical societies: American College of Physicians
Disclosure: Nothing to disclose.

Medical Editor

Curtis W Slipman, MD, Director, University of Pennsylvania Spine Center; Associate Professor, Department of Physical Medicine and Rehabilitation, University of Pennsylvania Medical Center
Curtis W Slipman, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Association of Academic Physiatrists, International Association for the Study of Pain, and North American Spine Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Richard Salcido, MD, Chairman, Erdman Professor of Rehabilitation, Department of Physical Medicine and Rehabilitation, University of Pennsylvania School of Medicine
Richard Salcido, MD is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American College of Physician Executives, American Medical Association, and American Paraplegia Society
Disclosure: Nothing to disclose.

CME Editor

Kelly L Allen, MD, Regional Medical Director, IMX-Medical Management Services
Disclosure: Nothing to disclose.

Chief Editor

Denise I Campagnolo, MD, MS, Director of Multiple Sclerosis Clinical Research and Staff Physiatrist, Barrow Neurology Clinics, St Joseph's Hospital and Medical Center; Investigator for Barrow Neurology Clinics; Director, NARCOMS Project for Consortium of MS Centers
Denise I Campagnolo, MD, MS is a member of the following medical societies: Alpha Omega Alpha, American Association of Neuromuscular and Electrodiagnostic Medicine, American Paraplegia Society, Association of Academic Physiatrists, and Consortium of Multiple Sclerosis Centers
Disclosure: Teva Neuroscience Honoraria Speaking and teaching; Serono-Pfizer Honoraria Speaking and teaching; Genzyme Corporation Grant/research funds investigator; Biogen Idec Grant/research funds investigator; Genentech, Inc Grant/research funds investigator; Eli Lilly & Company Grant/research funds Novaritis; Novaritis  Novaritis; MSDx LLC Grant/research funds investigator; BioMS Technology Corp Grant/research funds investigator; Avanir Pharmaceuticals Grant/research funds investigator

 
 
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