eMedicine Specialties > Rheumatology > Osteoarthritis

Osteoarthritis: Differential Diagnoses & Workup

Author: Carlos J Lozada, MD, Director of Rheumatology Fellowship Program, Associate Professor, Department of Medicine, Division of Rheumatology and Immunology, Jackson Memorial Medical Center, University of Miami School of Medicine
Coauthor(s): Eli Steigelfest, MD, Consulting Staff, Department of Rheumatology, The Consultant Group, PC
Contributor Information and Disclosures

Updated: Apr 28, 2009

Differential Diagnoses

Rhinosporidiosis

Other Problems to Be Considered

Osteoarthritis (OA) can usually be diagnosed on clinical grounds. The history and physical examination findings are sufficient. Radiographic findings confirm the initial impression (see Imaging Studies), and laboratory values are typically within the reference range. The initial goal is to differentiate osteoarthritis from other arthritides (eg, rheumatoid arthritis).

Rheumatoid arthritis predominately affects the wrists and the metacarpophalangeal (MCP) and PIP joints. Rheumatoid arthritis rarely, if ever, involves the DIP joints or lumbosacral spine. Rheumatoid arthritis is associated with prominent prolonged (>1 h) morning stiffness. Radiographic findings of rheumatoid arthritis include bone erosion (eg, periarticular osteopenia, marginal erosions of bone) rather than formation. Laboratory findings that further differentiate rheumatoid arthritis include systemic inflammation, positive rheumatoid factor results, joint fluid with polymorphonuclear cell predominance, and a substantially elevated WBC count.

Clinical history and characteristic radiographic findings can be used to differentiate spondyloarthropathy from sacroiliac and lumbosacral spine involvement.

Secondary osteoarthritis must be considered in individuals with chondrocalcinosis, joint trauma, metabolic bone disorders, hypermobility syndromes, and neuropathic diseases.

Reactive arthritis is another problem that may be considered.

Workup

Laboratory Studies

  • No specific laboratory abnormalities are associated with osteoarthritis (OA).
    • Levels of acute-phase reactants and erythrocyte sedimentation rate are within the reference range.
    • Synovial fluid analysis usually indicates a WBC count below 2000/µL with a mononuclear predominance.

Imaging Studies

  • Radiography
    • Conduct imaging studies of the affected joint.
    • The presence of osteophytes (ie, spurs at the joint margins) is the most characteristic findings.
    • Other findings in osteoarthritis include asymmetric joint-space narrowing, subchondral sclerosis, and subchondral cyst formation.
    • Roentgenographic findings are often poor predictors of the degree of symptomatology in a particular patient.

Procedures

Arthrocentesis of the affected joint can help exclude inflammatory arthritis, infection, and/or crystal arthropathy.

Histologic Findings

Histologically, the earliest changes occur in the cartilage. Proteoglycan staining is diminished, and, eventually, irregularity of the articular surface with clefts and erosions occurs.

More on Osteoarthritis

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

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Further Reading

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Keywords

osteoarthritis, osteoarthrosis, OA, knee osteoarthritis, hip osteoarthritis, spinal osteoarthritis, foot osteoarthritis, secondary osteoarthritis, secondary OA, knee OA, hip OA, spinal OA, foot OA, osteophytes, joint pain, back pain, noninflammatory arthritis, degenerative joint disease, articular disease, articular cartilage disease, bony osteophytes

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Contributor Information and Disclosures

Author

Carlos J Lozada, MD, Director of Rheumatology Fellowship Program, Associate Professor, Department of Medicine, Division of Rheumatology and Immunology, Jackson Memorial Medical Center, University of Miami School of Medicine
Carlos J Lozada, MD is a member of the following medical societies: American College of Physicians and American College of Rheumatology
Disclosure: Nothing to disclose.

Coauthor(s)

Eli Steigelfest, MD, Consulting Staff, Department of Rheumatology, The Consultant Group, PC
Disclosure: Nothing to disclose.

Medical Editor

John Varga, MD, Professor, Department of Internal Medicine, Division of Rheumatology, Northwestern University
John Varga, MD is a member of the following medical societies: American College of Physicians, American College of Rheumatology, Central Society for Clinical Research, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Elliot Goldberg, MD, Dean of the Western Pennsylvania Clinical Campus, Professor, Department of Medicine, Temple University School of Medicine
Elliot Goldberg, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, and American College of Rheumatology
Disclosure: Nothing to disclose.

CME Editor

Alex J Mechaber, MD, FACP, Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine
Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Chief Editor

Herbert S Diamond, MD, Professor of Medicine, Temple University School of Medicine; Chairman Emeritus, Department of Internal Medicine, Western Pennsylvania Hospital
Herbert S Diamond, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American College of Rheumatology, American Medical Association, and Phi Beta Kappa
Disclosure: medifocus Honoraria Review panel membership; health dialogs Honoraria Consulting; West Penn Allegheny Health System None Board membership

 
 
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