Osteoarthritis Workup

Updated: Oct 10, 2017
  • Author: Carlos J Lozada, MD; Chief Editor: Herbert S Diamond, MD  more...
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Workup

Approach Considerations

Osteoarthritis is typically diagnosed on the basis of clinical and radiographic evidence. [3, 4, 5, 6, 7] No specific laboratory abnormalities are associated with osteoarthritis.

Researchers have investigated the use of monoclonal antibodies, synovial fluid markers, and urinary pyridinium cross-links (ie, breakdown products of cartilage) as osteoarthritic indicators. [68] No single biomarker has proved reliable for diagnosis and monitoring, but combinations of cartilage-derived and bone-derived biomarkers have been used to identify osteoarthritis subtypes, with possible impact on treatment. [69]

Levels of acute-phase reactants are typically within the reference range in patients with osteoarthritis. The erythrocyte sedimentation rate (ESR) is not usually elevated, though it may be slightly so in cases of erosive inflammatory arthritis. The synovial fluid analysis usually shows a white blood cell (WBC) count below 2000/µL, with a mononuclear predominance.

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Plain Radiography

Plain radiography is the imaging method of choice because it is more cost-effective than other modalities and because radiographs can be obtained more readily and quickly. [5, 8] One important characteristic of primary osteoarthritis is that the abnormalities found in the load-bearing (ie, highly stressed) areas of the affected joint differ from those found in the non–load-bearing areas. In the load-bearing areas, radiographs can depict joint-space loss, as well as subchondral bony sclerosis and cyst formation (see the image below).

This radiograph demonstrates osteoarthritis of the This radiograph demonstrates osteoarthritis of the right hip, including the finding of sclerosis at the superior aspect of the acetabulum. Frequently, osteoarthritis at the hip is a bilateral finding, but it may occur unilaterally in an individual who has a previous history of hip trauma that was confined to that one side.

The elbow is not commonly affected in osteoarthritis. However, elbow arthritis (see the images below) can occur as a result of trauma.

Osteoarthritis of the elbow is not commonly seen; Osteoarthritis of the elbow is not commonly seen; however, it can occur with a history of previous trauma.
Osteoarthritis of the elbow is not commonly seen; Osteoarthritis of the elbow is not commonly seen; however, it can occur with a history of previous trauma.
Osteoarthritis of the elbow is not commonly seen; Osteoarthritis of the elbow is not commonly seen; however, it can occur with a history of previous trauma.
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MRI, CT, and Ultrasonography

Magnetic resonance imaging (MRI) can depict many of the same characteristics of osteoarthritis that plain radiography can, but it is not necessary in most patients with osteoarthritis, unless additional pathology amenable to surgical repair is suspected. Pathology that can be seen on MRI includes joint narrowing, subchondral osseous changes, and osteophytes. Unlike radiography, MRI can directly visualize articular cartilage and other joint tissues (eg, meniscus, tendon, muscle, or effusion).

Computed tomography (CT) is rarely used in the diagnosis of primary osteoarthritis. However, it may be used in the diagnosis of malalignment of the patellofemoral joint or of the foot and ankle joints.

Currently, ultrasonography has no role in the routine clinical assessment of the patient with osteoarthritis. However, it is being investigated as a tool for monitoring cartilage degeneration, and it can be used for guided injections of joints not easily accessed without imaging.

For more information, see Imaging in Osteoarthritis.

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Bone Scanning

Bone scans may be helpful in the early diagnosis of osteoarthritis of the hand. [9] Bone scans in osteoarthritis typically yield a symmetrically patterned, very mildly increased uptake. 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 osteoarthritis. Bone scans also can help to differentiate osteoarthritis from osteomyelitis and bone metastases.

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Arthrocentesis

A diagnostic joint aspiration for synovial fluid analysis can help exclude inflammatory arthritis, infection, or crystal arthropathy. The presence of noninflammatory joint fluid helps distinguish osteoarthritis from other causes of joint pain. Other synovial fluid findings that aid in the differentiation of osteoarthritis from other conditions are negative Gram stains and cultures, as well as the absence of crystals when fluid is viewed under a polarized microscope.

For more information, see the following:

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