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.^[70]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.^[71]

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.

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 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.

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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; however, it can occur with a history of previous trauma.

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

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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.

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.

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:

Treatment & Management

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Media Gallery

Anteroposterior (AP) radiograph of the hip reveals severe superior migration of the femoral head (which reflects loss of articular cartilage), subchondral sclerosis, prominent osteophytes, and a large Egger cyst in the superior acetabulum. Mild flattening of the superior aspect of the femoral head is present.
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; however, it can occur with a history of previous trauma.
Osteoarthritis of the elbow is not commonly seen; however, it can occur with a history of previous trauma.
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.
Arthroscopic view of a torn meniscus before (top) and after (bottom) removal of loose meniscal fragments.
Arthroscopic view of an arthritic knee.
Arthroscopic view of a knee after the removal of loose fragments of articular and meniscal cartilage.
Arthroscopic view of the removal of cartilaginous loose body.
Anteroposterior radiograph shows knee replacement in 1 knee and arthritis in the other, with medial joint-space narrowing and subchondral sclerosis.
Anteroposterior radiograph of the pelvis and hips shows an arthritic hip not treated surgically and a total hip replacement.
Anteroposterior radiograph obtained after knee replacement.
Lateral radiograph obtained after knee replacement (same patient as in the above image).
Oblique projection demonstrates gradual narrowing and sclerosis of the facet joints as one progresses down the lumbar spine.
Standing radiograph of the knee reveals narrowing of the medial and lateral femorotibial compartments with marginal osteophytes.
H&E stain, high power magnification showing clusters of chondrocytes (center) that is a proliferation known as "chondrocyte cloning". Image courtesy of Francis Gannon, MD.
H&E stain, medium power magnification showing numerous vertical slits (upper left) in the articular surface cartilage known as "fibrillation" with increase in eosinophilia of the remaining cartilage due to loss of proteoglycans. Image courtesy of Francis Gannon, MD.
Gross photograph of external (top) and cut surface (bottom) showing areas of complete loss of articular cartilage with peripheral osteophytes formation. Image courtesy of Francis Gannon, MD.

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Author

Carlos J Lozada, MD Director of Rheumatology Fellowship Training Program, Professor of Clinical Medicine, Department of Medicine, Division of Rheumatology and Immunology, University of Miami, Leonard M Miller School of Medicine

Carlos J Lozada, MD is a member of the following medical societies: American College of Physicians, American College of Rheumatology

Disclosure: Received honoraria from Pfizer for consulting; Received grant/research funds from AbbVie for other; Received honoraria from Heel for consulting.

Coauthor(s)

Schartess S Culpepper Pace, MD Assistant Professor of Medicine, Division of Rheumatology, University of Miami, Leonard M Miller School of Medicine

Schartess S Culpepper Pace, MD is a member of the following medical societies: American College of Rheumatology

Disclosure: Nothing to disclose.

Chief Editor

Herbert S Diamond, MD Visiting Professor of Medicine, Division of Rheumatology, State University of New York Downstate Medical Center; 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, Phi Beta Kappa

Disclosure: Nothing to disclose.

Acknowledgements

Samuel Agnew, MD, FACS Associate Professor, Departments of Orthopedic Surgery and Surgery, Chief of Orthopedic Trauma, University of Florida at Jacksonville College of Medicine; Consulting Surgeon, Department of Orthopedic Surgery, McLeod Regional Medical Center

Samuel Agnew, MD, FACS is a member of the following medical societies: American Association for the Surgery of Trauma, American College of Surgeons, Orthopaedic Trauma Association, and Southern Orthopaedic Association