Osteoarthritis Symptoms and Diagnosis

Osteoarthritis (OA) is a type of joint disorder that develops when cartilage (slippery tissue that covers the ends of bones in the joints) wears away, allowing the joints to rub together.

The most commonly affected areas include these joints:

• Knees
• Hips
• Hands and fingers
• Spine

Osteoarthritis rarely affects the elbows, wrists, and ankles.

Most people with osteoarthritis are middle-aged or older because the condition occurs slowly over time, developing as a result of normal wear and tear on the joints.

It rarely affects people younger than age 40, and at least 80 percent of people over age 55 have X-ray evidence of the disorder, even if they present no clear symptoms.

But osteoarthritis can occur and cause symptoms in younger adults due to sports injuries, obesity, and other types of arthritis, which encompass various inflammatory joint conditions. (1)

Early Signs and Symptoms of Osteoarthritis

Osteoarthritis symptoms can vary from person to person, and some people don’t experience symptoms at first.

Common symptoms of osteoarthritis include these issues:

• Joint Pain It often gets worse with activity and better with rest (though exercise is an important part of arthritis therapy). Painful joints may be tender to the touch. If you have severe osteoarthritis, the joint pain may also occur when resting and at night.
• Stiffness People most commonly experience stiffness associated with osteoarthritis in the morning. The stiffness usually gets better within 30 minutes of getting out of bed, but it can return throughout the day if the joint remains inactive for too long.
• Swelling Excess fluid in the joints may cause swelling.
• Crepitus You may experience a crackling or grating sensation when moving an affected joint. This is called crepitus, and it may occur because the normally smooth surfaces inside the joint are becoming rough as the bones rub together.
• Bony Protuberances You may experience bony outgrowths or bone spurs under the skin near joints. In many people, these protuberances grow bigger over time. (1)
• Loss of Flexibility Over time, you may experience a loss of flexibility in the affected joint. (2)

Joint-Specific Osteoarthritis Symptoms

Osteoarthritis symptoms may vary depending on the joints involved.

For example, crepitus often occurs with knee osteoarthritis. The knee may also occasionally buckle or give away, and eventually, it may become bent and bowed. (3,4)

Hand osteoarthritis may cause numbness in the fingers and difficulty performing motions that require gripping and twisting, such as opening jars. Over time, you may lose the ability to completely open and close your fingers. (6)

If you have hip osteoarthritis, you may experience seemingly non-hip-related symptoms, including pain that starts in the groin or thigh and radiates to your buttocks or knee. You may also experience difficulties walking or develop limp in your walk due to a decreased range of motion in the hip. (7)

Arthritis of the spine, on the other hand, can cause feelings of weakness, tingling, or numbness in the arms and legs if the spinal cord is compressed. (8)

Osteoarthritis Testing and Diagnosis

Diagnosis of osteoarthritis typically begins with your doctor getting your medical history. You will be asked when your symptoms started, how they’ve changed over time, what other symptoms they are associated with, if you have morning stiffness, and what other medical conditions you or close family members have.

It’s important to let your doctor know if anyone else in your family has osteoarthritis: A family history of the disease is a risk factor for osteoarthritis. Most people with primary osteoarthritis (osteoarthritis that develops from normal wear and tear instead of a specific cause) have family members with the condition. (9)

You should also tell your doctor if you’re experiencing any psychological distress, including anxiety, insomnia, depression, weight loss, irritability, and increased forgetfulness and difficulty concentrating. (3)

Your doctor will then give you a physical examination to look for these signs of osteoarthritis or other ailments:

• Tenderness of the joint
• Crepitus
• Bony enlargement of the joint and joint deformities
• Restricted joint range of motion and pain during movement
• Instability of the joint that causes it to give away
• Altered gait
• Muscle atrophy or weakness
• Joint swelling from fluid (3)

Tests for Osteoarthritis

Your doctor will use a number of tools, including imaging and laboratory tests, to help determine whether you have osteoarthritis:

X-rays X-rays can help determine how much joint damage there is and how the joint is changing over time. They can also show problems such as cartilage loss, bone damage, and bone spurs. X-rays may appear normal during the early stages of osteoarthritis.

Magnetic Resonance Imaging (MRI) This is another type of imaging. It is used to examine cartilage, ligaments, and tendons for damage that can’t be seen on an X-ray.

Joint Aspiration In this test, your doctor will numb the painful area and insert a needle into the joint to take a fluid sample. A laboratory technician will examine the fluid for signs of crystals, infection, or inflammation. This test can be used to help rule out other medical conditions or forms of arthritis, such as gout. (2,10)

Arthroscopy In this surgical procedure, your surgeon will numb the area and then insert a small viewing tool (called an arthroscope) into the joint through several small incisions. Arthroscopy was once commonly used as a diagnostic tool for knee osteoarthritis but now is typically used only to determine the extent of cartilage damage (for this application, arthroscopy may be better than an MRI). (11)