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If you think you have symptoms of osteoarthritis (OA), it is key to see your GP as soon as possible. It is important to make an appointment and discuss the necessary treatment based on your particular symptoms, as early osteoarthritis diagnosis and treatment means the outcome is often more successful.
How do you diagnose osteoarthritis?
There is no single test that can be carried out for a firm diagnosis of OA; instead, there are osteoarthritis diagnosis criteria.
Your GP will start by looking at your medical history. They will ask whether there is a family history of the condition and explore the typical risk factors that can lead to the disease and may require further tests. Risk factors include:
- Your age: the disease typically presents in people over the age of 50.
- Obesity or excess weight: the stress on weight-bearing joints increases with excess weight.
- Excess joint activity or injury: your work or the choice of sport you play can increase the risk of developing OA.
- Repetitive actions: over a long period or where there are historic injuries to the affected joints, particularly ones that have been fractured or operated on, repetitive actions can contribute to the onset of OA.
- These risk factors do not immediately determine that OA will develop or the presence of OA; however, combined with other symptoms, they can contribute to a diagnosis.
- Your doctor will also check for physical symptoms:
- Tenderness in the joints
- Crepitus - creaking or grating sounds
- Swelling or bony protrusions
- Lack of movement
- Joint instability
- Muscle wastage
You may be asked to carry out some tasks to check the range of motion in the affected joins and your general mobility. If there is still a lack of clarity around diagnosing OA from a physical examination, your GP can refer you for further tests. Depending on the outcome of these, you may be referred to a specialist.
A blood test will not give a firm diagnosis of OA but will be used to rule out other forms of arthritis.
You can also be referred for a joint aspiration, otherwise known as arthrocentesis. This procedure is usually carried out on the knee but can also be performed on the hip, elbow or big toe. This procedure involves using a needle and syringe to take a fluid sample from your joint for further testing. The removal of fluid can relieve the joint of the symptoms.
The fluid will be examined for crystals, which should not be seen in healthy synovial fluid. Uric acid crystals present in the fluid would point towards a diagnosis of gout, while calcium pyrophosphate crystals indicate pseudogout. A white blood cell count higher than usual could show that there is infectious arthritis, gout or rheumatoid arthritis. Infection is determined by the presence of microorganisms and is confirmed with a further culture study. A high red blood cell count often follows injury to the joint and is also raised in those with OA.
Diagnosing OA is most commonly carried out using X-rays. An X-ray will highlight changes to the joints, particularly whether the bone has developed protrusions (osteophytes). An X-ray will also show whether there is reduced space between the bones or calcium has accumulated. People over 60 frequently present degeneration of the joint but not all will experience the symptoms associated with OA. The X-ray will be used to add to the full picture for a diagnosis.
A magnetic resonance imaging (MRI) scan does not give a definite diagnosis of osteoarthritis; however, as with an X-ray, it can be used to check for damage to the soft tissue in and around the joint, such as in the cartilage, tendons and muscles. It will also pick up any bone changes that the X-ray does not show and will rule out any other joint or bone issues.
Once all these factors have been examined, your doctor or specialist may reach a diagnosis of osteoarthritis and decide the best course of treatment, or they may not be able to reach a specific diagnosis. Either way, you may wish to pursue a course of treatment.
Knee osteoarthritis diagnosis: expert advice and treatment
We have a team of experts whose focus is specifically on knee osteoarthritis diagnosis and treatment. We understand that chronic knee pain can make day-to-day tasks difficult and have a debilitating effect on your quality of life. We would always encourage you to seek medical attention, as an early diagnosis and course of treatment can be more successful.
With this in mind, we have partnered with private physiotherapy clinics across the UK to offer a free 15-minute consultation, either in person or via Skype or telephone. Thee clinics will talk through your symptoms and discuss the possible next steps. Use our ‘find a clinic’ tool to find the closest clinic to you.
From there, our team of experts is on hand to provide up-to-the-minute advice and expertise across a range of specialisms linked to knee osteoarthritis, ensuring you receive the right course of treatment. Our experts are leaders in their specific fields: physiotherapists to elite sportsmen and women, physicians specialising in post-surgery rehabilitation, consultant orthopaedic surgeons and radiologists, and a clinical specialist orthotist.
The type of treatment available will depend on the severity of your symptoms. For more severe cases, surgical treatment may be prescribed, while non-surgical may be the course of treatment for those with less severe symptoms. A combination of the two could be the best course of action. Typically, non-surgical treatments will be performed before progressing to surgery.
Surgical treatment could include joint replacement surgery or keyhole surgery to remove loose pieces of bone and tissue from your knee. This technique, known as arthroscopic lavage, is not usually available on the NHS. Another treatment is joint fusion, which is where surgery is used to fix the bones of the joint together. This prevents the joint from moving and alleviates the associated pain.
Non-surgical treatments may involve managing the pain by using warm and cold compresses, walking aids, physiotherapy, supportive footwear and splints or braces.
Protecting the cartilage in the knee is key to minimising further damage and keeping the need for surgery at bay for as long as possible. A knee brace may be the most beneficial course of treatment, especially for those with unicompartmental knee OA. The brace dissipates the pressure to the worst affected areas of the knee by applying corrective forces, providing improved knee stability. Current knee braces have been more efficiently designed compared with their older, bulkier counterparts and come in a range of materials and fits.
Finding the right support or brace can be overwhelming, with different braces having different purposes. Some braces are designed to provide compression, managing inflammation around the joint and delivering pain relief. This type would do little to help those suffering from degenerative conditions such as osteoarthritis or where the ligament is unstable due to damage. Similarly, a brace that provides stability for continued mobility after ligament damage is no use to those with osteoarthritis.
There are several specific braces for OA sufferers. Unloader bracing is designed to provide relief for patients where the cartilage has degraded on one side of the joint, moving the pressure on the knee to the less affected side. Without the bones in the joint in friction, the pain is alleviated. Patellofemoral OA bracing is for those suffering from pain at the front of the knee, making climbing stairs difficult.
An accurate diagnosis is very important in ensuring you have the right brace. It is recommended that you speak to the manufacturer at a minimum before making a purchase, but it is best to consult a clinical professional. A professional with the relevant expertise will be able to make a recommendation tailored to your specific requirements.
They can check the fit and feel, as a good fit is essential to the brace working efficiently. They will also look at your condition holistically and provide advice about combined treatments such as orthotics, nutrition, physiotherapy and exercise.
Insoles and wedges may be recommended to work in combination with a knee brace depending on other symptoms, such as issues regarding your ankle. The right footwear can also have a beneficial effect, reducing pain and allowing you to pursue your normal activities. For those suffering from OA in the foot, ankle, knees or hips, the wrong footwear can exacerbate existing issues and cause long-term damage to joints, muscles, tendons and ligaments elsewhere in the body. High heels are notoriously bad, while flat shoes with good shock absorption, cushioning and arch support are recommended.
Muscles are strengthened through physical exercise, stabilising the knee joint and keeping the cartilage hydrated. Exercise can have the added benefit of losing weight, relieving pressure on the joint. Activities such as hiking, swimming and yoga are recommended, whereas high-impact sports such as squash, tennis and downhill skiing should be avoided.
These treatments will always work best when they are administered early and are guided by expert and professional clinical advice.