The problem with using X-rays to diagnose arthritis

June 18, 2013

Mark L. Friedman, MD, FACEP, FACP

Anyone can have "˜arthralgias' "“ joint pains "“ at any time in their life. Virtually everyone who has been diagnosed with "˜arthritis' "“ inflammation of the joints "“ can assume that they will have pain in the affected joints occasionally, frequently, or even constantly. At least, that's what the public has been led to believe.

The truth is, there are many types of arthritis and many causes for arthralgias that have nothing to do with arthritis.

What I have noticed is that many physicians make a clinical diagnosis of arthritis, usually osteoarthritis, also known as "˜wear and tear' arthritis, based solely on a patient's symptoms. In truth, there are several factors that go into the proper diagnosis of true arthritis "“ the presence of joint tenderness, redness of the skin around the joint, inflammation of the joint capsules, the presence of inflammatory markers in the blood such as elevated CRP, sed rate, ANA, etc. In addition, especially if few or none of these markers are present, X-rays revealing joint damage may indicate the presence of probable current or past joint inflammation.

As I always say, "A proper diagnosis leads to proper treatment."

What I would like to emphasize, however, is that being diagnosed with arthritis is not only frequently an inaccurate label foisted upon you by your clinician, but even the presence of true, clinical arthritis does not mean you will have pain or immobility for the rest of your life.

In my years in medicine, I have seen people with X-rays that show NO EVIDENCE of joint damage and their blood tests show virtually no evidence of inflammatory disease, but their clinical symptoms are quintessentially those of arthralgias, immobility, even body-wide pain. I have seen other patients with knee X-rays showing joint damage so severe that they shouldn't be able to walk, but instead continue to play sports or dance without any significant pain or impairment.

With the advent of modern pain medications, anti-rheumatic medications, and more importantly prolotherapy to help heal ligaments, tendons, and cartilage around joints, even people with significant joint damage may regain partial or even full mobility of affected joints.

For those with no evidence of joint injury or inflammatory disease, a proper assessment by a doctor truly experienced in the diagnosis of the other causes of joint destabilization and pain may lead to a better understanding of what ails you "“ leading to proper treatment.

A good osteopathic examination, for example, by a D.O. (Doctor of Osteopathic Medicine) "“ which includes all of the above tests as well as a full hands-on functional assessment of the neurologic, muscular, and skeletal systems "“ may lead to diagnoses that are not found by other means. More importantly, a D.O. properly trained in hands-on osteopathic manipulative treatment and other treatments such as prolotherapy may be able to decrease pain and restore function where others have not succeeded.

Don't let the diagnosis of arthritis get you down. Explore your options and get moving!

Dr. Cohn is employed at the Born Preventive Health Clinic in Grand Rapids, Michigan, where he is focused on treating acute/chronic pain and injury via osteopathic manipulation and prolotherapy. Dr. Cohn regularly blogs on medical issues and other issues of global and personal interest.

Originally published Jun 18, 2013 10:00:06 AM.