Can X-rays diagnose arthritis?

An x-ray can show the damage done to the bones of the joint due to loss of protective cartilage and bones rubbing directly against each other.

X-rays are more than sufficient for diagnosing arthritis. They can show bone spurs (osteophytes), subchondral cysts (the fluid-filled cysts that sometimes occur beneath the hardened bone), and joint space narrowing (the most classic finding in arthritis of the knee). As the cartilage degenerates, the bones move closer and closer together until they actually grind into each other. X-rays can mark this progression, although hopefully measures will be taken to slow or halt the progression once it is identified.

The degree of severity of arthritis on an X-ray often does not correlate with symptoms. A person with a terrible looking X-ray of the knee may be completely symptom-free. Likewise, a person who shows minimal arthritis on an X-ray may be experiencing severe pain. This does not mean that one person is stoic and the other is a complainer. Different people have higher or lower thresholds for pain, depending on their body biochemistry and the synapses within their brain. Many factors influence the pain threshold in a given individual, including social support, depression, painful stimuli and other potential biochemical and neuromodulating factors.

A treatment plan should be based on the severity of the symptoms, not X-ray findings. X-rays allow doctors to follow the progression or remission of disease and give an idea as to the extent of the anatomic damage that has already occurred.

The presence of asymptomatic findings of arthritis on an X-ray should be taken as a warning that the joint is not healthy and will probably become painful if you don't start taking better care of it. Noticing signs of arthritis on X-ray should prompt a greater sense of urgency for the patient to take steps to reduce the risk of developing worsening arthritis, which likely will eventually lead to pain and suffering if it is not appropriately managed.