Diagnosing Arthritis

Content provided by the Faculty of the Harvard Medical School

Diagnosing arthritis poses a significant challenge to any physician because of the sheer number of conditions that can cause joint discomfort and because there are rarely tests available to establish a definitive diagnosis. Consequently, a doctor must rely heavily on your description of symptoms and other relevant information, plus a physical examination. That's why you should prepare for your appointment by making a list of your symptoms and the circumstances under which they occur. Do you notice them during or after a particular activity? Or first thing in the morning?

Primary care doctors can usually determine at the first visit whether the problem is a form of arthritis or some other musculoskeletal problem. But it may take several visits for your physician to make a more specific diagnosis. While this delay can be frustrating for the patient and family, charting the course of your symptoms is often the only way a doctor can accurately diagnose arthritis.

Your Medical History

Your symptoms — what they are, when they first began, and how they've changed over time — provide potent clues to whether arthritis is inflammatory or noninflammatory. Your doctor will need to know about the following:

  • type of joint symptoms (such as pain or stiffness)

  • effect of activity (such as increased pain or relief of stiffness during or after a particular activity)

  • general pattern of joint symptoms (started gradually or suddenly, worsened over time or stayed about the same, migrated from one joint to another, or fluctuated in intensity)

  • any other symptoms (fever, fatigue, weight loss, skin problems, bowel problems)

  • events that occurred near the time the symptoms first appeared (such as viral illness, bacterial infection, injury, vaccination, new medication, or change in activity)

  • time of day that joint symptoms are worst (prolonged morning stiffness suggests inflammatory arthritis; night pain is more typical of noninflammatory joint disease)

  • presence or absence of joint swelling, redness, or warmth

  • previous episodes of similar symptoms

  • family history of arthritis or rheumatic disease.

Pain and Stiffness

In rheumatic diseases, pain and stiffness go hand in hand. Pain is a subjective experience that's often difficult for people to describe, quantify, or even pinpoint. Chronic arthritis produces aching pain when the affected joints are moved, as opposed to the burning or prickling pain unrelated to motion that typifies neurologic disorders. Most people can describe the location of pain in small joints, such as the hands or feet. However, with large joints, the pain is generally more diffuse and may radiate, making it difficult to pinpoint. For example, hip arthritis may cause pain in the groin, thighs, buttocks, or even knees.

People often describe vague muscle aches as stiffness, but rheumatologists use the term more specifically for joint discomfort when a person attempts to move: stiffness is the tendency of a joint not to move easily and may be prominent even when joint pain is not. The duration of stiffness in the morning or after any period of inactivity can help doctors distinguish osteoarthritis from rheumatoid arthritis and other types of arthritis.

Mild morning stiffness is common in osteoarthritis and resolves after a few minutes of activity. Sometimes people with osteoarthritis notice more stiffness during the day after resting for an hour or so. In rheumatoid arthritis, however, morning stiffness may not begin to improve for an hour or longer. Occasionally, morning stiffness is the first symptom of rheumatoid arthritis.

The nature and duration of your joint symptoms can be helpful. For example, pain and stiffness that develop gradually and intermittently over several months or years suggest osteoarthritis. Rheumatoid arthritis or another inflammatory arthritis may cause pain, stiffness, and fatigue that worsen over several weeks or a few months. In contrast, sudden pain is more likely a result of injury or fracture, and pain that intensifies over several hours is typical of bacterial infection or gout.

Your Guide to Arthritis

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Treatments for any type of arthritis are largely the same.