What Does Arthritis Look Like? Recognizing the Symptoms

Arthritis can cause visible changes to the joints, making them look knobby or puffy. Often, however, a hand, knee, or other body part affected by arthritis looks normal on the outside. An X-ray or other imaging test can help your healthcare provider see changes in the joints that are not otherwise visible.

This article discusses the visible and physical symptoms of arthritis in different parts of the body, and what arthritis looks like on an X-ray.

Recognizing the Symptoms of Arthritis

Arthritis refers to a group of diseases that cause inflammation and swelling of one or more joints. There are more than 100 different types of arthritis that affect all ages, races, and genders, with the most common types being:

• Osteoarthritis
• Rheumatoid arthritis
• Psoriatic arthritis

Symptoms vary depending on the type of arthritis but usually include:

• Joint pain
• Stiffness
• Decreased range of motion
• Swelling

Symptoms can come and go, or they may be chronic and get worse over time.

Arthritis symptoms can vary in intensity, from mild or moderate symptoms to severe disability that makes everyday tasks and functional movements like standing and walking very difficult and painful.

Osteoarthritis

Osteoarthritis, also called degenerative joint disease, affects more than 30 million Americans. While many people associate osteoarthritis with the wear and tear that the body’s joints endure over time with aging, more than half of Americans affected by osteoarthritis are under the age of 65.

Osteoarthritis can affect any joint, but it's most common in the:

• Back and spine
• Hips
• Knees
• Neck
• Shoulders
• Fingers and hands

Anyone who repetitively overuses their joints, including athletes, military personnel, and those with physically demanding jobs, may be at an increased risk for developing osteoarthritis.

Cartilage is a form of connective tissue that covers the end of each bone in the body and provides cushioning and shock absorption to the joints, allowing them to move smoothly. In osteoarthritis, the cartilage breaks down over time, causing pain and increased difficulty moving the joints.

Bones may begin to break down with worsening arthritis, resulting in painful excess growth of bone called bone spurs, or osteophytes, that can cause further damage to the cartilage. In severe osteoarthritis, the cartilage wears down so much that bone rubs directly against the bone with movement of the joints, causing increased pain, inflammation, and joint damage.

On an X-ray, osteoarthritis can look like a narrowing of the space between the bones in the affected joint. There may also be visible bone spurs in the joint's margins.

Risk factors that increase the likelihood of developing osteoarthritis or progressing symptoms include:

• Older age
• Genetics
• Obesity
• Low bone density
• History of trauma or joint injury
• Low levels of physical activity

Arthritis in the Back and Spine

Osteoarthritis of the spine often occurs with aging, but can progress faster in people who have poor posture, are very sedentary, do not exercise, or are overweight.

Symptoms of spinal arthritis include:

• Low back pain
• Stiffness in the spine and loss of range of motion
• Tenderness over the affected vertebrae of the spine
• Possible nerve root compression 

Arthritis of the spine can cause degenerative narrowing of the openings in the vertebrae where the spinal cord and nerve roots sit. If the narrowing is severe, compression of the spinal cord or nerve roots can develop, causing radiating pain into the hips and legs, resulting in a condition called spinal stenosis.

Other symptoms include numbness, weakness, burning, or tingling in the legs.

Hip Arthritis

Osteoarthritis of the hip usually affects people over 50 years old and occurs when the cartilage in the ball and socket joint of the hip wears down over time from aging or injury. Pain and stiffness develop in the hip, and are usually worse in the morning, after prolonged sitting, or upon waking in the morning.

Other symptoms of hip osteoarthritis include:

• Groin or thigh pain
• Grinding or clicking of the hip joint
• Decreased range of motion
• Increased pain with weather-related pressure changes

When symptoms of hip arthritis are severe, standing and walking become difficult and painful. If they do not improve with conservative treatment options, total hip replacement surgery may be performed to reduce pain and improve function.

Knee Arthritis   

The prevalence of knee osteoarthritis has been increasing in the United States each year. It is estimated that 45% of all Americans will develop knee osteoarthritis sometime in their lifetime, and of those diagnosed, 54% will receive a total knee replacement to treat their symptoms.

A total knee replacement is often the last resort used to treat severe symptoms of knee osteoarthritis when the cartilage of the knee joint has significantly worn down, limiting everyday activities and making standing, walking, and going up and down stairs very challenging and painful.

Common athletic injuries including anterior cruciate ligament (ACL) ruptures, meniscus tears, and patellar (kneecap) dislocations place patients at an increased risk for developing knee osteoarthritis later on. Approximately 50% of patients who suffered an ACL rupture will develop knee osteoarthritis between five and 15 years after injury.

Arthritis in the Neck

Osteoarthritis of the neck, also called cervical spondylosis, affects more than 85% of people over the age of 60. Pain and stiffness in the neck are the most common symptoms. They often respond well to conservative treatments like pain medications and physical therapy.

Symptoms of neck arthritis can worsen with looking up or down for a sustained duration or with activities like driving and reading that involve holding the neck in the same position for a prolonged period of time. Rest or lying down often helps to relieve symptoms.

Other symptoms of neck arthritis include:

• Headaches
• Grinding or cracking when moving the neck
• Muscle spasms
• Possible nerve root compression 

Arthritis in the Shoulder

Osteoarthritis of the shoulder usually affects people over 50 years of age, and is more common in the acromioclavicular joint than the glenohumeral joint of the shoulder. The acromioclavicular joint is where the clavicle joins the shoulder blade, while the glenohumeral joint is the ball and socket joint of the shoulder that allows the arm to move.

Arthritis of the shoulder can develop over time from repetitive wear-and-tear or following a traumatic injury such as a shoulder fracture, dislocation, or rotator cuff tear. The most common symptoms of shoulder arthritis include pain, stiffness, and loss of range of motion. As arthritis progresses, any movement of the shoulder can cause pain.

If symptoms do not improve with conservative measures, surgical methods may be used to manage symptoms of shoulder arthritis. Surgical options include:

• Arthroscopy: During shoulder arthroscopy, a surgeon makes small incisions around the shoulder to insert a camera and surgical instruments to clean out the inside of the shoulder joint.
• Total shoulder replacement: Severe shoulder osteoarthritis can be surgically treated with a shoulder replacement, or arthroplasty, where the ball and socket of the glenohumeral joint are replaced with metal components to reduce the bone on bone contact. Sometimes a reverse total shoulder replacement is performed which the ball and socket components of the shoulder joint are reversed.
• Resection arthroplasty: Resection arthroplasty is used to treat arthritis of the acromioclavicular joint, where the end of the clavicle is removed to reduce irritation and compression.

Arthritis in the Fingers and Hands

It is estimated that 40% of all adults in the United States will be diagnosed with osteoarthritis in at least one hand before the age of 85, with women being twice as likely as men to develop symptoms.

Arthritis of the hands and fingers causes painful inflammation and swelling of the joints of the wrists and fingers, making activities like gripping, grasping, and pinching very challenging and painful. Over time, arthritis can cause noticeable deformation of the finger joints.

Medications, cortisone injections, splinting, physical therapy, and activity modification can all be used to help manage symptoms. If arthritis affects the thumb joint and conservative measures fail to improve symptoms, a trapeziectomy may be performed to decrease joint pain and inflammation.

Rheumatoid Arthritis

Rheumatoid arthritis (RA) is an autoimmune condition where the body produces an immune system response to attack its own joints, causing pain, inflammation, and swelling. Over time, the cartilage breaks down, narrowing the space between bones, and joints can become unstable or stiff.

If left untreated, rheumatoid arthritis can cause permanent and irreversible joint damage. 

Unlike osteoarthritis, which is more likely to develop on one side of the body, rheumatoid arthritis is usually symmetrical affecting both sides of the body, most commonly in the hands, feet, wrists, elbows, knees, and ankles.

On an X-ray, rheumatoid arthritis can look similar to osteoarthritis, but it is more likely to affect multiple joints of the body. It can also cause systemic body symptoms like fatigue and weakness, and it produces prolonged morning stiffness more than osteoarthritis. Women are two to three times more likely to be diagnosed with rheumatoid arthritis than men.

Psoriatic Arthritis

About 30% of patients with psoriasis, an inflammatory condition of the skin, develop an autoimmune, inflammatory form of arthritis called psoriatic arthritis. Psoriatic arthritis can affect the joints of the entire body and result in permanent joint damage if left untreated.

Psoriasis affects 74 million adults in the United States, and 60-70% of patients diagnosed with psoriasis will develop psoriatic arthritis.

While there is no treatment to cure the condition, medications may help reduce symptoms like joint pain and inflammation and prevent disease progression. Treatment is aimed at promoting remission and preventing joint damage.

How Is Arthritis Diagnosed?

The prognosis for those diagnosed with arthritis becomes worse the longer the condition goes undiagnosed, so it is important to seek medical attention if you think you might have symptoms of arthritis. A physical examination combined with a review of your medical history and X-ray imaging are used to confirm a diagnosis of arthritis and identify the affected joints. 

Blood tests that examine levels of rheumatoid factor, anti-cyclic citrullinated peptide, erythrocyte sedimentation rate, and C-reactive protein can help confirm a diagnosis of rheumatoid arthritis or psoriatic arthritis since these substances are typically elevated in these inflammatory conditions.

Summary

Arthritis can sometimes cause visible changes, such as knobby joints. However, you often need an X-ray to see the effects of arthritis.

Arthritis symptoms can vary from mild discomfort to significant disability that can limit everyday activities. It is important that you seek medical attention if you have been experiencing joint pain, stiffness, or swelling for more than three months.

The most common type of arthritis is osteoarthritis, which can affect the knees, back, shoulder, hands, and other joints. Other types of arthritis include rheumatoid arthritis and psoriatic arthritis.