How to read a joint scan without borrowing trouble

Ask what the arthritis x ray shows

A report may mention less space between bones, bone spurs, or bones that no longer line up evenly. Those findings can support a diagnosis. They don't measure your soreness or show how easily you walk, climb stairs, or reach. Words such as mild or severe describe what appears on the scan.

Your day may feel quite different.

Ask the doctor to show which finding matches the exact sore spot. An old change elsewhere in the joint may not explain today's ache. For example, a break found after a fall needs prompt care. Old wear that doesn't match your exam may leave home care unchanged.

Bring the scan and a short note

Bring the written report and the scan images if you have them. Add the date of the first ache and movements that set it off. Include old injuries, current medicines, and any care that helped or didn't help. The doctor will then have useful facts beside the scan.

A few lines are enough.

If a report phrase worries you, ask what it means for walking, sleep, strength, or motion now. Ask if the finding sits where the joint hurts. The answer ought to join the scan and exam with the ordinary activity that's become difficult.

Ask whether another scan would change your care

A new scan may help after a fall, sudden locking, fast loss of motion, or fresh swelling. It can also help before a talk about surgery. Sometimes the exam suggests that soreness comes from the back or from a tendon near the shoulder. An MRI may then show more than an X-ray.

More detail isn't always useful.

Ask if a new scan would alter the doctor's advice about home care, medicine, or surgery. Ask what the doctor would suggest if it shows little change. When both answers are the same, you won't lose anything by waiting.

Sources

1. In the Framingham Osteoarthritis Study, 710 people over 50 with NO radiographic evidence of knee osteoarthritis underwent knee MRI: 89% had 'any abnormality'. Osteophytes appeared in 74%, cartilage damage in 69% and bone marrow lesions in 52%. Prevalence of at least one abnormality was 90-97% in painful knees and 86-88% in painLESS knees.

   Guermazi A, et al. — Prevalence of abnormalities in knees detected by MRI in adults without knee osteoarthritis: population based observational study (Framingham Osteoarthritis Study).. BMJ, 2012. DOI: 10.1136/bmj.e5339.

2. A systematic review found the proportion of people with knee pain who have radiographic osteoarthritis ranges from 15% to 76%, and the proportion of people with radiographic knee OA who have pain ranges from 15% to 81%. The authors conclude X-ray results should not be used in isolation when assessing an individual patient with knee pain.

   Bedson J, et al. — The discordance between clinical and radiographic knee osteoarthritis: a systematic search and summary of the literature.. BMC Musculoskelet Disord, 2008. DOI: 10.1186/1471-2474-9-116.

3. The Lancet Seminar on osteoarthritis states that diagnosis is clinically based despite widespread OVERUSE of imaging, that management should focus on core treatments - self-management and education, exercise, and weight loss where relevant - and that surgery should be reserved for people who have not responded appropriately to less invasive methods.

   Hunter DJ, et al. — Osteoarthritis.. Lancet, 2019. DOI: 10.1016/S0140-6736(19)30417-9.

4. In a two-year double-blind randomized trial of 140 patients with symptomatic knee OA and ultrasonic synovitis, intra-articular triamcinolone 40 mg every 12 weeks produced significantly greater cartilage volume loss than saline (index compartment cartilage thickness change -0.21 mm vs -0.10 mm; between-group difference -0.11 mm, 95% CI -0.20 to -0.03) with NO significant difference in pain.

   McAlindon TE, et al. — Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain in Patients With Knee Osteoarthritis: A Randomized Clinical Trial.. JAMA, 2017. DOI: 10.1001/jama.2017.5283.