When a person presents to a physician with complaints of joint pain and swelling, the doctor understands that numerous conditions could cause these symptoms. The history you provide and the results of your physical exam may point to one or more diagnoses. It is helpful to have further evidence to help clarify one diagnosis and eliminate others. Therefore, it is appropriate to perform x-rays on any swollen and painful joint to help determine the cause of these symptoms.
People with OA have characteristic changes in the joints that can be seen on an x-ray. These changes include an uneven loss of cartilage in the joint, called “loss of joint space” on the x-ray interpretation. Small growths of bone (bone spurs) may develop around the joints, and the bone underneath the cartilage may become thickened or hardened (bony sclerosis). In addition, the bone may change shape and develop cysts. In the early stages of OA, these bone changes may appear on x-rays, but the patient may not experience any pain or swelling.
Although x-rays cannot conclusively confirm the presence of OA, they can be a useful tool for distinguishing between OA and rheumatoid arthritis, gout, and other conditions. Additionally, x-rays establish a baseline for comparison. As the disease progresses, they can be used to monitor changes in the bones over time. Often, as part of a person's initial evaluation with a rheumatologist, chest x-rays are ordered in addition to x-rays of any swollen joints. Chest x-rays are performed to evaluate the lungs for diseases that are sometimes associated with arthritis.
X-rays are usually performed in a special hospital department (Radiology) by a radiologic technician or a radiographer, who will tell you which part of your body is to be x-rayed. These technicians are highly skilled. They must have college degrees, undergo additional training, and pass a state licensing examination before they can take x-rays. These technician's training is different from that of the radiologist—a radiologist is a physician who is trained to interpret x-ray images.
To make the image, x-rays are passed through your body and captured on special film. This film is then developed and examined. Standard x-rays are particularly good at showing abnormalities of the bone, but they rarely show problems in soft tissues. For this reason, they do not show the changes associated with early-stage arthritis very well. Despite this drawback, x-rays can highlight areas that help the doctor to diagnose arthritis, such as damaged areas on the bone.
I am not certain about diagnosis not concerning the spine. In my case MRI's were performed to confirm the diagnoses and pinpoint the areas in the neck and spine that were causing the pain.