Do you have osteoarthritis? Monitor your symptoms

Researchers seeking the underlying cause of osteoarthritis (OA) have expanded their search beyond cartilage and into the underlying bone. Early diagnosis and treatment is the best approach for any type of OA, but is especially important for OA of the knee.

• Treatment, including drugs, weight loss, exercise, hyaluronic acid injections and walking aids can all help prevent further joint damage.
• If left untreated, OA of the knee can become disabling, leaving joint replacement surgery as a patient's only recourse.

You should be concerned if:

• One or more joints has a deep and aching pain that is steady or intermittent
• Pain is worsened by exercise or other activities and eased by rest
• Joint pain develops that won't go away, even after resting the joint for several days
• One or more joints feels stiff for 30 minutes or less after you get out of bed
• One or more joints swells or feels tender
• Affected joint has grinding feeling or makes a grinding sound
• When you start moving after sitting during the day — after driving a fairly long distance or seeing a movie, for example — you feel stiff for the next 20 or 30 minutes

Joint pain that does not abate after a few days of rest is a clear signal that you should see a doctor. Experts now believe that morning stiffness (also known as gelling) results from the accumulation of synovial fluid inside the joint while the person with arthritis is asleep.

Once the person wakes up and starts moving, the excess fluid is pumped out and the stiffness subsides. Osteoarthritis pain tends to worsen toward the end of the day. In many other types or arthritis, the pain remains constant during the day or is worse in the morning.

If your doctor skimps on either the conversation or the physical exam and tries to diagnose or rule out osteoarthritis on X-rays alone, find yourself another doctor.

Taking your medical history as part of the initial visit is a crucial part of the diagnostic process, since it can help your doctor determine what type of arthritis you have and choose the right laboratory tests to confirm the diagnosis.

You can do your doctor and yourself a big favour by arriving well-prepared. Try to bring:

• Your medical records, including copies of recent X-rays and blood tests
• A list of other medical problems that you have
• A list of all the drugs you take — prescription and over-the-counter as well as herbs or other dietary supplements
• A written "narrative" in which you describe your problem as fully as you can, including: how long ago the joint pain began, whether the symptoms came on suddenly or slowly, which joints were initially affected, what triggered the symptoms (e.g., exercise, climbing stairs, etc.) and the activities most strongly impacted by your joint pain.

Bones and bone spurs can be seen on X-rays, but cartilage is invisible because it doesn't contain calcium salts.

So cartilage is essentially visualized by its absence: In a normal joint, the black and apparently blank space separating two bones is the cartilage at the ends of the bones.

As osteoarthritis progresses, X-rays show this blank space increasingly narrowing as more cartilage is lost and the bones get closer together.