Radiographic Knee OA | Knee Osteoarthritis Signs & Symptoms

The diagnosis of osteoarthritis has often been based on the radiographic appearance of the joint space according to the criteria of Kellgren and Lawrence rather than clinical features. However, recent research has shown that radiographic imaging and the amount of pain and limitation a patient experiences does not have as strong of a correlation as once believed. More so, central sensitization and psychosocial factors might play an important role in explaining which patients with radiographic osteoarthritis experience pain and which don’t.

The cluster by Altman et al. from the year 1986 has a sensitivity of 95% and a specificity of 69% for three out of six signs and symptoms. With four out of six positive findings, sensitivity decreased to 84%, but specificity increased to 89%.

For this reason, this cluster has a high clinical value to rule out or confirm osteoarthritis of the knee.

The cluster contains the presence of knee pain plus the following six items:

1. Age older than 50 years, due to the fact that the prevalence increases with increasing age, with a peak around 78 to 79 years.
2. Morning stiffness of fewer than 30 minutes, which is an important factor to distinguish osteoarthritis from rheumatoid arthritis, in which case stiffness is usually lasting longer than 30 minutes.
3. Crepitations upon examination of range of motion. To assess this point, you can have your patient squat. It’s important to distinguish between bony crepitus, which rather sounds like a creaky door from synovial crepitus, which is the common pop a lot of people experience from an early age.
4. Tenderness upon palpation of bony margins. This is due to the fact that the subchondral bone, in contrast to the cartilage itself, is highly innervated and might be sensitive upon palpation.
5. Bony enlargement of the knee joint due to the formation of osteophytes.
6. No increase of temperature, which again is commonly associated with an active inflammatory process like in rheumatoid arthritis.

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As mentioned earlier, radiographs alone do not define the clinical syndrome of osteoarthritis, as 40% of the patients included in the study by Altman were asymptomatic. This is a good message as it opens up possibilities for an effective treatment, including load management, strengthening, mobility exercises, and maybe more importantly, proper patient education and explanation of how psychosocial factors might contribute to the patient’s individual pain experience.

Check out the signs & symptoms for hip osteoarthritis as well.

References

Altman, R., Asch, E., Bloch, D., Bole, G., Borenstein, D., Brandt, K., … & Wolfe, F. (1986). Development of criteria for the classification and reporting of osteoarthritis: classification of osteoarthritis of the knee. Arthritis & Rheumatism: Official Journal of the American College of Rheumatology, 29(8), 1039-1049.

Kim, C., Nevitt, M. C., Niu, J., Clancy, M. M., Lane, N. E., Link, T. M., … & Guermazi, A. (2015). Association of hip pain with radiographic evidence of hip osteoarthritis: diagnostic test study. Bmj, 351.