In the first place diagnostic tests for osteoarthritis involve X-rays that will show typical changes of the adjacent bone called osteosclerosis. In addition, there often are osteophytes visible and possibly bone cysts in the bone adjacent to the osteoarthritic joint. Equally important, blood tests can be done to rule out other causes such as gout, where the uric acid level would be high, or rheumatoid arthritis, where the sedimentation rate and the rheumatoid factor would be elevated.
MCP, PIP and DIP joints
All these tests tend to be normal with osteoarthritis. However, with osteoarthritis of the finger joints there is a characteristic distribution of degenerative changes on X-rays. The hand/finger joints have three levels that can get affected. The first level are the MCP joints (=metacarpophalangeal) between the hand and the fingers (commonly called the “knuckles”). Second, the next row of joints are called the PIP joints (=proximal interphalangeal) and finally, the last row at the end of the fingers are called DIP joints(=distal interphalangeal). Typically with osteoarthritis degenerative changes are confined to DIP joints and PIP joints, but on the contrary, the MCP joints are typically not affected.
Diagnostic criteria of osteoarthritis
In the same fashion, the physician knows from the distribution pattern along with the characteristic X-ray changes mentioned above that this person suffers from osteoarthritis. Rheumatoid arthritis, in contrast, presents with a more proximal pattern with sparing of the PIP and DIP joints. In the end stages of osteoarthritis there is a complete loss of the joint space due to a loss of the cartilage layer of the joint. For the most part, bone is now rubbing on bone. In any event, it is no wonder that these patients are having excruciating pain!
The diagnosis is made on the basis of the history, the clinical examination, the X-rays and possibly by ruling out other underlying conditions that may contribute to osteoarthritis. For instance, the rare condition of hemochromatosis could lead to osteoarthritis in a young patient where normally osteoarthritis would not be expected. Treatment of this condition, when diagnosed, could prevent the worsening of osteoarthritis. Acromegaly due to an adenoma of the anterior pituitary gland can also cause osteoarthritis, which will respond by taking care of the underlying growth hormone overproduction. There is also a hereditary type II collagen defect and other hereditary connective tissue abnormalities (dysplasias) that can cause osteoarthritis. Unfortunately physicians do not have all the answers to these conditions.
Alternative Medicine Approach to Osteoarthritis
Osteoarthritis is a disease of the older patient. Aging is associated with hormone changes that often can be significant, but can be diagnosed only with appropriate blood tests. Many physicians feel uncomfortable with this, but as mentioned in the book cited below (Ref.8) anti-aging physicians will be able to help you with this. Most patients have already been on several years of anti-inflammatory medications, which interfere with the body’s hormone synthesis pathways.
Disbalanced hormones at the onset of osteoarthritis
For instance, progesterone is often low in both men and women at the age when osteoarthritis strikes, which leads to accelerated breakdown of the cartilage in joint surfaces. However, it would be a mistake to only measure progesterone levels as often a number of other hormones are out of balance as well as I have summarized how “anti-aging medicine for women and men” works in a link under related topics at the end of this page. In addition to healthy nutrition, exercise and regular sleep, replacement with bio-identical hormones will bring the body’s functions back to normal. In this state bone and cartilage repair and breakdown are back to a youthful functioning (osteoarthritis is not part of youthful joints).
1. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 52.
2. ABC of rheumatology, second edition, edited by Michael L. Snaith , M.D., BMJ Books, 1999.
3. EL Cain et al. Clin Sports Med 2001 Apr;20(2):321-342.
4. B. Sears: “Zone perfect meals in minutes”. Regan Books, Harper Collins, 1997.
5. Goldman: Cecil Textbook of Medicine, 21st ed.(©2000)W.B.Saunders
6. Ferri: Ferri’s Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc.
7. Rakel: Conn’s Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier
8. Suzanne Somers: “Breakthrough” Eight Steps to Wellness– Life-altering Secrets from Today’s Cutting-edge Doctors”, Crown Publishers, 2008