Arthritis Imaging in Ajax: What X-Rays Can Show

“Arthritis” is not a single condition. The word simply means inflammation of a joint, and it is used as an umbrella for many different conditions. The two that people hear about most often are osteoarthritis, which develops gradually as the cartilage cushioning a joint wears and the bone around it remodels, and inflammatory forms such as rheumatoid arthritis, in which the body’s immune system targets the lining of the joints. Gout, psoriatic arthritis and others sit under the same umbrella.

Because the causes differ, the way arthritis is investigated differs too. Still, one test comes up again and again across all of them: the plain X-ray. It is quick, widely available and very good at showing bone, which is where many of the lasting signs of arthritis eventually appear.

This article explains what a joint X-ray can show about arthritis, where it falls short, and what to expect if your provider has sent you for one. It is written for people in Ajax, Pickering, Whitby and surrounding communities and is meant to help you have a more informed conversation with your health-care provider, not to replace it.

Reading a joint like a radiologist does

A healthy joint on X-ray has a recognizable look. The ends of the two bones are smooth and rounded, and there is a clear gap between them. That gap is not empty space; it is filled with cartilage, which does not show up on X-ray. So when a radiologist looks at the “joint space,” they are really looking at an indirect sign of how much cartilage is there.

When a radiologist reports on arthritis, they often comment on a handful of features. You may see some of these words in your report.

Joint space narrowing

As cartilage thins, the bones sit closer together, and the gap on the X-ray gets smaller. Narrowing can be even across the joint or more pronounced on one side, which can tell the reader something about the type of arthritis.

Osteophytes

Often called bone spurs, osteophytes are small outgrowths of bone at the edges of a joint. They are a typical feature of osteoarthritis and represent the bone’s attempt to remodel.

Subchondral sclerosis

This is a mouthful that means the bone just under the cartilage looks whiter and denser than usual. It is another response of bone to changing load.

Cysts

Small, rounded, darker areas near the joint surface can appear in some forms of arthritis.

Erosions

In some inflammatory types of arthritis, the edges of the bones can develop small “bites” called erosions. Their pattern and location can help a provider think about which kind of arthritis is present.

Alignment

X-rays show whether a joint is lined up as expected. In the knee, for example, they can show if one side of the joint has worn more than the other, which can affect alignment. In the fingers, they can show drifting or bending of the small joints.

Joints that are commonly X-rayed for arthritis

Almost any joint can be imaged, but some come up far more often than others.

• Knees. Often imaged with you standing, so the joint is bearing weight. Standing views can show narrowing that would not be visible lying down, because the cartilage is under load.
• Hips. Usually imaged lying down, with a view of the pelvis and sometimes an additional view of the hip itself.
• Hands and wrists. Common in both osteoarthritis and inflammatory arthritis. Both hands are often imaged together so they can be compared. Our practical guide to hand and wrist X-rays explains how those images are taken.
• Feet and ankles. Often part of the work-up when inflammatory arthritis or gout is a question, and for big-toe joint stiffness.
• Shoulders. Imaged when stiffness and pain suggest joint changes rather than a tendon problem.
• Spine. Wear-related changes in the spine are common. If back or neck pain is what brings you in, see our posts on back pain X-rays and cervical spine X-rays.

Why the picture and the pain do not always agree

This is perhaps the most important thing to understand about arthritis imaging. The amount of change on an X-ray and the amount of pain or stiffness a person feels do not always line up.

Some people have quite marked changes on their knee X-ray and get through the day with only mild aches. Others have significant pain and relatively modest X-ray findings. There are several reasons for this:

1. X-rays show bone, not everything else. Pain can come from the joint lining, surrounding muscles, tendons and ligaments, none of which show in detail on a plain X-ray.
2. Early changes may not be visible yet. In the early stages of some types of arthritis, the joint can be inflamed and painful before the bone changes enough to appear on X-ray.
3. Each person’s experience of pain is different. Activity levels, strength, sleep and many other factors influence how a joint feels.

For these reasons, providers look at X-ray findings together with your history, examination and sometimes blood tests. An X-ray is a helpful baseline and a way to track change over time, but it is rarely the whole story on its own.

Where ultrasound and other tests fit in

Because X-ray does not show soft tissue well, providers sometimes use ultrasound alongside it. Ultrasound can show fluid in a joint, thickening of the joint lining and the condition of nearby tendons, and it allows the sonographer to watch structures move in real time. Our article on musculoskeletal ultrasound describes what that type of scan looks at.

Other tests, such as MRI, may be arranged by your provider or a specialist when more detail is needed. Blood tests can be part of the picture for inflammatory types of arthritis. Your provider will decide which, if any, are needed.

Arthritis is not the same as osteoporosis

People sometimes mix these up because both involve bones and both become more common with age. Arthritis affects joints. Osteoporosis is a loss of bone strength throughout the skeleton that makes fractures more likely. A joint X-ray is not designed to measure bone density; a separate test, bone mineral density, does that. It is entirely possible to have one condition, both or neither.

Getting ready for a joint X-ray

Preparation is minimal, but these steps help things go smoothly:

• Wear clothing without metal near the joint being imaged. Leggings or track pants without zippers work well for knees and hips; you may also be offered a gown.
• Remove jewellery from any hand, wrist or ankle being imaged.
• Mention past surgery. If you have had a joint replacement, plates, screws or other hardware, let the technologist know. It does not stop the X-ray, but it helps them choose positions.
• Tell the technologist if you might be pregnant.
• Bring your health card and any paperwork from your provider. If you are unsure what to bring for a walk-in visit, call the clinic to confirm.
• Let us know about mobility needs. Standing for knee images or climbing onto the table can be hard with sore joints. Our clinic has ground-floor access, and technologists will help you get into position safely and at your own pace.

Making sense of the report with your provider

Arthritis reports can be full of unfamiliar terms, and reading one on a patient portal before your appointment can be unsettling. Words such as “degenerative,” “moderate” or “advanced” describe what the images look like, not how well you will manage day to day. It can help to jot down a few questions before your follow-up visit:

• Which features on the report are typical for my age, and which are not?
• Does the pattern suggest one type of arthritis more than another?
• Is anything on the report unrelated to my symptoms?
• Would repeat images be useful in the future, and if so, why?
• Are other tests, such as ultrasound or blood work, worth considering?

Your provider can put the findings in context and talk with you about options. Choices about activity, therapy, medicines or referrals are medical decisions to make together with them, based on your whole health picture rather than the X-ray alone.

Arthritis X-rays at our Ajax clinic

Walk-in digital X-ray is available at Rossland Diagnostic Clinic, Unit 102, 300 Rossland Road East, during opening hours: Monday to Friday from 9:00am to 5:00pm and Saturday from 8:00am to 3:30pm. Because the department can close to walk-ins once daily capacity is reached, calling 905-426-3111 for live availability before you leave home is a good idea. Free parking is available on site.

After your exam, a report is sent to your provider, who will review it with you. If an urgent finding is identified, the ordering physician is alerted. Images can be provided on CD when needed, which can be handy if you are seeing a specialist who wants to look at them directly. If the pictures are part of ongoing monitoring, your provider may suggest repeat images at some point to compare over time.

Key takeaways

• Arthritis is a family of conditions, and X-ray is one of the most common tests used to look at affected joints.
• X-rays show bone changes such as joint space narrowing, bone spurs and erosions, but not cartilage or soft tissue directly.
• How a joint looks on X-ray does not always match how it feels, so your provider will interpret images alongside your symptoms and examination.
• Ultrasound, blood tests and other imaging may be added when your provider needs more information.
• Preparation is simple: avoid metal near the joint, mention past surgery and let the technologist know about any mobility needs.

To learn more about the service, visit our X-ray page. You are welcome to call us at 905-426-3111 with questions, or request an appointment for ultrasound and other booked imaging.