Question
I was diagnose 2 years ago with Rheumatoid Arthritis and just recently had an X-ray done on my hand and they doctor said it is Osteoarthritis.  Can they really see the difference between the two in an x-ray?  When I was first diagnosed they saw nothing in my hand x-ray but saw early stages of Rheumatoid in my hips.  My blood test was negative.  Usually when I have pain it is on both limbs but usually a little more severe on the right side.  I was told Osteoarthritis doesn't affect both sides like Rheumatoid.  How do I know which it is?

Answer
Melanie,

No one wants any type of arthritis. But if you have to have it
You can not base a diagnosis of what type of arthritis you have based on a x-ray. While there are small differences between the way osteoarthritis and rheumatoid arthritis show up on a x-ray they are not enough to give a diagnosis on. I will try and explain some of the differences.

RA is an autoimmune disease. This is where your body's immune system attacks your joints and organs thinking that they are foreign matter. Because of this it will attack many joints and usually the same joints on both sides of the body. When it attacks the joints in the hand usually most or all of the joints of the hands are involved. This will show up on the x-ray.

Osteoarthritis is caused by wear and tear or trauma to a joint or joints. Because of this the joints in your hand will not have the same amount of wear and tear or trauma to them. This will show arthritis different on different joints. This is especially true when you compare the x-rays of one hand to the other.

Remember that these are minor differences and are different for every person. Since the way that arthritis shows up is different for every person you can not say for sure what type of arthritis it is from a x-ray. Besides there are over 100 other types of arthritis besides the two mentioned above.

The good news is that it sounds more like osteoarthritis than it does RA. It is much better for you in the long run if it is not RA. RA is a terrible disease than will eventually effect not only the joints in your body but can effect many organs as well.

I have not seen all the tests so I can not say what type of arthritis it is. Your doctor is probably basing his opinion that it is osteoarthritis base on many things not just the x-ray. If the arthritis in your hip had been RA then now two years latter you would expect to see it effecting your knees, ankles, wrists, elbows and hands. I am surprised that any doctor would use the term rheumatoid arthritis based on seeing the early stages of arthritis in your hips. RA is not diagnosed based on arthritis effecting one set of joints.

You expect to see arthritis on both sides of the major joints such as knees and hips since you use these joints the same. It is not unusual to see osteoarthritis effecting joints on both sides. When it comes to shoulders, elbows, wrists and hands you would expect the arthritis to be more evident on the prominent side because you would expect that a right handed person would use these joints more than the left.

Here is a link where you can find more information about the different types of arthritis.

http://arthritis-symptom.com/Rheumatoid-arthritis-symptoms/index.htm

I wish you the best

Rusty