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Everything You Should Know About Joint Space Narrowing

Overview

Key points

  1. Joint space narrowing can cause pain and trouble moving the affected joint.
  2. Your doctor may use X-ray, MRI, or ultrasound images to identify joint space narrowing.
  3. Joint space narrowing can be a sign of osteoarthritis or rheumatoid arthritis. It can also be caused by aging or overuse of a joint.

Your joint cartilage allows your joints to move freely and absorb impact. As you get older, the cartilage in your joints can start to become worn, especially in your knees, hips, and hands. Losing this cartilage makes it much harder for the joint to handle everyday movements and tasks.

After much of the cartilage has worn away, you may start to feel pain. Moving your joints may be more difficult. The pain can also mean that the space between the bones of the joint has narrowed enough to change the joint’s range of motion. When joint space narrowing has happened, the cartilage no longer keeps the bones a normal distance apart. This can be painful as the bones rub or put too much pressure on each other.

Joint space narrowing can also be a result of conditions such as osteoarthritis or rheumatoid arthritis. If you feel abnormal pain in your joints, your doctor may want to take X-rays or other imaging tests. These will help the doctor look for any narrowing in the painful joint. Then, based on your results, your doctor may suggest a treatment plan or lifestyle changes to address the cause and minimize the pain.

Testing for joint space narrowing

Your doctor may order one or more tests to see detailed images of where joint space narrowing or damage has happened.

X-ray

To get X-ray images, your doctor or a trained radiologist will use an X-ray machine to create black and white images of your bones. The images can help them see signs of joint damage or narrowing in more detail.

Taking X-rays only takes a few minutes and won’t require you to undress unless your doctor needs to see an area under your clothes. Your doctor will give you a covering of some sort to protect you from radiation, too.

X-ray images are usually ready in a few minutes. This makes it one of the most commonly used tests for examining your bones for joint space narrowing.

Magnetic resonance imaging (MRI)

During an MRI, your doctor will place you inside a large machine that uses radio waves to create images of the inside of your body. This test can produce highly detailed images.

Let your doctor know if you are claustrophobic. The inside of the machine is very small, so you may opt for a different type of imaging test. Your doctor may also prescribe a mild sedative to help manage symptoms of claustrophobia.

Your doctor will likely ask you to remove your clothing and any accessories for best imaging results. You’ll also need to remain still during the test.

MRI results are usually ready within an hour.

Ultrasound

During an ultrasound, your doctor will apply a special gel to the joint area that they want to examine. Then they’ll use a device called a transducer to send sound waves into your body. These sound waves bounce off the structures in your body, which helps generate images.

This test is quick and painless, usually less than 30 minutes. You may only be a little uncomfortable as your doctor moves the transducer around the affected joint area.

Ultrasound images are viewed in real time. Your doctor can see your bones immediately as they move the transducer around on your skin.

Physical exam

If your doctor thinks you may have a condition causing your joint space narrowing, they might also recommend a physical examination. This may require you to undress and cause you some mild discomfort as your doctor touches, or palpates, the joints and sees how flexible they are. The doctor will also ask about the level of pain or discomfort you feel when you move your joints.

Understanding your results

Your doctor will show you your X-rays or other imaging results. They’ll walk you through the process of examining your bones for abnormalities.

If your doctor thinks you have a condition causing your joint space narrowing, they'll look for abnormally low levels of joint cartilage, which is the most visible symptom of joint space narrowing. They may look for osteophytes, also knowns as bone spurs, in your joints. These usually appear as a result of losing your cartilage. They may look for subchondral cysts as well. These are sacs filled with fluid made of joint material. They stick out of your joint. The doctor may also look for subchondral sclerosis, which is hardened tissue in the bone around your cartilage.

If your doctor believes you have rheumatoid arthritis, they may ask you to take a blood test. This will help them look for more evidence of inflammation in your body. Blood tests require a needle to draw blood. Let your doctor know if you’re uncomfortable with needles or the sight of blood.

Causes

Joint space narrowing may occur from overuse of your joints. It can also occur as you get older. Other risk factors, such as obesity and muscle weakness, can contribute to joint space narrowing.

Joint space narrowing can also be a sign of osteoarthritis (OA). OA is a type of arthritis that usually affects your knees or finger joints. Around 80 percent of adults in the United States older than 65 have some signs of OA.

The condition can also indicate rheumatoid arthritis (RA). This is a type of arthritis that happens when your immune system attacks your body tissues and causes chronic inflammation.

Treatment

Your treatment depends on the cause of your joint space narrowing.

If you’re diagnosed with OA, your doctor may prescribe medications such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDS) like ibuprofen (Advil, Motrin) or naproxen (Aleve) to manage your joint pain. Low-impact exercise, such as yoga, may also help keep your joints flexible despite the discomfort of the narrowing joint. Your doctor may also suggest cortisone or lubrication injections to numb the pain or cushion the joint area.

If your doctor diagnoses you with RA, they may recommend medications known as disease-modifying antirheumatic drugs (DMARDS). These include methotrexate, adalimumab (Humira), or a combination of the two. These drugs can allow you to keep working or taking part in regular physical activity without causing more narrowing in your joints. Your doctor may also prescribe NSAIDs to keep the pain under control.

In some cases, you may need to undergo joint replacement surgery. In this procedure, your doctor removes the affected parts of your joint and replaces them with metal or plastic prosthetics. As with any surgery, joint replacement surgery carries some risks that can increase as you age. Talk to your doctor about the benefits and risks. A joint replacement can have a significant impact on your lifestyle, but can also help you reverse or recover from cartilage loss or joint damage.

Outlook

Arthritis and other joint-related conditions are common. Joint space narrowing can be treated in many ways that will help preserve your quality of life. Work with your doctor to find a treatment that works best for you.

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