The osteoarthritis diagnosis is one of the most profitable conditions in medicine. It is blamed for causing an extensive range of potentially symptomatic conditions including bone spurs, joint disease, sacroiliitis and facet syndrome in the spine, as well as a diversity of problems in virtually all the skeletal joints of the body. There is no cure for arthritis and typical treatment consists exclusively of pain relief measures typically implemented using powerful pharmacological products.
What most diagnosed patients do not know, since their doctors do not tell them, is that osteoarthritis is virtually universal in the adult population. Osteoarthritis is normal to demonstrate throughout the body and virtually all adults past the age of 40 will display some degree of arthritic activity in their neck and lower back, if not elsewhere. Furthermore, osteoarthritis is not inherently painful or pathological, although it can be, on a case-by-case basis. In our extensive experience working with literally hundreds of thousands of arthritis patients over the past 15+ years, we estimate that the diagnosis of truly pathological OA was correct in perhaps 5 to 10%. The remaining 90 to 95% presented symptoms that were not consistent with the osteoarthritis diagnosis, but were still treated for the condition regardless.
This dissertation focuses on the true and objective facts of osteoarthritis diagnosis. We will examine the diagnostic process and why the condition has been called “the great scapegoat” by enlightened physicians the world over.
Osteoarthritis is a normal result of living. It is that simple. The condition describes changes in the protective mechanisms of the bodily joints and the effects that these changes have on the structure of affected tissues. Osteoarthritis in the spine is most often seen in areas of regular movement, such as the mid to low cervical region and the lower lumbar region. It is far less often seen in the thoracic spine.
Osteoarthritis is encouraged by another spinal aging process called disc desiccation, more commonly known as degenerative disc disease. We have written extensively on the injustices of diagnosing and treating DDD, so for a complete picture of the diagnosis of osteoarthritis, we suggest that you read our coverage of this condition, as well. Let’s look at how osteoarthritis can potentially cause pain and neurological expressions:
OA can cause accumulations of spurs and debris in the central canal space, facilitating spinal stenosis. It must be known that most cases of central stenosis are not symptomatic and will only become so if the spinal cord or cauda equina becomes compressed.
Similarly, osteoarthritis can cause accumulations of material that narrow the neuroforaminal spaces. This is what can create a pinched nerve. However, very infrequently does the arthritis completely obliterate the nerve foramen, which is what is required to guarantee symptoms.
OA can cause joint dysfunction and pain when all the protective measures break down and encourage the growth of bone spurs or the accumulation of arthritic debris in area of the joint involving normal movement.
It must be made absolutely clear that the mere presence of arthritic changes in the spine, such as central stenosis, reduced foraminal patency or bone spurs, does not make the condition inherently symptomatic or pathological. In fact the vast majority of people with these changes will not have symptoms and will not develop them to any significant degree during their lifetimes.
Most adults who complain of back pain, see a doctor and subsequently undergo diagnostic imaging of any kind, will receive a diagnosis of osteoarthritis. This should be of no shock, as the condition is virtually universal. However, how the diagnostic process proceeds from this point forward varies greatly.
In some cases, the arthritis is very, very severe and there is some form of verified pathology, such as symptomatic spinal stenosis, that can be attributed to it. These patients are justifiably moved forward into the treatment phase. These cases account for 5% to 10% of diagnosed patients.
Of the rest, about 10% are told by their knowledgeable doctors that the arthritic changes visualized are normal and not likely to be the source of their pain. Therefore, diagnostic processing continues.
The remaining 80 to 85% are usually told that these arthritic changes are partially or wholly responsible for their pain, despite there being no evidence of any pathology generated by the condition. There is no definitively symptomatic central or neuroforaminal stenosis. There is no definitive mechanical pain. There is no joint dysfunction. Not surprisingly, the symptoms expressed usually are far too widespread, diverse and inconsistent to possibly come from such a relatively stable structural process like OA. Despite this fact, the diagnosis of osteoarthritis is made and the patient is placed into treatment.
This travesty shows not only poor doctoring, greed and unscientific thinking, but is also directly responsible for billions of dollars of unnecessary care, hundreds of thousands of unneeded surgical endeavors and the typically disappointing therapeutic outcomes suffered by patients due to simple misdiagnosis of the condition. Remember, all the while, the real cause of pain remains undiagnosed, untreated and therefore active in its potential to inflict grievous torment.
The point of this essay is crystal clear: Patients who are diagnosed as suffering from osteoarthritis might only be displaying the signs of osteoarthritis, while actually suffering from a completely different problem. No one doubts that the pain that you feel is real, but buying into a scapegoat diagnosis, while the real issue goes untreated, will not help you. Therefore, remember these basic facts if your OA is implicated as the source of back or neck pain:
1. The osteoarthritis diagnosis might be correct, but definitive evidence of pathology must be presented. Patients should always seek multiple diagnostic opinions in order to better their chances of receiving objective diagnostic processing.
2. Most osteoarthritis produces noticeable evidence that is easily imaged, but is not the source of pain or neurological effects. Virtually every adult will demonstrate OA in the spine and the degree of arthritis can be visually severe without producing any symptoms whatsoever.
3. Symptoms should correlate to the diagnosis in terms of expression, location, severity and consistency. This is where we find that most diagnostic processes go awry, as the symptoms seen clinically definitely do not correlate logically to the diagnosis made.
As an aside, even when the diagnosis of OA is clear and correct as the causative condition, treatment choices vary greatly. Be sure to set goals for curative or symptomatic care and select the best therapies to see these objectives to successful completion. There is no permanent cure for arthritis, but curative treatment measures can end the current symptom-generating conditions, while symptom-based care will do nothing to provide anything more than temporary and often cost-ineffective or health-damaging relief.