ABSTRACT
The definition of osteoarthritis is often difficult and there is considerable controversy as to whether osteoarthritis can be diagnosed on clinical grounds alone or whether it requires x-ray confirmation. There is frequently poor correlation between x-ray changes and clinical symptoms and some patients may have gross x-ray changes with little in the way of symptoms while others may have considerable pain and stiffness with only minor radiological changes. From a practical point of view in primary care, clinical signs and symptoms are much more important than x-ray changes and an x-ray should only be requested if the result is going to change the management of the patient. It can sometimes be difficult to convince a patient, however, that an x-ray is not necessary and that careful examination of the affected joint will give much more useful information. As there are no investigations useful in osteoarthritis other than to exclude other conditions, it is sometimes tempting to x-ray the joint merely to be seen to be doing something although this is neither logical nor sensible.
