Joint Space Narrowing

In the United States, 1 out of every 7 adults has osteoarthritis, and almost half of the affected population falls in the age group of 18-64 years (1).

It is common knowledge that performing the same task, such as running, bending, etc., becomes progressively difficult with age. This happens primarily due to the gradual wearing of the joint cartilage, which impedes the free movement of that joint.

If you are experiencing joint pain, it might be due to the gradual narrowing of the space between the bones in the joint, which might be affecting your range of motion. You should consult a doctor and understand the cause and treatment strategy related to this phenomenon.

Our board-certified orthopaedic surgeons at the San Diego Sports Medicine & Orthopaedic Center have extensive experience in treating patients with arthritis and would be able to offer their expert diagnostic opinion.

What causes joint space narrowing?

The bones in our joints are covered by articular cartilage, which cushions the joint movement. However, the articular cartilage can get damaged due to regular wear and tear, trauma, or other factors, such as obesity, causing joint space narrowing (2).

Additionally, osteoarthritis (bone-related) or rheumatoid (inflammation-related) arthritis can also contribute to the narrowing of the joint space.

What are the risk factors associated with the occurrence of joint space narrowing?

In 2017, a Multicenter Orthopaedic Outcomes Network (MOON) prospective cohort study was conducted on more than 3500 patients who had undergone anterior cruciate ligament reconstruction (ACLR) of the knee. The study showed that age and meniscal tear were significant predictors of joint space narrowing (3).

Another study showed that women were more likely than men to develop joint space narrowing as an early symptom of osteoarthritis (4).

How to diagnose joint space narrowing?

If your doctor suspects that you might have an underlying condition causing joint space narrowing, they might conduct a preliminary physical assessment of the relevant site to assess the degree of mobility and pain. Based on their observation, they might prescribe some blood tests, an X-ray, or an MRI to gather further evidence.

X-ray

Usually, the joint space narrowing in bigger joints, such as hip and knee, is evaluated using a weight-bearing x-ray to get a realistic projection of the relevant joint. The x-ray data would be used to evaluate the extent of joint space narrowing to assess the extent of osteoarthritis using the Kellgren-Lawrence classification of osteoarthritis (5). This scale grades the severity on a scale of 0-4, with 0 being the absence of joint space narrowing and 4 being significant joint space narrowing with bone on bone contact.

Note: Although rarely, your doctor might also prescribe an MRI to diagnose the extent of and the primary cause for joint space narrowing. This would be done only if the doctor suspects that the joint space narrowing observed in an x-ray film could be due to causes other than arthritis.

What are the common methods of treatment of joint space narrowing?

Currently, there are no effective drugs to regulate the progression of arthritis; thus, the strategies are limited to symptom management to improve the quality of life.

If osteoarthritis is the underlying cause, then over-the-counter pain-relief medications, such as acetaminophen, ibuprofen, naproxen, etc., might be given.

If rheumatoid arthritis is the underlying cause, then your doctor might prescribe disease-modifying antirheumatic drugs, such as hydroxychloroquine, methotrexate, adalimumab, tocilizumab, etc.

Your doctor might also recommend walking, yoga, or other low-impact exercises to retain the existing mobility.

In severe cases, such as grade 3-4 on the Kellgren-Lawrence scale, joint replacement surgery might be recommended to restore functionality. In that case, your doctor will provide a complete overview of the associated risks and benefits so that you can make an educated decision.

References

  1. A National Public Health Agenda for Osteoarthritis. Arthritis.org. Accessed April 28, 2021. https://www.arthritis.org/getmedia/7b7cb13b-7075-4173-be6e-38ec475952b2/OA-Agenda-CDC-2020-R3.pdf
  2. Kontzias, A. Osteoarthritis (OA). Merck Manual Professional Version. Kenilworth, NJ: Merck & Co., Inc.; 2019.
  3. Jones MH, Spindler KP. Risk factors for radiographic joint space narrowing and patient reported outcomes of post-traumatic osteoarthritis after ACL reconstruction: Data from the MOON cohort. J Orthop Res. 2017;35(7):1366-1374. doi:10.1002/jor.23557
  4. Halilaj E, Moore DC, Patel TK, et al. Older asymptomatic women exhibit patterns of thumb carpometacarpal joint space narrowing that precede changes associated with early osteoarthritis. J Biomech. 2015;48(13):3634-3640. doi:10.1016/j.jbiomech.2015.08.010
  5. KELLGREN JH, LAWRENCE JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis. 1957;16(4):494-502. doi:10.1136/ard.16.4.494

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San Diego Sports Medicine & Orthopaedic Center, Inc., San Diego, CA

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