Q. Can x-ray differentiate rheumatoid arthritis and osteoarthritis?

Answered by
Dr. Divya Agarwal
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Jan 21, 2017 and last reviewed on: Mar 24, 2021

Hi doctor,

I have been having joint pain in my left foot on the first joint of big toe for two weeks. It came on upon waking. The pain was inconvenient, but bearable for the first 36 hours. Then, it was extremely painful on the second day ( a worse pain I have ever had). Then, it has got slightly better, especially when raising the foot, although walking is painful and difficult and it is painful at night. I had high uric acid before the episode, and it is normal now. So, I suspected gout. I went to the doctor today for x-ray result and was told that I have arthritis in some of my joints. I asked if I should see rheumatologist and doctor said it is not worthwhile as they would only be interested in RA. From that, I guess that mine is osteoarthritis. The doctor said it is also likely I have gout. This leaves me a little confused. Can the x-ray distinguish between rheumatoid arthritis and osteoarthritis? I am a 42 year old male. What would the prognosis be if it is osteoarthritis or gout?



Welcome to

  • There is a strong possibility that this is gout. Considering that it occurred relatively acute, it is possible that it is gout.
  • The diagnosis of gout is by crystal examination in joint fluid and on clinical examination of joints.
  • Of course, osteoarthritis is one of the leading causes of arthritis after 40, and the big toe is a common joint. However, since the treatment is very different for both it is worthwhile visiting a rheumatologist.
  • X-rays can show that you have OA, but then there may be concomitant gout as well. Rheumatoid arthritis generally does not present like this.

For further information consult a rheumatologist online -->

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