Do we need radiographs to diagnose osteoarthritis?

The usefulness of plain radiography in the diagnosis of osteoarthritis is reviewed. While plain radiography is frequently used to define osteoarthritis in research and is traditionally discussed as a diagnostic modality in clinical practice, recent magnetic resonance imaging studies suggest that plain radiography has limited ability to detect osteoarthritic features at an early stage of disease such as might be encountered in general practice. Nevertheless, X-rays do play a role in the diagnostic process in general practice, but their usefulness relates more importantly to the exclusion of other diagnostic possibilities rather than confirmation of disease. More research is needed to develop diagnostic tools for osteoarthritis, particularly in clinical practice, as well as algorithms and guidelines for use of plain radiography in patients with chronic joint pain.