Laboratory tests are not useful in the diagnosis of OA. The erythrocyte sedimentation rate (ESR) is usually normal; it may be slightly increased in the inflammatory stage but even then rarely exceeds 35 mm/hour.101 The synovial fluid is generally relatively viscous and transparent and noninflammatory, with a cell count under 2000/mm3.102

The plain radiograph is the investigation most frequently used to confirm the clinical diagnosis. The radi-ologic features include narrowing of the joint space, osteophyte formation, sclerosis of the articular surfaces, and subchondral cyst formation. If plain radiographs do not show pathological alteration, a 99mtechnetium phosphate radionuclide scan or MRI may be required to show earlier signs of disease.103

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