What to Expect from a Rheumatoid Arthritis X-Ray

by Lene Andersen, MSW Patient Advocate

When you have rheumatoid arthritis (RA) or your doctor suspects that you may have this condition, they may order different tests to help assess how you’re doing. One of these tests is an X-ray. This slideshow will tell you how X-rays work, how they can help when you have RA, and what to expect when you get a referral to have one.

X-ray of hands with highlighted joints

X-rays and rheumatoid arthritis

When you have RA, X-rays may show the damage to the joints that can happen with active RA. This shows up as erosion or loss of bone in the joints. It may also show narrowing of the joint space, which can indicate RA damage.

Doctor showing and explaining to patient her X-ray

How X-rays are used in the treatment of RA

People who have RA or who are suspected of having RA may encounter X-rays in different contexts. First, this type of imaging test can be used as part of the diagnostic process. If you’ve experienced symptoms for a while, X-rays and blood tests may provide information about possible impact on joints that can help make a diagnosis of RA. Once you are under the care of a rheumatologist, they will likely use X-rays on a regular basis to keep an eye on possible progression of your condition.

Conceptual ray image

How X-rays work

X-rays show a picture of the structures and tissues within your body. This form of imaging was first discovered in 1895 by Wilhelm Roetgen, a German physicist. X-rays are a form of electromagnetic radiation that pass through the body and record an image of the bones either digitally or on special film.

Radiation area, some danger to X-rays, but not severe

Can X-rays hurt me?

The most common worry about getting an X-ray is whether they can hurt you, says Amanda Deller, X-Ray Technologist in Severna Park, Maryland. Getting an X-ray doesn’t hurt, but positions you have to be in to get the best photo of your joints may be a bit uncomfortable. X-rays do expose you to a bit of radiation, but “usually less than you would get riding in an airplane,” Amanda says.

Probably change into hospital gown for the x-ray

What to wear – Part I

You will usually be asked to change into a hospital down and remove jewelry to ensure that nothing you are wearing shows up on the X-ray — this is called an artifact. Even if you are wearing comfortable clothes with no metal, the X-ray technologist may still ask you to change into a gown. This is for your safety, Amanda says, “so you do not have to repeat the X-ray due to artifact.”

Easy cloths to wear for X-ray

What to wear – Part II

The best way you can prepare is by dressing comfortably in clothes that do not include any metal, as it shows on the X-ray and may obscure the view of what your doctor needs to see. Amanda recommends that women wear “spandex and a sports bra,” and for men “basketball shorts and tee shirts.” If you’re coming from work and can’t dress comfortably, don’t worry. You’ll be given a hospital down to wear instead.

Water, apple , and a book with bag.

What to bring

As with most medical appointments, some wait time can be expected. In addition to bringing your paperwork and payment, be prepared to get through time in the waiting room by bringing a book or magazine, a bottle of water, and some snacks. Note: Certain X-rays may require fasting, although this is not usually the case with X-rays of the joints. Your doctor or the clinic will let you know if you need to fast before the test.

Clinic lobby

Arriving at the imaging clinic

Plan to arrive for your X-ray 20-30 minutes ahead of your appointment. This will reduce your stress in case of busy traffic, trouble finding a parking spot, or others in line to check in at the clinic. Remember to bring your insurance information and make sure there’s enough money in your account or on your credit card to cover the co-payment. If you’re getting X-rayed in a hospital, you may also need a hospital card before checking in.

Illustration of X-ray machine

Your turn for an X-ray

When it is your turn, the X-ray technologist will take you into the testing room. The X-ray machine hangs from the ceiling on a flexible arm and there will be a few places where you can sit up against the wall for an X-ray. There will also be a metal gurney in the room, usually covered with a thin foam mattress.

Lead vests hanging in X-ray lab

Protecting your reproductive system

Before the process gets started, notify the X-ray technologist if you suspect you might be pregnant. If you are, they may have to take extra precautions to protect the baby. You should also tell them if you have an Intrauterine device (IUD), as it may contain metal. When X-rays are being done, both men and women will wear a lead blanket (not as heavy as it sounds) to cover their pelvic area, blocking X-rays from affecting the reproductive system.

Patient being x-rayed

Getting the X-ray

The technologist will help you position yourself, then they will maneuver the X-ray machine so a small cross is showing on the area to be X-rayed. They will then ask you to hold still, go behind a wall and you will hear a click and a brief buzz as the X-ray photo is taken. You should expect to have more than one X-ray of the area in question, possibly in different positions. The technologist may support your body with positioning cushions.

Doctor in front of X-rays

Getting the results

A specialist called a radiologist will review your X-rays and prepare a report for your doctor. This can take as little as a day or as long as several weeks. The next time you see your doctor, they will discuss the results with you and these may be used as part of the foundation for a diagnosis and treatment decisions. You may want to ask for a copy of the X-ray results for your own records.

MRI incase the cheaper X-Rays do not identifie

Limitations of X-rays

X-rays are effective and relatively inexpensive, so they are usually the first imaging tests to be ordered. However, they do have some limitations. They may not show damage, even with active RA. In fact, joint damage can show up on a magnetic resonance imaging (MRI) scan up to six months before it’s visible on X-ray. MRI and ultrasound are more sensitive in terms of detecting joint damage and can also show the inflammation of active RA. If your X-rays don’t show anything, you may consider asking for an ultrasound or MRI.

Lene  Andersen, MSW
Meet Our Writer
Lene Andersen, MSW

Lene Andersen is an author, health and disability advocate, and photographer living in Toronto. Lene (pronounced Lena) has lived with rheumatoid arthritis since she was four years old and uses her experience to help others with chronic illness. She has written several books, including Your Life with Rheumatoid Arthritis: Tools for Managing Treatment, Side Effects and Pain, and 7 Facets: A Meditation on Pain, as well as the award-winning blog, The Seated View. Lene serves on HealthCentral's Health Advocates Advisory Board, and is a Social Ambassador for the RAHealthCentral on Facebook page, facebook.com/rahealthcentral. She is also one of HealthCentral's Live Bold, Live Now heroes — watch her incredible journey of living with RA.