Quick answer: An X-ray uses a small dose of radiation to show bone. In arthritis it can show joint space narrowing, bony spurs and erosions, but not cartilage, early inflammation or how much pain you have. NICE says osteoarthritis is usually diagnosed without imaging, but recommends hand and foot X-rays for suspected rheumatoid arthritis. A limb joint X-ray equals less than 1.5 days of natural background radiation.
Checked on 10 October 2026 against the NHS guide to X-rays, UK Health Security Agency patient dose information and NICE guidelines on osteoarthritis (NG226), rheumatoid arthritis (NG100) and spondyloarthritis (NG65).
X-rays are the oldest and most widely used scan for joints. They are quick, cheap and good at showing bone. But they have limits, and an X-ray result does not always match how a joint feels. This guide explains when X-rays are used for arthritis, what they can and cannot show, what happens on the day, how much radiation is involved and how to understand your report.
What is an X-ray?
The NHS describes an X-ray as a test that takes pictures of the inside of your body using a small amount of radiation. Dense tissues such as bone absorb more X-rays and show up white, while soft tissues appear in shades of grey. This makes X-rays good for looking at bones and the space between them, but poor at showing cartilage, ligaments, tendons or early inflammation.
What an X-ray can show in arthritis
- Joint space narrowing. Cartilage does not show on X-ray, but the gap between bones indicates how much is left. A narrowed space suggests cartilage loss.
- Osteophytes. Bony spurs at the edges of a joint, typical of osteoarthritis.
- Subchondral sclerosis and cysts. Hardening and small cavities in the bone under the cartilage, also seen in osteoarthritis.
- Erosions. Small areas where bone has been worn away at the joint edges, seen in inflammatory arthritis such as rheumatoid or psoriatic arthritis, and in long-standing gout.
- Bone thinning near joints, sometimes seen in inflammatory arthritis.
- Changes in the sacroiliac joints and spine in established axial spondyloarthritis.
- Calcium deposits in cartilage, which may suggest calcium pyrophosphate deposition (sometimes called pseudogout).
- Alignment and deformity, and the position of a joint replacement.
- Fractures and other bone problems that might explain pain.
What an X-ray cannot show
- Cartilage, ligaments, tendons and the meniscus directly
- Early inflammation in the joint lining
- Early rheumatoid arthritis, before damage has happened
- Early axial spondyloarthritis, which may only show on MRI
- How much pain you are in
That last point matters. X-ray changes and symptoms often do not match well. Some people have marked changes on X-ray and little pain, while others have significant pain with mild changes. This is one reason NICE advises clinicians to use clinical assessment, rather than systems that numerically score severity, when deciding whether to refer someone for joint replacement.
When are X-rays used for arthritis?
Osteoarthritis
NICE says osteoarthritis can be diagnosed clinically without imaging in people who are 45 or over, have activity-related joint pain and have no morning stiffness or stiffness lasting 30 minutes or less. It advises against routine imaging unless there are atypical features, such as recent injury, prolonged morning stiffness, rapid worsening, deformity, a hot swollen joint, or concerns about infection or cancer. NICE also advises against routine X-rays for follow-up or to guide non-surgical treatment.
An X-ray may still be done if you are being considered for surgery, if the diagnosis is uncertain, or if something does not fit the usual pattern.
Rheumatoid arthritis
NICE recommends X-rays of the hands and feet for adults with suspected rheumatoid arthritis and persistent synovitis. When someone is newly diagnosed, NICE says X-rays of the hands and feet should be done to look for erosions, if not already done. Erosions at the start help predict how the disease might progress and can influence how intensively it is treated. Some teams repeat X-rays over time to check for new damage.
Axial spondyloarthritis
NICE's guideline describes using an X-ray of the sacroiliac joints as part of assessment, and requesting an MRI if the X-ray does not show clear changes.
Gout and other crystal arthritis
X-rays are not usually needed to diagnose gout, but they can show damage in long-standing gout or calcium deposits in other crystal conditions.
Back pain
NICE advises against routine imaging for low back pain in non-specialist settings.
How much radiation is involved?
The UK Health Security Agency publishes typical radiation doses from medical scans, compared with natural background radiation that we are all exposed to in everyday life:
| X-ray of | Equivalent natural background radiation | Estimated lifetime additional risk of fatal cancer |
|---|---|---|
| Limbs and joints (except hip) | Less than 1.5 days | 1 in a few million |
| Chest | 3 days | 1 in a million |
| Hip | 7 weeks | 1 in 67,000 |
| Pelvis | 4 months | 1 in 30,000 |
| Lumbar spine (lower back) | 7 months | 1 in 15,000 |
Source: UKHSA patient dose information, updated 28 September 2026. X-rays of hands, feet, knees and other limb joints involve very low doses. The NHS says that if you have lots of X-rays there is a very small risk that radiation could cause cancer, and your doctor will weigh this up before offering one. This is another reason clinicians avoid X-rays that will not change your treatment.
Always tell the radiographer if you are or might be pregnant.
Preparing for an X-ray
Joint X-rays need very little preparation. The NHS says you may be asked not to wear anything with metal in it, such as jewellery, zips, poppers, underwired bras or hair clips. Tell the radiographer if you are pregnant or might be, are breastfeeding, take any medicines or have allergies.
Wear clothes that make it easy to uncover the joint, for example shorts or loose trousers for a knee X-ray. You may be asked to change into a gown.
If you would like a chaperone, someone you know or a trained member of staff, you can ask for one.
What happens during the X-ray
X-rays are usually done in a hospital or community diagnostic centre by a radiographer. The NHS says the X-ray itself only takes a few minutes:
- The machine is lined up with the part of your body being X-rayed.
- The radiographer moves behind a screen or leaves the room.
- You keep very still for a few seconds while one or more images are taken. You will not feel anything.
- You may be asked to move into different positions.
For knee and hip arthritis, X-rays are often taken while you stand, because this shows the joint space under load. If standing or holding a position is difficult, tell the radiographer. They can help you get into position and give you support.
In many places you can walk in for GP-requested X-rays without an appointment. Check the instructions on your request form.
Getting your results
The NHS says you should be told when you will get the results. This may be on the same day or at an appointment a few weeks later. A radiologist or reporting radiographer writes a report that goes to the clinician who requested it. If you have not heard anything after a few weeks, contact the clinician who referred you or your GP.
Common terms in X-ray reports
| Term | What it usually means |
|---|---|
| Degenerative change | Wear-related changes consistent with osteoarthritis, very common with age |
| Loss of joint space / joint space narrowing | Thinning of cartilage |
| Osteophytes | Bony spurs |
| Subchondral sclerosis | Hardening of the bone under the cartilage |
| Erosions | Bone loss at joint margins, a sign of inflammatory arthritis |
| Periarticular osteopenia | Thinning of bone around a joint |
| Chondrocalcinosis | Calcium deposits in cartilage |
| Effusion | Extra fluid in or around a joint |
| No acute bony injury | No fracture seen |
Words like "mild", "moderate" and "severe" describe what the bones look like, not how much pain or disability you have. Discuss your report with your clinician before drawing conclusions.
X-ray, ultrasound or MRI?
- X-ray: best for bone, joint space, spurs and erosions. Quick, widely available, small dose of radiation.
- Ultrasound: shows inflammation in joints and tendons in real time, with no radiation. Often done in rheumatology clinics.
- MRI: shows soft tissues, early inflammation and the spine and sacroiliac joints in detail, with no radiation. Takes longer and is less widely available. See MRI scans explained.
- DEXA scan: a different, low-dose X-ray that measures bone density to check for osteoporosis, which can be more common with some types of arthritis and long-term steroid use.
For an overview of the whole diagnostic process, see how arthritis is diagnosed.
If you were told you do not need an X-ray
It can feel frustrating to be told you do not need a scan. But for typical osteoarthritis, NICE is clear that diagnosis and treatment, including exercise, weight management and pain relief, do not depend on imaging. An X-ray would expose you to radiation without changing what you are advised to do. If your symptoms change, or new features appear such as a hot swollen joint, rapid worsening or a joint that looks deformed, ask your GP to reassess. Our list of questions to ask your consultant includes questions about tests.
Do I need repeat X-rays?
Not routinely. For osteoarthritis, NICE advises against using imaging for follow-up or to guide non-surgical treatment, because the plan (exercise, weight management, pain relief and support) does not depend on how the X-ray looks. Repeat X-rays may be done if symptoms change significantly, before surgery, or if a different problem is suspected.
In inflammatory arthritis, some rheumatology teams repeat hand and foot X-rays at intervals to check whether new erosions are developing, which can help show whether treatment is controlling the disease. Ask your team whether and when you will have them.
X-rays after a joint replacement
If you have had a hip, knee or shoulder replacement, X-rays are usually taken after the operation to check the position of the new joint, and sometimes at follow-up appointments. Later in life, an X-ray may be used if a replaced joint becomes painful, to look for loosening or wear. If you develop new pain, swelling, clicking or instability in a replaced joint, contact your GP or the surgical team rather than waiting for a routine review. Our checklist on preparing for joint replacement covers what to expect before surgery.
Practical tips for the day
- Take your request form or appointment letter, and check whether you need to book or can walk in.
- Take your usual pain relief beforehand if standing or positioning is likely to be uncomfortable.
- Bring a list of previous X-rays or scans of the same joint, including where they were done, so they can be compared.
- If you use a walking aid, bring it.
- Ask when and how you will get the result before you leave.
When to get medical help
- Same day (urgent GP appointment or NHS 111): a hot, swollen, very painful joint, especially with fever or feeling unwell; or sudden severe joint pain that started without injury.
- A&E or urgent treatment centre: after a fall or injury if you cannot bear weight, the joint looks deformed, or you think you may have broken a bone.
- Call 999 or go to A&E: back pain with numbness around the bottom or genitals or new problems controlling your bladder or bowels.
- Routine GP appointment: if your arthritis is gradually getting worse or affecting new joints.
Frequently asked questions
Will an X-ray show arthritis?
It can show changes from osteoarthritis and from established inflammatory arthritis, such as narrowed joint spaces, bony spurs and erosions. It may look normal in early arthritis, because cartilage and inflammation do not show on X-ray.
Why does my X-ray look mild when my pain is severe?
X-ray appearance and pain often do not match. Pain is influenced by inflammation, muscles, nerves, sleep, mood and other factors that an X-ray cannot show.
Are X-rays safe?
Joint X-rays use very low doses of radiation. UKHSA estimates the dose from an X-ray of a limb joint is equivalent to less than 1.5 days of natural background radiation.
How long do X-ray results take?
The NHS says you may get results on the same day or at an appointment a few weeks later. Contact the clinician who referred you if you have not heard after a few weeks.
Do I need an X-ray before a joint replacement?
Usually yes. Surgeons use X-rays to plan the operation, although NICE says the decision to refer for joint replacement should be based on clinical assessment, not on X-ray scores alone.
Can I have an X-ray if I am pregnant?
Tell the radiographer if you are or might be pregnant. They will consider whether the X-ray is needed now and how to minimise any risk.
Can an X-ray tell if I need a knee or hip replacement?
Not on its own. NICE says referral for joint replacement depends on how much your symptoms affect your quality of life and whether non-surgical treatment has worked, judged by clinical assessment rather than an X-ray score.
Sources and further reading
- NHS: X-ray
- UK Health Security Agency: Patient dose information – guidance
- NICE NG226: Osteoarthritis in over 16s
- NICE NG100: Rheumatoid arthritis in adults
- NICE NG65: Spondyloarthritis in over 16s
- NICE NG59: Low back pain and sciatica in over 16s
- NHS: Rheumatoid arthritis – diagnosis
Educational information for people in the United Kingdom, not personal medical, legal or financial advice. NHS processes, rules and prices change, so check the linked official sources and speak to your GP, specialist team or pharmacist about your own situation. Charity no. 1218461. Pending clinical review. If you feel very unwell, call 999 or go to A&E. For urgent advice, contact NHS 111.
Continue with related help
- Arthritis blood tests explained — what results mean
- What happens at a rheumatology appointment — your first visit
- Surviving NHS waiting lists — your rights while you wait
- Preparing for joint replacement — a practical checklist