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How do you tell if it’s osteoarthritis or rheumatoid arthritis?


Osteoarthritis and rheumatoid arthritis are two common types of arthritis that cause joint pain, stiffness, and swelling. While both conditions affect the joints, there are some key differences between osteoarthritis vs rheumatoid arthritis in terms of symptoms, causes, risk factors and treatment options. Understanding the distinctions can help you identify which type of arthritis you may have.

In general, osteoarthritis is a degenerative joint disease that most often develops gradually over time due to wear and tear on the joints. Rheumatoid arthritis is an autoimmune disorder that causes inflammation throughout the body and attacks the joint linings.

Osteoarthritis tends to develop in older adults, while rheumatoid arthritis often starts at a younger age. Joint pain is the primary symptom of osteoarthritis. Rheumatoid arthritis also causes joint pain, but produces additional systemic symptoms like fever and fatigue.

While osteoarthritis cannot be cured, symptoms can be managed with lifestyle changes, exercise, braces, medication, injections and even surgery. Rheumatoid arthritis requires more aggressive treatment to stop the immune system from attacking the joints, including medications like DMARDs and biologics.

Let’s take a more in-depth look at how to distinguish osteoarthritis vs rheumatoid arthritis.

Symptoms

The main shared symptom between osteoarthritis and rheumatoid arthritis is joint pain, though the characteristics of the pain can be quite different.

With osteoarthritis, the joint pain is primarily due to mechanical wear and tear on cartilage and bones. It tends to get worse with use of the affected joint, but feel better with rest. The pain is typically localized to the joints experiencing degeneration. Common osteoarthritis symptoms include:

– Aching joints with use or overuse
– Stiffness and limited range of motion, especially first thing in the morning or after periods of inactivity
– Tenderness when applying pressure to the joint
– Swelling or inflammation that is localized around the joint
– Clicking, cracking or grinding noises when moving the joint (called crepitus)
– Bony nodules at finger joints from bone spur formation

Rheumatoid arthritis joint pain results from an overactive immune system attacking the joint linings, leading to inflammation and damage of cartilage and bone. The pain and stiffness are usually worse in the morning or after long periods of inactivity. Rheumatoid arthritis symptoms include:

– Joint pain on both sides of the body (symmetric)
– Joint swelling, warmth and tenderness
– Stiffness lasting over 30 minutes in the morning
– Fatigue, low energy, weakness
– Low-grade fever
– Reduced range of motion and deformity or deviation of joints over time

In addition to joint problems, people with rheumatoid arthritis often experience systemic symptoms like:

– Overall feeling of illness
– Loss of appetite
– Low-grade fever
– Firm nodules under the skin
– Dry eyes and mouth from Sjögren’s syndrome

Causes

Osteoarthritis and rheumatoid arthritis have very different underlying causes, even though they both affect the joints.

Osteoarthritis is considered a non-inflammatory or degenerative type of arthritis. It develops from years of repetitive stress and normal wear and tear that breaks down the cartilage cushioning the ends of bones. This allows bone to rub against bone, causing pain and stiffness. Risk factors like aging, obesity, joint injury and repetitive motions make people more prone to osteoarthritis. It often develops in joints of the hands, knees, hips and spine.

In contrast, rheumatoid arthritis is an inflammatory autoimmune disease. With rheumatoid arthritis, the body’s immune system mistakenly attacks its own healthy tissues in the joint linings. This triggers inflammation, thickening of the joint lining and buildup of synovial fluid. It can eventually damage cartilage and bone as well. The cause is not fully understood but believed to involve a combination of genetic and environmental factors. Rheumatoid arthritis most often impacts smaller peripheral joints like the wrists, fingers and toes symmetrically on both sides of the body.

Risk Factors

Certain factors increase the likelihood of developing osteoarthritis vs rheumatoid arthritis:

Osteoarthritis Risk Factors

– Older age – Risk rises dramatically after age 45
– Obesity – Excess weight adds stress to weight-bearing joints
– Joint injury – Sports, work-related or past injuries increase risk
– Genetics – Congenital defects and genetic mutations can predispose to osteoarthritis
– Repetitive joint use – Jobs or activities requiring repetitive motions
– Bone deformities – Misaligned joints from fractures, dislocations etc.

Rheumatoid Arthritis Risk Factors

– Family history – Genetic link in about 50% of rheumatoid arthritis patients
– Being female – Nearly 3 times as many women get rheumatoid arthritis
– Age – Onset typically between ages 30-50 but can start at any age
– Smoking – Much higher risk and severity, especially in men
– Obesity – Excess fat cells increase inflammation
– Environmental factors – Some viruses or bacteria may trigger rheumatoid arthritis in those genetically susceptible

Diagnosis

To diagnose osteoarthritis vs rheumatoid arthritis, doctors consider the location and pattern of joint symptoms, risk factors, exam findings, and results of imaging and lab tests.

Diagnosing Osteoarthritis

– X-rays showing loss of cartilage, bone spurs and other degenerative changes
– Joint exam revealing swelling, pain, crepitus, reduced motion
– Joint pain worse with use and better with rest
– Osteoarthritis risk factors like older age and obesity

Diagnosing Rheumatoid Arthritis

– Blood tests positive for rheumatoid factor and anti-CCP antibodies
– X-rays and MRIs showing joint damage characteristic of rheumatoid arthritis
– Symmetric joint involvement
– Prolonged morning stiffness over 30 minutes
– Extra-articular symptoms like fatigue and fever
– Family history of rheumatoid arthritis

Treatment

There is no cure for osteoarthritis or rheumatoid arthritis. However, a range of medication and non-medication treatments can effectively manage symptoms. The treatment approaches differ significantly based on the type of arthritis.

Osteoarthritis Treatment

– Weight loss to reduce stress on joints
– Low-impact exercise like walking, swimming, cycling
– Physical therapy for strength, flexibility and range of motion
– Braces, splints, canes or other assistive devices
– Acetaminophen or NSAIDs for pain relief
– Corticosteroid or hyaluronic acid injections
– Surgery like arthroplasty, osteotomy, arthroscopy

Rheumatoid Arthritis Treatment

– DMARD medications to slow disease progression by suppressing the immune system – Methotrexate most commonly used
– Biologic medications like TNF inhibitors that target parts of the immune system
– Low-dose corticosteroids to rapidly reduce inflammation
– Complementary therapies like massage, acupuncture
– Joint splints or orthotics
– Surgery to repair damaged joints

The medication treatment for rheumatoid arthritis is much more aggressive than osteoarthritis due to its autoimmune nature. Lifestyle approaches like diet changes, stress reduction and exercise are also important in managing rheumatoid arthritis symptoms.

Outlook and Prognosis

Osteoarthritis is a chronic, progressive condition that worsens over time and has no cure. However, symptoms can be well managed with treatment. With rheumatoid arthritis, early diagnosis and aggressive treatment is essential to achieve remission and prevent permanent joint damage.

Osteoarthritis Prognosis

– Gradual worsening over time, especially weight-bearing joints like knees and hips
– No way to reverse joint damage, but symptoms can be managed
– Osteoarthritis may severely impact quality of life from chronic joint pain
– Joint replacement surgery may be needed in severe cases

Rheumatoid Arthritis Prognosis

– Disease course varies – Some have mild symptoms that resolve while others have aggressive progression
– Early treatment can reduce or stop inflammation and prevent disability
– Medications can induce remission for prolonged periods
– Joint damage can occur rapidly if inflammation isn’t controlled
– Premature death from cardiovascular disease, infections and complications

While both types of arthritis are chronic, rheumatoid arthritis carries a higher risk of serious complications if not treated promptly and managed lifelong. Following doctor’s recommendations for medication, lifestyle changes and regular monitoring is key.

Conclusion

Osteoarthritis and rheumatoid arthritis share some similarities that make them easy to confuse, including joint pain, swelling and stiffness. But they have very different underlying causes – osteoarthritis from wear and tear versus rheumatoid arthritis from immune system dysfunction.

Key distinguishing factors include the joints affected, symmetry, systemic symptoms, morning stiffness duration, risk factors and typical age of onset. Osteoarthritis treatment focuses on symptom management. Rheumatoid arthritis requires medications to modify the autoimmune disease itself.

Being able to differentiate between osteoarthritis vs rheumatoid arthritis leads to earlier diagnosis and proper treatment to prevent rapid joint damage. Understanding the typical symptoms and disease course for each type of arthritis helps patients know what to expect and work with their doctor to manage symptoms optimally.

Factor Osteoarthritis Rheumatoid Arthritis
Underlying cause Degenerative wear and tear of cartilage Autoimmune inflammation of joint linings
Age of onset Over age 45 typically Younger, between ages 30-50
Joints affected Weight-bearing joints like knees, hips, spine Small joints – hands, wrists, feet
Pain character Dull, aching, worse with use Pain and stiffness, worse in mornings
Morning stiffness Brief or absent Over 30 minutes
Swelling Hard, bony Soft, fluid-filled
Damage pattern Asymmetric, one or few joints Symmetric, both sides of body
Extra-articular symptoms None Fever, fatigue, dry eyes
Outlook Progressive, manage symptoms Relapsing/remitting, aim for remission