The Difference between Osteoarthritis and Rheumatoid Arthritis

Patients often tell me “Doc, I have arthritis.” As a rheumatologist, it is my job to figure out if they indeed have arthritis, and even more importantly what type of arthritis it is. Two of the most common types I see are osteoarthritis and rheumatoid arthritis. How can these two entities be distinguished? Well, let’s take a closer look.

Rheumatoid arthritis (RA) is a chronic condition that causes inflammation in the joints, resulting in joint pain, stiffness, swelling and limited motion and function of many joints. The disease typically progresses from the peripheral joints, such as the hands and the feet, to the proximal joints, such as the elbows, knees, shoulders and hips. It affects approximately 1% of the population in the U.S. The stiffness seen in active RA is described as difficulty moving the joints after prolonged inactivity and is most often worse in the morning when getting out of bed. It can last anywhere from 1 hour to the whole day and tends to improve with activity. RA most often begins between the fourth and sixth decade of life, though signs and symptoms can start at any age. Diagnosis is based on laboratory data, physical exam, and imaging studies. If left untreated and uncontrolled it may lead to damage and destruction of joints, resulting in loss of the firm, rubbery tissue that cushions the bones at the joints, called cartilage, and also leads to deformities. While RA was once considered the most disabling type of arthritis, a variety of new treatment advances have now enabled those with RA to lead active and very functional lives.

Osteoarthritis (OA), on the other hand, is a chronic progressive disorder of the joints caused by gradual breakdown of the joint structures and typically affects middle-age to elderly people. It is also referred to as degenerative joint disease. This type of arthritis is often inaccurately referred to as the “wear and tear” of the joints. Rather, OA affects the entire joint, including the bone, cartilage, ligaments, and joint lining. It is the most common musculoskeletal disability in the elderly. Weight-bearing joints are most commonly affected, such as the hips and knees, but the hands, feet, shoulders, and spine can also be involved. Risk factors include previous trauma, overuse of joints, obesity, having family members with OA and being of an older age. Unlike those who have RA, patients with OA find their pain is worst at the end of the day and improves with rest. There is no cure for OA, so ultimately the treatment goal is to improve functionality and minimize pain and disability. The management focuses on exercise, patient education, weight loss, oral and topical medications, joint injections), and finally surgical interventions.

See your doctor if you have any of the symptoms mentioned above. Remember that once it has been established that you have arthritis, the next step is to determine which type you have, since treatment options differ between Rheumatoid Arthritis and Osteoarthritis. Regardless of the underlying cause though, the goal of treatment is to always improve quality of life and minimize pain.