Osteoarthritis vs Rheumatoid Arthritis: What’s the Difference?

There are over 100 different types of arthritis. While many forms of arthritis are similar, different types are more painful than others and can impact daily activities. Osteoarthritis and rheumatoid arthritis are two of the most common types. These two specific types of arthritis share some symptoms, but they have different causes and treatments.  

What is Osteoarthritis? 

osteoarthritisOsteoarthritis is the most common form of arthritis, affecting over 32.5 million adults in the United States. It is often known as degenerative joint disease or “wear and tear” arthritis because it can result from repetitive movements, like playing sports, that put pressure on the joints. Joints are the intersection where two bones come together. In between joints is cartilage, a firm but flexible protective tissue that cushions the ends of bones and protects them from rubbing against each other. With osteoarthritis, cartilage breaks down over time and causes the bones to rub together. When bones rub together it causes pain, stiffness, swelling, and other symptoms.  

Osteoarthritis occurs most frequently in the hands, hips, and knees. It may also occur in the shoulder and spine, usually at the neck or lower back. 

The risk of developing osteoarthritis increases with age, although it can occur at any age. Women are more likely than men to have osteoarthritis, especially after age 50.  When younger people develop osteoarthritis, it’s usually because of a joint injury or problems with how the joint formed. Although most people over the age of 60 have some form of arthritis, it is not an inevitable part of aging. Not everyone will develop it as they get older. 

Common symptoms of osteoarthritis include joint pain, stiffness, and swelling. Joint stiffness is most common in the morning and tends to improve with movement. Physical inactivity during the day, such as sitting for long periods, can cause stiffness or locking of the joints in some people with osteoarthritis.  

People with osteoarthritis might notice changes in the way the joints move and may feel like the joint is loose or unstable. Some people may experience crepitus, which is when a joint makes a popping or crackling noise with movement. It most commonly affects knee or shoulder joints, but it can also affect the ankles, elbows, fingers, and wrists.  

Other symptoms of osteoarthritis include: 

  • Loss of flexibility and reduced range of motion 
  • Inflammation 
  • Discomfort or tenderness at the affected area
  • Extra lumps of bone called bone spurs 
  • Swelling around the joint 

Osteoarthritis affects each person differently. For some, it may not affect daily activities. While others may experience significant pain and disability from the condition. As osteoarthritis becomes more advanced, the pain associated with it may become more severe.  

Stages of Osteoarthritis
Photo: TeachMeSurgery

Osteoarthritis can be divided into four stages: 

  • Stage 1 — This is the least severe stage. There is minor wear and tear in the joints and little to no pain in the affected areas.  
  • Stage 2 — In stage 2, X-rays will show noticeable bone spurs. The affected area will feel stiff after sedentary periods. 
  • Stage 3 — Cartilage in the affected area begins to erode. The joints become inflamed, causing discomfort during normal activities. 
  • Stage 4 — The cartilage is almost completely gone, causing an inflammatory response from the joint. Overgrowth of bone spurs may cause severe pain.  

Risk Factors for Osteoarthritis  

There are certain factors that may increase your risk for osteoarthritis. Some are modifiable and others are not. Risk factors include: 

  • Family members with the condition, particularly a parent or sibling 
  • An occupation that involves repetitive actions, like kneeling, climbing, or heavy lifting 
  • Having another condition that affects joint health, such as other types of arthritis  
  • Being at least 50 years old  
  • Overweight or obesity 

If you have osteoarthritis in one part of your body, you have an increased risk of developing it in other parts of the body. 

How is Osteoarthritis Diagnosed? 

There is no single test to diagnose osteoarthritis. A diagnosis is based on factors like medical history, symptoms, and age. To diagnose osteoarthritis or rule out other conditions, your doctor may run one of the following tests: 

  • X-ray or other imaging tests  
  • A joint fluid analysis is known as arthrocentesis. During an arthrocentesis, joint fluid is removed and analyzed to determine the cause of pain and swelling.  

How is Osteoarthritis Treated? 

Osteoarthritis is usually treated with a combination of treatments and will depend on factors like age, occupation, medical history, and the severity of the disease. The goals of treatment are to reduce pain and other symptoms, improve joint function, and maintain quality of life. Treatment is also meant to stop or slow disease progression.  

Treatment options may be non-pharmacologic, pharmacologic, complementary or alternative, or surgical. The safest and least invasive treatment options should be used first before moving on to more invasive and expensive options like surgery.  

Non-pharmacologic options include exercise, weight loss, or bracing, and splinting to support painful joints.  

Pharmacologic options include acetaminophen for mild osteoarthritis or non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin or ibuprofen. Opioids are also an option for osteoarthritis pain, but because of the potential for abuse, they should only be used if patients don’t respond to acetaminophen or NSAIDs.  

Complementary or alternative treatments for osteoarthritis can include acupuncture or glucosamine and supplements like chondroitin and turmeric. This combination may help relieve arthritis pain by slowing down the deterioration of cartilage.  

Surgery should only be considered when patients don’t respond to other treatments. The most common surgery is a total joint replacement, a procedure in which parts of the damaged joint are removed and replaced with a ceramic, metal, or plastic prosthesis.  

What is Rheumatoid Arthritis? 

Rheumatoid arthritis (RA) is an inflammatory and autoimmune disease. The immune system mistakenly attacks healthy cells in the body and causes painful swelling in the affected parts of the body. RA mainly attacks the joints, especially joints in the hands, wrists, and knees. In severe cases, rheumatoid arthritis can attack internal organs like the lungs and heart.  

Rheumatoid arthritis affects more than 1.3 million Americans. The specific causes of RA are unknown, but research has shown that autoimmune conditions may run in families. There are certain genes you are born with that may make you more likely to get RA. These include HLA-DRB1, STAT4, and HLA-DR4.  

The main symptoms of rheumatoid arthritis are joint pain, stiffness, swelling, and inflammation. Other symptoms include: 

  • Weight loss 
  • Fever 
  • Fatigue or tiredness 
  • Weakness 

stages of Rheumatoid Arthritis The joint damage RA causes usually happens on both sides of the body. If a joint in one of your arms or legs are affected, the same joint will likely be affected in the other arm or leg. The symmetry of joint damage is one way doctors distinguish RA from other types of arthritis.  

Rheumatoid arthritis is also divided into four stages:  

  • Stage 1  – The body mistakenly attacks its own joint tissue. There may be minor symptoms, such as joint stiffness in the morning, that gets better with movement.  
  • Stage 2 – RA may progress to stage 2 before a diagnosis is made. The body begins to make antibodies and the joints start to swell up. There may be inflammation in other organ systems, and lumps on the elbows known as rheumatoid nodules may develop. 
  • Stage 3 – The joints start to become bent and deformed. Misshapen joints can start to press on the nerves and cause nerve pain. The fingers may start to become crooked. 
  • Stage 4 – If not treated, RA will progress into the last stage and the joints will become fused. Most people do not reach this stage. 

Risk Factors for Rheumatoid Arthritis  

Like osteoarthritis, there are several factors that can increase your risk of RA, including:  

  • Age – Although RA can develop at any age, the likelihood increases with age. The onset of RA is highest for people in their sixties. When it starts between the ages of 60 and 65, it’s called elderly-onset RA or late-onset RA. Women and men get elderly-onset RA at nearly the same rate.  
  • Gender – Women are two to three times more likely to develop RA than men. About 75% of RA patients are women.
  • Smoking and exposure to smoke – Studies have shown that cigarette smoking not only increases the risk of developing RA, but can also make the disease worse. Children whose mothers smoked have double the risk of developing RA as adults.
  • Obesity 
  • Being obese can increase the risk of developing RA. Being overweight can also make the medication less effective. 

Another potential risk factor for women is a history of live births. Women who have never given birth may be at a greater risk of developing RA than women who have given birth. It has also been found that women who have breastfed their infants have a decreased risk of developing RA. While the reason for these associations is unclear, researchers believe there are long-lasting hormonal changes associated with pregnancy and breastfeeding that can affect the risk of RA.  

How is RA Diagnosed? 

There is no single test to confirm a diagnosis of RA. Your doctor can diagnose RA by reviewing your symptoms, a physical examination, and performing X-rays and other lab tests. 

Your doctor may run a blood test to look for antibodies in the blood that are commonly seen with RA. A blood test can also show if there are high levels of inflammation.  

It is best to get a diagnosis early to begin treatment. The early you can begin treatment, the more likely you can stop or slow disease progression.  

How is RA Treated? 

There is no cure for RA, but it can be treated and managed with medication and self-management strategies. Treatment may consist of disease-modifying anti-rheumatic drugs (DMARDs) that block the effects of chemicals your immune system releases when it attacks your joints.  

Non-steroidal anti-inflammatory drugs (NSAIDs) can help relieve pain and inflammation from RA. Unlike DMARDs, they do not slow the progression of the disease. Steroids, such as cortisone, can also help relieve pain and inflammation.  

physical therapy for arthritis Physical activity can help ease the symptoms of RA, but you may need to scale back if you experience a flare-up. You can do gentle range-of-motion exercises like stretching to keep the joints flexible. Low-impact aerobic exercises like walking or swimming can help increase muscle strength and relieve some of the pressure on your joints.  

Some patients may need medications called biologic response modifiers or biologic agents. These block immune system chemical signals that cause inflammation or joint damage.  

Managing Osteoarthritis or Rheumatoid Arthritis  

Both osteoarthritis and rheumatoid arthritis can have a profound impact on your daily life. They can affect your work or social activities and may make it difficult to do the things you used to do. Treatment can be beneficial for relieving the symptoms of osteoarthritis and RA, and self-management strategies can help you feel more in control of your health. 

It can be helpful to stay organized and keep track of your symptoms, pain levels, medications, and side effects. You can share this information with your doctor and the two of you can work together to figure out which treatment options will work best for you.  

It’s also important to address the emotional aspect of living with a chronic illness. Whether you’re newly diagnosed or have been living with osteoarthritis or RA for years, it’s normal to go through a range of emotions related to your disease. You may feel angry, depressed, or overwhelmed. Know that it’s OK to feel that way. 

If you feel comfortable, talking to a friend or loved one can be helpful when you feel like your disease is getting you down. Although asking for help can be hard, you may need to lean on your support system, especially if you are at a stage in your disease that makes it difficult to do things like shop or clean the house. Therapy can also be helpful if you are struggling.  

If you need extra help managing your condition, you may want to consider taking classes that can teach you disease management skills. They can also help teach you how to communicate with your healthcare providers. These classes can also help you find a new support system in other participants.  

No matter which condition you are living with, you don’t have to do it alone. At PatientsLikeMe, there are thousands of people just like you who are learning to manage osteoarthritis or rheumatoid arthritis. Join them today. 

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