Rheumatoid Arthritis vs. Osteoarthritis

The CDC reports that approximately fifty five million adult Americans have been diagnosed with arthritis. Simply put, arthritis is inflammation of the joints, which causes a number of unpleasant symptoms including joint pain and stiffness.

Common Types of Arthritis

The most common types of arthritis are Osteoarthritis (OA) and Rheumatoid Arthritis (RA). Osteoarthritis and rheumatoid arthritis have many of the same symptoms; however, they develop much differently. Both OA and RA are diseases that cause joint inflammation and pain and loss of function. There are important differences between the two. This article talks about what they have in common and what they don’t. So you can understand what is happening and together with your doctor make good choices about self care.

OA and RA are both joint diseases that involve joint deformity and pain as well as inflammation. From a conventional medical point of view, they are managed very differently. From an integrative/functional medicine point of view, there is much overlap in how we treat them.

The main areas of distinction between OA and RA are-

• What causes them
• Clinical presentation
• Treatment

Causes of Osteoarthritis and Rheumatoid Arthritis

Rheumatoid Arthritis is a classic autoimmune disease. The immune system gets “activated” and various changes cause the immune system to mistake the persons own cells for invading pathogens. So the body attacks itself and results in the disease.

In contrast, Osteoarthritis is not known to be an autoimmune disease. It is classically considered “wear-and-tear” arthritis where the cartilage and other structures of the joint wears down over time and the joints become restricted and painful. Recent research has shown that there is a systemic immune imbalance in people with osteoarthritis. There are elevations in immune chemicals called cytokines. Sometimes there will be a “flare up” of joint inflammation in Osteoarthritis, but the inflammation is not as intense as Rheumatoid Arthritis.

Clinical Presentation of Rheumatoid Arthritis and Osteoarthritis

The onset of Rheumatoid Arthritis can occur at any age, but it is most common between 30-50 years of age. Women are more likely than men to get RA. Smoking and family history increases risk.

Symptoms of Rheumatoid Arthritis include-

• Pain and stiffness in multiple joints, most often in the wrists and hands. Morning stiffness lasting more than an hour suggests inflammatory arthritis and should be evaluated.
• Fatigue
• Weight loss
• Low blood count
• Boggy swelling joints

A skilled doctor diagnoses Rheumatoid Arthritis based on history, exam, and presence of particular antibodies including rheumatoid factor or anti-citrullinated portein antibody.

In contrast, Osteoarthritis tends to be a disease of ageing. It is the most common form of arthritis, and is a big contributor to functional impairment and loss of independence in older adults.

Risk factors for Osteoarthritis include-

• Obesity
• Older age
• Join injuries
• Genetics
• Certain systemic bone diseases

It is most common in the hands, knees, hips and spine, but can also affect any joint. There is commonly morning stiffness in arthritic joints, but it typically gets better with movement. It is most commonly diagnosed on the basis of clinical history and exam, and xrays of the joints. Sometimes MRI can be used to clarify certain clinical questions. There are no blood tests for OA, but blood tests can help rule out other causes of joint pain, such as RA.

Treatment for Arthritis

There are various treatment options for Rheumatoid Arthritis and Osteoarthritis. There is a range of drugs that can be used to treat rheumatoid arthritis including NSAIDS like ibuprofen and prednisone. Newer “biologic” agents block specific inflammatory chemicals that can drive the inflammatory process. Some evidence has shown that diet and other lifestyle measures can reduce the inflammation of rheumatoid arthritis. The medications used for osteoarthritis are aimed at reducing pain and stiffness. There are no medications to stop the degenerative process. Medications often used for pain include acetaminophen and NSAIDs. Lifestyle medicine and functional medicine approaches have been shown to reduce systemic inflammation.

Physical exercise is important to maintain joint function in both OA and RA. If joints are acutely inflamed, care should be taken to not overly aggravate the joint. Skilled physical therapy can often be useful to make sure the exercise is safe and effective in maintaining or building joint function or mobility.

Injection therapies are also used in both OA and RA. Injection of anesthetic and corticosteroids can be useful for reducing acute joint inflammation. Corticosteroid injections may have potentially significant side effects, so they should be used wisely. There is a joint lubrication fluid called hyaluronic acid that may often reduce the pain of OA. It is recommended to consult your doctor to evaluate the best options for your situation.

The integrative doctors at Rose Wellness understand how arthritis can impact every area of your life. If you are experiencing joint pain, contact us today to see how we can help minimize joint pain and stiffness, protect against further joint damage, and show you ways to help improve your quality of life.