Osteoarthritis versus Rheumatoid Arthritis

Osteoarthritis (OA) is a degenerative condition where the cartilage in joints is damaged, disrupting the smooth gliding motion of the joint surfaces. The result is pain, swelling, and deformity that can worsen over time. The most common joints affected are knees, hips, spine, and hands. The pain of osteoarthritis increases with overuse and improves with rest.

Rheumatoid arthritis (RA), on the other hand, is an inflammatory autoimmune disease that affects connective tissue throughout the body. The most common result is redness, swelling, and tenderness in the joints. RA symptoms and severity can vary significantly between people. Some may have mild symptoms over a short period of time and some may have more severe forms that last many years. RA may occur in cycles of remission with no symptoms and flare ups where symptoms are more severe.

Joints Affected by Osteoarthritis:

Rheumatoid Arthritis:

Causes

Osteoarthritis is the result of wear and tear on joints over time. People may be more or less likely to have OA because of a combination of genetics and environment. Some may have mild symptoms with little progression, while others have symptoms that significantly worsen over time, affecting mobility and quality of life. In some cases, the cause of OA is unknown, but factors that increase stress on joints and the amount of wear and tear include:

• Malalignment of bones
• Previous trauma to the joint
• Excess weight
• Muscle and nerve problems that affect how the joint moves
• Health conditions that affect joints and surrounding tissues
• Repetitive movements over long periods of time

In people with rheumatoid arthritis their immune system mistakenly identifies healthy joint tissue as foreign tissue and attacks it. This attack causes irritation, swelling, and a thickening of the fluid in the joint. Over time, this constant inflammation wears away at the cartilage and bone, making movement painful and difficult. The exact cause of autoimmune disorders like RA is not known, but is believed to be a combination of:

• Genetic factors—faulty genes may redirect immune system to attack specific healthy tissue
• Environmental factors—may trigger gene defect and/or cause change in immune system
• Chemical or hormonal imbalances in the body

Risk Factors

A risk factor is something that increases your likelihood of getting a disease or condition. It is possible to develop osteoarthritis with or without the risk factors listed below. The risk of OA increases with age, especially in those over 50 years old. OA is more common in women than in men, but it affects men at an earlier age. Other factors that may increase your chance of OA include:

• Family history
• Obesity, which causes extra strain on the joints
• Occupation—jobs that require a lot of lifting, squatting, or repetitive joint use
• Weakness of muscles or tendons—joints without proper support have more stress
• Previous injury or surgery to the joint
• History of joint infection or disease
• Inherited structural abnormalities—may cause imbalance or malalignment that increases stress on joints
• Chemical or hormonal imbalances in the body—may affect the health of cartilage

Rheumatoid arthritis can develop at any age, but usually appears between 30 and 50 years old. RA is more common in women, but may appear later in life for men. Other factors that may increase your chance of RA include:

• Genetics—Some people with RA have specific genetic variations that are associated with abnormal immune response.
• Smoking—Current or past smoking nearly doubles the risk of RA. Smoking is associated with chronic inflammatory reactions throughout the body. Tobacco use in combination with genetic factors has the most impact on risk.
• Infection—Bacterial and viral infections cause an immune response. Inflammation stimulates a process to rid the body of infection. In some people, this inflammation and tissue building doesn't stop. Negative immune responses increase the risk of RA.
• Obesity —Some evidence suggests a link between obesity and an increased risk of RA.

Symptoms

Symptoms of osteoarthritis include:

• Increased pain and stiffness in the joint, especially when the joint is used or stressed
• Gradual loss of range of motion in the affected joint
• Joint instability, which may give the feeling of the joint giving out
• Grating or creaking sound when moving the joint
• Deformed or misshapen joints with or without visible nodes on the bones
• Swelling—joint may appear red or inflamed

Pain may be specific to activity and the joint affected. For example, knee pain may occur when climbing or going down stairs. It often affects one side of the body more than the other. Some people have symptoms that get worse, while others have symptoms that stabilize. If left untreated, OA can lead to significant disability.

Rheumatoid arthritis may involve the same joints on both sides of the body (e.g., right hand and left hand are both affected). The symptoms of RA vary from mild to severe or develop quickly or slowly over time, depending on the person. Though RA is a chronic condition, symptoms usually flare up and subside intermittently. Some people have symptoms that get worse over time, while others have long periods without symptom flares. Hallmark symptoms of rheumatoid arthritis include:

• Increased pain and stiffness in the morning that usually lasts 30-60 minutes or longer
• Red, swollen, tender, and warm joints
• Deformed, misshapen joints, especially the hands
• Because RA inflammation can affect many areas of the body it may cause:
  • Intense fatigue, decreased energy
  • Muscle aches and weakness
  • Decreased appetite
  • Weight loss
  • Fever and sweats
  • Depression
  • Problems sleeping
  • Bumps under the skin, called rheumatoid nodules

Treatment

The goals of osteoarthritis treatment include pain relief, maintaining mobility, slowing disease progression, and improving quality of life. Working with a healthcare team made up of doctors, surgeons, nurses, pharmacists, and other health professionals is important to help find the treatments that works best for each person. While there is no cure for OA, most symptoms can be managed with a combination of lifestyle changes and medications. If these don't work, surgery may be an option. The earlier OA is detected and treated, the better it can be controlled and joint damage minimized. OA treatment may include the following:

• Maintain a healthy weight to reduce stress on your body's joints.
• If possible, avoid activities that require intense, repetitive motion on joints.
• Get regular exercise to strengthen muscles. Strong muscles absorb shock and protect joints from excess stress.

In contrast, there are no current guidelines to reduce the risk of developing rheumatoid arthritis because the exact cause is not known. Managing certain RA risk factors may help. Steps include:

• Quitting smoking —When you quit smoking, the body begins to repair itself almost immediately. RA risk rises with each year of smoking.
• Maintaining a healthy weight— Obesity may be linked to a higher overall risk of developing RA and an earlier onset
• Drinking alcohol in moderation or not at all—Some studies have suggested that moderate alcohol consumption is associated with reduced risk of RA. Moderate alcohol intake means two drinks for men, and one drink per day for women.

Both osteoarthritis and rheumatoid arthritis can be debilitating diseases, if left untreated. For more information, visit the Arthritis Foundation website and talk to your doctor for diagnosis and treatment options.

Mary Elizabeth Tekesky, PA-C, with LewisGale Physician Orthopedics is available for consultation, diagnosis, and treatment if you are experiencing any symptoms. To schedule an appointment, call the office at (540) 951-6000 or click to book an appointment online below.

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