What's the difference between rheumatoid disease and osteoarthritis?

When people say 'arthritis' they usually mean any condition that causes painful joints. 

But not all arthritis is the same.

In fact, there are over 100 different types of arthritis. 

The word 'arthritis' means 'swollen joint'. 

Some - like osteoarthritis - have arthritis in the name, while others - like Lupus and Gout - don’t.

This causes a lot of confusion.

While arthritis conditions are all linked by this one common symptom, they may have very different causes, outcomes, and treatments.

The two most well-known types of arthritis are osteoarthritis (OA) and rheumatoid arthritis (RA).

Osteoarthritis affects over 27 million Americans, whereas rheumatoid affects around 1.3 million. Some unlucky patients may develop both rheumatoid and osteoarthritis.

Let’s take a closer look at these two forms of arthritis.

 Diagram showing difference between normal and arthritic joints

Osteoarthritis - a degenerative disease linked to aging

Osteoarthritis can occur as we age. It’s usually the result of years of wear and tear on the body, as natural cartilage wears down. 

OA may be caused by a combination of factors including age, genetics, hormones, joint injury, obesity and muscle weakness. Athletes are prone to osteoarthritis because of the strain they place on their joints.

Osteoarthritis can be very painful. Cartilage damage can eventually lead to bone spurs and bone-on-bone rubbing, typically in larger weight-bearing joints, such as knees and hips.

People with OA may wake up in the mornings with joint stiffness for around thirty minutes. Joint pain and stiffness flare up after physical activity.

OA can be treated with steroid injections into the joint, and oral NSAID drugs such as ibuprofen for pain. In severe cases, surgery may be necessary.

Rheumatoid arthritis: an autoimmune disease that can be diagnosed at any age

Rheumatoid arthritis is an autoimmune disease in which the body’s immune system mistakenly attacks the body’s joints. 

It can occur at any age, with people are diagnosed between the ages of 30 and 50 years. There is even a form that affects children, called JIA. 

Doctors don’t know what causes rheumatoid arthritis. RA has been linked to genetics, hormones, viral or bacterial infections or other environmental factors, and research is ongoing. 

RA typically attacks smaller joints first, such as the hands. Symptoms may appear in matching sets on both sides of the body. RA can occur throughout the body to as many as 30 separate joints.

Some RA patients develop firm lumps under the skin, called nodules. These lumps range in size from a pea to a golf ball and can be extremely painful.

RA patients may wake in the morning with soreness and stiffness, which can continue for several hours, and gradually improve over the course of the day. 

Unlike OA, RA is not limited to just the joints. It is a systemic illness that affects the whole body. Other symptoms include fever, fatigue and muscle pain. It can cause nerve damage.

When left untreated, RA can damage other internal organs, including the heart, eyes and lungs. 

People with RA have an increased risk of heart disease and cancer. This can occasionally result in a shortened lifespan.

Treatments include oral NSAID drugs, like Diclofenac and Ibruprofen to reduce pain and inflammation, as well as oral steroids like prednisone, and DMARDS like Plaquenil and Methotrexate (also used in chemotherapy). 

Biologic drugs - including Humira, Enbrel and Remicade - are becoming more widely prescribed for moderate and severe RA. They are often administered by IV infusion or self-injection. 

Janus kinase (JAK) inhibitors - like Xeljanz  - are a new class of RA drugs that can be taken in a pill form. 

It’s time to stop confusing RA and OA!

While osteoarthritis and rheumatoid arthritis are both diseases that can result in joint pain and loss of mobility, they have very different causes, symptoms and treatments. 

It can be frustrating for OA and RA patients when the two diseases are confused. 

Some rheumatoid patients and doctors prefer to say ‘rheumatoid disease’ instead of ‘rheumatoid arthritis’. This helps to distinguish between the two conditions, and acknowledges that rheumatoid is an autoimmune disease, like Lupus. 

If you think that you have ANY form of arthritis, you should seek medical help. Visit your doctor to get a clear diagnosis as soon as possible. 

The sooner you treat arthritis, the better your chance of a positive long term outcome.