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Osteoarthritis vs Rheumatoid Arthritis: Complete Guide 2021

Osteoarthritis vs rheumatoid arthritis

Understanding osteoarthritis vs rheumatoid arthritis is important because it can significantly impact treatment. Osteoarthritis is a complex biological disease of the contents that make up a joint, instead of the popular “wear and tear” theory, particularly in knee and hip joints. Rheumatoid arthritis is a dysfunction of the immune system that leads to increased inflammation, particularly in smaller joints. Both conditions have distinct symptoms aside from the symptoms they share including pain and functional disability. Osteoarthritis is best treated conservatively with diet, exercise, and intermittent pharmacological intervention while rheumatoid arthritis depends more heavily on pharmacological treatment. Let’s look at the differences.

If you’re dealing with joint pain that doesn’t seem to be going away, all of these questions might start flooding in including: 

  1. Do I have arthritis? 
  2. There are so many kinds, how do I know which one I have?
  3. What can I do about said arthritis?
  4. Do I need surgery?

It can be overwhelming to fall into this trap of trying to get all of the answers at once. There is a ton of information out there and unfortunately, our questions may remain unanswered. 

This article takes the most recent evidence on both of these conditions to help you get one step closer to cracking the code of your arthritis.  If your arthritis is isn’t diagnosed properly, you could be missing out on some of the best treatments! Let’s take a further look at how to differentiate osteoarthritis vs rheumatoid arthritis. 

Risk factors

Osteoarthritis:

Risk factors for osteoarthritis include genetics, history of joint injury, obesity, female gender, increasing age, and muscular weakness. Although, it is important to note that osteoarthritis is not inevitable with increasing age. Certain factors associated with getting older increase your risk of developing osteoarthritis but do not guarantee it.

You can also have what’s called secondary osteoarthritis, which is joint damage secondary to a pre-existing condition that impacts the joints. It’s “predisposing conditions include trauma or injury, congenital joint disorders, inflammatory arthritis, avascular necrosis, infectious arthritis, Paget disease, osteopetrosis, osteochondritis dissecans, metabolic disorders (hemochromatosis, Wilson’s disease), hemoglobinopathy, Ehlers-Danlos syndrome, or Marfan syndrome”.

Muscular weakness and changes in your joint structure can impact the amount of force going through certain parts of your joints. This is because these risk factors alter your mechanics and place unevenly distributed force on certain parts of your joint, initiating negative consequences. 

Rheumatoid Arthritis:

Risk factors are less clear compared to osteoarthritis. It has been found that rheumatoid arthritis is primarily driven by genetics or environmental factors with genetics having a strong component in this condition.  

According to researcher Krati Chauhan et al. in an article updated in 2020, “cigarette smoking is the strongest environmental risk factor associated with rheumatoid arthritis. Studies have shown in ACPA (anti-citrullinated protein antibody) positive individuals; there is an interaction between genes and smoking that increases the risk of RA”.

Symptoms

Osteoarthritis

Common symptoms of osteoarthritis include joint stiffness, localized joint pain, impaired balance, joint instability- buckling or giving way, occasional swelling, and limited range of motion. 

These symptoms typically have a gradual onset. The symptoms may be most apparent in knees, hips, spine, or hands. It is possible to have osteoarthritis in multiple joints. 

Here are a couple of statistics about the joints typically affected by osteoarthritis from Zhang et al.

“The age-standardized prevalence of symptomatic hand and knee OA is 6.8% and 4.9%, respectively, in Framingham subjects age ≥26 years.”

“However, prevalence of symptomatic knee OA was 16.7% among subjects age ≥45 in the Johnston County Osteoarthritis Project, much higher than that reported in the Framingham Study.”

“About 9% of subjects in the Johnston County study had symptomatic hip OA”

Gradually increasing pain in knee, hands, and/or hips with stiffness in the morning along with occasional swelling and instability, there is a chance you may have osteoarthritis. It is important to note that everyone has a different experience with osteoarthritis so these symptoms could vary. 

This post “What Does Osteoarthritis Feel Like” expands on the 4 most common symptoms. 

Osteoarthritic joints can experience occasional flare ups which are usually triggered by overactivity but can also be influenced by the weather, especially cold temperatures or humidity.

These flare ups typically include increased joint pain, increased joint swelling, and higher degree of stiffness.

Rheumatoid Arthritis: 

Compared to osteoarthritis, you may notice a quicker onset of symptoms that primarily affect your hands, but can also affect wrists, elbows, shoulders, ankles, and knees. 

You may also nodules that form on your joints in your fingers or toes, as they are found in 20% of the cases of rheumatoid arthritis. 

In the joints described above, you may notice swelling, redness, and warmth as well as prolonged joint stiffness that typically lasts longer than osteoarthritis. 

These symptoms usually occur at younger ages and usually affect multiple joints at once. This is compared to osteoarthritis which starts typically with 1-2 joints with a slower progression.

According to the Arthritis Foundation, pain flare ups are common with rheumatoid arthritis and can be debilitating. These flare ups include increased joint pain, increased swelling, and overall fatigue. A participant in a focus group described pain felt during a flare up as “…doesn’t let up. It just is unrelenting.” Severity and frequency does depend on the person.

These flare ups can be triggered by overactivity, not getting enough sleep, or followed by an infection such as a cold or flu. 

Fatigue, nausea, fever, and other systemic symptoms may be present due to the autoimmune nature of the condition. It can affect different organs and lead to other symptoms aside from pain and stiffness.

Diagnosis

Osteoarthritis

Osteoarthritis can be characterized into 5 different stages

According to Rouhin et al, “OA is a clinical diagnosis and can be diagnosed with confidence if the following are present:

1) pain worse with activity and better with rest

2) age > 45 years

3) morning stiffness lasting less than 30 minutes

4) bony joint enlargement

5) limitation in range of motion”

Osteoarthritis is typically diagnosed with ruling out other conditions such as other types of arthritis.

X-rays can show some degree of osteoarthritis but is not always the most accurate because research has shown that even with arthritic changes on an x-ray, people could be totally asymptomatic.

You may also want to have your C-reactive protein levels (CRP) tested as they  can be elevated in osteoarthritis as it indicates systemic inflammation.

Rheumatoid Arthritis

In accordance with the symptoms, there is a blood test that can be done for rheumatoid arthritis that tests for something called the rheumatoid factor. It has been found that “about 45% to 75% of patients with rheumatoid arthritis test positive for rheumatoid factor.”  

Presence of the rheumatoid factor doesn’t necessarily guarantee rheumatoid arthritis. It may be worth also testing for “Acute-phase reactants, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) may be elevated in the active phase of arthritis.”

X-rays may not be the most helpful for rheumatoid arthritis, especially in the early stages. In more advanced stages, some erosion and other joint changes may be observable. 

Treatment

Osteoarthritis

The best course of treatment for osteoarthritis includes managing pain through controlling inflammation. This is best done by: 

  • weight reduction to decrease inflammation associated with fat tissue
  • increasing exercise movements that do not flare up pain. Exercise actually is not bad for osteoarthritis compared to popular belief, learn more here.
  • adopting an anti-inflammatory diet such as the Mediterranean diet. Find the best anti-inflammatory foods list here.
  • medications for pain flare ups or uncontrolled pain including topical or oral non-steroidal anti-inflammatory drugs (NSAIDS). Duloxetine has also been shown to be an alternative if you are unable to take NSAIDs.
Conservative management can be successful for most patients. Finding a good food and exercise plan can be extremely powerful for pain relief.
 
But, if the condition progresses and if conservative management fails, surgery may be an option to consider. Deciding on a total joint replacement can be a big decision and one that should not be taken lightly. 
 
Surgery is a long process that requires extensive recovery. Like with any surgery, there are risks for complications and infections. Look at this article to see if you are ready to have a joint replacement.
 
There are options including partial and total joint replacements that would be worth discussing with your surgeon. 
 

Rheumatoid Arthritis

It has been found that “the early use of disease-modifying anti-rheumatic drugs (DMARDs) and biologics is more effective than treatment with glucocorticoids and NSAIDs” is one of the best treatments for rheumatoid arthritis. In order to get the maximum benefit of pain relief, it is necessary to supplement with other inflammation fighting behaviors such as diet and exercise.

Joint stiffness is a large part of rheumatoid arthritis and finding the right movements can be extremely effective in fighting joint stiffness almost immediately. The trick is finding the right movements that won’t flare up pain. The Arthritis Workout Planner would be perfect in this situation. 

There are potentials for joint replacement surgeries with rheumatoid arthritis too, with knee replacements being the most common. 

According to the Rheumatology network, researchers found that: 

After hip or knee replacement, patients with rheumatoid arthritis (RA) had lower rates of joint revision surgery than patients with osteoarthritis.

• However, patients with RA had higher rates of death and prosthetic joint infections following hip or knee replacement compared with patients with osteoarthritis (1.6% of patients with RA experienced an infection compared to the 1% with osteoarthritis).

Osteoarthritis vs rheumatoid arthritis checklist

osteoarthritis vs rheumatoid arthritis

When looking at osteoarthritis vs rheumatoid arthritis consider the following: 

  • Which joints are primarily affected? 
  • Does your morning joint stiffness last longer that 60-90 minutes?
  • What is your age?
  • Does rheumatoid arthritis or osteoarthritis run in your family?
  • Did your symptoms appear fast or slowly over time?
  • Do you experience fatigue, nausea, or a fever with your flares?

RECAP:

Remember larger joints are impacted likely by osteoarthritis (knee, hip, spine) while rheumatoid arthritis impacts smaller joints (hands, ankles, toes, shoulders, with some exceptions for larger joints like knees).

Morning stiffness that lasts longer than 90 minutes may be indicative of rheumatoid arthritis where as osteoarthritis morning stiffness usually can go away in 20-30 minutes with movement.

Younger <45 people tend to be affected by rheumatoid arthritis where as osteoarthritis typically occurs in those >45 years with the highest risk >60.

Both have a genetic component.

If your symptoms appeared more quickly, it could be indicative of rheumatoid arthritis due to the autoimmune nature of the condition. Osteoarthritis symptoms tend to develop over time. 

Experiencing other systemic symptoms may point to rheumatoid arthritis. Fatigue could be a symptom of osteoarthritis too due to poor sleeping habits.

NExt steps:

If you suspect you have osteoarthritis- seeking out care your primary care physician should be the first step. From there you can get a referral for physical therapy. 

If you suspect rheumatoid arthritis, you could start with your primary care physician but it may be a good idea to seek out a rheumatologist as they are specialists in inflammatory conditions like rheumatoid arthritis. 

If you have not yet grabbed our FREE Ultimate Arthritis Guide: The Top 5 Secrets You Need to Know to Overcome Joint Pain Forever, get it right HERE! 

Disclaimer: This post is for general informational purposes only. It should not be used to self-diagnose and it is not a substitute for a medical exam, cure, treatment, diagnosis, and prescription or recommendation. It does not create a doctor-patient relationship between Dr. Kuhn and you. You should not make any change in your health regimen or diet before first consulting a physician and obtaining a medical exam, diagnosis, and recommendation. Move Well Age Well, LLC and Dr. Alyssa Kuhn, PT, DPT are not liable or responsible for any advice, course of treatment, diagnosis or any conclusions drawn, services or product you obtain through this video or site.