Understanding the Differences Between Osteoarthritis and Rheumatoid Arthritis

Joint pain and discomfort can be incredibly frustrating and painful, and often lead to questions about whether it's osteoarthritis or rheumatoid arthritis. While both conditions cause similar symptoms, it's important to understand the key differences between them.

Osteoarthritis is the most common form of arthritis, while rheumatoid arthritis affects significantly fewer people. The primary difference between these two types of arthritis is the underlying cause of joint symptoms. Osteoarthritis occurs due to mechanical wear and tear on joints, whereas rheumatoid arthritis is an autoimmune disease that causes the body's immune system to attack its own joints. Understanding the differences between these two conditions can help with early diagnosis and management of symptoms.

CharacteristicRheumatoid ArthritisOsteoarthritis
Age at which the condition startsIt may begin any time in life.It usually begins later in life.
Speed of onsetRelatively rapid, over weeks to monthsSlow, over years
Joint symptomsJoints are painful, swollen, and stiff.Joints ache and may be tender but have little or no swelling.
Pattern of joints that are affectedIt often affects small and large joints on both sides of the body (symmetrical), such as both hands, both wrists or elbows, or the balls of both feet.Symptoms often begin on one side of the body and may spread to the other side. Symptoms begin gradually and are often limited to one set of joints, usually the finger joints closest to the fingernails or the thumbs, large weight-bearing joints (hips, knees), or the spine.
Duration of morning stiffnessMorning stiffness usually lasts longer than 1 hour.Morning stiffness usually lasts less than 1 hour. Stiffness returns at the end of the day or after periods of activity.
Presence of symptoms affecting the whole body (systemic)Frequent fatigue and a general feeling of being ill are present.Whole-body symptoms are not present.

Timing and Onset of Arthritis Pain

Osteoarthritis typically develops over time as the cartilage in joints gradually wears away, leading to pain and discomfort when bones rub against each other. The onset of osteoarthritis can be slow and intermittent over several months or years, and it is the most common type of arthritis affecting 27 million Americans. It's important to note that osteoarthritis is not an inevitable part of aging and there are ways to protect your joints, reduce discomfort, and improve mobility.

Rheumatoid arthritis, on the other hand, is an inflammatory condition that causes your immune system to attack the tissues in your joints. Unlike osteoarthritis, rheumatoid arthritis causes pain and stiffness that worsen over several weeks or months. It's not uncommon for flu-like symptoms of fatigue, fever, weakness, and minor joint aches to be the first signs of rheumatoid arthritis, rather than joint pain.

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If you're experiencing joint pain or discomfort, it's important to speak with a healthcare professional to receive a proper diagnosis and determine the best course of treatment for your specific needs.

Location of the Pain

Location is another key factor in distinguishing between osteoarthritis and rheumatoid arthritis. Both conditions can affect the hands, but there are differences in how they typically present.

Osteoarthritis often affects the joint closest to the tip of the finger, while rheumatoid arthritis usually spares this joint. Additionally, while rheumatoid arthritis can appear in any joint, it most commonly targets the hands, wrists, and feet. If you're experiencing pain or discomfort in your joints, it's important to seek medical advice for an accurate diagnosis and appropriate treatment options.

Joint Stiffness

When doctors refer to "stiffness," they mean that a joint doesn't move as easily as it should, rather than vague muscle aches. Stiffness may be a prominent symptom even when there is no joint pain.

In osteoarthritis, mild morning stiffness is common and typically goes away after a few minutes of activity. Some people with osteoarthritis also experience this type of stiffness during the day after resting the joint for an hour or so. On the other hand, morning stiffness in rheumatoid arthritis doesn't begin to improve for an hour or longer. Prolonged joint stiffness in the morning may be the first symptom of rheumatoid arthritis. If you're experiencing joint stiffness, it's important to speak with a healthcare professional for an accurate diagnosis and appropriate treatment.

Managing the Pain

Reducing pain, managing symptoms, maintaining function, and preventing joint destruction are the main goals of arthritis treatment, regardless of the type of arthritis diagnosed.

Dr. Aaron Bernstein, Harvard MD

Treatment options for both osteoarthritis and rheumatoid arthritis may include nonsteroidal anti-inflammatory medications like ibuprofen to reduce pain and inflammation, as well as corticosteroids like prednisone to target inflammation. For rheumatoid arthritis, medications that suppress the immune system may also be prescribed to send the disease into remission and prevent further damage.

Dr. Bernstein also recommends physical and occupational therapy to improve mobility and daily routines, and emphasizes the importance of healthy living habits, such as exercise and weight management. Smoking cessation is also crucial, as smoking not only increases the risk of developing rheumatoid arthritis but also interferes with the effectiveness of RA medications.

In severe cases, surgery may be necessary, such as hip replacement or repairing damaged tendons, to eliminate pain and improve joint function. Despite the potential disability caused by these conditions, Dr. Bernstein notes that treatment options have become more numerous and effective over time, and research continues to focus on finding cures and prevention strategies for osteoarthritis and rheumatoid arthritis.

William H. McDaniel, MD

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School.

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