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Osteoarthritis vs. Rheumatoid Arthritis: What’s the Difference?

Getting the correct diagnosis can prevent long-term complications.

Osteoarthritis and rheumatoid arthritis both cause inflammation of the joints, but it’s important to understand their differences.

Osteoarthritis (OA), the more common of the two, is caused by wear and tear of the joints. It is more likely to occur with age.

Rheumatoid arthritis (RA) is an autoimmune disease that causes the body to attack the joints. It is usually diagnosed in people in their 30s to 50s but can happen at any age.

The two types affect joints differently. The symptoms are somewhat different. So are the treatments. It's important to get the correct diagnosis.

People around age 50 and older can get both types at the same time.

Most common symptoms

Pro Tip

If someone has osteoarthritis, they often think they should just give up and accept the pain. The truth is, in addition to medications, sometimes joint injections can be very helpful. And physical therapy and exercise, too. —Dr. Sara Penn

Arthritis of any kind causes stiff joints, or difficulty moving a joint normally. Stiffness may be worse in the morning. You may have joint swelling with either type of arthritis. Often you’ll also notice pain around the joints.

Symptoms of osteoarthritis

  • Joint stiffness in the morning that often goes away within 30 minutes. Taking a hot shower may make it feel better.
  • Joints stiffen up when you’re inactive, like after a long drive or just sitting at your desk for an hour or more.
  • Joint swelling.

Symptoms of rheumatoid arthritis

  • Joint stiffness in the morning. It can last 30 to 60 minutes or longer. You may also have bodywide stiffness.
  • The joint stiffness tends to get better as the day goes on. But it often comes back in the evenings when you are less active.
  • Joint swelling is more severe in rheumatoid arthritis. There is more swelling, redness, and joint warmness.
  • Fatigue: Since RA is a systemic illness—it is in the whole body—feeling tired is common. Fatigue is less common in osteoarthritis.
  • In the early stages of rheumatoid arthritis, you might feel fatigue, weakness, and minor joint discomfort—as opposed to obvious joint stiffness, pain, and swelling.

Which joints are affected? OA vs RA

Osteoarthritis

  • Osteoarthritis often occurs in joints that have been previously injured. It also affects weight-bearing joints, such as knees, hips, and lower back (the lumbar spine).
  • In the hands, the joints most commonly affected are the base of the thumbs (where the thumb meets the wrist) and the joints closest to the nails.

Rheumatoid arthritis

  • Joints are affected in a symmetrical way, meaning you tend to get it in the same joints on both sides of the body. In osteoarthritis, it’s not symmetrical.
  • The most commonly affected joints are the small joints of the hands, wrists, and toes.
  • There are a few joints that are never affected by RA: the base of the thumbs, the big toe joints, and the lower back.
  • Most people with RA have five or more affected joints.

Causes of arthritis

Osteoarthritis occurs when the cartilage in between the bones that act as a cushion wears thin. Because this wear and tear is a slow process, the pain typically starts gradually over months to years. Previous injuries are also a risk factor for osteoarthritis.

Rheumatoid arthritis is an autoimmune disease. It is caused by your own immune system attacking the joints. It is believed to be caused by a combination of genetics and some kind of environmental exposure, but the specifics are not known.

Treating arthritis

Pro Tip

The majority of patients with rheumatoid arthritis do quite well. We have so many amazing treatment options nowadays. We can individualize patient treatment plans. —Dr. Penn

Osteoarthritis

Treatment is focused on increasing your joint movement and reducing pain with physical therapy and medications.

  • Acetaminophen (Tylenol) is usually the first treatment. If it doesn’t work, your doctor will probably suggest an anti-inflammatory medicine like ibuprofen (Motrin/Advil) or naproxen (Aleve).
  • If you cannot take an anti-inflammatory pill (usually because of another medical issue), you can use an anti-inflammatory cream or gel, such as Voltaren gel or Pennsaid. These are rubbed on the affected joints several times a day.
  • Strengthening the muscles surrounding the affected joints can help with pain. This is especially true for the hands, knees, and low back. You may want to work with a physical therapist to create the best exercise program for your pain.

Rheumatoid arthritis

The medications for rheumatoid arthritis have improved a lot over the past 30 years. There are now many choices. They all help quiet down the immune system so your body stops attacking its own joints.

The treatments vary based on their strength, possible side effects and long-term risks, method of taking it (pill or injection), and how they work. Some people do well with a single medication, while others need a combination of two to three medications. There may be times when you will need to change to a different medication.

  • Disease-modifying antirheumatic drugs (DMARDs): These help prevent joint damage. They include methotrexate, hydroxychloroquine (Plaquenil), leflunomide, and sulfasalazine. Potential side effects include liver damage and bone marrow suppression.
  • Biologic agents: These reduce the immune system’s ability to damage the joints. Several biologic agents have become available in recent years, such as adalimumab (Humira), infliximab (Remicade), and etanercept (Enbrel). They may suppress your immune system and increase the risk of infections.

How serious is it?

Osteoarthritis

Although OA does not impact internal organs, it can become debilitating over time. How it affects the body is different for each person. Along with other factors, it depends on which joints are affected and your age when the arthritis started.

Exercising and strengthening the muscles will help preserve joint function and reduce stiffness and pain.

Rheumatoid arthritis

Although RA is a chronic condition that requires lifelong treatment, treatments have improved the quality of life for people. In the past, those with RA developed joint deformities that got worse with time. But the current treatments help keep RA from shortening your lifespan or causing severe deformity.

As with any chronic inflammatory condition, the risk of heart disease and stroke is higher than average. You should keep blood pressure and cholesterol under control and avoid smoking.

Lifestyle changes

Dr. Rx

Some important questions to ask your doctor: What treatment options do you think are best for me, taking my other medical issues, medications, etc. into account?  How long will it take for the treatment to take effect, so I can determine if it is working or not? —Dr. Penn

It is important to have a good diet and regular exercise for both RA and OA.

  • A healthy diet with lots of fruits and vegetables. Eating less red meat and dairy may reduce inflammation and help with symptoms.
  • Weight loss in general is helpful if you have osteoarthritis, especially if the arthritis is in the weight-bearing joints such as knees, hips, low back, and feet.
  • Regular aerobic exercise and strength training are good for overall health and especially cardiovascular health.
  • Massage therapy and acupuncture may help relieve symptoms.
  • Stop smoking if you smoke.
  • Paraffin wax treatments can provide temporary pain relief when used on arthritic hands.
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