Don’t Confuse Osteoarthritis and Rheumatoid Arthritis
⌚️ read time: 4 minutes
Hardly a day passes without a patient who astutely asks me: “What's the difference between osteoarthritis and rheumatoid arthritis?”
I touched on this briefly in a previous article (linked here) about arthritis in general. But let's get a little deeper.
As a review, arthritis is any process where you have lost the soft cartilage end cap located where two bones come together. When you lose that cartilage cap, the bones will rub directly against one another, generating a sort of grinding sensation and…pain.
This is common amongst all types of arthritis, regardless of how the body got to that point.
Now let's explore key differences.
Osteoarthritis
This is typical “aging” arthritis. Over the course of our life, that cartilage end cap breaks down and cannot effectively heal. Unfortunately, there really is no known way to get it back once it's gone.
Common symptoms of osteoarthritis include stiffness, worsening pain with impact activities of the joint, and morning pain/stiffness that typically goes away once you start moving.
A word of caution. I have lots of patients who come to me saying, “Oh yeah, my doctor told me I have osteo.”
And what I've found is, “osteo” can mean any number of things. Osteoarthritis is one, but osteoporosis is another.
Both of these could be considered conditions of aging, but they are actually radically different and not necessarily correlated (other than, of course, both are more common in the elderly).
Osteoporosis is a thinning of the bones themselves whereas osteoarthritis is a condition at the joint between the bones involving the cartilage end cap, as we’ve discussed.
Pink: Smooth cartilage cap between bones in a normal joint
Rheumatoid Arthritis
I want you to think of rheumatoid arthritis as a completely different entity from osteoarthritis. Rheumatoid arthritis truly is more of an autoimmune disease. This means your immune system accidentally identifies the cartilage cells in that end cap as a foreign invader.
The immune system then does what it is trained to do — eliminate outside threats.
So now your body attacks your own cartilage, thus breaking it down and resulting in the same mechanical pain as osteoarthritis but with an added boost of inflammatory pain.
There's no doubt, people who suffer with this their whole lives are warriors. Rheumatoid arthritis is a very painful condition.
This is oftentimes, but not always, hereditary. Common symptoms include random, diffuse swelling in various joints throughout the body. These patients also have morning pain, but it typically doesn't improve once they get up and move around. In severe untreated cases, the degree of inflammation can actually lead to joint destruction and visible deformities of the joints.
Pink: Rough cartilage cap between bones in an arthritic joint
Why does it matter?
So ultimately, why does this really matter?
Primarily because the treatments for each are radically different.
Treatment around osteoarthritis is primarily symptomatic. Meaning there is no real treatment for the underlying process — because the underlying process is wear and tear over the years!
Despite what random corners of the internet might tell you, there is no way (currently) to regrow cartilage inside the human body.
Which means that your treatment options include rest, therapy, over-the-counter medications, prescription medications, injections, or surgery (often in the form of a joint replacement).
On the other hand, the treatment these days for rheumatoid arthritis is almost entirely medical. We used to operate on rheumatoid arthritis a lot when there were very few medical options. Patients would get bad joint deformities and need corrective surgery.
But with the advent of numerous groundbreaking medications over the last couple of decades, rheumatoid arthritis rarely gets to the point of needing surgery anymore. These medications block the damage from the immune system and, more often than not, control the destructive effects of rheumatoid arthritis.
Takeaways:
Osteoarthritis and rheumatoid arthritis, though they sound similar, are radically different disease processes
Though both end up at the same point (loss of cartilage in the joint), the paths to this endpoint are divergent
This delineation has many consequences, most notably in the available methods to treat each condition
I find that my patient conversations are so much more productive if we start from the same point of knowledge. I hope this helps you understand these two separate types of arthritis more easily in case you or a family member are dealing with one of these painful conditions.
