By Hope Cristol and Kim Painter. Medically reviewed By David Zelman, MD
Rheumatoid arthritis (RA) and osteoarthritis (OA) are common types of arthritis. Both cause pain and joint damage, but they’re different diseases.
RA is an autoimmune disease. It happens when your immune system doesn’t work the way it should. When you’re healthy, your immune system attacks invaders like bacteria and viruses. When you have RA, your immune system also sees your joints as enemies and launches an attack on them. The specific target of these attacks is the synovial membrane, a lining that lubricates and protects joints.
OA isn’t an autoimmune disease. You get it because the cartilage (spongy tissue) between your joints breaks down - often due to daily wear and tear. As a result, the bones on either side of the cartilage start to change and ache. It’s much more common than rheumatoid arthritis.
These may be the most important differences between RA and OA. But there are many others that can help doctors find out which type you have and how to treat it.
Rheumatoid Arthritis Symptoms
RA tends to cause morning stiffness that can last an hour or more. That’s one of the things that sets it apart from OA. Rheumatoid arthritis also can develop and progress quickly. And it tends to affect both sides of the body at once. It can develop at any age, though most often shows up in midlife.
Other RA symptoms that set it apart from OA include:
• Fatigue
• Low fevers
• Low appetite
• Joints that get forced into bent positions over time
• Lumps called rheumatoid nodules that grow under your skin
(These aren’t common.)
Osteoarthritis Symptoms
OA tends to develop slowly over many years and is most common in older adults. You might notice it in a single joint or on one side of your body. Your joints might swell, but not as much as with RA. With OA, your main issues are:
• Joints that don’t feel as stable or strong as they once were
• Noises (cracking, grinding) when you move the joint
• Pain
• Stiffness -- with briefer morning symptoms than in RA and stiffness that might come back after you’re active
Osteoarthritis vs. Rheumatoid Arthritis in the Hands
Both OA and RA can cause hand symptoms, but they’re different. RA in the hands is common and it’s usually in both hands. It most often affects the wrists and the knuckles. In RA, swollen joints might make your fingers look like sausages. Over time, the position
of your fingers can change, too. RA can even damage and break the tendons that allow your fingers to bend and straighten. In some cases, you might develop numbness and tingling in your fingers.
OA is more likely to affect a single hand at first, though it might affect both. That’s because OA attacks joints you use the most. OA in your hands is most likely to affect the base of your thumb or the finger joints closest to your fingernails. It can also affect the wrist. Osteoarthritis sometimes causes bony bumps over finger joints
Rheumatoid Arthritis vs. Osteoarthritis: Risk Factors
RA and OA share at least a couple of risk factors. You may be more likely to get RA if you have a family member who has it. The same goes for OA. Excess weight also seems to play a role in both diseases.
Other things that raise your risk of OA include:
• Deformed joints, like knocked knees or legs of different lengths
• Joint injury
• Older age
• Overuse of a joint
The things that make RA more likely include:
• Being a woman
• Being around dangerous chemicals like asbestos or silica
• Having gum disease - possibly because the same bacteria might trigger joint and gum inflammation
• Smoking
Most Common Joints Affected
OA can affect any joint, but it tends to happen in joints you’ve injured or use over and over. Think knees, hips, back, neck, thumbs, and big toes.
RA can also cause joint problems throughout your body. The disease is especially common in the small joints of your hands and feet. It also strikes shoulders, elbows, knees, and ankles. Unlike OA, RA tends to leave your back alone.
Rheumatoid Arthritis vs. Osteoarthritis: Treatments
There’s no cure for either RA or OA, and no way to reverse joint damage. Treatments for both diseases aim to reduce pain and help the joints work better. But with RA, the main goal of treatment is to slow or stop disease activity -- to make your body stop attacking itself.
With both RA and OA, you might work with physical therapists to learn helpful exercises and with occupational therapists to learn techniques that help you function better in daily life. You might use heat and cold to soothe sore joints. Surgeries, including joint replacements, also can be part of treatment. But medications are mainstays of treatment for both conditions.
Drugs for RA
• Acetaminophen, which reduces pain but not inflammation
• Corticosteroids, which are powerful anti-inflammatories that can also help regulate your immune system
• Disease-modifying drugs (traditional disease-modifying antirheumatic drugs, or DMARDs, and biologic drugs), which slow the course of the disease
• Nonsteroidal anti-inflammatory drugs (NSAIDs), which reduce pain and inflammation
Drugs for OA
• Joint injections of corticosteroids or lubricants
• NSAIDs
• Pain-relieving drugs like acetaminophen
• Rub-on creams or gels that reduce pain
• The antidepressant drug duloxetine (Cymbalta), which can ease chronic pain
You may notice that opioid drugs, also known as narcotics, aren’t on either list. They’re not typically prescribed for RA and OA due to the risk of side effects over time, such as extreme tiredness, constipation, and dependency.
Weight Loss for Arthritis
In an ideal world, we’d all be at our healthiest weight. When you have RA or OA, reaching that health goal becomes even more important. Think of it as a kind of drug-free pain relief that just happens to have many other health benefits.
When you have OA: Extra weight puts extra stress on your joints, especially your knees, hips, and low back. Losing weight gives those joints some relief.
When you have RA: In addition to taking pressure off your joints, weight loss has other benefits. Research shows it can reduce disease activity - another way of saying it slows the attack on your joints.
Diet alone may help you shed pounds, but don’t neglect gentle exercise. It can help improve your muscle strength, reduce joint pain, ease stiffness, and thus lower your disease-related disability. Before you go on a trendy diet or join a gym, ask your doctor for advice on the best ways to approach diet and exercise when you have RA or OA. They might suggest you work with a physical therapist or trainer to exercise safely and effectively. A nutrition counselor might help you make changes in your diet that you can stick with and enjoy.
Takeaways
Osteoarthritis and rheumatoid arthritis can both make your joints hurt, but they are different diseases with different root causes and treatments. OA, the most common type, is caused by wear and tear on your joints. RA is an immune disorder that causes joint
inflammation and damage. If you have joint pain, it’s important to get a diagnosis so you get the right treatment.
