Most people have had experience with arthritis at some point in their lives whether it affects them or someone they know. Arthritis isn’t just one condition though, it is a general term for joint pain. In reality, there are over 100 (who knew?) types of arthritis out there. The vast majority of people will experience something called Osteoarthritis (OA). Another more common form of arthritis is Rheumatoid Arthritis (RA). In this blog post I will go into the differences between these two types of arthritis and what sets them apart.
What it is:
- OA can also be referred to as Degenerative Joint Disease, but most people are moving away from the term
- It is a load-related condition that is actually a disease of the entire joint, not just the cartilage. OA can also involve the ligaments, bones and synovium (protective joint lining).
- RA is actually an auto-immune condition where your body’s immune system incorrectly sees your joint synovium as foreign and threatening, and attacks it. [2,3].
- This leads to a release of inflammatory cells at the synovium which cause the joint to become painful
- This condition is actually not related to joint load or stress, but there could be a hereditary link
- Pain or aching in the joint during activity, after long activity or at the end of the day.
Signs and Symptoms:
- Joint pain and stiffness that is most noticeable for the first ~ 30 minutes of the day and after getting up from resting for awhile
- You may notice a limited range of joint movement that is helped with activity
- Swelling, clicking and cracking are also things you may notice, which are all related to an increase in joint fluid
- RA is progressive, so in the early stages, you may not see many symptoms, but rather experience tenderness and pain in the joints
- As symptoms worsen, you may start to see some redness and swelling in the affected joints.
- People with RA experience morning stiffness similar to those with OA, however it will often linger for closer to 60 minutes.
- It is common for people with RA to experience a low-grade fever and fatigue in association with their symptoms [3,5].
Commonly affected areas:
- Typically happens in joints that take more load, or following injury (ie. ACL injury, recurrent ankle sprains)
- Will affect single joints in isolation
- Often occurs in knees, hips, spine and hands
- Typically happens in the same joint on both sides of the body simultaneously
- Often occurs in hands, knee and ankles ie. knuckles of hands
- RA can also cause problems systemically in the eyes, heart and circulatory system
Contributing Factors and who is at risk:
- Obesity and being overweight are big contributing factors as they put extra stress on the joints
- Muscular weakness, previous injury, and joint overload are also large contributors and often will happen in concurrence with each other
- Increasing age and genetics can affect your chances of getting OA
- For reasons unknown, women are more likely than men to get OA
- It is thought that the people who develop RA have a gene that causes them to be more likely to get this disease, and do so after being exposed to an environmental trigger (ie. virus, strong emotional response, etc.)
- As like OA, women are more susceptible than men to get RA
- Different races also interestingly have a different likelihood of getting RA .
- Previous thought was that people will benefit from rest and pain relief, but the larger medial consensus now is that activity is the best treatment strategy
- Strengthening and load bearing exercise is now known to assist in the healing process of affected cartilage [1,4].
- Pain management in the form of oral medication recommended by a pharmacist of doctor such as paracetamol, non-steroidal anti-inflammatories (NSAIDs), or stronger medications.
- Hydrotherapy, swimming and cardiovascular exercise than offloads the joint (ie. cycling) in more severe cases has excellent effects on function
- In extreme cases surgery is considered, but joint replacement surgery should be reserved for those who have actively participated in conservative management for a minimum of 6 weeks, and whose quality of life has significantly declined.
- The main focus for treatment of RA is to limit and slow the joint inflammation.
- Anti-inflammatory medications are used such as NSAIDs, corticosteroid (steroidal anti-inflammatory) and a kind of drug referred to as DMARDs to slow the actions of the immune system. Methotrexate is a DMARD that is used for both RA and in chemotherapy .
- Activity and exercise are also important in managing RA symptoms, as movement will lubricate the joint space and assist with pain
- Often-times, health professionals will develop exercise and activity plans of varying intensity levels for the when the joints are feeling good, and for flare-up times.
- Surgery is also an option in RA, but is more focused on ‘cleaning up’ the joint space and removing chronically inflamed tissues. They also may remove Rheumatic nodules in the joint.
I hope you found this interesting and educational, in my next blog post I will go into more detail around OA and its management.
If you would like to book in for an initial Physiotherapy consultation regarding the above conditions or anything else, I would love to help! I am in the clinic Monday, Tuesdays, Thursdays and some Saturdays so ask at the front desk or book online!
Doctor of Physiotherapy
 https://www.arthritis.org/diseases/osteoarthritis.  https://www.arthritis.org/diseases/rheumatoid-arthritis.  https://www.uofmhealth.org/conditions-treatments/cmc/arthritis/rheumatoid.  https://pubmed.ncbi.nlm.nih.gov/29669488/.  https://www.ajmc.com/view/ace006_12dec_gibofsky_s295to302.