Contrast osteoarthritis with rheumatoid arthritis.
|
|
Osteoarthritis |
Rheumatoid arthritis |
|
Cause |
Deterioration of cartilage and overgrowth of bone often due to “wear and tear”. |
Autoimmune inflammation of the synovial membranes, which leads to the destruction of the articular cartilage. |
|
Joints |
More often affects the larger weight-bearing joints, such as the hips and knees. |
More often affects the smaller joints of the hands, wrists and feet. |
|
Complaints |
Worse pain at the end of the day, when wear and tear builds up. |
The stiffness is worse after rest, such as the first thing in the morning, and often lasts at least 30 minutes or more. |
|
Systemic? |
NO |
Can be a systemic disease. |
|
Gender? |
NONE |
Rheumatoid arthritis is three times more common in females versus males |
|
Labs? |
Lab tests normal |
80% of patients are sero-positive (ie positive rheumatoid factor) |
|
X-rays |
Bone spurs, sclerosis common. Asymmetric joint space narrowing (where the wearing and tearing took place)
|
Osteopenia more common. Symmetric joint space loss
|
|
Exam: |
Effusion, tenderness |
Effusion, tenderness but redness/warmth more common. Synovitis |
If both rheumatoid arthritis and osteoarthritis can lead to end-stage destruction of the joint -and both can-why is it important to differentiate between the two?
If you believe, as I do and you should, that the doctor has three jobs (identify diagnosis, state prognosis and offer treatment) the RA/OA difference holds three important distinctions:
- Because RA is a systemic disorder than can affect many organs of the body; therefore, it is important to check for, manage, and prevent other manifestations of the disease—ie, DIAGNOSE EXTRA-ARTICULAR disease
- RA has a different prognosis, in terms of overall health as well as joint specific.
- The diagnosis affects treatment: treatment for RA is not just symptomatic, and it also targets the root cause of the disease: immune abnormalities. This is accomplished with biologics and disease-modifying anti-rheumatic drugs (DMARDs) and Biologics. The goal is not just palliation but to STOP DISEASE PROGRESSION!