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Contrast osteoarthritis with rheumatoid arthritis



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!

 

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