Do I Have Rheumatoid Arthritis or Osteoarthritis? How to Tell the Difference

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You’re having joint pain and you suspect it’s arthritis. Does it matter what’s causing it? You bet. The two main types of arthritis are osteoarthritis (OA) and rheumatoid (RA). Despite what you may have heard, they are not the same. Here’s how to tell what you have so you can get started on the right kind of treatment.


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OA and RA are different conditions

OA is most often the result of wear and tear. It usually happens as we age — think of grandma’s bulging knuckles — or in younger people who have had an injury in a joint. RA, on the other hand, is an autoimmune disease, which means the immune system malfunctions and instead of attacking infection and bacteria, it also attacks your own cells and tissues. It can affect you at any age, most often between the ages of 30-60.


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OA is in the joints while RA can affect the whole body

OA is a degenerative disease that affects the joints, especially larger, weight-bearing joints (knees, hips, and spine). In the United States, 27 million people have OA. The cartilage in the joints breaks down, causing swelling, pain, and difficulty moving. RA is a systemic autoimmune disease, in which the immune system malfunctions and attacks the body’s own tissues. RA inflammation causes the cartilage in the joints to be eaten away, which also leads to swelling, pain, and difficulty moving. It can also affect other parts of the body, such as your organs and vascular system. About 1.3 million Americans have RA.


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Symptoms are different

OA is located in one or more specific joints and therefore, symptoms associated with it — pain, difficulty moving — tend to be isolated in the affected joint. Because RA is an autoimmune disease that affects the whole body, the person may experience symptoms related to the affected joint, but also low-grade fevers, loss of appetite, and feeling sick, very similar to how you feel when you have the flu.


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Morning stiffness acts differently in RA and OA

One of the characteristics of different types of arthritis is morning stiffness. After long periods of inactivity, your body feels stiff and sore, and it can be painful to move. People with OA usually experience morning stiffness that last 30 minutes or less, whereas people with RA experience morning stiffness that lasts more than 30 minutes and can even last hours. To deal with morning stiffness, try range-of-motion exercises, a warm shower, or talk to your doctor about pain medication.


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Large joints versus small

As mentioned earlier, OA tends to affect large and weight-bearing joints, although it can also be present in shoulders, elbows, and fingers. RA can affect all of your joints, including some smaller unexpected places. This includes your jaws, which can make it hard to eat, as well as your vocal cords — if you have a feeling of a lump in your throat or a tendency toward unexplained laryngitis, RA may be the culprit.


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Visibility

Once RA symptoms show up in the joint, it is usually quite visible, often causing significant swelling. OA, on the other hand, may not be visible to the naked eye for quite a while. Early signs may include a bony protrusion, or you may need an X-ray to identify joint changes associated with the condition.


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DIP and the spine

Some doctors state that swelling, pain, and deformities in the distal interphalangeal (DIP) joint — that is, the finger joint just below your nail — is only affected by OA and are not present in RA. However, research shows that some people with RA experience inflammation and damage in the DIP joint, but this happens usually only after the other joints in the finger have been affected by RA. Similarly, the spine can be affected by OA, but RA will only affect the top joint in the neck.


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What about the rest of your body?

As we get older, we may start developing a number of age-related conditions, such as heart disease, osteoporosis, and type II diabetes. These may happen as a “side effect” of the aging, but are not connected to OA. When you have RA, the inflammation can affect your organs and therefore lead to conditions that are connected to RA. Untreated RA causes a higher risk of heart disease, osteoporosis, and type II diabetes. It’s important to have an annual physical so you can address any issues.


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Treatment in OA and RA

After long history of no treatments for RA, the last 20 years has seen the development of many options for effective treatment and it is even possible for people with RA to go into remission. Treatment for OA is usually limited to treating only the symptoms. At this stage, there is no medication that can control osteoarthritis. With one exception — rarely, someone may have inflammatory erosive osteoarthritis, which in very stubborn cases may be treated with certain RA medications.


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Getting a diagnosis

If you experience symptoms and wonder if you might have OA or RA, it’s important to visit your family doctor. They will be able to order blood or imaging tests that can give them more information about what’s happening in your body. Usually, OA is managed by your family doctor, whereas RA requires a referral to a rheumatologist for ongoing assessment and treatment.