If you're dealing with stiffness, pain and swelling in any of your joints, you may well be dealing with arthritis. But depending on a variety of factors, you may be experiencing one of more than 100 different arthritis conditions. Simply put, arthritis is not a single condition.
If you’re dealing with stiffness, pain and swelling in any of your joints, you may well be dealing with arthritis. But depending on a variety of factors, you may be experiencing one of more than 100 different arthritis conditions. Simply put, arthritis is not a single condition.
“Arthritis is a very global term that implies there’s some inflammation involving a joint,” says Dr. Esther Lipstein-Kresch, chief of rheumatology at ProHEALTH Care in New York.
Under the umbrella of arthritis, the two most common conditions are osteoarthritis and rheumatoid arthritis. Although they have some overlap in symptoms, osteoarthritis and RA are two very different diseases.
The most common arthritis condition is osteoarthritis — this is the so-called wear-and-tear arthritis. The Centers for Disease Control and Prevention reports that more than 30 million Americans have osteoarthritis.
In osteoarthritis, joint cartilage breaks down over time. Dr. David Pugliese, a rheumatologist at Geisinger in Danville, Pennsylvania, says that because it’s a simple function of time and wear, everyone will eventually develop some degree of arthritis. When and how severe the symptoms will be depends on several factors, including how heavily a joint has been used, whether an injury has occurred in that joint and genetics.
Lipstein-Kresch says osteoarthrosis “is more of a boney-type of arthritis” that develops in certain joints in the hand and largely affects the spine, weight-bearing joints and shoulders. Dr. Hareth Madhoun, assistant professor of clinical medicine in the department of internal medicine , division of rheumatology at The Ohio State University Wexner Medical Center, says it’s common in the “smaller joints of the hands and wrists.”
That said, “osteoarthritis is a disease of mainly weight bearing joints,” Lipstein-Kresch says, and it can cause significant disability. For instance when it develops in the hips and knees of obese patients, this can lead to intense pain when walking. Although it’s common in the lower limbs, it’s uncommon for osteoarthritis to develop in the ankles, and Lipstein-Kresch says science isn’t sure why it tends to skip those joints.
Because osteoarthritis develops from the use of a joint over time, it’s more common among older adults. Women are at greater risk for it, but men are more likely to develop it prior to age 45. “Osteoarthritis is a chronic, degenerative disease that typically develops in people in their fifth or sixth decade of life and is generally not seen in a very young population,” Madhoun says.
On the other hand, rheumatoid arthritis is an autoimmune disease, in which the immune system mistakenly attacks the body. The Arthritis Foundation reports that rheumatoid arthritis affects an estimated 1.5 million U.S. adults.
Rheumatoid arthritis starts by affecting the lining of the joints, but can move on to damage bone, cartilage, muscles and ligaments around the joints.
To understand how it happens, think of a joint. That’s where two bones come together with a cushioning layer of cartilage in between, Pugliese says. That cartilage interface “is wrapped with a synovium — that’s a baggie that holds the joint together,” and the lining of that synovial membrane “is full of immune cells. The purpose of that is to protect the joint.” However, “if you were to get an infection in the joint, that lining would become very active — it would generate a lot of redness, swelling and pain as the immune system tries to kill whatever infection you’ve got.”
This is essentially what happens when people develop rheumatoid arthritis. “Their immune system becomes activated and treats their joints as if they have infections. In the absence of any trigger or trauma, the joint becomes inflamed and irritated.” Fluid builds up and an inflammatory reaction is triggered. That’s what causes the symptoms of rheumatoid arthritis, Pugliese says.
This inflammation in the synovium leads to the hallmark symptom of RA — a type of swelling called rheumatological synovitis, Madhoun says. This type of swelling, which Lipstein-Kresch refers to as fusiform or “sausage-shaped” swelling, causes the affected joint to “feel sort of mushy as opposed to feeling bony.” This is a differentiator from osteoarthritis, where the affected joint “tends to feel bony and isn’t usually symmetrical. The fusiform swelling in rheumatoid arthritis is more symmetrical,” she says. “Typically, what affects one hand is going to affect the other as well.”
RA often starts in the small joints of the hands and then progresses to involve other, larger joints, such as the shoulders, hips, knees and ankles. “It doesn’t affect the lower spine, but it does affect the cervical spine,” which is the neck, Lipstein-Kresch says.
Other symptoms include morning stiffness that lasts about an hour but tends to improve with movement. Volar subluxation, a type of deformity, can develop in the hands of people with RA.
Symptoms can range from mild to severe, and while some patients alternate flares with remissions, active disease is continuous for others. Fatigue is often a problem. In some cases, the effects go far beyond the joints and can involve major organs and other body systems such as the blood vessels, nervous system, lungs and bone marrow.
Although anyone can develop rheumatoid arthritis at any time, it’s more common among middle aged adults — a younger crowd than usually tends to develop osteoarthritis. Women are also more likely to develop this condition, Madhoun says. “Smoking is another really big factor in developing rheumatoid arthritis.”
Early on, treatments for both arthritis types start the same way, with nonsteroidal anti-inflammatory drugs. These mild pain medications such as ibuprofen (Advil, Motrin) and naproxen sodium (Aleve) can reduce pain, swelling and inflammation and are often available over-the-counter. Your doctor may prescribe a higher dose.
With rheumatoid arthritis, “early diagnosis and aggressive treatment is critical. Slowing disease activity can help minimize or even prevent permanent joint damage,” the Arthritis Foundation reports. This may require the use of more aggressive treatment, known as disease-modifying anti-rheumatic drugs. These DMARDs, used to slow the progression of joint damage, include methotrexate (Trexall). DMARDs have long been considered the gold-standard for treating rheumatoid arthritis and have been around for a long time.
Some patients may also benefit from the use of corticosteroids to bring down inflammation quickly. These powerful drugs, such as prednisone, can also help relieve pain in more acute cases and may slow the progression of joint damage, but may have side effects — increased risk of developing diabetes or osteoporosis are two — that prevent long-term use.
A newer group of drugs, called biologics, has been developed over the past two decades. These powerful immunosuppressant drugs, which are cultivated from living cells, are usually administered as an injection or intravenous infusion. They offer many patients an improved outlook and better management of rheumatoid arthritis. Various drugs on the market target different molecules in the body to help control inflammation. Examples include adalimumab (Humira), secukinumab (Cosentyx) and abatacept (Orencia).
For most rheumatoid arthritis patients, surgical intervention is a distant option, but may come into play when deformities impede function. Joint fusion procedures may alleviate pain, but can significantly reduce the range of motion a patient has in the affected joint.
On the other hand, the pharmacological options for treating osteoarthritis are few. “For osteoarthritis, there really isn’t much of anything,” Madhoun says. “We typically rely on acetaminophen (Tylenol) or anti-inflammatories such as ibuprofen (Advil, Motrin) and naproxen sodium (Aleve). These may be administered as oral medications or topical creams rubbed on the site of pain to relieve inflammation.
If those medications don’t do the trick, “the next step typically tends to be more pain management, such as opioids,” Madhoun says. Then, of course, comes the necessary discussion of risks versus benefits because use of opioid pain medications can quickly lead to dependence. Some patients may receive steroid injections into the joint to reduce pain and inflammation, Madhoun says.
For some patients with advanced osteoarthritis, surgery may become an option. “If the degenerative arthritis progresses enough, we recommend joint replacements,” Madhoun says.
For both conditions, controlling pain and slowing the progression of the disease should be the primary aims. As such, certain lifestyle changes may make a big difference in the trajectory of both diseases. These may include:
— Physical therapy and exercise. A physical therapist may be able to help you regain function in an affected joint through the use of targeted and progressive exercises. Beyond physical therapy, being as active as possible and focusing on developing the muscles around an affected joint may significantly improve your function and pain levels. “A lot of times people ask us whether exercise is good, and the answer is always yes,” Madhoun says. “You just have to find the exercise that suits you best. Not everybody can run or swim or bike. You have to find an exercise that makes you feel good and that you are able to do.” Finding an exercise you enjoy means you’re more likely to stick with it over the long-run, which will impart more benefits.
— Weight reduction. If you’re overweight and have arthritis symptoms in any weight-bearing joints, such as the hips or knees, dropping even just a few pounds may make a world of difference in your pain levels. “Every pound of weight a person carries translates into 4 or 5 pounds of pressure on the joint,” Pugliese says, so if you were to lose 20 pounds, that would take “up to 100 pounds of pressure off each of your weight-bearing joints.” This can be particularly helpful for people with osteoarthritis.
— Diet. Many rheumatologists advise their patients to follow a diet protocol that reduces inflammation throughout the body. So far, omega-3 fatty acids are the only dietary compound that has proven to be effective in reducing inflammation. Seafood, flaxseed and canola oil, beans, nuts and seeds are all high in omega-3s. If you notice a flare-up in symptoms when you eat a certain food, consider trying to reduce or eliminate that item from your diet. “There are a million and one diets you could find online, and some people come in and tell me every time they have something fried, their arthritis flares up or they give up gluten even though there’s no indication that they actually have a gluten sensitivity,” Lipstein-Kresch says. “It’s difficult to assess the placebo effect in that type of situation,” but if you notice an increase in symptoms when you ingest a certain food, it might be time to consider skipping it.