Arthritis is inflammation of joints. Arthritis is a blanket term which includes all types of arthritis like osteoarthritis, rheumatoid arthritis and gout. This article will discuss each type of arthritis in detail, highlighting their clinical features, symptoms, causes, investigation and diagnosis, prognosis, the course of treatment they require, and finally the differences between them.
Osteoarthritis is a very common joint condition. Women are more prone to symptomatic osteoarthritis than men. Females get it three times more commonly than males. It usually sets in around 50 years of age. Osteoarthritis occurs due to wear and tear. When it sets in spontaneously, without any previous joint disorders, it is called primary osteoarthritis. When it occurs as a result of another joint disease it is called secondary osteoarthritis. Joint injuries and diseases like hemochromatosis give rise to secondary osteoarthritis.
Osteoarthritis usually starts with a single joint. There is pain on movement. The pain becomes worse in the evenings. There is a dull aching pain while the joint is at rest and a sharp pain on movement. The range of motion is limited, and there is joint tenderness. Bony swellings called “Heberden’s nodes” occur. Joints become stiff in the morning and become more mobile with movement. Joints are unstable and prone to dislocations and ligament injuries. Osteoarthritis progresses to involve multiple joints overtime. Most commonly affected joints in multiarticular osteoarthritis are distal inter-phalangeal joints, thumb metacarpo-phalangeal joints, cervical spine, lumbar spine, and knees.
The x-rays of joints show loss of joint space, sclerosis under the joint cartilage, and marginal osteophytes. In some patients, CRP can be slightly elevated. Regular pain killers, anti-inflammatory drugs, low dose tricyclics, weight reduction, walking aids, supportive foot ware, physiotherapy, and joint replacement are a few treatment methods.
Rheumatoid arthritis is a persistent, symmetrical, deforming, peripheral arthropathy. Peak age of onset is around 50 years, and females get it more than males. Also, prevalence is higher in smokers. Patients with rheumatoid arthritis present with swollen, painful, stiff hands and feet. Symptoms are more prominent in the mornings. Rheumatoid arthritis may present as recurring monoarthritis of various joints, persistent monoarthtritis, vague limb girdle pain, and sudden onset of widespread arthritis. There are metacarpophalangeal joint swelling, digital ulnar deviation, dorsal wrist joint subluxation, Boutonniere’s and swan neck deformities, and Z thumbs in rheumatoid arthritis. Hand extensor tendons may rupture and the adjacent muscles waste. There may be similar foot changes as well as atlanto-axial subluxation. Anemia, nodules, lymph node enlargement, vasculitis, splenomegaly, red eyes, pleurisy, and amyloidosis are known systemic features.
X rays show juxta-articular osteoporosis, reduced joint space, bony erosions, and finally carpal destruction. ESR and platelets are high. Rheumatoid factor is present in blood. Regular exercise, walking aids, wrist splints, NSAID, intra-lesion steroid injections, and disease modifying drugs are used in treating rheumatoid arthritis.
Read about Gout here.
What is the difference between Osteoarthritis, Rheumatoid Arthritis, and Gout?
• Osteoarthritis is due to wear and tear while rheumatoid arthritis is due to an immune reaction. Gout is due to deposition of urate crystals in joint tissues.
• Rheumatoid arthritis usually affects small joints and osteoarthritis usually affects large joints. Gout affects small joints initially and then spreads to involve large joints.
• Pain becomes worse in the evening, in osteoarthritis while the pain is worse in the mornings, in rheumatoid arthritis. Gout causes pain on movement and pain is worse in the morning.
• ESR is normal in osteoarthritis while high in rheumatoid arthritis.
• Rheumatoid factor is present in 80% of rheumatoid arthritis patients while it is absent in osteoarthritis and gout.
• There are no osteophytes in rheumatoid arthritis.
• Advanced rheumatoid arthritis needs disease modifying drugs while osteoarthritis does not. Gout arthritis is managed with pain killers and reducers of urate.
1. Difference Between Lupus and Rheumatoid Arthritis
2. Difference Between Osteoarthritis and Rheumatoid Arthritis
3. Difference Between Arthritis and Osteoarthritis
4. Difference Between Osteoarthritis and Osteoporosis