The two most common forms of arthritis - osteoarthritis and rheumatoid arthritis - can cause similar aches and pains, but there are key differences.
We sat down with Clare Jacklin, chief executive of National Rheumatoid Arthritis Society (NRAS), to discuss how to distinguish one from the other.
Are all forms of arthritis the same?
“Most definitely not,” says Clare, “rheumatoid arthritis is a systemic condition affecting the whole of the body, whereas osteoarthritis may affect one or two joints.”
Often referred to as wear and tear, osteoarthritis occurs when the cartilage protecting the end of the bones wears down.
Inflammatory conditions like rheumatoid arthritis, however, are caused by an auto-immune reaction. The synovial membrane becomes inflamed and then, if the inflammation is left untreated, it erodes the bone. The inflammation can be excruciatingly painful and the erosion can cause deformity to the joint.
The immune system becomes reactive when it is triggered by things like stress or illness. Inflammation occurs when the immune system continues to be overactive after the person has recovered and starts attacking the healthy lining of the joints.
What are the key symptoms of rheumatoid arthritis?
Someone is diagnosed with rheumatoid arthritis roughly every twenty minutes, but what symptoms should people look out for?
“Early morning stiffness is a red flag for rheumatoid arthritis. Even after a good night's rest, some people find their joints are frozen into position. It could take an hour before they get any movement,” says Claire.
People with rheumatoid arthritis often experience fatigue. “Fatigue is more than tiredness. It's an overwhelming inability to function. You’re just completely drained,” Claire adds.
Hot and swollen joints are a key symptom, because the disease is affecting the synovial membrane - i.e. the squishy bit between the joints. “It can feel like hot acid running through the body,” says Claire.
When somebody has an inflamed joint, it can feel physically hot. It may also be swollen, squishy and painful. “People have often said that when they have inflammation in their joints, they can't have a sheet or a duvet touching the joint because it's so painful,” says Claire.
What are the differences between the symptoms of osteo and rheumatoid arthritis?
There are around 400,000+ UK adults living with rheumatoid arthritis, which means one in every 100 has this condition.¹ 8.5 million people have pain attributed to osteoarthritis in the U.K, 1 in 5 adults (18.2%) over 45 years of age in England has osteoarthritis .²
More people have osteoarthritis, but what else makes the conditions different? Osteoarthritis primarily affects the joints, whereas rheumatoid arthritis can also affect internal organs such as the eyes, jaw and heart.
Rheumatoid arthritis tends to be symmetric. “You'll get pain in both hands, both elbows, both shoulders, both knees and so on. With osteoarthritis, it may be one or two fingers on one hand and the elbow on the other arm,” Claire adds.
The average age for rheumatoid arthritis is between 40 and 55, but it can affect adults of any age. “Just yesterday, I was talking to a 19-year-old, a 27-year-old and a 36-year-old who had been diagnosed with it,” says Claire. Most people in their 60s or older have osteoarthritis to some degree, but it can also affect younger people.
What are some of the key ways that these symptoms can be treated?
There is no cure for rheumatoid arthritis, but it can be managed with a combination of medication and lifestyle changes. Mild to moderate symptoms can be treated with anti-rheumatic drugs. For more severe symptoms, there are more targeted treatments.
Lifestyle factors like stopping smoking, weight management, keeping fit and living an active lifestyle are also beneficial for managing rheumatoid arthritis.
Osteoarthritis can be managed by similar lifestyle changes, regular exercise to keep the joints moving, pain medication and, in some cases, surgery.
Does exercise and moving painful joints benefit all forms of arthritis?
“Exercise is vitally important for all forms of arthritis,” says Claire, “even when going through a flare-up, it's important to keep a range of movements going.”
Strengthening the muscle around the joint and improving balance is very helpful, which is why yoga, tai chi and gentle forms of exercise are important alongside aerobic activity.
How can a doctor tell the difference between osteo and rheumatoid arthritis?
Rheumatoid arthritis can be hard to identify because the symptoms are often seen in isolation. Younger people who are not normally associated with arthritis may come in with symptoms like painful joints or fatigue, so it’s important for a doctor to look at the full patient history and refer them to a rheumatologist.
A diagnosis of rheumatoid arthritis will be made by a rheumatologist in a hospital setting. They can use ultrasound to see if there is inflammation going on in the joints.
Osteoarthritis is normally diagnosed via X-ray of the affected joint, which can show loss of joint cartilage and narrowing of space between the joints. Joint fluid analysis is sometimes performed to rule out gout or inflammatory arthritis. The location and appearance of the joint can also help the doctor come to a diagnosis.
For more information about rheumatoid arthritis, please call the NRAS helpline on 0800 298 7650 or visit nras.org.uk