Painful and stiff joints may be signs of arthritis. It is crucial to know which type of arthritis you have because there are important differences, particularly in management and treatments.
Osteoarthritis (OA) is the most common type of arthritis and is seen especially among older people. In OA, the cartilage covering bone joints wears away, causing swollen joints and painful movement.
Rheumatoid arthritis (RA) also causes painful, swollen joints, but it occurs when the body’s immune system attacks the lining of joints.
Symptoms of Osteoarthritis
Osteoarthritis starts slowly. You may notice the first symptoms as joint pain or stiffness after exercising. It can occur in any joint, but OA most often affects the knees, hands, hips and spine.
The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) lists these warning Signs of osteoarthritis:
- Stiffness in a joint after getting out of bed or sitting for a long time
- Swelling in one or more joints
- Crunching feeling or the sound of bone rubbing on bone
Symptoms of Rheumatoid Arthritis
The Arthritis Foundation lists the following symptoms of rheumatoid arthritis (RA):
- Regular morning joint stiffness
- Persistent joint pain that does not improve
- Joint pain that is getting worse over time
- Joints that are swollen, red, hot or tender to the touch
- Joint pain accompanied by fever
- Several affected joints
- Joint problems that affect your ability to move or function
These symptoms should be evaluated by a doctor.
Differences Between OA and RA
RA is diagnosed by a series of clinical signs and symptoms and sometimes with the aid of blood tests. Osteoarthritis is diagnosed by history, clinical signs and X-ray of the worn joint. Osteoarthritis occurs later in life or after damage to the joint by injury. Rheumatoid arthritis occurs at any age and is more common in women.
One important difference between OA and RA is that rheumatoid arthritis can go into remission. In remission, morning stiffness, pain and joint swelling are greatly reduced, allowing RA patients to be more active. Remission doesn’t always last, but if RA treatment is started early, the odds of going into remission are greatly increased.
Some treatment options for OA and RA are different. Reducing pain is an important treatment goal for both OA and RA, but because RA involves the immune system, several biologic agents have been developed to help the body fight the disease.
"OA tends to be more of a 'wear and tear' process where the joint starts to break down secondary to heavy use of the joint (such as in past athletics) and/or too much force being put across the joint (such as being overweight). RA more commonly appears in younger people, starting in the 20s or 30s at the symptom onset, while OA tends to start becoming problematic more-so beyond 50 years of age," said Dr. Daniel Clearfield, Primary Care Sports Medicine Physician at the Ben Hogan Bone and Joint Institute in Fort Worth, Texas.
"Regardless of the diagnosis of OA or RA, exercise has shown to be a beneficial modality in helping to relieve pain, increase function, and provide for a better outlook. I try to give my patients a goal to walk 3,000 steps in 30 minutes every day. This increases their muscle strength and endurance around their joints, which helps as they are not putting the pressure on their joints directly anymore, it is being distributed out over the muscles, ligaments, and tendons to put less 'pounding' on their weight-bearing joints," Dr. Clearfield said.
Treatment Approaches to Osteoarthritis
Several treatments are used to relieve the pain of OA.
Pain-relieving analgesic pills, like acetaminophen (brand name Tylenol), are available over-the-counter. Nonsteroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen (brand names Advil and Motrin) and naproxen sodium (brand names Aleve), may also be used for pain relief. Stronger pain relief may be provided by prescription medications.
Analgesic creams, some of which contain capsaicin or salicylates, also can reduce pain when applied to joints.
Some OA patients find relief with steroid injections in the affected joints.
Most people don’t need surgery for OA, but for those who haven’t responded well to other treatments, joint replacement surgery may bring relief from pain and increase mobility.
Treatment of Rheumatoid Arthritis
NSAIDS are often used to treat RA. A prescription medication called celecoxib (brand name Celebrex) is an NSAID that inhibits COX2, an enzyme associated with pain and inflammation. Celecoxib has been used to treat RA.
Prednisone, prednisolone and methylprednisolone are potent and quick-acting prescription medications used to get inflammation under control quickly.
The Arthritis Foundation advises that RA should be treated early. One type of medication used early to treat RA is disease-modifying antirheumatic drugs (DMARDS). If these medications are used early, they can help prevent severe joint damage. The most commonly prescribed DMARD is methotrexate. Methotrexate may be given by injection or taken in pill form.
Biologic agents work outside cells to block specific steps in the inflammation process. There are nine approved biologics for RA:
- adalimumab (brand name Humira)
- anakinra (brand name Kineret)
- abatacept (brand name Orencia)
- etanercept (brand name Enbrel)
- certolizumab pegol (brand name Cimzia)
- infliximab (brand name Remicade)
- rituximab (brand name Rituxan)
- golimumab (brand name Simponi)
Some of these medications are given by infusion into the blood through a vein and some are given by an injection into the skin.
According to the NIAMS, "The person’s general condition, the current and predicted severity of the illness, the length of time he or she will take the drug, and the drug’s effectiveness and potential side effects are important considerations in prescribing drugs for rheumatoid arthritis."
NIAMS states, "Many of the drugs that help reduce disease in rheumatoid arthritis do so by reducing the inflammation that can cause pain and joint damage. However, in some instances, inflammation is one mechanism the body normally uses to maintain health, such as to fight infection and possibly to stop tumors from growing. The magnitude of the risk from the treatment is hard to judge because infections and cancer can occur in people with rheumatoid arthritis who are not on treatment, and probably more commonly than in healthy individuals. Nevertheless, appropriate caution and vigilance are justified."
Alternative Treatments for Arthritis
Some alternative treatments have been used by both OA and RA patients.
Gentle stretching and physical activities that work the joints gently, like walking and water exercise, may reduce the pain of arthritis. Some patients benefit from working with a physical therapist.
Losing weight reduces the pressure on joints and may help decrease the pain as well.
Heat and cold treatments, meditation and acupuncture have also been used for pain relief.
Electrical nerve stimulation delivered to the painful joint by a small pocket-sized unit has been shown to provide pain relief to some OA patients.
Advancements in RA Treatment
A new class of medications, called JAK inhibitors, are medications taken by mouth that work by inhibiting a cell enzyme involved in the inflammation and immune reaction of RA. They are different from other biologics because they work inside the cell.
Tofacitinib (brand name Xejlanz) is a JAK inhibitor that was approved by the FDA in November 2012 for adults with moderate to severe active RA who have not improved with methotrexate treatment. It may be taken with methotrexate.