OA vs RA: How to Tell the Difference Between Two Common Causes of Joint Pain
If you’re feeling joint pain, you might be wondering how to tell the difference between osteoarthritis and rheumatoid arthritis. People who visit the Caplan Health Institute wonder about this all the time. The fact is there are subtle differences between osteoarthritis vs. RA symptoms. These differences can signal which condition you may have. In this blog post, we’ll dive into the differences between osteoarthritis and rheumatoid arthritis and discuss functional medicine treatments for each condition.
Cause of Osteoarthritis
Osteoarthritis, which is what people call general arthritis, is caused by wear and tear in the joints. Overuse injuries can cause wearing down of cartilage, which is the cushion between the bone. When the cartilage starts to break down, it causes more bone growth because the body is trying to stabilize that joint and fix the damage and wear and tear. The bone growth leads to abnormal bony growths. There’s less cushion and more bone being produced.
The body is trying to do a good thing by fixing damage, but it’s doing a messy job. It’s creating more inflammation because there’s more bone on bone without the cushion of cartilage, and that causes more pain. That can also create sore muscle tissues around that area. OA is the result of that bone growth happening to stabilize the joint. It’s fueled by chronic inflammation and it creates more low grade chronic inflammation, resulting in pain.
Causes of Rheumatoid Arthritis
RA is different than OA because RA is an autoimmune disease, and it starts more in the fluid of the joints. Between the joints there is cartilage, the cushion that stops bone from rubbing against bone. There’s also fluid between the joints called synovial fluid that helps bring nutrients to those tissues and creates cushioning between the joints. In rheumatoid arthritis, an impaired immune system causes inflammatory chemicals to build up in that fluid. That causes damage to the cartilage, which in turn causes damage to the bone.
The mechanism of RA is the immune system causing the inflammation rather than wear and tear to the joints as with OA. However, like osteoarthritis, in RA the body tries to stabilize the damaged area, so it starts to create bony changes, which in turn causes more inflammation and pain.
Slower Onset vs. Faster Onset
Another way you can determine whether it’s OA or RA is how long it takes for the condition to develop. Osteoarthritis is a gradual wear-and-tear process. It comes on slowly and gradually and can take years for someone to start noticing symptoms like pain and stiffness.
Rheumatoid arthritis can be a lot quicker in its onset because the immune system is triggered and there’s an onslaught of inflammatory chemicals. RA can be a lot more rapid and symptoms present in weeks or months versus over a longer period of time.
Asymmetrical vs. Symmetrical
With osteoarthritis the damage is usually asymmetrical. For example, one knee or one hip. With RA, because it’s more of a systemic autoimmune issue instead of just wear and tear, it’s usually more symmetrical in the body. You’ll see it on both sides of your body. For example, both hands are affected.
Osteoarthritis vs. Rheumatoid Arthritis: Morning Stiffness
With rheumatoid arthritis, you might notice that your pain is worse in the morning after you’ve been resting or not moving. People with RA get out of bed and they’re stiff for a while, and it’s hard to get going. But once you finally get going and start moving it gets better—that’s a sign of RA. With OA, on the other hand, activity usually makes it worse. You’re putting more wear and tear on the joints and putting more demand on the bone. Because OA is more of a mechanical bone-on-bone issue.
Because RA is caused by the inflammatory chemicals in the joint fluid, when the joint fluid hasn’t been moving and circulating and is stuck in place—such as when you’ve been sleeping or sitting too long—those inflammatory chemicals build up in the joint fluid. That’s why starting to move helps flush those chemicals out and helps with the pain in RA. Getting the circulation going lowers some of those inflammatory molecules in the joint fluid.
How long stiffness lasts for RA and OA also differs. People with RA usually have more stiffness than those with OA. If you have RA, you usually have a longer period of feeling stiff in the morning, around 30 to 60 minutes until you get moving. With OA, stiffness lasts for a few minutes and then goes away.
Osteoarthritis vs. Rheumatoid Arthritis Joints Affected
Usually there’s a pretty clear pattern in the joints that are affected. It’s not always black and white, but usually in OA it’s the bigger weight-bearing joints that are impacted. Knees, hips, and some of the fingers are really common. It’s usually one sided. For example, one knee or one hip instead of both. With RA it starts in the smaller joints, the hands, the wrist, the feet. That’s where people with RA will notice pain, stiffness, and swelling.
Early Signs of Rheumatoid Arthritis
Because RA is driven by the immune system, early signs are fatigue and stiffness, which show up long before joint malformation or swelling. Fatigue is a significant rheumatoid arthritis symptom. RA is not simply joint pain. People describe the stiffness of RA as a deep achy stiffness. They complain of discomfort and achiness along with the stiffness. In contrast, OA does not usually have a fatigue component. Joint swelling and pain are the early OA symptoms.
Another early sign of rheumatoid arthritis is reduced grip strength. If your hands are involved, which is more common in RA than OA, there usually are going to be issues with grip strength.
If you have a weaker grip, you may experience problems with opening bottles or cans and gripping and dropping objects. Some of that can appear early on before the joints actually start to change or form bumps.
Osteoarthritis Often Affects Injured Joints
OA is more common at a site where you’ve had an injury to a joint. That’s going to be the weak spot that develops arthritis. If you’ve had a sports injury, ankle sprains, or joint surgery, that’s going to be the target of the inflammation. That doesn’t happen in rheumatoid arthritis.
Diagnosing RA and OA
There are no lab markers for osteoarthritis, but there are laboratory tests that can be helpful for RA. Rheumatoid Factor (RF) is one of the first tests a healthcare provider will order if they suspect RA. They’ll usually also order an anti-cyclic citrullinated peptide (anti-CCP) antibody test. An anti-CCP Antibody Test checks for antibodies that target CCP, a protein that’s modified in RA. Anti-CCP Antibodies can appear years before RA symptoms.
RA does not always have a textbook pattern of autoimmune test findings. Sometimes an anti-CCP antibody test is positive even when the RF is not. There are even some people we’ve worked with who have been diagnosed with seronegative RA, which means they don’t have a positive RF, but they fit enough of the criteria that they have RA.
Doctors also often test inflammation markers such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Functional medicine doctors might also check levels of inflammatory chemicals found in the joint fluid, known as cytokines, to assess the immune system.
Functional Medicine Approach to OA and RA
Because osteoarthritis is due to inflammation and wear and tear, conventional medicine’s answer is to have the patient take anti-inflammatory medicines. In functional medicine, however, we want to do something different. We want to look for factors contributing to your inflammation. It could be the foods you’re eating. It could be you’re getting exposed to toxins and harmful substances in your environment. It could be that you need certain nutrients or antioxidants. For example, low omega-3 levels can create inflammation.
We want to fix why you have an excessive amount of inflammation. That’s a big difference between functional medicine vs. conventional medicine. Functional medicine looks for the why instead of just a band aid solution.
The typical conventional approach to RA is very similar: using anti-inflammatory medications, steroids, and immune-modulating medications, whether it’s immunosuppressants or biologics. Their goal is basically to block the inflammatory chemicals the immune system is making or suppress the immune system from being able to make those chemicals. However, suppressing the inflammation doesn’t fix why it’s happening in the first place. In a functional medicine approach, we want to figure out why the immune system is overproducing these inflammatory chemicals.
We look for root causes of rheumatoid arthritis, which may include components in your diet, lifestyle factors, and different forms of stress on your body. Maybe you’re not sleeping, or you’re over-exercising, or under-exercising, or your stress levels are too high, or you’re not eating the right foods. Our treatment would be based on what is causing the inflammation in your body, so we can fix those problems. Either way, we’re looking for the deeper “why,” instead of just trying to band-aid it.
Once you get the inflammation down by fixing the root sources of it, we can teach you how to maintain that state of lower inflammation. In the case of RA, we can teach you how to maintain that state of remission where the immune system is not attacking you anymore and not creating those inflammatory chemicals. We want to learn what caused it in the first place so that we can learn how to stop it from happening again or causing further damage. That’s the end goal: learning a different way to take care of your body. You can do this by figuring out what your body likes or doesn’t like and how it responds to different factors.
If you know what your body does well with or doesn’t do well with, you’ll be able to make more of an informed decision about lifestyle choices and diet. That’s really important for the long-term goal of not just getting you out of pain, but figuring out how to help your body heal, repair, and perform at its best.
Kinesiology Tape for Joint Pain
Even taking natural anti-inflammatories is still more of a band-aid approach because it’s not addressing why the problem happened in the first place. This is why we suggest physical solutions in addition to nutrition and supplementation. We often recommend kinesiology taping for people who visit our practice. You can apply the tape to the areas that are swollen, painful, or damaged, and it can help with creating more stability in that area. Kinesiology tape activates muscles, enhances blood flow, lessens swelling, and relieves pain.
If someone is trying to do more exercise, but their joints are hurting, I’ll have them use the kinesiology tape. It helps them get through those workouts because the kinesiology tape helps activate the stabilizing muscles around the joint and helps create better circulation in that area. In doing so, it decreases the inflammation and can help you with your goal of being able to exercise more. Whether you’re using kinesiology taping for knee osteoarthritis or kinesiology tape for rheumatoid arthritis or any type of joint pain, we’ve found it to be very beneficial.
Figuring Out Your Joint Pain Causes
At the Caplan Health Institute, we can pinpoint the cause of your joint pain and help reduce osteoarthritis or rheumatoid arthritis symptoms. It’s important to note that in most cases, you can’t reverse the damage that’s been done. You can’t reverse bony growths. But using a functional medicine approach you can get the inflammation down and eliminate the pain, swelling, and stiffness.
We can help you feel better and become more active. The first step? Schedule a free 15-minute discovery consultation, by phone or video.
If you decide to come on board as a practice member, we can order tests to determine if you have rheumatoid arthritis and create a personalized plan to show you which strategies will work best for you. We call our patients “practice members” because they take an active role in their health. In addition, our Caplan Health Institute coaches can work with you to make sure you’re staying on track and not slipping backward. The result is you’ll feel better than you have in a long time, with less pain and stiffness in your joints and a more hopeful outlook.
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