Many patients that come to our clinics at IceFire Physiotherapy or Northside Hand & Upper Limb Clinic wonder if they have some form of arthritis. Usually they have notices they have swelling in one or more joints, or some changes to the shape of the joints in their hands and fingers.
There are over 120 different arthritic types of diseases, which are collectively called arthritides.
There are two broad groups of arthritides.
1) Inflammatory arthritides include: psoriatic arthritis, rheumatoid arthritis, osteomyelitis, gout, pseudo-gout, systemic lupus erythromatosus, and ankylosis spondylitis. There are no known causes for any of these diseases. However, it is thought that the risk of getting the disease is related to one or more of the following: genetics, hormones, smoking and obesity. Some of these diseases affect women more than men, such as rheumatoid arthritis; about 9 out of 10 people with psoriatic arthritis are women. [ref aapmr.org]
2) The famous non-inflammatory arthritis is osteoarthritis. As for some of the inflammatory arthritides, women are more often affected than men. It is thought to be caused by a combination of genetic factors and excessive wear and tear.
This short article will focus on the differences between rheumatoid arthritis and osteoarthritis.
To understand these diseases it is necessary to know a little about a common human joint. A typical joint consists of a bag – the joint capsule – wrapped around the ends of two bones where they come together to move upon each other (i.e to articulate). The inside lining of the bag consists of a thin layer called the synovium, which produces the lubricating fluid for the joint (the synovial fluid). The surfaces of the bones in the joint capsule are covered in another thin layer (articular cartilage).
Although the synovium of joints affected by rheumatoid arthritis (RA) and osteoarthritis (OA) show similar inflammatory changes in many ways [ref tandfonline.com], rheumatoid synovial joints will appear more severely affected. In osteoarthritis the articular cartilage can become badly damaged.
Many more people have osteoarthritis than rheumatoid arthritis. In America for every one person with RA there are more than 25 with OA. In Australia there are over 406,000 people with rheumatoid arthritis, but more than 2 million people affected by osteoarthritis. When a person has the early stages of the symptoms of rheumatoid arthritis and osteoarthritis do differ, especially as the diseases progress over time.
RA: Lots of joints become painful, stiff and swell OA: It is mostly the joints of the fingers, hands and knees that are affected. The hip and spine can also be affected.
RA: Often the joints that are sore on one side of the body are the same joints equally affected on the other side of the body. This symmetrical pattern is quite common with RA. OA: Often the pattern of joints affected is assymetrical. Some of my patients will only have the fingers of their right hand affected, and their left knee will be much worse than their right knee.
RA: Upon waking in the morning, stiffness of the painful joints will last more than 30 minutes. OA: Stiffness upon waking usually lasts much less than 30 minutes; quite often less than 5 minutes.
RA: It affects other parts of the body apart from joints, and this may be related to why people with RA often have fever and fatigue. OA: It is not thought that this disease causes fever or fatigue. In fact many of my patients with osteoarthritis are full of energy and frustrated that their painful knee is slowing them down.
Rheumatoid Arthritis treatment: Treatment should include medication, and it is very important that a doctor or rheumatologist be involved in choosing this medication as soon as possible. Medication may include antitumour necrosis factor (anti-TNF) drugs such as infliximab (Remicade is one brand that contains this active ingredient). Hand therapy and physiotherapy also have an important part to play. Osteoarthritis treatment: Physiotherapy and hand therapy play a very important part, with medication being much less important compared to the need for it when someone has rheumatoid arthritis.
Many patients are very pleasantly surprised to see how much they have improved after receiving physiotherapy at IceFire Physiotherapy. Exercises have a very important role to play in achieving great results.
Jonathan ClerkePrincipal Physiotherapist, IceFire Physiotherapy, Brendale (in the northern suburbs of Brisbane, beside Albany Creek, Eatons Hill, Warner and Strathpine)