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Rheumatoid arthritis vs osteoarthritis: key differences

Rheumatoid arthritis is an autoimmune disease. Osteoarthritis is the most common type of arthritis and becomes more common with age. Learn the signs, the warning symptoms and which doctor to see in Bangladesh.

Many people in Bangladesh call any joint pain “bath” or simply “arthritis”. But there are different kinds of arthritis, and the two most talked about are very different conditions. Rheumatoid arthritis (often shortened to RA) happens when the body’s own defence system attacks the joints. Osteoarthritis is the most common type of arthritis and becomes more common as people get older. Telling them apart matters. If RA is diagnosed and treated late, it can cause lasting joint damage, so early care from a specialist is important.

What is rheumatoid arthritis?

Rheumatoid arthritis is an autoimmune disease. This means the immune system, which normally fights infections, attacks healthy tissue by mistake. In RA it attacks the tissue that lines the joints. The joints become inflamed, which means painful, swollen and warm. RA mainly affects the small joints, usually the same joints on both sides of the body. Over time it can cause joint deformities and disability.

RA is a long-term condition. It is also a systemic disease, which means it can affect other parts of the body as well as the joints. It often comes and goes in flares, which are periods when symptoms get worse.

The exact cause of RA is not known. According to the World Health Organization (WHO), some risk factors can be changed (smoking and obesity) and some cannot (genes, being female and age).

What is osteoarthritis?

Osteoarthritis is the most common type of arthritis. It often affects joints that carry the body’s weight. Worldwide, the knee is the joint affected most often, followed by the hip and the hand. It usually starts in the late 40s or later, but it can also affect younger people, including athletes and people who have injured a joint. WHO expects cases to keep rising because populations are ageing and obesity and injuries are becoming more common.

WHO also points out that osteoarthritis is not an inevitable part of growing old.

How the two conditions differ

Feature Rheumatoid arthritis Osteoarthritis
Cause The immune system attacks the joint lining Develops over time. More likely with older age, obesity and joint injury
Usual joints Usually starts in the small joints of the hands and feet, often on both sides of the body. Wrists, ankles, knees, shoulders and elbows are also often affected Knees most often, then hips and hands. Often the weight-bearing joints
Pain pattern Pain and stiffness often worse after rest, and may ease with movement Pain mainly linked to activity
Morning stiffness Usually lasts more than 30 minutes Little or none, usually under 30 minutes, and eases with movement
Joint look and feel Swollen, warm, tender, sometimes red Any swelling tends to feel hard and bony

These are typical patterns, not strict rules. Only a doctor can tell for sure.

Who gets rheumatoid arthritis?

WHO says about 18 million people worldwide were living with RA in 2019. About 70% of them were women, and 55% were older than 55. The UK’s NHS says RA is often diagnosed between the ages of 40 and 60.

In Bangladesh, a national survey of musculoskeletal conditions (problems of the bones, joints and muscles) was published in BMC Rheumatology in December 2020. It found RA in about 1.6% of adults. RA was much more common in women (2.4%) than in men (0.7%). An earlier Bangladesh survey, from 2005, had found 0.9%. Osteoarthritis is far more common than RA: WHO estimates that about 528 million people worldwide were living with it in 2019.

Common symptoms of rheumatoid arthritis

  • Pain, swelling and stiffness in joints, often the same joints on both sides of the body, such as both wrists
  • Pain and stiffness that lasts more than 30 minutes in the morning or after a long rest
  • Joints that feel warm and tender
  • Joints that do not move as well, which makes daily tasks harder
  • Tiredness, low energy, fevers, sweats, poor appetite or weight loss

How rheumatoid arthritis is diagnosed

No single test can prove RA. The diagnosis is based mainly on what a doctor finds, supported by tests:

  • Your history and an examination, to look for swollen, inflamed joints.
  • Blood tests such as rheumatoid factor and anti-CCP antibody. Rheumatoid factor is positive in about two-thirds of people with RA, so some people with RA test negative. ESR and CRP measure inflammation, but they can be normal in people with RA. A normal result does not rule RA out.
  • X-rays of the hands and feet, which help show how severe the disease is. Early on they are often normal.

Osteoarthritis is mainly diagnosed from the symptoms and an examination: joint pain linked to activity, little or no morning stiffness, and the weight-bearing joints being affected.

How treatment works

The main treatment for RA is a group of medicines called DMARDs (disease-modifying anti-rheumatic drugs). Started early, they can slow or stop joint damage. WHO lists other types of treatment too, including anti-inflammatory painkillers, steroid medicines and biological medicines. In severe cases, surgery can reduce pain and help a joint move again, and rehabilitation afterwards is important. Physiotherapy can also help keep the joints working and reduce pain.

The Bangladesh Rheumatology Society published national recommendations for treating RA with medicines in 2023. They are based on a treat-to-target approach, which means the specialist sets a clear goal for controlling the disease and adjusts treatment to reach it.

WHO says many people with moderate or severe osteoarthritis could benefit from rehabilitation, such as physiotherapy.

Only your doctor should decide your medicines. Do not change any arthritis medicine without asking your doctor first.

Warning signs: get medical help

Go to a hospital emergency department straight away if:

  • A joint suddenly becomes red, hot and swollen and you have a fever or feel generally unwell. This can be an infection that needs treatment in hospital immediately.
  • You get a widespread rash, chest tightness, severe itching, hives, or swelling of the lips, tongue or throat.

See a doctor urgently, the same day, if:

  • You have severe pain and swelling in just one joint that started suddenly
  • Your joint pain does not get better with painkillers
  • The skin around a joint is red or hot (redness can be harder to see on brown or black skin)
  • You have sore joints with a high or low temperature, or you feel hot, cold or shivery
  • You have sore joints along with sore eyes or problems with your vision
  • You have sore joints along with pain when you pass urine, discharge from the penis or vagina, or a rash or sores on the genitals

See a doctor soon if you have joint pain, swelling or stiffness that you cannot explain and that does not go away within a few days. Ask to be seen by a specialist quickly if the small joints of your hands or feet are swollen, if more than one joint is affected, or if morning stiffness lasts more than 30 minutes. People who wait a long time to see a specialist are much more likely to end up with permanent joint damage.

Which doctor should you see?

  • Rheumatologist: a specialist in RA and other immune joint diseases. This is the main doctor for diagnosing and treating RA.
  • Medicine specialist (internal medicine) or general physician: a good first step if you are not sure what kind of arthritis you have. They can examine you and refer you to a rheumatologist.
  • Orthopaedic surgeon: a bone and joint surgeon, for badly damaged joints that may need surgery.
  • Physiotherapist and physical medicine (rehabilitation) specialist: help with exercise, movement and staying independent.
  • Other specialists: RA can affect other parts of the body, and your rheumatologist can refer you if needed.

For general health advice, you can call the government’s Shasthyo Batayon health call centre on 16263 and speak to a doctor at any time of day or night.

Living well with arthritis

  • Stop smoking. Smoking is a risk factor for RA.
  • Aim for a healthy weight. Obesity is a risk factor for RA and is linked to osteoarthritis.
  • Ask your doctor whether physiotherapy could help you.
  • Keep all follow-up appointments.
  • Look after your mood. Low mood can come with inflammatory arthritis, so ask for support if you need it.

Sources

This article is for general information only. It does not replace advice from a qualified doctor who has examined you.

Find a doctor

Browse Rheumatology doctors in Bangladesh on ratings.com.bd, with chambers and, where listed, visiting hours and phone numbers.

Sources

This article is general information, not medical advice. It was written by AI from the sources above. It did not pass the automatic check, and an administrator chose to publish it; no doctor or editor has reviewed it. For a diagnosis or treatment, see a registered doctor.

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