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Arthritis is the result of cartilage wear and tear or joint damage, where two or three bones come together. To prevent bone-on-bone friction, there is a spongy cap called cartilage that allows smooth gliding between the bones. However, this cartilage can become damaged for various reasons. The two main types of arthritis are osteoarthritis and rheumatoid arthritis.
In this article, Dr. Ravikumar Mukartihal, Consultant Orthopaedic and Robotic Joint Replacement Surgeon, SPARSH Hospital, explains the differences between osteoarthritis and rheumatoid arthritis, as well as how these conditions are treated.
Osteoarthritis is characterized by the gradual wear and tear of cartilage over time, resulting from prolonged usage. As the two bones in a joint experience friction, the cartilage gradually thins and deteriorates. When the cartilage becomes too thin, the bones may touch the subcortical bone beneath it, leading to pain. This degenerative process occurs as a result of long-term wear and tear.
Osteoarthritis commonly affects women aged 55 and above, while males typically experience it at 60 years and older. This condition primarily affects loading joints such as the knees and hips, rarely occurring in the hands. Symptoms may include pain, limited joint movement, and stiffness, particularly in the morning.
Unlike osteoarthritis, rheumatoid arthritis is not caused by cartilage wear and tear. Instead, it is triggered by inflammation. The synovial tissue, responsible for producing synovial fluid (a thick liquid located in between joints), becomes inflamed, reducing its flow. In certain instances, the body's immune system, altered by factors such as viral infections, fails to recognize its own tissues. Consequently, it produces an excess of anti-inflammatory cells and tissues, which attack the cartilage. Unlike primary arthritis, which is directly caused by cartilage wear and tear, rheumatoid arthritis is a secondary form. It occurs when our immune system releases chemicals due to its failure in recognizing its own tissues. This crucial difference distinguishes rheumatoid arthritis from osteoarthritis.
Rheumatoid arthritis can develop at any age, spanning from 10 to 50 years. Patients with this condition often endure significant pain, morning stiffness, and, in some cases, joints may become bent in abnormal positions. Rheumatoid arthritis can involve small joints like those in the hands and feet.
For osteoarthritis, treatment typically involves anti-inflammatory medication, lifestyle adjustments, dietary restrictions, weight management, and exercise. These measures can be effective until the condition progresses to stage 4, where joint replacement surgery becomes the only viable option.
In rheumatoid arthritis, weight reduction and similar measures are not as effective. Instead, the focus is on altering the immune system by reducing inflammation through anti-inflammatory medications and disease-modifying drugs like corticosteroids. These interventions are most successful before the cartilage sustains extensive damage. If the cartilage is severely damaged and pain and swelling persist, joint replacement surgery becomes necessary to achieve positive outcomes. When it comes to surgeries for osteoarthritis, it usually happens at the older age i.e above 55 years. Whereas, in rheumatoid arthritis, since it can happen at any age, the surgeries also happen relatively early like at the age of 35 years.
Once rheumatoid arthritis develops, it becomes a lifelong condition. Unlike other forms of arthritis, it does not go away on its own.
Osteoarthritis, commonly observed in older individuals, is caused by the natural wear and tear of cartilage. Adopting a healthy lifestyle, maintaining a balanced diet, managing weight, and engaging in regular exercise can significantly delay the onset of osteoarthritis. In the early stages (1 and 2), physiotherapy is often the recommended treatment, while in more advanced stages (3 and 4), surgery may be necessary. This condition typically affects weight-bearing joints like the hips and knees.
In contrast, rheumatoid arthritis can develop in younger age groups, ranging from 8 to 50 years old. This form of arthritis is characterized by joint inflammation and chemical changes that damage the cartilage, often affecting multiple joints. While lifestyle changes have limited impact on rheumatoid arthritis due to its immune system-driven nature, medication can effectively control inflammation in the early stages. In cases of severe arthritis, surgery becomes the primary option.