How to Understand Rheumatoid Arthritis & Osteoarthritis – Chronic Pain and Treatment Strategies

The previous two articles in this series analyzed and discussed rheumatoid arthritis (RA) in some detail. The link between chronic pain and RA was analyzed and the progression of the RA chronic pain complex was revealed. Particular attention was paid to small joint pain, usually involving the neck, hands, and feet in the early stages of the disorder, then spreading as the disease takes hold and progresses. The progression of chronic, often acute pain affecting the larger joints, to include the upper, middle, and lower back, hip and knee pain, and even leg pain, usually expressed as sciatica, was discussed. As discussed in “Understanding Rheumatoid Arthritis – Dealing With Chronic Pain Associated With RA Part I & II,” RA is a chronic and systemic disorder, widespread throughout the body, and without cure. In this article we will discuss the differences between rheumatoid arthritis (RA) and an often misdiagnosed, misunderstood “cousin,” osteoarthritis (OA). We will discuss diagnostic features distinguishing the two disorders, the symptoms of RA versus OA, and some treatment variations and similarities. The very different outcomes, or prognoses, as well as certain strategies for confronting the two conditions head on will also be explored. Finally, strategies for alleviating, and in some cases eliminating, the chronic pain associated with rheumatoid arthritis and osteoarthritis will be offered. Chronic pain treatment strategies, to include treatment for neck pain, back pain, hip and knee pain, and sciatica, will be compared and analyzed.

As noted above, rheumatoid arthritis is a chronic, systemic disorder. Rheumatoid arthritis is an autoimmune disease occurring when the individual’s immune system doesn’t work properly or malfunctions. Rheumatoid arthritis causes chronic, often acute pain, stiffness and swelling, and progresses from small joint involvement, to large joint involvement, and ultimately to multiple organ consequences. Chronic pain associated with RA is usually the result of an inflammation of the synovial membrane, synovitis. The inflammation of the synovial membrane leads to friction, the friction leads to joint degeneration, which leads to more inflammation, which leads to more friction and joint degeneration. As the disease progresses, and begins to affect other organ systems, the result is usually total disability. The exact cause of rheumatoid arthritis has not been established. Many experts believe that RA may be the result of genetics, environment, and/or a number of other factors to include hormones and the body’s reaction or response to stress. Onset of RA typically occurs in women between the ages of 30 and 50 years of age. However, rheumatoid arthritis has been known to strike the very young, men, and certain ethnic groups, to include a disproportionately high number of Native Americans. RA is also seen in higher numbers among smokers. Rheumatoid arthritis is generally not attributed to such things as aging, trauma and injury or obesity. Beginning with small joint pain and stiffness, the disorder culminates in deformity and chronic, often acute, back pain, hip and knee pain, and sciatica.

Osteoarthritis (OA) is generally considered an age-progressive phenomenon. Sometimes called the “wear and tear” disorder, OA may also be attributed to injury, trauma, stress, and/or obesity. Osteoarthritis typically expresses with joint pain, stiffness, and loss of function and did decrease in the range of motion. Unlike rheumatoid arthritis, osteoarthritis generally affects weight bearing joints, particularly the spine, the pelvis or hips, and the knees. Chronic back pain, particularly of the lower back, and leg pain (sciatica) are quite common. However, OA may also be present in the neck, the hands, particularly the finger joints, and even the big toe. Osteoarthritis generally worsens later in the day or after considerable activity. Alternately, rheumatoid arthritis is generally known for morning stiffness or stiffness occurring as the result of a lack of activity or after periods of prolonged inactivity.

Significantly, while as many as 1.5 million individuals in the United States have been diagnosed with rheumatoid arthritis, over 20 million people have been diagnosed with osteoarthritis. While diagnosis for osteoarthritis is usually established with the use of x-rays, in some cases CAT scans, rheumatoid arthritis usually takes a more comprehensive battery of diagnostic tests to properly diagnose. RA sufferers may require extensive blood tests, x-rays, CAT scans, and in some cases even an MRI to properly diagnose the disorder. The very different symptoms of the two disorders, one systemic and the other a “wear and tear” disorder, are evident in the laboratory and radiographically (x-rays).

Treatment strategies for RA and OA are often remarkably similar. Although RA requires pharmacological intervention, generally in the form of disease-modifying anti-rheumatic drugs or DMARDs, to reduce stiffness and chronic pain, as well to inhibit joint damage, this should not be the only treatment strategy employed. DMARDs often take weeks, even months to build up in the bloodstream and fully take effect, so NSAIDs are often used synergistically, and as a stop-gap until DMARDs are effective. Osteoarthritis, on the other hand, may also be treated by NSAIDs. However, ibuprofen and acetaminophen are routinely prescribed for pain associated with osteoarthritis.

In addition to medication, both rheumatoid arthritis and osteoarthritis are responsive to physical therapy and ice to reduce inflammation and swelling. Individuals suffering from RA or OA typically respond well to exercise. Exercise is particularly effective for RA sufferers in order to offset periods of inactivity and the stiffness associated with a sedentary lifestyle or simply the stiffness related to characteristic morning stiffness. Osteoarthritis, on the other hand, responds well to exercise for different reasons. Individuals affected by OA, a typically age-progressive, trauma, and stress related phenomenon, respond quite well to strengthening of the musculoskeletal system, particularly the core muscles responsible for posture and overall strength. As muscles atrophy, deterioration of the bones, particularly the vertebrae and weight-bearing joints, is quite common, leading to “wear and tear” and an exacerbation of the overall condition and subsequent degeneration. The degeneration leads to a constellation of chronic pain symptoms, to include neck pain, back pain, and sciatica.

Ultimately, while etiology or cause of rheumatoid arthritis and osteoarthritis are quite different, symptoms, such as swelling, inflammation, stiffness, and chronic pain are characteristic of both conditions. Individuals suffering from RA and OA are affected by a progressive disorder, both leading to total disability if not properly treated. Individuals diagnosed with osteoarthritis, because of the very nature of the disorder, have a much better chance of alleviating and even eliminating the long-term effects. RA is, by its very nature, more problematic. That being said, individuals suffering from rheumatoid arthritis may take control of the outcome, their prognosis, by engaging in an aggressive, holistic treatment strategy, one typically designed to treat the symptoms, since etiology is still unclear. In both instances, medication, ice for inflammation, swelling, and to reduce pain, and a medically approved, individualized program of stretching and exercise should be commenced as soon as possible. Chronic pain associated with both conditions should be taken as a warning to do something, rather than to do nothing. To do nothing will exacerbate either condition, leading to further degeneration and the progression of both disorders and their symptoms, to include chronic pain in the form of joint pain, neck pain, back pain, and/or sciatica.