Arthritis is a common condition of the joints, which leads to pain, stiffness, swelling, and inflammation due to changing joint surfaces. According to the CDC, 23% of adults have arthritis, and nearly half of those are limited in their activity due to arthritis. The two most common types of arthritis are osteoarthritis (OA) and rheumatoid arthritis (RA). In this blog we’ll discuss the difference between these two forms of arthritis as well as recommendations for treatment options.
OA is the most common form of arthritis and occurs when the protective cartilage that cushions your bones wears down over time. It usually occurs around middle age (50s), more so in women than men and typically occurs in the hands, hips, knees, and back. While it can be brought on with normal, “wear and tear” on the joints, family history can also be a contributing factor as can overuse, obesity and previous trauma or an injury to a joint. OA is also referred to as degenerative joint disease. As cartilage wears down, this decreases the space between your joints allowing the bones to touch each other, causing pain. On an x-ray, the joint can appear to have collapsed, just like an old building would overtime. Even though the joint spaces are smaller, swelling can occur, causing an enlargement or bump, which are easily visualized. It is often observed more in the hands and wrists, as there are many joints. OA can occur in any of the joints within the fingers and thumb.
RA is an inflammatory condition caused by an autoimmune disease. In a healthy person, the immune system fights off bacteria and viruses. In a person with RA, the immune system mistakes some of the body’s healthy cells as invaders and releases inflammatory chemicals that attack the healthy synovium, or the lubricant-like fluid that assists in movement of the joints. The inflamed synovium becomes thick and the joint becomes painful, tender and may even appear red or swollen, making movement more difficult. RA commonly affects the hands, knees and ankles and typically occurs in the same joint on both sides of the body. The smaller joints of the hands and wrists are usually affected first. With RA, stiffness will last more than 30 minutes after awakening. Besides joint pain, other signs of RA include fever, fatigue or tiredness and weakness. RA can cause problems in other parts of the body as well, including the lungs, heart, and eyes. RA symptoms can suddenly increase in intensity, known commonly as a flare. When symptoms improve, this is known as a remission.
RA can begin at any age, but the tendency to develop RA increases with age, with typical onset being adults in their 60s. Women are 2-3 times more likely than men to develop new cases of RA, with women who have never given birth being at a greater risk. Conversely, women who have breastfed, have a decreased risk of developing RA. Along with specific genes, factors like smoking and obesity places one at a higher risk of developing RA and can make the disease process worse.
RA and OA can both be diagnosed by a physical examination by a skilled practitioner, x-rays and through lab tests. While medications are the first line of defense for those suffering from RA, it’s important to note that both RA and OA can lead to deformities of the fingers at each joint. In fact, osteoarthritis at the base of the thumb is very common.
Persons with RA or OA can both benefit from many of the same strategies to manage symptoms:
The Hand Therapists at Athletico can recommend joint protection techniques and adaptive strategies and devices (orthosis and splints) to allow you to continue to perform activities of daily living and for hobbies or leisure. Some of these techniques can be found in this blog on Living with Arthritis: Tips and Tricks for Healthy Hands. Our team can also suggest specialized exercises as part of a home program to protect the joints, decrease stiffness, correct joint instability, and improve the ability to use the hands if living with RA or OA. If surgery is required to manage your arthritis, our therapists can work closely with your physician to optimize your outcome to allow for a successful recovery.
“American Society of Hand Therapists (ASHT).” American Society of Hand Therapists (ASHT), 2016, https://www.asht.org.
“Arthritis Foundation | Symptoms Treatments | Prevention Tips | Pain Relief Advice.” Arthritis Foundation | Symptoms Treatments | Prevention Tips | Pain Relief Advice, http://arthritis.org. Accessed 26 Feb. 2021.
“Arthritis Types | CDC.” Centers for Disease Control and Prevention, 27 July 2020, https://www.cdc.gov/arthritis/basics/types.html.
Higgins, James, et al. Hand and Upper Extremity Rehabilitation. 3rd ed., Churchill Livingstone, 2006, pp. 649–57.