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Bony Pathology: OA vs RA

  • Writer: Physical Therapy International Service
    Physical Therapy International Service
  • Mar 11
  • 6 min read

Authors: Jenna Little and Ella Bonner





Osteoarthritis (OA) and rheumatoid arthritis (RA) are types of joint inflammation diseases that have some similarities, but often come with different signs and symptoms and varied treatment options. While it is normal to feel differently as we age, these bony pathologies are common but are not considered “normal” for adults. They could cause pain and disability in individuals but are treatable with proper physical activity, physical therapy (PT) interventions, and medical management. 


OA is a condition of the smooth cartilage of the joints and is characterized by the fact that the surface wears down over time, leaving little room between the joints. It is the more common type of arthritis and is caused by deterioration of the joints. Typically, only one isolated joint faces the initial effects of OA and it can progress to affect other isolated joints individually in some people. While anyone can get OA, it often occurs in individuals in their late 40s-60s. Statistically, women are more likely to get OA than men, and it is common after menopause.


On the other hand, RA is both an autoimmune and an inflammatory disease. The body’s immune system attacks the thin membrane of the joints. It is known as a “systemic” disease because, as compared to OA, it can affect the joints in the entire body. RA also tends to affect both sides of the body, for example, both hands or both feet. Similarly to OA, RA is seen in individuals with older age, and women are about two to three times more likely to be diagnosed than men. Genetics can play a role in the diagnosis, therefore, if someone in an individual's family has the disease, they are at a greater risk of having it themselves. There are other risk factors for developing RA such as long-term smoking. 


OA has some commonly affected joints that are in the hands, knees, hips, neck, and low back. As osteoarthritis evolves, it can impact different parts of the joint such as the cartilage, tendons, synovium, bone, and the meniscus in the knee. When osteoarthritis worsens, it can cause pain, swelling and loss of range of motion in the joint. As time goes by, the joints or bone itself could lose their shape and abnormal bone growths could appear which are called osteophytes or bone spurs. The pain that occurs can be localized or radicular, and in some cases, it can worsen in the morning. The affected joints can also face stiffness, limited range of motion, swelling, and instability. 


There is not a single test to diagnose OA but there are a lot of factors that go into making the diagnosis. Firstly, medical history and family history can be used, as well as current medications, and symptoms. After this, completing a physical consultation looking at reflexes, joints that may have issues, and general health. After a physical exam, obtaining images of the problem joints would be next. While the impacted joint in its early stages is not able to be seen through an x-ray, you may be able to see bone remodeling or spurs and loss of joint space. MRIs then can show the soft tissue damage at the joint space.

 

While OA cannot be “cured,” there are many types of treatment options for it. The goals of treatment are not to make the OA fully go away, as that is not possible, but instead to reduce pain, slow the progression, improve and maintain the functions of the joints, and create a healthy lifestyle. PT can be an option to treat the effects of OA by introducing various exercises, all focusing on increasing or maintaining range of motion. You also want to focus on muscular strength directed to the muscles most affected by the arthritic changes. Low impact workouts that have little force on the joints are a great option to do with a PT. Other methods of physical activity such as aquatic therapy are also a beneficial way to decrease the force and pressure on the joints while still working on improving range of motion. 


The joints most affected by rheumatoid arthritis are found in the hands, wrists, feet, ankles, knees, shoulders, and elbows. The joints become inflamed and it often affects both sides of the body. The symptoms can differ from person to person, and may come on suddenly or worsen over time. Some symptoms of rheumatoid arthritis are pain, stiffness, swelling, painful movement, bumps developed on joints, difficulty with daily activity, fatigue, difficulty with gripping, and even fevers. Rheumatoid arthritis can be the cause of disability in individuals because of the pain and limited movement, which can contribute to mental health diagnoses like depression and anxiety. Additionally, it may begin to affect other areas of the body like the lungs, nerves, muscles, heart, blood vessels, and kidneys because of its inflammatory traits. 


Because RA is an autoimmune disease, it can be diagnosed a little differently than OA. During early stages, the symptoms of RA are very similar to those of other diseases, making it difficult to determine. In general, the affected joints will be physically examined for swelling, redness, and warmth, and they will assess strength and reflexes. Blood tests can tell us a bit about the diagnosis, as well as looking for the Rheumatoid Factor (RF) or Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein(CRP) which appear with an immune response in the body. As time goes on, X-rays and MRIs can be used to see the progression and how severe the disorder is in your body. While there is no cure for RA either, medications can help limit the symptoms felt by the individual. Surgery can also be used as a last resort if one’s joints are severely affected to help regain range of motion. In PT, the main focus of the sessions would be to maintain flexibility in the joints and make difficult daily tasks hurt as little as possible. Regular exercise can help maintain range of motion in the joints and strengthen the muscles of the affected joints. 


While the diagnosis of either OA or RA can feel like a big deal, we as physical therapists can be there to support our patients work through it in the best way possible. Instead of instructing patients and giving direct orders of things to do, it is best to play the role of a “teammate” with and devise a collaborative plan. This will help the patient feel more motivated and supported to take the PTs advice, such as continuing/starting physical activity in their daily routine. Also, asking the patient about their mindset and reasoning behind the diagnosis can help the PT understand the “why” behind the patient’s behaviors. Finally, making sure that the patient knows that their actions are their choices and the outcome is up to them. This is an important concept when coming up with a treatment plan and educating the patient. By putting the patient in the front of their care, it will encourage them to take initiative in their life to do what is needed and best for their wellbeing. 


It is important as providers, we are careful with the words we say and how we describe diagnoses to our patients. Unnecessary harmful language can be detrimental to the mindset of a patient when receiving imaging or being educated on their diagnosis of arthritis. Concepts such as “bone-on-bone” or ideas of fear to return to regular activity thinking it will “damage the joint further” are harmful and not supported in the rehabilitation of arthritis. Instead, we encourage helpful language that serves to help the patient understand their diagnosis, prognosis, and plan of care better and empowering them to take charge of their treatment.


While OA and RA both affect joints and have similar symptoms like pain and stiffness, there are major differences between the two. They have varying causes, developments of the disease, treatment options, making understanding what makes them unique to each other is crucial. Though the joints are affected from both types of arthritis, RA comes with more symptoms that often affect the rest of the body. Both diagnoses can take an emotional toll on the patient. Therefore, physical therapists play a crucial role in being a support person for patients and helping them take initiative on managing the disease symptoms. Patients need all the support they can get as it affects many parts of their daily living, but there is so much we can do to help them live a normal, long, and healthy life! 



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