Arthritis and Joint Pain: Osteoarthritis vs Rheumatoid Arthritis

Stiff knees in the morning, a hand that aches when you open a jar, a back that complains when you climb stairs. Joint pain is one of the most common reasons people visit a doctor in Pakistan, and it often gets brushed off as “just age” or “gas”. But arthritis is not one disease. There are more than a hundred types, and the two you will hear about most, osteoarthritis and rheumatoid arthritis, are very different and are treated differently.

Osteoarthritis vs rheumatoid arthritis

Osteoarthritis (OA) is wear and tear. The smooth cartilage that cushions the joint thins over time. It mostly affects the knees, hips, hands and spine, usually after 45, and is more likely if you are overweight or have had a joint injury.

Rheumatoid arthritis (RA) is an autoimmune disease in which the immune system attacks the lining of the joints. It can start in your thirties or forties, affects small joints of the hands and feet on both sides, and is three times more common in women. It can also cause tiredness, fever and affect other organs.

How to tell them apart

• Morning stiffness: OA stiffness settles within about half an hour. In RA it lasts an hour or longer.
• Pattern: OA pain is worse after activity and better with rest. RA pain and swelling are often worse after rest.
• Swelling and warmth: more obvious and symmetrical in RA, often with fatigue and low fever.
• Joints involved: OA hits weight-bearing joints. RA often starts in the wrists, knuckles and toes.

Pain in a single hot, swollen big toe or ankle may be gout, which is another form of arthritis, and low vitamin D can also add to aches (see our guide on vitamin D deficiency).

Diagnosis

Your doctor will examine the joints and ask about stiffness, swelling and family history. X-rays show cartilage loss in OA. Blood tests such as ESR, CRP, RA factor and anti-CCP help diagnose RA, and uric acid and vitamin D are often checked too. Early diagnosis matters in RA, because treatment started in the first few months can prevent permanent joint damage.

Treating osteoarthritis

• Weight loss: every kilo you lose takes several kilos of pressure off the knees.
• Exercise: walking, swimming, cycling and strengthening the thigh muscles protect the knee. Rest alone makes joints stiffer.
• Heat and cold: warm packs ease stiffness, and cold packs help after an activity flare.
• Supports: a knee brace or a walking stick can reduce strain.
• Pain relief: gels and creams for the skin, paracetamol, or short courses of anti-inflammatory tablets as advised by your doctor. Painkillers are not a long-term plan, and can harm the stomach and kidneys if taken for months on your own.
• Joint injections or surgery for severe cases that do not respond to other treatment.

Supplements such as glucosamine are widely used. Evidence of benefit is mixed, and some people feel better while others do not. They are not a replacement for exercise and weight control.

Treating rheumatoid arthritis

RA needs a rheumatologist. Treatment uses disease-modifying medicines (DMARDs) such as methotrexate, hydroxychloroquine and leflunomide, which slow the disease and protect joints, sometimes with newer biologic medicines. These need regular blood tests and must never be started or stopped without medical advice. Anti-inflammatory painkillers only relieve symptoms, they do not stop damage.

Everyday tips

• Stay active, a little every day, rather than long rest followed by overdoing it.
• Choose a firm chair with armrests and avoid sitting on the floor for long if your knees are painful. A commode seat helps.
• Spread tasks through the day and use jar openers or lighter pots.
• Do not walk barefoot on hard floors. Cushioned shoes help.
• Quit smoking, which raises RA risk and worsens it.
• Do not rely on “joint oil” from roadside sellers or hakeems that include steroids.

When to see a doctor

• Joint pain lasting more than a few weeks
• Swollen, warm, red joints, or morning stiffness longer than an hour
• Pain with fever, weight loss or extreme tiredness
• Joint pain in a young person, or in several small joints at once
• Sudden severe pain in a joint, which could be infection or gout

Key takeaways

• Osteoarthritis is wear and tear. Rheumatoid arthritis is an autoimmune disease. They need different treatments.
• Exercise, weight control and the right support help most people with OA.
• RA must be treated early by a specialist to prevent joint damage.
• Avoid long-term self-medication with painkillers and steroid-laced “joint oils”.

Related medicines on Medimart

• Glucosamine sulphate: a supplement some people with osteoarthritis use
• Diacerein: prescribed for osteoarthritis symptoms
• Etoricoxib: an anti-inflammatory painkiller, for short use under medical advice
• Methotrexate, hydroxychloroquine and leflunomide: RA medicines used only under a specialist

You can also browse arthritis and joint pain products, supports and braces and hot and cold therapy on Medimart, with delivery across Pakistan. Prescription medicines are supplied only against a valid prescription.

This guide is for general information and does not replace advice from a doctor.