Oftentimes in the clinic, I encounter patients who do not know whether they should circle “OA” or “RA” on their medical history form. While both are considered arthritis, they are very different diagnoses and influence my clinical decision making when determining a plan of care. It is very important that you, as a patient, understand your diagnoses – arthritis or otherwise – and can clearly communicate them with your physical therapist or other healthcare providers.
Osteoarthritis
This is what most people think of as classic arthritis – that deep, achy, stiff pain in your joints that feels better once you get moving and feels worse when you sit still or are in cold weather. Yes, this is the type of arthritis that allows you to become the family barometer swearing you feel the weather in your bones.
A simple linguist approach to understanding osteoarthritis is breaking down the word meaning from its Greek origins: osteo - “bone;” arth – “joint” and the -itis suffix: “inflammation.” Based on this, we can create a blanket diagnosis for many joint issues, but we should always be aware it IS a fairly vague and broad definition often used to diagnose general joint degeneration, loss of cartilage, bony changes, increased bony congruency, inflammation and the general symptoms mentioned above.
It should also be noted that arthritis is a NORMAL change and condition in the human body. I cannot emphasize that enough!! If you have arthritis (if you’re over the age of 18 or over 16 with a history of injuries I bet you do!) do not fret! Don’t fret, don’t worry, don’t feel as if you mistreated your body or did something wrong. Understand arthritis itself is a normal change and should not be viewed as something you need to “fix.” In fact, I tell my patients we don’t typically think twice about arthritis until it becomes symptomatic – meaning you begin to FEEL those achy symptoms. Patients often come to me in a panic because they have arthritis in their back or knees or hips and treat it as an inescapable punishment or doomsday diagnosis. A diagnosis of arthritis is not a figurative death sentence – you should not expect your life’s activities will cease as you know them. In fact, I prescribe the opposite – a diagnosis of osteoarthritis should actually encourage you to move MORE! Get the blood pumping and bones moving. Movement is what helps cue the body to make more lubricating synovial fluid in the joints. A sedentary lifestyle has the opposite effect – so stay moving!
Below is an x-ray image of a knee. On the left is a picture of a “healthy” knee and on the right is a knee with the onset of osteoarthritis. You can clearly see the affected knee on the right has inflammation, subchondral sclerosis, cortical stress, increased joint congruency and potential malalignment due to affected joint spacing. (Clearly, 😉.) But all of these findings evident on an x-ray image do not necessarily tell us the patient is symptomatic (having symptoms such as pain).
Can PT help reverse this condition? I haven’t seen conclusive evidence that PT can help reverse OA, but it can certainly help reverse some of the effects, reduce symptoms and help the individual continue or return to a preferred level of function/activity.
Rheumatoid Arthritis
Rheumatoid Arthritis, “RA,” is an autoimmune condition that can affect joints in the body, but it can also have systemic effects on the eyes, mouth, lungs and even heart. Since it is an autoimmune condition, the inflammation results from the body attacking its own cells, as opposed to the inflammation we see in OA that often results from normal degenerative changes, overuse and injury.
Diagnosis for RA includes x-ray imaging, but also includes blood testing for autoimmune factors. Women are more likely than men to have RA and it can onset in a woman’s 30s. It also tends to present symmetrically - both sides of the body.
Treatment also varies for RA when compared with treatment for OA. RA requires holistic management and the direct care of a physician – usually a rheumatologist or endocrinology specialist.
As a PT, it is very important for me to know if you have RA, other autoimmune conditions, or even RA risk factors so I can 1) screen for concerning red flags or signs that maybe require a referral to an outside physician or specialist, 2) determine an appropriate plan of care and 3) understand potential reasons progress may be slow.
Many autoimmune conditions are actually clusters, so having RA may predispose you to having other autoimmune conditions and vice versa. It doesn’t mean, however, that you cannot continue to enjoy a good quality of life. With PT, self care and the watchful eye of an involved physician, you can certainly learn how to manage RA with proper diet, exercise and avoidance things that contribute to flare ups.
So remember, OA and RA are related but separate conditions requiring different paths when it comes to your healthcare. There are many other types of arthritis, but these are two of the most common and the two that I most often see confused with each other. It is very important to know the difference and communicate your medical history truthfully and accurately with all healthcare professionals.
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