Lecture Notes: Osteoarthritis vs Rheumatoid Arthritis

Overview

• Osteoarthritis (OA): Arthritis caused by deterioration of articular cartilage (hyaline cartilage).
• Rheumatoid Arthritis (RA): Arthritis due to the immune system attacking the synovium within the joint.

Osteoarthritis (OA)

• Definition: Deterioration of articular cartilage leads to decreased joint space and bone rubbing.
• Symptoms:
  • Pain and stiffness
  • Limited mobility
  • Bone spurs (osteophytes) and cartilage fragments in joint space
  • Sclerosis (abnormal hardening of bone)
• Joints Affected:
  • Commonly weight-bearing joints: hands, hips, knees, spine
  • Asymmetrical: may affect one side of the body
• Risk Factors:
  • Age (40+ years)
  • Repeated injuries
  • Obesity
  • Genetics
  • Strenuous labor
• Diagnosis:
  • X-rays showing reduced joint space, bone spur formation
• Treatment:
  • Weight loss, exercise
  • NSAIDs
  • Topical creams, joint injections
  • Possible surgeries like osteotomy

Rheumatoid Arthritis (RA)

• Definition: Immune system attacks synovium, causing inflammation and pain.
• Symptoms:
  • Systemic effects: fever, anemia, affect on heart, eyes, lungs
  • Symmetrical joint involvement
  • Common in fingers, wrists, neck, shoulders, elbows, feet, ankles
  • Possible bone fusion (ankylosis)
• Diagnosis:
  • Blood tests (e.g., rheumatoid factor, C-reactive protein)
  • X-rays for joint deterioration
• Treatment:
  • DMARDs and oral corticosteroids
  • Exercise
  • Sinovectomy, arthrodesis for severe cases
  • Oral supplements for anemia

Comparison: OA vs RA

• Cartilage vs Synovium: OA affects cartilage; RA affects synovium.
• Symmetry: OA is asymmetrical; RA is symmetrical.
• Systemic Effects: RA affects other body systems; OA does not.
• Morning Stiffness:
  • OA: Less than 30 minutes
  • RA: Greater than 30 minutes

Mnemonics for Symptoms

• OA Mnemonic (OSTEO):
  • O: Outgrowths (Bouchard's and Heberden's nodes)
  • S: Sunrise stiffness (< 30 minutes)
  • T: Tenderness (hard and bony)
  • E: Experience crepitus
  • O: Only joints affected
• RA Mnemonic (Seven S's):
  • Sunrise stiffness (> 30 minutes)
  • Soft, tender warm joints
  • Swelling
  • Symmetrical
  • Synovium inflamed
  • Systemic impact
  • Stages: Synovitis, Pannus formation, Ankylosis

Management & Treatment Considerations

• Exercise: Important for both; focus on low-impact activities.
• Medication:
  • NSAIDs for pain
  • RA-specific treatments: DMARDs, corticosteroids
  • OA-specific treatments: Topical creams, joint injections

Study Tips

• Understand differences in joint involvement (symmetry, affected joints)
• Know diagnostic tests and their relevance
• Familiarize with common treatments and their goals
• Recognize the systemic impacts of RA versus the localized effects of OA.

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