Painful joints is this osteo- or rheumatoid arthritis?(Disease/Disorder overview)

f the 17.5 million people in the UK with a long-term condition, 9.5 million have some form of arthritis.1 A patient who presents for assessment of their respiratory function, cardiovascular disease, or diabetes and mentions that they are struggling with a painful joint is a common scenario in primary care. This article will describe the differences between osteoarthritis and rheumatoid arthritis, the most common form of inflammatory joint disease (Figure 1).

Types of disease Some characteristics are common to rheumatoid arthritis and osteoarthritis, but there are also important differences in presentation, treatment and management (Table 1, overleaf). Rheumatoid arthritis Rheumatoid arthritis (RA) affects about 1% of the population and women are more likely to be affected than men (three women to one man).2 RA can present at any age, but the peak age of onset is the fourth or fifth decade.3 It is an inflammatory joint disease that is driven by a faulty immune response causing an aggressive immune attack on the synovial tissue that lines all moveable joints. This destruction of synovial tissue causes proliferation of the joint lining (pannus), which grows and extends, eroding articular surfaces and ultimately the bone, eventually destroying the joint. Erosions occur early in the disease and it is common practice to look at X-rays of the hands and feet to identify the first sign of erosions. Ultrasound is increasingly used to identify early signs of inflammatory joint disease, leading to a more pro-active approach to treating the condition early and improving long-term outcomes. Ultrasound can identify early signs of synovitis, the precursor to the development of joint erosions Systemic effects of RA include damage to vital organs such as the lungs, heart and kidneys. RA is an aggressive inflammatory condition that reduces life expectancy, with outcomes similar to those of non-Hodgkin's lymphoma and triple heart bypass.4,5 The main presenting symptom is joint pain, usually symmetrical and commonly affecting the metacarpophalangeal (MCP) joints of the hands or the metatarsophalangeal (MTP) joints of the feet. There is often fatigue and early morning stiffness of the joints, the latter persisting for between 30 minutes and several hours.

Osteoarthritis Osteoarthritis (OA) is the most common joint disorder, and most individuals aged over 65 years will show some radiographic evidence of the disease.6 Wear and tear can lead to destruction of articular cartilage and changes in subchondral bone. Osteophytes (bony spurs on the margin of joints) and abnormalities to ligaments may also be seen. These changes are a natural reaction of synovial joints to damage, and the remodelling or repair process may lead to joint pain and stiffness. Estimates suggest that there are …