To understand the difference between osteoarthritis and rheumatoid arthritis, one needs to have basic knowledge of the structure of the joint. Any joint in the human body is movable: that means, it allows the articulating bones to move relative to each other. Where the bone surfaces touch, they are covered with cartilage to make glide easy and painless. From the inside, the joint is lined with a synovial membrane, which secretes a fluid, or lubricant, which also facilitates the movement of the articular surfaces.
With rheumatoid arthritis, an inflammation of the joints occurs, affecting the ability to properly move the extremities. Inflammation is most often provoked by infections, systemic connective tissue pathologies, or metabolic disorders (Lin et al., 2020). Regardless of the underlying cause, a key link in joint damage in rheumatoid arthritis is associated with inflammation. It mainly affects the synovial membrane of the joint, since there are many blood vessels in it, and they are important accomplices of the inflammatory response (Lin et al., 2020). The synovial effusion formed during inflammation, that is, the fluid produced by the synovial membrane, causes the classic symptoms of arthritis: pain, swelling, and joint dysfunction.
Meanwhile, osteoarthritis is a degenerative disease associated with the gradual and slow destruction of cartilage. As in the case of rheumatoid arthritis, in osteoarthritis there is also inflammation – but it is caused by elements of the collapsing cartilage plate (Sharma, 2021). Most often, injuries, frequent inflammations, metabolic disorders, and, especially, degenerative age-related changes lead to the destruction of cartilage tissue (Chow & Chin, 2020). As a rule, at the beginning of the development of deforming osteoarthritis, the amount of intra-articular fluid decreases (Sharma, 2021). The cartilage loses its elasticity, becomes covered with cracks, and subsequently, if no measures are taken, is almost completely destroyed, resulting in debilitating pain.
The patient is suffering from osteoarthritis, as the symptoms point to cartilage degeneration rather than inflammation. Pain in the joint area is present in both osteoarthritis and rheumatoid arthritis. However, in osteoarthritis, pain in the early stages of the disease occurs only when moving, after excessive physical exertion, and increases gradually over many years – such as in the patient’s case (Sharma, 2021). Meanwhile, the inflammatory reaction that occurs with arthritis manifests itself as characteristic symptoms: the skin over the joints turns red, and the joints themselves swell due to intra-articular effusion and become noticeably bigger (Lin et al., 2020). The patient does not show any of these symptoms, nor does he report having them in the past. With osteoarthritis, there is also a change in the contours of the joint, but this process is stretched for years and is not accompanied by reddening of the skin.
The patient needs to understand that osteoarthritis is a degenerative disease, and without proper treatment and certain changes in lifestyle, it will only progress further, eventually impairing the patient’s mobility to the point of disability. The patient has stated that he already feels constant pain – 4 out of 10 on the pain scale – which evidences that the degeneration process has been occurring for a long time. Thus, the patient requires not only treatment for his condition but also changes in his everyday life to accommodate his disease and prevent it from developing further. First of all, it is important to explain to the patient that his osteoarthritis is chronic and will stay with him for the rest of his life. However, the doctor must note that that should not discourage him from changing his lifestyle to a healthier one. Instead, the patient must understand that the progression of the disease depends on his own efforts alongside the treatment, and it is his responsibility to prevent himself from becoming disabled.
The patient should be educated on how to slowly and gradually introduce moderate physical activity into his life, as well as a healthier diet. Culturally sensitive intervention programs are crucial for promoting holistic wellness among Native Americans, thus, patient education must incorporate indigenous cultural values such as social connections, communal support, and specific physical exercises (O’Brien et al., 2020). Examples of such exercises might include daily walking through uncomplicated patches of land, collecting berries, taking part in community activities, riding horses, and fishing (O’Brien et al., 2020). The prevalent disease among Native Americans can already be considered fairly healthy, as it consists mostly of fish, meat, berries, and vegetables, although the patient should be advised to reduce the amount of salt and fat he consumes.
In order to prevent osteoarthritis, it is necessary to be physically active, establish a proper and nutritious diet, and control weight. In terms of medical interventions, people who are at risk of developing osteoarthritis should treat concomitant diseases in a timely manner and immediately contact a doctor when the first symptoms of osteoarthritis appear (Sharma, 2021). In the initial stages, osteoarthritis is treated conservatively: drug therapy, physiotherapy, and dietary changes are used. As part of the drug therapy, the patient should take topical nonsteroidal anti-inflammatory drugs, chondroprotective, and intra-articular injections based on hyaluronic acid. In advanced cases, when the cartilage is destroyed, the only way to restore mobility is to install an endoprosthesis – an artificial joint.
References
Chow, Y. Y., & Chin, K.-Y. (2020). The role of inflammation in the pathogenesis of osteoarthritis. Mediators of Inflammation, 2020, 1–19. Web.
Lin, Y.-J., Anzaghe, M., & Schülke, S. (2020). Update on the pathomechanism, diagnosis, and treatment options for rheumatoid arthritis. Cells, 9(4), 880. Web.
O’Brien, P., Bunzli, S., Lin, I., Gunatillake, T., Bessarab, D., Coffin, J., Garvey, G., Dowsey, M., & Choong, P. (2020). Tackling the burden of osteoarthritis as a health care opportunity in indigenous communities—a call to action. Journal of Clinical Medicine, 9(8), 2393. Web.
Sharma, L. (2021). Osteoarthritis of the knee. New England Journal of Medicine, 384(1), 51–59. Web.