Ask the Doctor at Saint John’s: The Two Main Types of Arthritis

Q: What’s the difference between osteoarthritis and rheumatoid arthritis?

A: By Orrin Troum, M.D., rheumatologist at Saint John’s Health Center.
There are actually over 100 types of arthritis. Osteoarthritis and rheumatoid arthritis are the two most common forms. There is currently no cure for either osteoarthritis or rheumatoid arthritis, but there are a variety of successful treatments for both.

Osteoarthritis affects approximately 25 million people in this country. It is characterized by degeneration of the cartilage (slippery tissue that covers the ends of bones in a joint), eventually leading to pain and joint stiffness. Since the cartilage itself has no nerve endings, the process often begins before affected individuals realize it.

Once the wearing away of cartilage allows the bones underneath to rub together, it can cause a great deal of discomfort. Onset of the disease is gradual and usually begins after age 40. It is currently believed to be the result of mechanical and molecular events in affected joints.

Rheumatoid arthritis, believed to be the result of a faulty immune response, can begin at any age. It’s an inflammatory disease that primarily affects the lining of joints (the synovial membrane; synovial fluid lubricates and nourishes joint tissue). Inflammation of the synovium leads to erosions of cartilage and bone. Pain, swelling, and redness occur.

When adult patients first come to see me, they’ve often tried the over-the-counter NSAIDs (non-steroidal anti-inflammatory drugs) aspirin, ibuprofen, or naproxen, or the analgesic acetaminophen. I like to initially explore a nonpharmacologic approach when that’s a reasonable option. Patients may benefit greatly from exercise, strength workouts, and weight loss. Fish rich in omega-3 fatty acids have been shown to ease rheumatoid arthritis symptoms.

Usually, a pharmacologic approach is required. Initially, the same medications are used to treat both osteoarthritis and rheumatoid arthritis. Celebrex is the only COX-2 inhibitor (a particular category of NSAIDs) currently on the market. Regardless, there are quite a few other medicinal options.

For Osteoarthritis, "joint fluid therapy", derived from purified rooster combs, also known as Hyaluronic acid, Supartz, Synvisc and others, can be very helpful. Hyaluronic acid is a natural component of cartilage and joint fluid. It's also found in a variety of animals.

This joint fluid gel is injected directly into the knee joint weekly for three to five weeks to provide long-term pain relief from osteoarthrits of the knee. Other joints are being studied and will hopefully be offered in the future. Injections for knee osteoarthrits is an insurance approved treatment.

For Rheumatoid Arthritis, Disease Modifying Therapy, medications such as Methotrexate, Arava, Plaquenil or even newer medications like Enbrel, Humira, Remicade, Orencia, Rituxan can halt the progression of the disease.

Some have found nutritional supplements such as glucosamine and chondroitin helpful. Individuals must be aware; however, that labeling for these nonprescription items is not required by law to accurately state what’s inside.

Although there are currently no known cures for osteoarthritis and rheumatoid arthritis, new drugs are increasingly available to relieve symptoms and improve function. In addition, good self-management, including exercise, weight loss and smart nutrition can help reduce pain and disability.

Orrin Troum is a Board Certified rheumatologist on staff at Saint John’s Health Center. For more information about Dr. Troum or other Saint John’s services, please call (310) 829-8990 or visit the website at www.stjohns.org. For a physician referral or a second opinion, please call 1-888-ASK-SJHC.

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