Rheumatoid Arthritis vs. Arthritis

Arthritis is a general term for joint inflammation, and rheumatoid arthritis is a specific autoimmune disorder that starts in the joints.

Arthritis is a general term used to describe joint disease. Rheumatoid arthritis (RA) is a type of arthritis in which the body’s immune system mistakenly attacks the joints, causing chronic inflammation.

Rheumatoid arthritis is an autoimmune disease that occurs when the body’s immune system attacks the joint linings (synovium) that produce fluid that lubricates the joints. This results in signs and symptoms of inflammation, swelling, and pain in and around the joints, and in some cases, a rash. Over time, if left untreated, RA damages cartilage and bone and causes permanent joint deformity.

RA affects joints on both sides of the body, typically the hands, feet, wrists, elbows, knees and ankles, although it can also affect other joints. It can also affect the cardiovascular or respiratory systems.

Different types of medications are used to treat RA, including nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, disease-modifying antirheumatic drugs (DMARDs), and subsets of DMARDs (biologics and JAK inhibitors). Rheumatoid arthritis is diagnosed with a physical exam and history, a blood test and sometimes xrays.

Other types of arthritis include:

• Osteoarthritis – the most common type of arthritis, resulting from degeneration of cartilage
• Inflammatory arthritis – examples include rheumatoid arthritis and psoriatic arthritis
• Infectious arthritis – an infection triggers joint inflammation
• Metabolic arthritis – a buildup or uric acid in the blood causes joint pain

Rheumatoid Arthritis

When the disease is active, RA symptoms and signs can include

• fatigue,
• loss of energy,
• lack of appetite,
• low-grade fever,
• muscle and joint pain,
• joint redness,
• joint swelling,
• joint tenderness,
• joint warmth,
• joint deformity,
• rheumatoid nodules,
• stiffness,
• loss of joint range of motion,
• loss of joint function, and
• limping.
• People with active inflammation of joints from RA can also experience
• depression,
• anemia
• frustration, and
• social withdrawal.

Muscle and joint stiffness are usually most notable in the morning and after periods of inactivity. This is referred to as morning stiffness and post-sedentary stiffness. Arthritis is common during disease flares. Also during flares, joints frequently become warm, red, swollen, painful, and tender. This occurs because the lining tissue of the joint (synovium) becomes inflamed, resulting in the production of excessive joint fluid (synovial fluid). The synovium also thickens with inflammation (synovitis).

Rheumatoid arthritis usually inflames multiple joints and affects both sides of the body. In its most common form, therefore, it is referred to as a symmetric polyarthritis.

• Early rheumatoid arthritis symptoms may be subtle.
• The small joints of both the hands and wrists are often involved.
• Early symptoms of RA can be pain and prolonged stiffness of joints, particularly in the morning.
• Symptoms in the hands with rheumatoid arthritis include difficulty with simple tasks of daily living, such as turning door knobs and opening jars.
• The small joints of the feet are also commonly involved, which can lead to painful walking, especially in the morning after arising from bed.

Occasionally, only one joint is inflamed. When only one joint is involved, the arthritis can mimic the joint inflammation caused by other forms of arthritis, such as gout or joint infection.

Chronic inflammation can cause damage to body tissues, including cartilage and bone. This leads to a loss of cartilage and erosion and weakness of the bones as well as the muscles, resulting in joint deformity, loss of range of motion, destruction, and loss of function.

Rarely, rheumatoid arthritis can even affect the joint that is responsible for the tightening of our vocal cords to change the tone of our voice, the cricoarytenoid joint. When this joint is inflamed, it can cause hoarseness of the voice.

Symptoms in children with rheumatoid arthritis include limping, irritability, crying, and poor appetite.

Arthritis

Symptoms of arthritis include pain and limited function of joints. Joint inflammation from arthritis is characterized by joint stiffness, swelling, redness, pain, and warmth.

• Stiffness of the joint can lead to poor function.
• Tenderness of the inflamed joint can be present with or without pain.
• When large joints are involved, such as the knee, there can be loss of cartilage with limitation of motion from the joint damage.
• When arthritis affects the small joints in fingers, there can be bone growth and loss of hand grip and grip strength of the hand associated with stiffness.
• Arthritis of weight-bearing joints can lead to difficulty walking from poor joint function and arthritis pain.

Many of the forms of arthritis, because they are rheumatic diseases, can cause symptoms affecting various organs of the body that do not directly involve the joints. Therefore, symptoms in some patients with certain forms of arthritis can also include

• fever,
• gland swelling (swollen lymph nodes),
• weight loss,
• fatigue,
• feeling unwell, and
• even symptoms from abnormalities of organs such as the lungs, heart, or kidneys.

The cause of rheumatoid arthritis is unknown. Even though infectious agents such as viruses, bacteria, and fungi have long been suspected, none has been proven as the cause. The cause of rheumatoid arthritis is a very active area of worldwide research.

It is believed that the tendency to develop rheumatoid arthritis may be genetically inherited (hereditary). Certain genes have been identified that increase the risk for rheumatoid arthritis. It is also suspected that certain infections or factors in the environment might trigger the activation of the immune system in susceptible individuals. This misdirected immune system then attacks the body's own tissues. This leads to inflammation in the joints and sometimes in various organs of the body, such as the lungs or eyes.

No one knows what triggers the onset of rheumatoid arthritis. Regardless of the exact trigger, the result is an immune system that is geared up to promote inflammation in the joints and occasionally other tissues of the body. Immune cells, called lymphocytes, are activated and chemical messengers (cytokines, such as tumor necrosis factor/TNF, interleukin-1/IL-1, and interleukin-6/IL-6) are expressed in the inflamed areas.

Gut bacteria, smoking, and gum disease

Environmental factors also seem to play some role in causing rheumatoid arthritis. For example, scientists have reported that smoking tobacco, exposure to silica mineral, and chronic periodontal disease all increase the risk of developing rheumatoid arthritis.

There are theories about gut bacteria (the microbiome of gut microbes that naturally exist in the lining of the bowels) that may trigger the onset of RA in genetically susceptible people. No specific microbes have been identified as definite causes.

Arthritis

The causes of arthritis depend on the form of arthritis. Causes include

• injury (leading to osteoarthritis),
• metabolic abnormalities (such as gout with elevated uric acid blood levels and pseudogout with hypercalcemia),
• hereditary factors,
• the direct and indirect effect of infections (bacterial and viral), and
• a misdirected immune system with autoimmunity (such as in rheumatoid arthritis and systemic lupus erythematosus).

Arthritis is classified as one of the rheumatic diseases. These are conditions that are different individual illnesses, with differing features, treatments, complications, and prognoses. They are similar in that they have a tendency to affect the joints, muscles, ligaments, cartilage, and tendons, and many have the potential to affect other internal body areas.

The major risk factors for most forms of arthritis are inherited genetic predispositions. Trauma-related arthritis is related to the risk of injury from specific activities.

Rheumatoid Arthritis

There is no known cure for rheumatoid arthritis.

To date, the goal of treatment in rheumatoid arthritis is to reduce joint inflammation and pain, maximize joint function, and prevent joint destruction and deformity.

• Early medical intervention has been shown to be important in improving outcomes.
• Aggressive management can improve function, stop damage to joints as monitored on X-rays, and prevent work disability.
• Optimal RA treatment involves a combination of medicines, rest, joint-strengthening exercises, joint protection, and patient (and family) education.
• Treatment is customized according to many factors such as disease activity, types of joints involved, general health, age, and patient occupation.
• RA treatment is most successful when there is close cooperation between the doctor, patient, and family members.
• RA medications include NSAID (non-steroidal anti-inflammatory drugs) and corticosteroids for pain and inflammation symptoms.
• Drugs that affect the progression of rheumatoid arthritis are called DMARDs (disease-modifying anti-rheumatic drugs)
• These "second-line" or "slow-acting" medicines may take weeks to months to become effective. They are used for long periods, even years, at varying doses. If maximally effective, DMARDs can promote remission, thereby retarding the progression of joint destruction and deformity.

Arthritis

The treatment of arthritis is dependent on the precise type of arthritis present. An accurate diagnosis increases the chances for successful treatment.

Treatments available include

• physical therapy,
• home remedies,
• splinting,
• cold-pack application,
• paraffin wax dips,
• anti-inflammatory drugs,
• pain medications
• (ranging from pain-relieving over-the-counter medications such as acetaminophen [Tylenol] and ibuprofen [Motrin, Advil] to narcotics),
• immune-altering medications,
• biologic medications, and
• surgical operations (including joint replacement surgery).

Pain from osteoarthritis of the knee can be relieved by hyaluronic acid injections.

Rheumatoid arthritis can require medications that suppress the immune system (DMARDs mentioned earlier).

Low back arthritis that is irritating nerves of the spine can require surgical repair.

For more on treatments of particular forms of arthritis, see the corresponding articles for the form of arthritis of interest.

Rheumatoid Arthritis

Rheumatoid arthritis is not a curable disease at this time. As the science of genetics and disease as well as autoimmunity evolve, it is very likely that cures for rheumatoid arthritis will become available.

• Early and aggressive treatment tends to result in optimal outcome.
• Understand how your rheumatoid arthritis, as well as the effects and side effects of its treatment, will be monitored.
• Maintain a working relationship with your treating doctor. Consider consulting with a rheumatologist.
• Have a game plan for addressing flare-ups of the rheumatoid inflammation.
• Preplan your treatment options for travel with your doctor.
• Review with your doctor any concerns about your rheumatoid arthritis, its influence on your lifestyle activities, your avocations, and your long-term life goals.

Arthritis

The outlook for patients with arthritis depends on its severity, complications, and whether or not there are non-joint manifestations of the disease. For example, rheumatoid arthritis can affect the lungs, kidneys, eyes, etc. Chronic joint inflammation can lead to permanent damage to the joint and loss of joint function, making movement difficult or impossible.