Osteoarthritis vs rheumatoid arthritis

Hello fellow medics,

I hope you are all keeping well, staying focused and working towards your end goal with enthusiasm…

If you are sitting the Clinical Skills Exam (or Clinical Exam) please check out this blog.

It is a quick summary of the main differences between osteoarthritis (OA) and Rheumatoid arthritis (RA).

As always my blogs are based on the “general principles” and not the minutiae detail (there are plenty of other books to find that information). This is about getting you thinking about joint disorders, so it sticks in your brain. This hopefully will mean less to memorise (which is always a bonus).

This is a common station as it tests different areas, including: your ability to take a thorough history of presenting complaint (to differentiate between OA and RA), perform a succinct examination and convey your empathy towards the patient when considering the impact of such disorders (ie a great social history). So lets get into it…

OA vs RA

As I have stated above, the main differences can be found in any book. Usually presented as a table of some sort, with differentiating signs and symptoms.

I will just give a few main pointers that doesn’t seem to change over time.

1) RA- it is a inflammatory process. Hence, you will get inflammation of the joints with “synovitis” - this means swelling of the joint. Beware, this can also happen in OA, but less so. The swelling in RA tends to be “soggy” whereas the swelling in OA is due to the osteophytes and therefore “hard”.

2) RA presents with joint stiffness - ie > 30 minutes in the morning. This is a prominent factor in RA. Although in OA, there is “jelling” of the joint, this is less so in morning and more after sitting for prolonged times.

3) RA affects the small joints, OA the big joints. If only medicine was that simple…Technically there is overlap between both conditions, but realistically (and from an OSCE point of view: Remember the OSCE reflect the majority of cases, and is not there to trip you up)- OA affects hips and knees, and shoulders; RA affects small joints of hand and wrists.

4) RA typically affects younger people, and OA affects older population. This makes sense, as OA is a wearing away of the cartilage, affects big joints and so with “time” it will present. RA tends to have a genetic component and so can present at any age.

These are the key differing symptoms, with many over laps. Medicine is never clear cut, but if you have the principles and concepts, it makes it a whole lot easier in the exam and in “real life”.

Social history

I cannot emphasise social history enough in these consultations. The impact of both these conditions on the patients life, activities of daily living (ADL), occupation and consequently psychologically is paramount.

Knowing the patients social situation is vital. Once you know this, whatever dilemma you are faced with i.e. History taking station, Breaking bad news, disgruntled relative; you will have the correct information to connect with the patient/relative.

Ask about:

1) Living arrangements - who do they live with? Do they live in a house with stairs? Do they have steps leading up to their house?

2) Social care - Do they have any care at home ie carers twice a day? Will this need to increase?

3) Family- do they have family nearby to help with shopping?

4) Occupation- Do they have a job that involves needing to use small joints of hands ie receptionist? How will their work be impacted?

All the questions above will need to be asked to build a “diagnostic picture”, help the management and build rapport.

MDT (MULTIDISCIPLINARY team) approach

Whichever diagnosis it is (or both..), the approach will be from a MDT. So being familiar with the different agencies is important to provide patient reassurance and advice.

Some of these services will be:

1) Rheumatologist - if RA/inflammatory condition is suspected

2) Orthopaedic surgeon- if OA is very severe. Also the Orthopaedic teams are involved in RA for those patients whose joints have been heavily affected by the inflammatory process. They can fuse joints and also replace etc.

3) Occupational Therapist- to help with ADLs/work related situations/home status.

4) Social Workers- To assess if social care is needed in home ie carers

5) Physiotherapist - to help with maintaining mobility of the joint

I hope you found all the information useful above. The main aim is to give an over view, and some “light reading”!.

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Please don’t hesitate to send me an email for any advice or if you would like to sign up for one:one/pairing revision session. I provide structured and to the point consultation skills to help you in passing the clinical exam.

Stay happy and safe.