Osteoarthritis Versus Rheumatoid Arthritis

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1. Arthritis: A Quick Overview
2. What is Osteoarthritis?
3. What is Rheumatoid Arthritis?

One of the most confusing topics of inflammatory bone disorders is distinguishing osteoarthritis from rheumatoid arthritis. Which is which, and how does one differ from the other?

Osteoarthritis and rheumatoid arthritis are both conditions affecting the bones, specifically the joints and cartilages. However, certain characteristics set them apart.

Arthritis: A Quick Overview

Whenever you think of arthritis, you should think about the joints that link the bones to each other. But the main factor these joints have, which is directly affected by arthritis, is the cartilage.

Cartilage has many functions to ensure that the bones don’t rub each other. Cartilage is a strong, flexible connective tissue that protects the joints and bones. It acts as a shock absorber and a cushion that reduces friction and rubbing together of the bones. 

Arthritis occurs when the cartilage is not able to function normally. This can be caused by the wearing down of the cartilage or inflammation in the joint, resulting in an insurmountable amount of pain.

What is Osteoarthritis?

“Osteo” means bone; remember that. Osteoarthritis, on the other hand, technically means that there is decreased cushion or cartilage between joints. Osteoarthritis is the most common form of arthritis. It is most common in the geriatric population. 

As we age, cartilage decreases and degenerates. The consistent rubbing of joints can cause cartilage depletion. The weight-bearing joints are primarily affected by osteoarthritis, which results in pain.

Osteoarthritis Signs and Symptoms

Manifestations of osteoarthritis are the result of decreased cartilage, swelling or injury. The following signs and symptoms are associated with osteoarthritis:

• Pain
• Stiffness
• Tenderness
• Loss of flexibility
• Grating/clicking/crackling bones
• Bones spurs
• Swelling

Types of Osteoarthritis

There are two types of osteoarthritis you have to be aware of, namely:

1. Bouchard’s nodes – little nodules appear around the fingers
2. Heberden’s nodes – swellings around the joints near the fingertips

Nursing Interventions for Osteoarthritis 

• Administer medication (topical, oral to include nonsteroidal anti-inflammatory medications (NSAIDS)) and intra-articular injections.
• Assist with low-impact or water exercise.
• Provide hot and cold therapy, physical therapy, and supportive devices.
• Encourage Weight loss (if needed)

Osteoarthritis Nursing Considerations

1. Cortisone shots

The primary intervention usually given to patients with osteoarthritis is the administration of cortisone shots. Cortisone shots reduce inflammation caused by constant friction by being the buffer between the joints.

How are cortisone shots given?

The cortisone is given via injection into the joint space. This is called intra-articular injection, which can relieve pain and swelling. This injection can also cushion to relieve stiffness and pain, allowing easier movement. 

Cortisone injections can be given more than once but no more than three to four times per year. Caution is advised as cortisone can also damage the cartilage.

2. Cartilage coating

Cartilage transplant is only a short-term solution. However, the health care provider (HCP) can inject a synthetic cartilage into the joint space. More invasive measures are when the HCP performs surgery to place a synthetic gel or metal into the joint space to prevent the bones from further rubbing.

Osteoarthritis Patient Education

Since osteoarthritis affects weight-bearing joints and bones (hip and knees), instruction for the patient is key. Instruct the patient to avoid exercises requiring lifting heavy items or rigorous activities that would primarily affect and cause stress on those areas. 

So weight-bearing exercises are not recommended. Physical therapy, stretching, or water exercise are better therapy sources for osteoarthritis patients.

What is Rheumatoid Arthritis?

Rheumatoid Arthritis (RA) is a chronic inflammatory disorder that affects the joints, specifically the feet, and hands. The body’s immune system attacks its own tissues causing painful bone erosion and joint deformity. RA can have times of remission and flare, andcan progress to affect major organs as well.

Types of Rheumatoid Arthritis

• Seropositive RA: This type of RA is characterized by certain antibodies in the blood, including rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) antibodies.
• Seronegative RA: This type of RA does not have the antibodies typically associated with the disease.
• Juvenile idiopathic arthritis (JIA): This type of RA affects children under the age of 16 and can cause joint pain, swelling, and stiffness, as well as fever and rash.
• Palindromic rheumatism: This rare type of RA causes episodes of joint pain and swelling that come and go.
• Felty’s syndrome: This is a severe form of RA that can cause an enlarged spleen and a low white blood cell count.
• Rheumatoid vasculitis: This rare complication of RA affects blood vessels and can lead to skin ulcers, nerve damage, and other serious problems.

Rheumatoid Arthritis Signs and Symptoms

• Pain, stiffness, and swelling in the joints (usually affecting multiple joints)
• Fatigue
• Joint tenderness and warmth to the touch
• Joint deformity (over time)
• Morning stiffness (lasting more than an hour)
• Loss of appetite and weight loss
• Anemia
• Rheumatoid nodules (firm lumps under the skin)
• Fever
• Dry eyes and mouth (Sjögren’s syndrome, often seen in conjunction with RA)

Rheumatoid Arthritis Nursing Interventions

• Administer medications as prescribed. Rheumatoid Arthritis is commonly treated with nonsteroidal anti-inflammatory drugs (NSAIDs), disease-modifying antirheumatic drugs (DMARDs), and corticosteroids. 
• Assist with activities of daily living (ADLs). RA can make it difficult for patients to perform activities such as dressing, grooming, and bathing. 
• Provide education on joint protection. Joint protection techniques can help to prevent further damage and pain to joints affected by RA. 
• Encourage exercise and physical therapy. Regular exercise and physical therapy can improve joint function, decrease pain, and prevent further damage in RA patients. 
• Assess for and manage complications. patients with RA may be at risk for complications such as infection, anemia, and osteoarthritis. 
• Provide emotional support. Chronic conditions such as RA can take a toll on a patient’s emotional well-being. 

Rheumatoid Arthritis Patient Education

Educate the patient on managing RA symptoms such as pain, stiffness, and swelling. Encourage the use of heat and cold therapy, physical therapy, and rest. 

Advise the patient on the importance of maintaining a healthy diet, regular exercise, and adequate rest. Also, emphasize the importance of follow-up care with their health care provider, (HCP), including regular monitoring of RA symptoms, medication management, and laboratory testing.

Osteoarthritis Nursing Assessment

The difference between osteoarthritis and rheumatoid arthritis is the underlying cause of the joint symptoms. Osteoarthritis can be caused by wearing and tearing on the joints related to various issues. 

Rheumatoid arthritis (RA) is an autoimmune disease that attacks the joints and can also attack major body organs. Both can be treated similarly for symptomatic relief. However, RA may require medication known as DMARDs for management.

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