1. What causes rheumatoid arthritis and is it the same cause of osteoarthritis?
2. What are the major symptoms of rheumatoid arthritis (RA)?
3. What are the major symptoms of osteoarthritis (OA)?
4. I’ve been told that I have an autoimmune disease . What does that mean?
5. I have dry eyes and a dry mouth and have been told that this is a form of arthritis. How can that be?
6. Does arthritis lead to more serious conditions or diseases ?
1. What causes rheumatoid arthritis and is it the same cause of osteoarthritis?
As a rheumatologist when I look at arthritis, I divide it into two main categories: degenerative arthritis, (sometimes called osteoarthritis) and inflammatory arthritis of which rheumatoid arthritis (RA) is the most common form.
Rheumatoid arthritis is an autoimmune disease where the body fights against itself, while osteoarthritis is a degenerative process that begins in the cartilage usually secondary to injury or aging. Most forms of arthritis have a genetic basis. That means we inherit a tendency towards getting the disease. Then there can be a trigger to start the disease process.
In RA it has been suggested that the trigger could be an infection, some type of toxicity or anything that could elicit an immune response. This results in the immune sytem getting “turned on” and unfortunately it begins to attack the joints. The hallmark of this attack is inflammation (swelling, heat, redness and pain) in the joints. This inflammation results in destruction of the joints and can affect the entire body.
Osteoarthritis(OA) begins usually as the result of an injury to the cartilage or just as the result of aging of the cartilage. Some people inherit cartilage that can begin aging in their 20s- 30s. Whether it is injury or aging, the cartilage loses its ability to repair itself and weakens, eventually resulting in pain and loss of protection for the bone underneath. While there can be some inflammation in OA, it is much more severe in RA.
2. What are the major symptoms of rheumatoid arthritis (RA)?
We tend to see pain and swelling of the small joints (usually symmetric) in RA. For example, the small joints of the hands and feet are common sites for rheumatoid arthritis. This pain and swelling tends to improve as the day goes on. Another common symptom in RA is morning stiffness. It is usually much longer than the stiffness found with osteoarthritis (OA). It can actually last well into the afternoon and usually improves with increased use of the joints. One of the most difficult symptoms to treat in RA is fatigue. Weight loss, fever, and a general feeling of “yuckiness” can also be associated with active RA. Twenty percent of rheumatoid patients may have Sjogren’s syndrome, an autoimmune condition associated with dry eyes and/or dry mouth.
3. What are the major symptoms of osteoarthritis (OA)?
Pain in the joints, sometimes associated with decreased function are the most common symptoms of OA. The joints affected most often by OA are the hands and the weight bearing joints (knees, hips, and back). There tends to be much less inflammation in OA when compared to rheumatoid arthritis. The enlargement of the OA joints comes more from increased bone formation and spurs and less from soft tissue swelling and fluid. There can be loss of range of motion in OA depending on the amount of damage to the joint. Much of the functional loss (lack of ability to do things) seen in OA comes from atrophy of muscles that results from lack of use. Building and maintaining muscle mass around the joints is very helpful in preventing this.
4. I’ve been told that I have an autoimmune disease. What does that mean?
Autoimmune diseases are characterized by the body’s own immune system mistakenly fighting against itself. These diseases have varying symptoms depending on where the majority of the immune action is taking place. One of the most well known autoimmune diseases is systemic lupus erythematosis. The symptoms of this disease can vary from just a mild rash with joint aches to severe kidney or brain involvement. As with most of the autoimmune diseases that rheumatologists treat, females are more commonly affected than males. Many times autoimmune disease are associatied with skin disease and arthritis. One autoimmune disease that may occur more frequently in men is ankylosing spondylitis, an inflammatory disease of the back. A very common autoimmune disease is thyroid disease. Other examples include Sjogren’s syndrome, scleroderma, polymyositis, dermatomysitis, Bechet’s desease, sarcoidosis, and Crohn’s disease. Although Crohn’s disease is an autoimmune disease of the bowels it can be associated with an arthritis, which oftentimes brings Crohn’s patients to the rheumatologist.
5. I have dry eyes and a dry mouth and have been told that this is a form of arthritis. How can that be?
Sjogren’s Syndrome is an autoimmune disease that can be associated with an arthritis. The hallmark of this disease is dryness of the eyes and/or the mouth. This occurs because the body’s immune system fights againt the tear glands and the salivary glands. While many consider this just a “nuisance” disease, lack of saliva cause damages to the teeth and gums resulting in decay and loss of teeth. Saliva acts as an antibacterial in the mouth. Recurrent burning of the mouth can be the result of a chronic yeast infection that thrives in this environment. Lack of tears in the eyes can also have devastating results such as corneal ulcers if left unattended. While we have no cure for this disease there are products that can treat the symptoms quite effectively.
6. Does arthritis lead to more serious conditions or diseases?
Again we have to differentiate between inflammatory and degenerative arthritis. Many types of inflammatory arthritis can have what are known as extra-articular manifestations. Those are symptoms unrelated to the joint problems. For example, various types of lung and heart conditions can be associated with an inflammatory arthritis. There are also a number of inflammatory eye diseases that are associated with arthritis. Joint pains can even sometimes precede the bowel manifestations of Crohn’s disease or ulcerative colitis.
Rheumatoid arthritis and lupus are independent risk factors for heart attacks. As a result, patients with these conditions must be very careful to keep control of other risk factors such as high blood pressure, blood sugar, hyperlipidemia and smoking.
Osteoarthritis does not have extra-articular manifestations. However, any type of chronic pain condition can lead to depression associated with a decreased quality of life. Total joint replacements for OA give some patients a new lease on life once they are able to resume activities with out the constant pain.
