Osteoarthritis vs Rheumatoid Arthritis
Osteoarthritis and Rheumatoid Arthritis are easy to mix up on the boards. Here's a side-by-side comparison — presentation, workup, imaging, and first-line treatment — drawn from our full outlines.
Osteoarthritis vs Rheumatoid Arthritis at a glance
- Osteoarthritis: Non-inflammatory degenerative joint disease driven by progressive articular cartilage loss.
- Rheumatoid Arthritis: Chronic symmetric inflammatory polyarthritis with autoantibodies and erosive joint damage.
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Side-by-side comparison
| Feature | Osteoarthritis | Rheumatoid Arthritis |
|---|---|---|
| At a glance | Non-inflammatory degenerative joint disease driven by progressive articular cartilage loss. | Chronic symmetric inflammatory polyarthritis with autoantibodies and erosive joint damage. |
| Classic presentation | Heberden nodes (DIP) and Bouchard nodes (PIP); squared first CMC joint; medial knee joint-line tenderness.; Insidious joint pain worse with activity and improved by rest; Brief morning stiffness (<30 minutes) and gel phenomenon after inactivity; Reduced range of motion, crepitus, functional limitation; Knee: medial joint-line pain,… | Symmetric MCP/PIP/wrist swelling with positive MCP/MTP squeeze test, plus rheumatoid nodules in seropositive disease.; Insidious symmetric polyarthritis of small joints (MCP, PIP, wrists, MTPs); Morning stiffness lasting >1 hour, improving with activity; Fatigue, low-grade fever, weight loss; Hand weakness and difficulty with grip;… |
| Workup / key labs | ACR clinical criteria for knee OA: knee pain plus at least 3 of: age >50, stiffness <30 min, crepitus, bony tenderness, bony enlargement, no palpable warmth. Radiographic hallmarks (Kellgren-Lawrence): joint-space narrowing, subchondral sclerosis, subchondral cysts, marginal osteophytes.; Generally not required for diagnosis when… | 2010 ACR/EULAR classification: score ≥6 of 10 across (a) joint involvement, (b) serology (RF/anti-CCP), (c) acute-phase reactants, and (d) symptom duration ≥6 weeks classifies as RA.; RF and anti-CCP (anti-CCP higher specificity; both predict erosive disease); ESR and CRP (elevated, used to track activity); CBC (normocytic anemia of… |
| Imaging | Weight-bearing plain radiographs of the affected joint — first-line; MRI reserved for atypical presentations, suspected meniscal or ligamentous injury, or possible avascular necrosis; Ultrasound can detect effusion and osteophytes but is not routinely needed | Plain radiographs of hands and feet — periarticular osteopenia, symmetric joint-space narrowing, marginal erosions (MTPs often earliest); Ultrasound or MRI — more sensitive for early synovitis and erosions before plain-film changes; Cervical spine flexion/extension films in established disease to assess atlantoaxial subluxation prior to… |
| First-line treatment | Patient education and self-management programs; Exercise: low-impact aerobic, strengthening (quadriceps for knee OA), aquatic therapy; Weight loss (5-10% body weight) for knee or hip OA in overweight patients; Topical NSAIDs (diclofenac gel) — preferred initial pharmacotherapy for hand and knee OA; Acetaminophen up to 3 g/day (modest… | Early DMARD therapy within 3 months of diagnosis — methotrexate is anchor drug; start 10-15 mg PO/SC weekly with folic acid 1 mg daily; Conventional DMARDs — methotrexate, hydroxychloroquine, sulfasalazine, leflunomide (often combined as 'triple therapy'); Bridging low-dose prednisone (≤10 mg/day) until DMARD takes effect; taper as… |
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