Arthritis and osteoarthritis are terms that are often used interchangeably in the general population. However, although both refer to diseases that affect the joints, they present great etiological, therapeutic and prognostic differences.
How is arthritis different from osteoarthritis?
In general, osteoarthritis is considered a degenerative process of "wear" of the articular cartilage that causes pain (usually with the use of the joint, improving at rest) and deformity of the same. Although there may be some degree of joint inflammation, it is not characteristic.
On the contrary, arthritis consists of inflammation of the joints, and manifests itself with pain, swelling and difficulty of movement. The pain of arthritis is characteristically more intense early in the day (after a period of prolonged inactivity), and does not improve with rest. According to the cause, there are different types of arthritis (infectious, deposit of microcrystals, autoimmune ...).
What is it and why is rheumatoid arthritis occurring?
Rheumatoid arthritis is a type of autoimmune arthritis, in which antibodies are formed that act mainly against the joints, leading to inflammation.
The cause of the disease is still unknown. It is known that there are alterations in the immune system that activate a series of immune processes causing joint inflammation. Although it is not a hereditary disease, numerous genes involved in these alterations have been identified.
It is considered a multifactorial disease, that is, in a genetically predisposed person, there are a series of circumstances (such as exposure to certain microorganisms or tobacco) that lead to the development of it.
Who is affected?
It affects 1 in 200 people in Spain, being more common in women than in men. Although it can debut at any age, its onset is more frequent between 40 and 60 years. The risk of suffering from this disease is greater in the relatives of patients with rheumatoid arthritis and in smokers.
What manifestations does it produce?
The most characteristic symptoms are pain and joint swelling, especially of the wrists and small joints of the hands and feet, although it can affect almost any joint. Cervical pain may also be due to this disease, while the lumbar and dorsal spine is not affected.
These symptoms are accompanied by difficulty in initiating the movement, especially in the mornings, which we know as "morning stiffness". Characteristically, this rigidity is greater than 30 minutes, unlike arthrosis, in which, although there may be a certain degree of rigidity, its duration is shorter.
If the inflammation is maintained over time, it can cause joint deformity and loss of mobility, which can cause disability and decrease in quality of life.
Although it mainly affects the joints, it is a systemic disease, that is, manifestations can appear at other levels: fever, tiredness, anemia, loss of appetite and weight, tingling in the hands and feet, cough, feeling of shortness of breath , dry eyes or mouth, spots on the skin ...
How is it diagnosed?
Many of the rheumatic diseases, such as psoriatic arthritis or systemic lupus erythematosus, present with manifestations similar to those of rheumatoid arthritis. Unfortunately, there is no single test that diagnoses the disease. As in a large part of rheumatic diseases, the diagnosis is made with the sum of several criteria established by scientific societies.
Given the suspicion that a person may suffer from this disease, it should be sent as soon as possible to the rheumatologist, a doctor specialized in diseases of the locomotor system. Currently there are Early Arthritis Units that facilitate rapid attention to these patients. An early diagnosis will imply early treatment, fundamental factors to improve the evolution of the disease.
The doctor will perform a detailed questioning and a complete examination. If you consider it necessary, you will request a series of tests to confirm the diagnosis of rheumatoid arthritis and rule out other diseases. A general analysis, the determination of certain antibodies such as rheumatoid factor and markers of inflammation, and the performance of simple radiographs are essential in the initial assessment. In certain cases other studies may be necessary.
In spite of the accomplishment of all these tests, in some occasions it may not reach the diagnosis early and it is throughout the evolution when it is diagnosed. Other patients may never meet criteria for rheumatoid arthritis or other rheumatic diseases, being classified as undifferentiated arthritis.
What is your treatment?
There is no curative treatment. However, we have an extensive therapeutic arsenal that allows us to control the disease in a growing percentage of patients.
Nutrition has not been shown to influence the disease. However, it is recommended to avoid overweight and follow a healthy and balanced diet. Although joint overload and forced postures should be avoided, it is beneficial to perform regular physical exercise such as walking or swimming.
Initially, rheumatoid arthritis is treated with anti-inflammatory, analgesic and corticosteroid drugs. Early treatment with the so-called disease-modifying drugs improves the prognosis of the disease. Among these drugs, methotrexate is the most used and remains the cornerstone of treatment despite the emergence of new therapies. Many times it is necessary to combine several drugs. Intra-articular corticosteroid infiltration is another frequently required technique. When these measures are not sufficient, it may be necessary to move to a higher therapeutic level constituted by the so-called biological therapies. These therapies act against molecules involved in inflammatory processes, slowing or decreasing them. But nevertheless, its limited availability and its potential side effects make it necessary for an appropriate selection of the candidate patient to receive it from his rheumatologist. New drugs are constantly being investigated for the treatment of this disease.
Surgery may be indicated in certain cases very rebellious and localized, or to correct deformities.