RA and OA
The two major types of arthritis are rheumatoid arthritis (RA) and osteoarthritis (OA). If you have RA, you probably know a lot about OA as well, if for no other reason than you get to do a lot of explaining to other people what the difference is between the two types.
Osteoarthritis is a common form of arthritis
OA is the more common type because it’s caused by wear and tear on the joints. If you’re active enough or are just lucky to live long enough, your joints will start suffering from being used. This is particularly true of load-bearing joints such as knees and hips but can affect any joint in the body. I have OA in the distal joints of my hands (the ones closest to my fingernails) from years of using a keyboard.
People with rheumatoid arthritis can also have osteoarthritis
So the bad news is that people who have RA can also get OA. While drugs that treat RA may help ease some of the inflammation caused by OA, they really don’t treat the effects of OA that include pain from joint damage. This can be extremely frustrating to someone with RA because you might believe that your symptoms are caused by RA and, since you’re in pain, your treatment plan isn’t working. The case may be that your treatment plan is working quite well holding your RA in check, but that you also suffer from OA which isn’t being addressed.
Sometimes, symptoms are due to OA and not RA
I ran into exactly this situation during my last visit with my rheumatologist. I’m on what I consider a pretty aggressive treatment plan for my RA that includes high doses of a biologic plus methotrexate. I’ve been wondering if the treatment was still working as I’ve had increased stiffness and pain.
My labs look fine (although my labs ALWAYS look fine) and during her examination, my rheumatologist remarked that while several of my joints were tender, on that particular day, they weren’t significantly swollen. Given those results, you have to at least consider that my concerns were caused by OA rather than RA.
Because OA is caused simply by using (or overusing) your joints, it isn’t a disease like RA that can be treated. Instead, doctors generally treat the symptoms. A primary line of defense for OA are non-steroidal anti-inflammatory drugs, also known as NSAIDs. While there are a lot of NSAIDs that can be purchased over the counter (ibuprofen, Advil, and Aleve as examples), there are also a number of prescription-strength drugs such as Celebrex (celecoxib), Mobic (meloxicam), and Daypro (oxaprozin). In addition, there are topical NSAIDs like Voltaren gel that are also often prescribed.
Steroids and surgery
Beyond that, physicians might prescribe steroids (either orally or injected directly into the joints) or lubricating injections of hyaluronic acid. Finally, there is surgery ranging from arthroscopic “cleanup” of debris and joint spurs to full joint replacement. I know because I’ve had all of this done at one time or another. In my case, my rheumatologist has ordered a low dose of an NSAID that should help calm any symptoms caused by OA. We’ll see in three months whether this helps or not.
Talk to your rheumatologist about new symptoms
My point in all of this is that when our joints ache, we often tend to assume RA and perhaps that our RA is getting worse or our treatment plan isn’t working as well. While that might be the case, being human means that we are prone to all kinds of conditions and ailments and that we need to look at the other things that might be causing our issues. This might include things like simple overexertion or more permanent issues like OA. And always, talk to your rheumatologist about any new symptoms you might have.
When was your last flare?