Separating Age from Arthritis

As a person who feels very strongly about clarifying the distinction between osteoarthritis and rheumatoid arthritis I have discovered something that makes that quest even more of a challenge at times. I am finding that as I age it can be difficult to separate osteoarthritis from rheumatoid arthritis in terms of symptoms.

How can you tell the difference between OA and RA?

Recently, in the midst of a flare due to that wonderful gap time between stopping a medication that has failed and the new one becoming (hopefully) effective, I had a routine visit with my rheumatologist. He indicated after examining my knee that the symptoms I was feeling (pain, stiffness, etc.) may well be due to osteoarthritis or a combination of RA and osteo. It really made me do a double take. I had always so neatly separated the two knowing that the root cause is entirely different. Now as I am aging and beginning to experience osteoarthritis I have to reconcile that despite the differences there are also similarities beyond the simple fact that at the root they both involve our joints.

Joint "wear and tear" vs autoimmunity

The differences still remain. Put simply, osteoarthritis is primarily a  "wear and tear" of the joints with no systemic complications while RA is autoimmune in nature with episodes or "flares" that are accompanied by systemic symptoms and long term effects with not only joints but other organs and functions as well. RA is incurable, progressive and inflammatory.

I never realized I'd be managing both conditions

All of that said, I had not stopped to consider that at some point both would be a part of my life! Osteoarthritis often progresses as we age since it is a result of the use (or misuse) of our joints and the repetitive workload they endure for decades and decades. So now I have to discuss how to treat osteoarthritis as well as RA. Fun times. My Rheumatologist was encouraging in this area. He indicated that anti-inflammatories are useful for both as is mild and consistent exercise, heat/cold therapy and potentially joint replacement should the need arise. Even my maintenance use of Medrol (corticosteroid) as much as I hate it, can be helpful with osteoarthritis as can corticosteroid injections into the joint.

Another comorbid condition to add to the list

Believe it or not the use of similar treatment protocols was welcome news. The thought of dealing with yet an entirely new disease with separate and potentially demanding protocols was not something I relished. All too often those of us with RA are slammed with news of yet another cohabitating condition that we have to address.

I recall when I discovered that I had reflux from years of using RA medications.  I was introduced to a whole new slew of protocols and medications including starting on proton pump inhibitors, raising my bed 4 inches, avoiding a long list of foods, etc. It was startling to say the least to realize that I had another demanding condition to contend with.  Lucky for me (not sure lucky is the right word) I developed an esophageal hiatal hernia that eventually required some drastic surgery and the surgeon was able to permanently correct the reflux issue so I no longer have to deal with that condition. Being able to stop taking a medication was fantastic. Without getting too technical, I was also able to stop taking a blood pressure medication I was on to regulate heart rhythm.  It turns out because my stomach had migrated completely into my chest cavity it was under my heart and disrupting the heart rhythm. So when that was corrected we were able to stop THAT medication as well.  A true miracle for sure.  It has been a little over a year now and I still have to pinch myself sometimes to remember that there is a silver lining at times as we make our way through our chronic disease management.

So the fact that I am now "of the age" when osteoarthritis is entering my life I will recall and embrace the fact that it may not be so much different from a day to day management perspective than the RA. Although quite different in all the ways we are familiar with, similarities may serve us well in our journey of RA management.

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