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Diagnostic Criteria of Osteoarthritis (OA) vs. Rheumatoid Arthritis (RA)

Osteoarthritis (OA) and Rheumatoid Arthritis (RA) are the two most common forms of arthritis, both causing joint pain and stiffness, but they have distinct underlying mechanisms, clinical presentations, and diagnostic features.

Osteoarthritis (OA) – “Wear and Tear” or Degenerative Arthritis

OA is a progressive condition characterized by the breakdown of joint cartilage and underlying bone. It’s primarily a mechanical problem, though inflammation can play a secondary role.

Key Diagnostic Criteria/Features:

• Cause: Degeneration of articular cartilage due to mechanical stress, aging, injury, or overuse. It’s often considered a disease of the whole joint, involving bone, ligaments, and muscle.
• Onset: Gradual and insidious, typically developing over years.
• Affected Joints:
  • Usually affects weight-bearing joints (knees, hips, spine).
  • Commonly affects specific joints in the hands (distal interphalangeal (DIP) joints, proximal interphalangeal (PIP) joints, and the base of the thumb – carpometacarpal joint).
  • Tends to be asymmetrical (affecting one side more than the other, or isolated joints initially).
• Morning Stiffness: Present, but usually short-lived (less than 30 minutes, often 5-10 minutes), and improves with movement.
• Pain Pattern:
  • Worsens with activity, movement, and weight-bearing.
  • Improves with rest.
  • Often described as a deep, aching pain, worse towards the end of the day.
• Swelling: May be present, but often mild, firm, and bony (due to osteophytes), rather than soft and inflammatory. Effusions (fluid in the joint) can occur but are usually non-inflammatory.
• Joint Deformity: May develop bony enlargements due to osteophytes (bone spurs).
  • Heberden’s nodes: Bony enlargements at the DIP joints (most distal finger joints).
  • Bouchard’s nodes: Bony enlargements at the PIP joints (middle finger joints).
• Systemic Symptoms: Absent. OA is generally not associated with systemic symptoms like fever, fatigue, weight loss, or rash.
• Imaging (X-rays): Show characteristic changes:
  • Joint space narrowing: Due to cartilage loss.
  • Osteophytes: Bone spurs at the joint margins.
  • Subchondral sclerosis: Increased bone density (whiteness) beneath the cartilage.
  • Subchondral cysts: Fluid-filled sacs in the bone beneath the cartilage.
• Laboratory Tests: No specific blood tests for OA. Inflammatory markers (Erythrocyte Sedimentation Rate [ESR], C-Reactive Protein [CRP]) are typically normal or only mildly elevated. Rheumatoid Factor (RF) and Anti-CCP (anti-cyclic citrullinated peptide) antibodies are negative.
• Synovial Fluid Analysis: If performed,