"I have arthritis" and "I have osteoarthritis" are often used as if they meant the same thing. They do not. The two conditions share a symptom — joint pain — but they have different causes, they behave differently and, most importantly, they are treated differently. Telling them apart is the first step towards the right treatment and towards not losing time.
What each one is
Osteoarthritis is wear of the cartilage, the cushion covering the ends of the bones inside a joint. As that cartilage thins, the bones rub against each other and the joint becomes painful and misshapen. It is related to age, mechanical overload, excess weight, old injuries and genetics, and it mainly affects knees, hips, hands and the spine.
Inflammatory arthritis is inflammation of the joint itself. It can be a one-off episode (from an infection or from crystals, as in gout) or a chronic autoimmune disease such as rheumatoid or psoriatic arthritis, in which the immune system attacks the lining of the joint. It is not an older person's illness: it often begins between the ages of 30 and 50.
Put simply: osteoarthritis is wear; arthritis is inflammation.
Telling them apart from the symptoms
Several clues point one way or the other before any test is done:
- Morning stiffness. In osteoarthritis it lasts a few minutes, under half an hour, and eases as you move. In inflammatory arthritis it can last an hour or more.
- Relationship with activity. Osteoarthritis pain worsens with use and improves with rest. Arthritis pain often does the opposite: it improves with movement and wakes people in the early hours.
- How the joint looks. Arthritis produces obvious swelling, warmth and sometimes redness. Osteoarthritis produces a harder, bony deformity without heat.
- Symmetry. Rheumatoid arthritis tends to affect the same joints on both sides and spares the joints at the fingertips; hand osteoarthritis settles precisely there.
- General symptoms. Marked fatigue, a low-grade fever, weight loss or symptoms in other organs point towards an inflammatory disease rather than wear.
These pointers are a guide, not a substitute for assessment. If pain lasts more than six weeks, if swelling persists, or if it wakes you at night, it is worth getting it looked at.
How it is diagnosed
Diagnosis always starts with the history and the physical examination: which joints hurt, for how long, how the pain behaves and what the family and medical background is. Tests then help to confirm the picture:
- Blood tests. Inflammatory markers (ESR, C-reactive protein) and antibodies such as rheumatoid factor or anti-CCP help identify autoimmune arthritis. Uric acid is checked if gout is suspected. A positive rheumatoid factor on its own diagnoses nothing, and a negative one does not rule the disease out.
- X-ray. Very useful in osteoarthritis: it shows joint space narrowing, hardening of the bone and bony spurs. In arthritis, X-ray changes appear later, once damage has occurred.
- Musculoskeletal ultrasound. It sees what an X-ray cannot: fluid inside the joint, thickening of the synovial membrane, tendinitis and bursitis. With Doppler it detects active inflammation at an early stage, and it is also used to guide injections precisely.
Sometimes an MRI or an analysis of the joint fluid is needed to complete the picture. And if the concern is bone fragility rather than the joint itself, a different test applies — we explain it in our article on bone density scans and osteoporosis.
Which treatments work
No treatment regrows worn cartilage, but there is a great deal that can be done to reduce pain and keep the joint working.
- Exercise. This is the best-evidenced measure in osteoarthritis, ahead of any tablet. Strengthening the muscles around the joint — quadriceps for the knee, glutes for the hip — unloads it and reduces pain.
- Weight control. Every kilo lost translates into several times that in reduced load on the knees when walking.
- [Physiotherapy](/en/especialitats/fisioterapia). Manual therapy, a prescribed exercise programme, and techniques such as INDIBA radiofrequency for pain and tissue recovery.
- Medication. Painkillers and anti-inflammatories in short courses, always as prescribed by a doctor. In autoimmune arthritis, disease-modifying drugs change the outlook completely, and the earlier they are started the better.
- Injections. Corticosteroids to settle a specific inflammatory flare, or hyaluronic acid to lubricate the joint in mild to moderate knee osteoarthritis, with the aim of gaining months of comfort and better movement. They are not miraculous: each case is assessed on its merits.
- Surgery. The last step, when pain and loss of function no longer respond to anything else.
Rheumatologist or orthopaedic surgeon?
A common source of confusion, with a simple rule:
- The rheumatologist treats the medical conditions of the musculoskeletal system: rheumatoid and psoriatic arthritis, gout, lupus, fibromyalgia, osteoporosis and the follow-up of osteoarthritis. See them if there is swelling, pain in several joints, prolonged morning stiffness or a suspected autoimmune disease.
- The orthopaedic and trauma surgeon deals with surgical and injury-related problems: fractures, meniscal and ligament injuries, disc herniation, tendon problems and joint replacement when osteoarthritis is advanced.
If you are unsure, start with [general practice](/en/especialitats/medicina-de-familia): a family doctor is best placed to point you in the right direction.
Frequently asked questions
Can osteoarthritis be cured?
Lost cartilage cannot be restored, but pain can be controlled well and progression slowed with exercise, weight control, physiotherapy and the right treatment. Many people with osteoarthritis lead entirely normal lives.
Do cold and damp make the pain worse?
Many people notice it, and changes in atmospheric pressure may play a part, but the weather does not damage the joint. Keeping moving and keeping warm is usually enough.
Is a rheumatology appointment covered by my insurance?
With most companies, yes. You will find the full list on our health insurance page; some insurers require prior authorisation, which our reception team arranges for you.
At Centre Mèdic Palafrugell, rheumatology, orthopaedics, radiology and physiotherapy work together, so diagnosis and treatment move forward without unnecessary waiting. Call us on 972 30 65 65 or write to us through the contact form.
