Osteoarthritis and RA

Morning all!

I've got a bit more energy today, Alleluia! So far I've frittered it away on the internet ...... pondering Minka's knees & Osteoarthritis. Must get out of this bed & play catch up!

But anyway I found something that puzzles me so I've got a bit of a techy question, here goes.

I know that there's a tendency to think of Osteoarthritis as 'just' a mechanical process whereas actually it's about the breakdown of living tissue & is considerably more complex than, say, a piece of wood or metal wearing down. And I found this on medscape which states that Osteoarthritis produces inflammation:

"In stage 3, the breakdown products of cartilage induce a chronic inflammatory response in the synovium."

What is puzzling me is whether this inflammation can be detected as raised ESR or CRP? And if so, wouldn't a bad case of Osteoarthritis look like Inflammatory Arthritis?

The 'only' (huh!) signs of my RA are difficult to control inflammation, swollen joints etc. i.e. I'm completely sero-negative. I'm not questioning whether or not I actually have a systemic, inflammatory condition - I'm pretty sure about that. But what I'm wondering is how much of the inflammation I get is down to RA & how much is generated by the worsening of my knee & hip erosions due to doing audacious things like standing up & walking?

And also it's not just about me, I'm just interested (and putting off a whole lot of forms that await me downstairs!)

Hope you are all in the best possible shape,

Luce x

18 Replies

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  • Hi a very interesting question as I have RA and Osteo and often wonder which is giving all the pain and inflammation. Will be interested to read any answers.

    Wendy xx

  • Have your doctors ever mentioned OA producing inflammation? I've just found out that in addition to the more serious erosions in my knees & hip I have 'degenerative changes' at the base of both thumbs and both big toes. I'm not usually so tidy!

    Wondering whether you see your OA & RA as separate or whether the OA is secondary, caused by the RA. I'm even beginning to wonder whether OA can trigger RA ..... but that way lies madness!

  • Oh Wooly we are very similar. I don't have the hip problem, mine is spinal but knees, thumbs and toes are the same. I got OA a long time before RA and am never sure whether the problems stem from OA rather than RA. Evidently the spinal problems are OA as my consultant said that RA does not usually cause problems with the spine.

    I figure OA starts the problem then RA moves in and finishes the job!

    Jo

  • Have you got a cast iron diagnosis of RA? 'Cos if you are sero-negative there's always the possibility that your arthritis is actually a form of Spondyloarthritis which does affect the spine.

    Do you honestly think that maybe your OA somehow started off the RA? Or is it more that your RA seems to attack your weakest joints most? My RA definitely goes in for the kill where there is a pre-existing problem - I had years of on / off irritating but small problems with my knees and they are the joints the RA has had most fun with!

    Pleased to meet a fellow neat & tidy symmetrical thumb & toe person! x

  • Yes, I have definately got RA. Had it since 2004. No idea if OA started off RA, think it is unlikely because, together with hands and feet, I also have problems with wrists and shoulders all of which are definately down to RA, not OA. I think my knees are OA finished off by RA (just had a new knee).

    Spine could be spondyloarthritis as I had spondylolythesis (where one vertebrae moves on top of the next one, bending spinal cord), but RA consultant thinks that is due to OA. Had a spinal fusion to fix that but I still have a very badly slipped disc which I think they will have to do something about as it is causing severe back ache.

    All I know is that if one doesn't get me the other will!

    I have had an underactive thyroid for many years and it seems to me that if you get one autoimmune problem you are very likely to get another.

    I could easily believe that if you have an OA problem in a joint then RA exploits that weakness. I am sure that is what has happened with my knees.

  • My mum has OA and yet she show signs similar to inflammatory arthritis, her nails are also the same as mine with PsA but the GP is adamant she has only OA, and she won't request to see her rhumey again, as he discharged her. I have tried telling her that she can go back but she has stuck her foot down and says no. But yes I agree with you there is comparison.

  • It's interesting isn't it? I am beginning to think that the relationship between OA and inflammatory arthritis is more complex than most of us think (or than doctors know or let on).

  • There is a type of erosive inflammatory arthritis, which is extremely nasty and which does produce raised ESR. My sister has this in her hands, as does my mother and it is scarily destructive. I don't really remember how it progressed in my mother , but just that she stopping knitting, cooking etc etc. In my sister it has destroyed the top joints in one of her hands in a matter of months, but in a different way to my fingers and toes - hard to describe but they just look and feel v different.

    However, I don't think most osteo does this, although it is more dynamic a disease than just mechanical grinding down of joints most people's are not as aggressively erosive. I found this via internet which seems to agree.... ncbi.nlm.nih.gov/pubmed/215... Px

  • I'm not sure how reliable Medscape is. It sounds authoritative. Your mother's and sister's arthritis sounds very scary.

    The article does go on to discuss erosive (inflammatory) Osteoarthritis & describes it as being marked by a greater degree of inflammation (so is basically still sticking to the view that 'ordinary' osteo produces inflammation too):

    emedicine.medscape.com/arti...

    I do feel I'd like to know more about Osteoarthritis so will keep delving I expect.

  • ITS American..!!

  • Ha ha! Duly noted, Summer.

  • Hi. I was told by rheumy that I have genetic osteo which is inflammatory and aggressive. No other real explanation but seems not just wear and tear condition which is why it's presenting in hands and feet x

  • Are you inclined to ask your Rheumy for more info? 'Cos they should put you in the picture - unless of course you feel you know quite enough about it to be going on with ......

    Hope your condition is under control mistymeana. What puzzles me is why they still call it a form of Osteo if it's inflammatory??

    I've always had the suspicion that there's more to even wear & tear Osteo than meets the eye & there do seem to be occasional studies which support that. I suppose I'm wondering whether some of the numbers that make up my pesky ESR are attributable to my Osteoarthritis. And also whether Osteoarthritis can turn into RA ..... and all sorts of similar questions! x

  • Oh blimey, don't get me started! Asked for a second opinion as went from having sero neg for over 20 yrs with a garnish of OA and then a recently-diagnosed sprinkling of fibromyalgia to a re-classification of "it's only fibromyalgia" with afore-mentioned genetic OA in a 10 minute appointment which involved a quick glance at up to date x-rays of hands and feet and no questioning or examination. Asked to see sero-neg specialist who seemed miffed that I'd questioned one of his team's diagnosis, prodded my foot a bit and packed me on my way with OT referral. They were wonderful and referred me on to physio. Also wonderful and starting hydrotherapy soon. Had call from them this week and they possibly referring on to Orthopaedics re back pain. Dentist not convinced of new diagnosis and referred me to Oral Health as having symptoms consistent with RA type problems. Rheumy kept me on hydroxy and arcoxia as says sometimes used for OA (?) so at least getting some meds. So I'm certainly getting my money's worth out of NHS at the moment and seeing the sights of local hospital as been to four departments so far and two more pending. Time will tell if anything is diagnosed at new referrals. Trouble is, even when my toes and fingers turn into sausages and I can't see my ankle bones or bend anything, my blood markers don't show anything. Not always fun being an interesting/awkward case! x

  • Oh my goodness! The best bit definitely sounds like the hydrotherapy - I'm sure that will be bliss & give short-term relief at least.

    How arrogant & blinkered some consultants are ..... their professional pride doesn't matter two hoots compared to your health & day to day wellbeing.

    My original question suddenly doesn't seem that important either ...... though maybe if you have got inflammatory Osteo the inflammation stays localised somehow & that's why it doesn't show up in bloods. I believe that's one explanation for why people with AS sometimes don't show raised inflammation levels.

    Perhaps an MRI scan & expert interpretation of that might help clarify diagnosis .... but I think the private route might be required to ensure that someone really studies what your bones show in detail.

    Good luck with all these referrals - hope things get a lot clearer and you get effective meds. x

  • I have the same question!

  • Obviously not a hot issue but more a slow burn one with lots of people pondering the same questions!

    The paragraph headed 'Inflammatory Response' in this link says it all in a way ...... so many 'maybes' and 'probablys' .... but acknowledging that inflammation may be a cause and not just a result of Osteoarthritis. So again I start thinking are Osteo and Inflammatory conditions on a continuum rather than necessarily separate & utterly different?

    I like it over here ..... it's like 'thinkers corner' ..... thing is I do know that I'm no scientist & often get the wrong end of the stick entirely so am waiting for someone to come along & put me straight! (But hope they are gentle with me!)

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