OA question

My 'interesting' rheumy appointment yesterday at least focused my mind on some things that keep puzzling me. What I don't fully understand is the difference, from the patient's point of view, between damage caused by Osteoarthritis which, as Arthritis Research puts it, can be 'a result of damage from a different kind of joint disease, such as rheumatoid arthritis' and damage to a joint that is purely caused by RA?

I get the impression that damage & erosions caused by RA and only RA are more serious. But is this necessarily the case? From the patients point of view, any joint damage is bad news & OA can be disabling.

As I see it, OA that comes about because of RA is basically an RA problem linked to poorly controlled inflammatory arthritis & it’s just as important to look out for it as it is to keep a watch on other forms of damage.

I understand that anyone can get OA quite independently of RA & at the same time as RA, but for OA to coincidentally show itself in the same joints that are swollen & tender because of RA, and at exactly the same time, without the causal connection that Arthritis Research mentions seems to me to be too much of a coincidence.

I'd be very grateful for any thoughts anyone has about this. Luce xx

30 Replies

  • I'd agree that OA that comes about because of RA is an RA problem. Its also incredibly difficult to actually tell the difference on most imaging, unless you get an MRI with the right sequences to show inflammation, and you happen to get it at an active time. Also, if you have any evidence of inflammation through blood tests, etc (ESR, CRP) then the inflammation should be the primary problem that is being dealt with. I think you only need to know or call it OA if you still have residual problems after you have been treated properly for the inflammatory condition, and got that totally under control. I see it a bit like fibro - I don't see any reason to diagnose fibro UNLESS you know the RA is totally under control and there are residual symptoms that aren't dealt with by RA treatment, or unless there are some of the really specific fibro symptoms that aren't seen in RA (like the supersensitive aching all over thing).

    I think generally OA is a bit too much of a catch-all diagnosis.

  • For starters, thank you for agreeing with me. It's fine if others don't and anyway I'm interested in all views on this, but just to get some recognition about what I'm talking about is a huge relief.

    Something I'd like to ask you is, when you say it's difficult to tell the difference on imaging, do you mean it's difficult to tell the difference between ...... what? OA damage & RA damage? Or OA inflammation (I know it produces some localised inflammation) & RA inflammation? Sorry to be so specific but it has come to this with me & my rheumy. He used to tell me that my joint damage was caused by 'secondary' OA. But all of a sudden it's unrelated to RA apparently. x

  • From my point of view a £&^*+ joint is a £&^*+ joint, so there isn't much difference to me whether it's OA or RA what done it. But, someone once explained to me that there can be a a slight difference between the damage caused by each that is visible to a skilled person on x rays and so on. Which aren't completely mutually exclusive, and also have an element of guesswork based on probabilities. So the way I understood what they were saying is that if the problems start in the large joints, and show up as one type of damage in X-rays then they put their money on OA. But if start in smaller joints, and show up as a slightly different type of damage then more bets are on RA. So my spine, which has narrowing of joint spaces, and my knees that have osteophytes (?) are OA, but the damage to my feet has been done by the RA inflammation.

    Here's a research paper that gives a few clues radiology.rsna.org/content/...

    I did have similar circular debate with my rheumy, as I now have knuckles that are knobbly, which she says are secondary OA. But these are the self same knuckles that were hugely inflammed before my RA was disciplined. So from my point of view the damage is caused by RA, even if the end result is OA like knobbles.

    (I'm still fuming about your rheumy appt...so my reply was unprintable...)


  • Again, just hearing that you get what I'm on about helps put me back on an even keel. I'll look at that research paper. Your circular debate with your rheumy is exactly what has happened to me except that my rheumy has burst a blood vessel over it, metaphorically.

    I don't really differentiate the damage done - it's damage done. But what I'm reading time & again is that RA inflammation can damage cartilage & then you get bone on bone damage which looks like OA and to all intents and purposes is OA. And it seems to me that it can then, for convenience sake, be dismissed as OA i.e. no need for or point in monitoring joints.

    Thanks Polly. x

  • Just had a very similar experience.....rheumy says OA.......But my bloods said differently...I really dont understand.....then he jabs me with a Steroid jab????...How long does that last ...no other meds!!!

    soo confused....Gp was sure it was RA.....hands feel like their on fire!!....

    I think Im gonna forget the whole experience and carry on as per usual!! Else I will end up with high BP.......Oh what a waste of time!!

  • It is a bit of a nightmare isn't it? At some point yesterday after bad experience with rheumy I just knew that I wasn't going to let all this get to me. I think you do have to just carry on being you whether that means trying to find out more or deciding to ignore the most exasperating things ... and knowing it's not just you who feels exasperated is some comfort! x

  • Hi I'm just catching up with this thread, can i ask have you had the it's wear and tear nothing we can do when every time you move your shoulders or knees its agony, what has caused the wear and tear I didn't have it 4 years ago pre RA so where has it come from???. Interesting about the back as well. I have had 3 ops on my spine for stenosis. Real serious ops loss bladder control etc. I read an article from an American rheumy who is convinced RA causes stenosis of the spine I'll try and find it and link it on here. Love and hugs don't get too frustrated it's ot good for you lol. xxxTricia P.

  • Hi Tricia, I've just got back from 6 days away. I've been thinking a lot about all this &, in a nutshell, feel fairly convinced that my RA & OA are connected. My experience, like yours (like loads of us I think) is that everything has come at once - my joints were okay before the sudden onset of what was eventually diagnosed as inflammatory arthritis.

    How does this sound as an hypothesis: yes, I'm in my 50s - lots of us are. I may well now have a tendency towards OA & that doesn't just mean 'wear & tear', for example ageing can sometimes mean that cartilage becomes less resilient & does not renew itself as it once did. Perhaps my cartilage was already a bit rough. Along comes inflammatory arthritis, bringing with it massive swelling of some joints that stretches tendons & ligaments and puts considerable strain on the affected joint. That is surely just the 'environment' OA needs to really take off? So from a bit of OA, I could quickly end up with galloping OA.

    I reckon there must be some interaction between RA and OA - it can't all be coincidence.


  • Hi I hope you had a few good days and didn't worry too much, I had cause for an apt with the Rheumy a couple of weeks ago due to these hot flashes another one of those mysteries anyhow I saw his new registrar who aid crikey you have a lot of wear and tear in your large joints shoulders knees elbows but not hips, but like you I didn't have it 4 years ago, nor did I have a problem with my spine onset like you inflammatory arthritis for the first 6 months then a change of diagnosis to RA, then the back played up told it was a slipped disc 2 days later I lose the use of my legs and the pain goes to nuclear. 2 ops later I still have RA and wear and tear and hot sweats had to leave my job I loved. By the way I remember one of my first appts with Rheumy nurse and she did tell me that RA affected tendons and cartilage and even the internal organs as in the oesophagus as I sometimes have problems swallowing. So in fact I don't know the answers lol, but like you I know that RA has knackered my body in more ways than one. Gentle hugs Tricia P

  • I was told by my GP that OA and RA erosion show up differently under x-ray. She even drew me a little picture (I wish the doctors would give me their drawings - they make great fodder for our embroidery work).

    I completely agree with your hypothesis that this can't just be coincidence that OA and RA arrive simultaneously. I have reported that my lower back ache and hip pain goes away with the higher dose of MTX and comes back when the dose lowers so don't feel it's right to dismiss the inflammatory element.

    I think it matters to us because we feel that if RA is the cause then surely the drugs we take for RA should help keep control of secondary OA too? And if they won't take x-rays at regular intervals how on earth can we believe them? After all RA is too slippery a disease to follow the obvious path - which is what can sometimes make a diagnosis so slow, especially if someone presents with less obvious symptoms and is sero negative. So if it's this highly variable disease in the way it presents itself then doctors surely need to be more canny and flexible in their thinking in order to spot deviant manifestations of the disease and try to halt it as well?

    Ultimately they need to listen very hard to their patients in the way that a really good detective will listen to her or his clients for clues, big and small. Tilda xx

  • I just replied to you. It made sense nearly. Then it disappeared. Will try later. x

  • And of course I don't only mean RA but all types of inflammatory arthritis.

  • Or as my rheumy would put it 'RHEUMATOID, PSORIATIC, WHATEVER!!!' x


  • What a flamin' liberty this man has?! Have you thought about writing everything down as succinctly as you write on here and sending it to him so he can consider how he behaved and what he should be addressing at this next consultation in a few weeks time? That is definitely what I would do in order to make sure he doesn't waste any more of your time with ridiculous gesticulating and raising of his voice etc? He needs to address your concerns properly this time, as he is paid handsomely to do. Xx

  • Yes, I intend to record everything. He's done me a favour really - the experience woke me up. It's a cold type of anger I'm left with which means I'll just go through whatever steps I need to. I think he is probably someone who can't stand questions especially of the persistent variety. I can handle being wrong - I expect to be when it comes to understanding all this complex stuff - but he's never been very good at explaining things.

    Oh & just accessed that link Polly gave. Already things are a bit clearer though I think I'm going to have to really over it very carefully to take it in properly. xx

  • Interesting reading. I've been told I have RA & take hydroxy which worries me as I think maybe it isn't strong enough. All my joints are swollen & painful most of the time,my knee being the worst. The rheumy says its OA & wouldn't X-ray or scan it & told me to go back to my gp,which I did. I've had an MRI scan which shows erosion of the cartilage, no-one has explained why or what to do now so in the meantime I suffer. It's a bloody minefield x

  • Hi Caroline. That sounds awful actually? I dread being abandoned on too low a dose almost as much as I dread being over medicated.

    The trouble with only taking Hydroxy is that no one has to monitor you apart from an optician once a year. I think you need to go back to your GP and ask to have the knee erosion explained. If they say its OA then they probably do know this from MRI or x-ray, but it is about time all these medical practitioners took trouble to explain to us how they are so sure. And if its al based on probability, because RA usually does not affect these joints initially - how can we be certain we aren't the unusual ones since RA is an unusually versatile disease? Also how can they rule out other types of inflammatory arthritis which are less symmetrical often and which might affect one knee or hip. Its all relies too much on speculation and is fairly unscientific to my mind. Are oncologists this vague about the various types of cancer I wonder? I sincerely hope not. X

  • I think I need to go back to the drawing board, probably again & again, so I won't pretend to be sure about anything. But if RA damages cartilage, which it can do, then especially in a big, weight-bearing joint like the knee OA starts up & will probably progress even after systemic inflammation has been dampened. It's a chicken & egg situation if you look at it like this - which I do for now though I'm hoping to understand more if there's more to learn. x

  • Hi

    I read this article after looking for info on spinal damage with RA as i'd been told it was nonscence to blame RA but it seems that RA can and does damage

    This is part of a long report on spinal stenosis but reports on osteo and RA . .

    this is the link to the full report. niams.nih.gov/Health_Info/S...

    I hope that this doesn't cause anyone a problem or a worry, I sometimes feel that there are no end of strange sympptoms for RA or the Drs just blame it.Lol xx

    Osteoarthritis. Osteoarthritis is the most common form of arthritis and is more likely to occur in middle-aged and older people. It is a chronic, degenerative process that may involve multiple joints of the body. It wears away the surface cartilage layer of joints, and is often accompanied by overgrowth of bone, formation of bone spurs, and impaired function. If the degenerative process of osteoarthritis affects the facet joint(s) and the disk, the condition is sometimes referred to as spondylosis. This condition may be accompanied by disk degeneration, and an enlargement or overgrowth of bone that narrows the central and nerve root canals.

    Rheumatoid Arthritis. Rheumatoid arthritis usually affects people at an earlier age than osteoarthritis does and is associated with inflammation and enlargement of the soft tissues (the synovium) of the joints. Although not a common cause of spinal stenosis, damage to ligaments, bones, and joints that begins as synovitis (inflammation of the synovial membrane which lines the inside of the joint) has a severe and disrupting effect on joint function. The portions of the vertebral column with the greatest mobility (for example, the neck area) are often the ones most affected in people with rheumatoid arthritis.

  • Hi, this is a really great link, Tricia, thanks, explains stuff so well and in language us ordinary mortals can comprehend. Look through the A to Z for all other ailments too!

    Just had an MRI for OA as doc now thinks I have this now more than RA.......ho hum.


  • H Jan

    Thanks Jan, I'm not sure that a Dr can just say oh it's OA more than RA as the significant signs are different, ie fatigue, swelling stiff, my sister has significant OA in hips knees elbows shoulders but the pain wears her but she doesn't get the fluey feeling or burning or anything secondary like dry eyes mouth and skin. I do hope the MRI shows the true illness i'm not sure if one is worse than the other, I do know my sister thinks RA is worse. keep in touch Jan and best wishes to you tricia P x

  • Hi Tilda,yes I do need to go back to my GP,I'm just a bit reluctant as she has said quite clearly that won't talk to me about RA as she doesn't know enough about it & that's why I have a consultant. The consultant won't talk to me about my knee because he says it isn't RA,I don't know how he can be so sure without seeing the scan. My friend has OA & her knee & symptoms are nothing like mine,I think he's wrong. I have pain swelling stiffness & burning in all my joints but the right knee is by far the worst & to top it all I can't take painkillers. Things are never straight forward are they! x

  • Go back to back to your GP and be firm I would say. Explain that between the two of them your health is deteriorating and you believe your RA is worsening. She can order x-rays herself to rule out or support what type if arthritis this is and she is copping out by saying its all up to your consultant. If you don't get any joy is there another GP you can see? X

  • Yes your right I will & yes I can see another doc. Thanks x

  • Don't ever apologise for trying to get your head around all things arthritic Luce. I sense you are still feeling pretty diminished by this bad experience and I'm not surprised - but please remember you did absolutely nothing wrong and your husband was there to verify this. And I think you are sure of something - that you absolutely don't want to be treated like this by him or anyone else, ever again! The NRAS helpline might be the best place for you to turn for help organising your thoughts for this next, hopefully much better consultation. it foes sound to me as if there was some strange dynamic being introduced by having this young work experience girl present. How to put someone off going into rheumatology perhaps!? Xx

  • Thanks Tilda. x

  • I asked my consultant about the pain i was getting in hands back and feet as my CRP was low 5, how was this possible. there was no swelling just pain and the knuckles have moved and they feel thicker to my touch. His answer was they are not part of PsA as that is under control . He then did the preasure points in the elbow and knees and said they were delayed. He also felt my shins and asked if they were painful which they were. Out come was Fibro. and i'm going to try Hydro. when i next see him in October. Fingers crossed,


  • Sorry to hear about this latest diagnosis Chris. I hope the new treatment helps. x

  • thank you we live in hope.


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