Link between RA and OA???

I've been pondering on this a while but not really got any closer to the shedding any light on the matter. I wondered if there was a link with RA (and other similar types of inflammatory arthritis) and OA. I say this because I've noticed several people say they have OA as a result of RA.

I had MRI scans a year ago and the radiologist wrote that I have secondary OA in my ankles (in addition to active RA inflammation in my feet); I previously had lots of inflammation in my ankles (confirmed by a radioactive isotope scan). I asked if the apparent 'OA' was as a result of RA and my rheumy said "probably". I googled and sure enough, it told me that the causes of secondary OA include RA. However, someone on the NRAS helpline says that OA damage and RA damage appears differently on x-ray and MRI. So, I'm still none the wiser.

Am I right in saying that RA/inflammatory arthritis can cause erosions that look like RA but it can also cause osteoarthritis-like joint damage?

I hope this is clear, let me know if it is just a jumble of words.

18 Replies

  • I would love to know the answer to this question as it puzzles me to x

  • Hi I'm really glad you've asked this question and I'm gonna add to it if you don't mind ... I've a very close friend who seems to have developed quite an aggressive OA if there is such a thing, sorry I don't know that much about OA. However it has got particularly bad in the last few months and to me a lot of her symptoms sound more like RA. So my question is can RA develop as a secondary to OA. My friend is 55 and becoming quite badly affected.

    Sorry if my question might seem a little stupid but as I said I don't know much about OA and only more recently diagnosed with RA myself. Thanks

  • Hi

    OA is as I understand it caused by simple wear and tear through use.

    RA is where the body's immune system attacks the joints.

    I see no reason why you can't have both. Perhaps your friend should get checked out as RA can usualy be controlled, OA is progressive and might be slowed a little by glucosomine etc.

    Might be hard to persuade the medics to do the tests but if they are sero-positive it will be easier.

  • I have both of these wonderful (NOT) diseases, OA came first about 35-40 years ago that has now taken over most of my joints and the RA was diagnosed about 18 months ago.

    Most of my joints have OA and it hurts like hell but a doctor I went to see about my very painful feet and ankles, take your shoes and socks off she said lol I did so and she was shocked at the swelling on my ankles, she then said its no wonder you struggle to walk. Off to the Rheumatologist she said and the rest is history.


  • OA and RA , and other inflammatory diseases can and do exist along with each other, probably being diagnosed at different times. But it is the active auto-immune, inflammatory diseases that need to be treated aggressivly.

    It is likely, in a given location, that the inflammation from RA can cause the bone surface to become weakened and susceptible to the wear and tear that is characteristic of OA, though not exactly causing OA. Perhaps coincidental. Or it may just be a judgement call by the Radiologist.

  • I believe there are clearly distinguishable characteristics that a qualified and experienced rheumatologist can recognise - but often I reckon it's based on the location of your symptoms. So in the hands RA tends to affect the MCP joints (knuckles) and OA affects the DIP joints (joints closest to your finger nails). Of course there's overlap and most people with RA will also get OA as they progress through their lives, but many people with OA won't also get RA.

    But I do know of several people who now have RA having suffered from OA first for many years, so in answer to your question Rosie Rabbit - yes your friend could well have RA. But there are mild types of wear and tear OA and very aggressive OA and personally I dread the latter more than RA because at least there are some very effective meds for RA whereas there's nothing for OA really apart from pain meds and NSAIDS. Tilda x

  • I've heard that not all radiologists can tell the difference between very aggressive RA erosions and OA.

  • Well my rheumy seemed to be able to tell with my hands that there were signs of early OA but none of RA. He did qualify this by saying that early RA erosions would be very hard to pick up on so I don't think he finds x-rays that useful.

  • Yes I've heard that X-rays aren't the most useful tool. I do find it interesting that both myself and others have had active and uncontrolled RA in certain joints that is labelled as OA damage.

  • this may be odd, and I may be unique, but when I was having anti-tnf I found the joints which my rheumy said were osteo got better as well as the rheumatoid ones. Can it be that anti-tnf helps all sorts of pain, or maybe the lessening pain all round was a relaxation thing.

  • Yes that is interesting. Although I sometimes get saddened on this site by how much people feel OA is a mild thing to be dismissed compared to their inflammatory arthritis. I know that someone from the helpline said that they have people calling them about OA and asking if there are drugs to slow things down - and then getting really upset to learn that there are no drugs which modify OA as there are for RA. Pain is pain is pain and not everyone with OA only has it in a thumb. However personally I think it's the crossover in autoimmunity (ie diseases such as Sjogrens, Lupus, Psoriasis, Vasculities and Crohns to name but a few) that's really interesting to me. The mechanical stuff hasn't affected me by causing much damage yet and so I tend to focus on RA as an autoimmune disease. The fact that my OA arrived shortly after my RA makes me think that they egg each other on really. x

  • Well, i had rheumatic fever aged 4 (now 65) and suffered pain most all of my life after and was always told it was OA, my knees, hips, spine and neck greatly affected. But 11 yrs ago after contracting very severe virus I was completely struck down with what was later diagnosed RA, and that was me done for I can tell you!! Now after all this time, my Rheumy classes the OA as secondary to RA, so I am totally confused by it all. All i really know is I suffer much pain and disability and I am the proud owner of both OA and RA. I can tell the difference in the pain though, OA is a grumbling, grinding kind of pain, whereas RA pain is hyper bad, burning, feels like a million bee stings kind of awful thing which completely takes my body over, and of course the total fatigue with RA is all encompassing! I saw a very good ortho surgeon couple of weeks ago about my wrists. He got my x rays up and was able to show me clearly the RA erosions and then the OA wear and tear damage sustained. This is the first time I have ever seen the differences between the two types, he told me I had a lovely cocktail mix of RA/OA and was most sympathetic, and i am now awaiting complicated surgery. Lynda x

  • Thanks everyone and I am definitely going to speak to my friend again and tell her all your info. Yes I too thought there was little treatment for OA and when I googled aggressive OA it described an erosive type that some think may be linked to an autoimmune inflammatory process! My poor friend has also quite significant osteoporosis and I really fear for her. Thanks all Rx

  • There is an erosive inflammatory osteoarthritis, as my sister has this in her hands. And it's really horrible and there's nothing that can be done about it.

    But one of the differences is that osteo isn't systemic, so yes it affects your joints and a damaged painful joint hurts just the same no matter what caused it, but it doesn't go on to affect other bits of your body like RA can if left untreated. So there is another aspect as well as the joint damage.

    Like many others I have both, but most of the OA affected joints are I think a result of age and whilst uncomfortable aren't as bad as the OA damage I have in my back which I reckon hurts more than the RA affected joints.... So it's all a bit of a balancing act to manage the different types of damage!

  • I joined Arthritis Care back in 1980's and asked then for a booklet on having both diseases at once as I had them both. Was told that not many people had both at nce. The more I talk around the more people say they do. I can't write one but would love guidance on managing both diseases. If you treat one it seems from their books to be different to treatign the other. I am baffled and try to do my best withthe Tai chi and massages. Still wish I could take a painkiler though esp after this accident I had last week when I impinged the shoulder and have a bruise black on my arm 8 inches long and around 4 inches wide. A and E have seen it and I am using arnica gel on it

  • Yes that arthritis care booklet is very useful. I've got both too,

  • Yes they are useful and I cannot deny it. But why not a booklet with both RA and OA in treated together for those of us who have both. Sometimes the info just get a bit mixed up in my head as to what to do. I also have neurological pains and one consultant many years ago also add fibro though I do not think I have that. Can someone write one? Even if it bought in a shop and not a freebie [I know it is paid for by the members].

  • I've got both& like Tilda said they can tell by the hands! Anyway that's what my rheumy said. He also thinks that there will be other classifications of arthritis - It's not as black & white as a lot of doctors would like to believe it is!

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