Osteoarthritis and Rheumatoid Arthritis

This blog was transcribed from our 13th episode of our Spine & Rehab Specialists podcast series featuring Harry Koster, PT, Cert. MDT and Marlene Gomez, PT, DPT. Scan this QR code or click the button on the right side of this page if you are interested in listening to this, or any of our other episodes!

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The word Arthritis can be broken down into two parts. The first part “artho” means joint and “itis” means inflammation so putting it all together Arthritis can be a number of different conditions that affect and cause inflammation in the joints. The majority of the time people assume Arthritis is just an “old age” thing and one day we will all have to accept it, but that is definitely not the case. There is a specific kind of Arthritis that does progress over time with age but that is specific to Osteoarthritis and there are many different types of Arthritis that are not associated with older age. One of the most common types of Arthritis is Rheumatoid Arthritis, it is more systemic and a little bit more severe but it is not one that automatically comes with old age.
 
Osteoarthritis tends to develop over time progressively and causes what some people call “wear and tear” to the cartilage surrounding the joint. Most of the joints in our body have a thin lining of connective tissue called cartilage. Cartilage surrounds the ends of the joints and its function is t help reduce friction when the joints are moving, it helps everything move smoothly. Compare it to ice for an example, a smooth layer of ice is ideal for gliding smoothly across but if you were to take some tool and crack the ice it becomes rough which is what’s happening to the cartilage. There’s some damage and wear and tear in the in the cartilage it’s not as smooth as it used to be, so the joints won’t move as smoothly anymore which causes those symptoms like stiffness and joint pain. Normally cartilage is very smooth but over time it can get sand-papered out.
 
Genetics play a part in causing Arthritis, some people might genetically be more prone to getting it than others but there are multiple different things that can contribute to it beyond just genetics. Things like injuries, bad habits, and more can contribute to that wear and tear that’s happening. Arthritis is typically seen in joints called weight bearing joints so we see a lot of people who have it in the knees and the hips because they carry a lot of load but it can affect other joints as well. We take into consideration what the patient does throughout the day, we need to know what their occupation is or if they play any sports or anything of that repetitive nature where they would be using the same joint over and over. For example, a baseball pitcher uses the shoulder over and over they might get arthritis in the shoulder or someone who has a very labor-intensive job that requires a lot of bending or picking up that’s when we see it in the knees, the hips, the back/spine, and places like that.
 
When most people find out they have Arthritis they automatically think they are going to have to choose between living with it and the pain or getting some kind of replacement surgery or something of that surgical nature, but that is usually not the case. There is a lot of evidence that Physical Therapy does reduce a lot of the pain and symptoms and also improves function. A lot of what we target is improving mobility in the joint, reducing the pain and reducing the symptoms. When people have arthritis they typically tend to not want to move as much and that is what contributes the most to the stiffness in the joints, the less you move you the weaker and tighter your muscles get. Although the part of the body that has Arthritis is the main point of the pain and discomfort, it is not the only part of the body we look at.
 
For example, if someone has arthritis in the knees we will not only address the muscles immediately around the knee, we will also take a gool look at the hip to see if there is any weakness or lack of mobility that the knee has to take the extra load for. It’s a matter of us taking a look at the whole body not just that one joint, we need to identify what deficits and problems there are and then really address them. As Physical Therapists we can’t go in there and replace the cartilage or try and fix everything but the benefits people experience from trying Physical Therapy as a treatment are phenomenal.
 
Surgeries are a big deal they are not just expensive, the recovery process is a big long process to deal with as well and it can be very painful. Some people come into our clinic looking like they are heading towards a total hip or total knee replacement and they end up not needing it or at least postponing it by a couple of years because of the care and education we provide through Physical Therapy. Plus, if you have a surgery you are going to need Physical Therapy afterwards either way so it definitely can be beneficial to start at therapy first. PT beforehand is going to be beneficial as far as strengthening the muscles and gaining some joint range of motion back so that the recovery is a little easier on your body, and also in the aspect of educating the patient on exactly what is going to happen to their body and how they should go about taking care of it after.
 
When treating Osteoarthritis specifically the most common treatment options are pain medications for the pain and anti-inflammatory medication to help if there is some inflammation or swelling which is often present with Osteoarthritis. Other than that there’s more invasive treatments like surgeries or certain injections to help the cartilage but even then these are all temporary solutions. And there is obviously also, Physical Therapy. So far for people with Osteoarthritis, Physical Therapy has proven to be very beneficial. It’s really a matter of the earlier you do it the better and more effective it will be as a treatment. After a certain point with Osteoarthritis there can be major issues inside the joint that can be harder to treat but if someone with that kind of damage had come in maybe a few years earlier that damage could have been majorly slowed and even prevented.
 
Physical Therapy for someone with Osteoarthritis would consist of a few different things. Education is one of the most important things we do here for our patients, we can educate patients on techniques they can use to preserve the joints and on how to do things and move in a better way that doesn’t put as much strain on the joints. Modifying certain activities helps a lot, we have seen patients that are trying to kneel but have a hard time getting up for an example, and when we watch them get up we notice they do it in a way that is putting more force through their knees than necessary. We look at things like this so we can modify the way patients move and show them a better way to get up from a kneeling position for example to help them protect their joints in the long run. They aren’t necessarily moving incorrectly but there is definitely a better way.
 
Treatment options for Rheumatoid Arthritis is a little different. Rheumatoid is different from Osteo Arthritis because it’s systemic, which means it’s a chronic and inflammatory condition. It’s inflammatory in that it’s the immune system that is attacking the joints in the body, it can even involve multiple joints and it tends to progress and become a little more debilitating over time. People with Rheumatoid Arthritis tend to experience not only pain and inflammation in the joints, but joint stiffness, redness and warmth in the joints, and the joint stiffness in the morning tends to last longer. Osteoarthritis can cause inflammation too on some occasions but with Rheumatoid Arthritis it is a much bigger deal.
 
Patients who suffer from Rheumatoid also tend to get flare ups where there’s even more inflammation and symptoms and joint stiffness and pain and even in extreme cases, joint and bone destruction. And because it’s systematic the patient during the flare up will feel just generally unwell, they might be tired or have a low grade fever even. There can be some erosion of the bone itself and that’s where you start seeing the damage and the deformities in the joints. For example Rheumatoid in the hands over time may look like bent and stiff fingers and just completely different. It’s definitely a more sever condition than Osteoarthritis and not necessarily related to wear and tear, almost any age can be affected its not just specific to the older population.
 
The important thing to remember when treating Rheumatoid is that its systemic and chronic so early on you really do need to see a specialist to prevent the eventual damage and try to slow the progression of the joint damage. A doctor might offer treatments such as cortical steroids and anti-inflammatories but also specific medications that are used to suppress the immune system because that is what is attacking their joints. These different medications and disease modifying drugs often come with a lot of side effects and at times can stop working when the patient’s body becomes accustomed to it causing the patient to switch often between a number of different medications. Cortical steroids can often weaken the bones as a side effect as well when the patient is already at risk of that just by having Rheumatoid.
 
When working with a Rheumatoid patient we also take into consideration the fact that their medication is suppressing their immune system so they might be more prone to infection that some of our other patients. We also have to consider if the patient is a fall risk and address their balance so they don’t end up suffering a bone injury on top of all the other pains that come with Rheumatoid.
 
There are many different kinds of arthritis but these are two of the most common and the teo we probably see the most of in our clinic.

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