Inflammatory Arthritis vs. Non-inflammatory Arthritis: Differences Worth Knowing

Overview of Arthritis

Arthritis is a general term used to describe many conditions that cause inflammation of the joints. Arthritis causes soreness, stiffness, swelling, and pain.(1,2,3,4) There are over 100 different types of arthritis, all of which have different causes and treatments. The symptoms of arthritis typically develop over a period of time, but in some cases, the onset can be sudden.

Arthritis is commonly observed in people over the age of 65, but sometimes it can also affect children, teenagers, and younger adults. Arthritis is also more common in women than in men and in people who are overweight or obese.(5,6,7)

Inflammatory and non-inflammatory arthritis are the two most common types of arthritis. The most common type of inflammatory arthritis is rheumatoid arthritis, while the most common type of non-inflammatory arthritis is osteoarthritis.(8,9,10,11)

Difference Between Inflammatory vs. Non-inflammatory Arthritis Based on Causes

Osteoarthritis and rheumatoid arthritis have very different causes.

Causes of Inflammatory Arthritis (Rheumatoid Arthritis)

Rheumatoid arthritis is a complicated disease and an autoimmune disease. It is known to affect the following body parts:(12,13)

  • Hands
  • Elbows
  • Wrists
  • Feet
  • Ankles
  • Knees

Rheumatoid arthritis is an autoimmune disease like psoriasis or lupus, meaning that it is the body’s own immune system that starts to attack the healthy tissues and joints. The exact cause of rheumatoid arthritis, though, still remains a mystery. Since women are more susceptible to developing rheumatoid arthritis than men, experts believe that there might a genetic or hormonal factor involved in the causes of this condition.

Rheumatoid arthritis may also affect children and other body parts like the lungs and eyes.(14)

Causes of Non-inflammatory Arthritis (Osteoarthritis)

Osteoarthritis is known as non-inflammatory arthritis, but it can still cause some inflammation in the joints. The main difference is that the inflammation caused by osteoarthritis is likely due to wear and tear.(15)

Osteoarthritis is caused when the cartilage of a joint breaks down. Cartilage is the tissue that covers and provides cushioning to the ends of the bones in a joint.(16)

If you injure a joint, it can sometimes accelerate the progression of osteoarthritis, but even day-to-day activities can cause osteoarthritis later in life. Being overweight or obese and putting the extra strain on your joints can also be a cause of osteoarthritis.

Non-inflammatory arthritis is known to usually affect the knees, hips, hands, and the spinal cord.

Difference Between Inflammatory vs. Non-inflammatory Arthritis based on the Symptoms

The symptoms of osteoarthritis and rheumatoid arthritis are quite similar. Both conditions involve pain, stiffness, and inflammation in the joints. However, the stiffness in rheumatoid arthritis tends to last for a longer time as compared to osteoarthritis flare-ups. The stiffness in rheumatoid arthritis is also worse in the morning, right after getting up.(17)

On the other hand, in people with osteoarthritis, the discomfort is typically only concentrated in the impacted joints. Since rheumatoid arthritis is a systemic disease, its symptoms also include fatigue and weakness.(18)

Difference Between Inflammatory vs. Non-inflammatory Arthritis Based on Diagnosis

Your doctor will begin with a physical examination of your joints and then order some screening tests. For example, an MRI scan can help reveal the exact condition of the soft tissues in a joint, like cartilage. Conventional X-ray are also used to look for cartilage breakdown, bone erosions, or damage.

Your doctor may also order a blood test to find out if you are experiencing joint problems due to rheumatoid arthritis. A blood test searches for the presence of the rheumatoid factor, or cyclic citrullinated antibodies that are commonly found in the bloodstream of people with rheumatoid arthritis.(19)

Difference Between Inflammatory vs. Non-inflammatory Arthritis Based on Treatments

As mentioned above, the treatment of the different types of arthritis varies depending on the exact type.

Treatment for Rheumatoid Arthritis

Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and corticosteroids may be prescribed to help alleviate the pain and swelling in people with rheumatoid arthritis. However, there are more specific drugs that are specially designed for the treatment of this form of arthritis. Some of these include:

Biologics: Biologics are a class of drugs that respond to your immune system’s response that is causing the inflammation instead of blocking the entire immune system.(20) However, biologics are not typically the first line of treatment for rheumatoid arthritis. If you have moderate to severe rheumatoid arthritis, and your condition has not improved after other treatments like disease-modifying antirheumatic drugs (DMARDs), it is only then that your doctor will consider biologics. Biologics may be prescribed either alone or along with other medications for rheumatoid arthritis. Here are some of the common biologic drugs that are prescribed for treating rheumatoid arthritis:

  • Abatacept (brand name: Orencia)
  • Adalimumab (brand name: Humira)
  • Belimumab (brand name: Benlysta)
  • Certolizumab (brand name: Cimzia)
  • Etanercept (brand name: Enbrel)
  • Golimumab (brand name: Simponi, Simponi Aria)
  • Infliximab (brand name: Remicade)
  • Rituximab (brand name: Rituxan)
  • Tocilizumab (brand name: Actemra)
  • Tofacitinib (brand name: Xeljanz)

Disease-modifying antirheumatic drugs (DMARDs): This class of drugs works by blocking the body’s immune system response, which helps slow down the progression of rheumatoid arthritis.(21) There are many different medications that are used as DMARDs for treating rheumatoid arthritis, but some of them are prescribed from frequently than others. For example, hydroxychloroquine (brand name: Plaquenil) and sulfasalazine (brand name: Azulfidine) are prescribed for mild rheumatoid arthritis, while methotrexate is one of the most commonly prescribed DMARD for rheumatoid arthritis.

Janus kinase (JAK) inhibitors: Janus kinase inhibitors are a new type of DMARD that works by blocking certain responses of the immune system to help prevent joint damage and inflammation.(22)

Even today, new drugs are being researched and tested to treat rheumatoid arthritis and reduce the severity of symptoms.

Treatment for Osteoarthritis

Doctors are likely to prescribe non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen for mild cases or minor flare-ups of osteoarthritis.(23)

Corticosteroids may also be prescribed for reducing inflammation in the joints. These can either be taken orally or by injection.

Physical therapy can also help improve your muscle strength and also increase your range of motion. Strong muscles will be able to provide better support to the joint and also help relieve pain during movement. However, when the damage to the joint is severe, your doctor may recommend that you need to undergo surgery to repair or replace the affected joint. This is usually done only after trying other treatments, and they have failed to provide you with adequate pain relief and mobility.

Can Lifestyle Changes Help in Arthritis?

Living with rheumatoid arthritis or osteoarthritis can be challenging. Weight loss and regular exercise can help reduce the strain on your joints. Regular exercise will not only build support to your joints by strengthening the muscles around them, but it will also help you lose weight.

For people with severe arthritis, assistive devices like raised toilet seats, canes, or other such equipment that help you drive a car or perform daily tasks will help you keep your independence and overall quality of life.

You should also focus on eating a healthy diet that is rich in fruits, vegetables, whole grains, low-fat proteins. In addition, a diet that focuses on relieving inflammation and prevents weight gain is the ideal diet for arthritis.

Conclusion

Even though there is no cure for rheumatoid arthritis or osteoarthritis, both conditions can be managed and are treatable. Getting an early diagnosis of arthritis and starting treatment early can help you get a better outcome. Remember that it is not a good idea to just chalk joint stiffness and pain to the signs of natural aging. If you have pain, swelling, or stiffness in your joints, you should consider making an appointment with your doctor. This is all the more recommended if these symptoms have started interfering with your day-to-day activities.

Aggressive and early treatment, along with a better understanding of your condition, can help you remain active and continue to enjoy a good quality of life in the long run.

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