The difference between rheumatoid arthritis and osteoarthritis

Published April 2024 | 6 min read
Expert contributors Krista Sutherland-Smith, Arthritis Australia; Claire Barrett, president of the Australian Rheumatology Association; Andrew Briggs, Australian Physiotherapy Association
Words by Trudie McConnochie

Osteoarthritis and rheumatoid arthritis are the most common forms of arthritis. Learn the difference between them, including symptoms and treatments.

When we talk about arthritis, you may think of an older person with stiff knuckles or a retired footy player with a dodgy knee. But Sydney executive assistant Ali Tawharu, who was diagnosed with rheumatoid arthritis at age 34, doesn’t fit any of the stereotypes – and her experience is not as uncommon as you might think.

The idea that arthritis is simply part of ageing is one of many misconceptions about this chronic condition, says Krista Sutherland-Smith, consumer information resource manager at Arthritis Australia. Part of the problem, she says, is that most people don’t know there are more than 100 types of arthritis, with osteoarthritis and rheumatoid arthritis being two of the most common.

"People often think osteoarthritis only affects old people and is from wear and tear on the joints, when in fact it’s a result of the joint working extra hard to repair itself," says Krista. "Rheumatoid arthritis, on the other hand, is an autoimmune disease that causes pain and swelling of the joints in addition to other inflammatory symptoms."

While both forms can be diagnosed at any age, "osteoarthritis tends to be more common in people aged over 40 or those who have had previous damage to the joint or joint injuries, for example from sporting injuries", explains Krista.

By contrast, rheumatoid arthritis is a progressive disease where the immune system attacks the lining of your joints, and it can also affect other parts of the body such as eyes, lungs and heart. It's most commonly diagnosed in people aged 30 to 60 and is more likely to affect women than men.

Around one in five Australians over the age of 45 is living with osteoarthritis, compared with almost 1 in 50 of the population with rheumatoid arthritis.

Ali, now 41, says she knew very little about arthritis before her diagnosis, which came after years of unexplained bouts of severe joint pain that would disappear then reoccur months later in a different part of her body. X-rays didn’t show anything concerning, so Ali’s mum, a nurse, suggested she request a blood test from her GP to rule out an autoimmune condition.

"When I went back to the doctor [for my results], he kind of went silent when he was reading them," she recalls. "My 'rheumatoid factors' were completely normal, but my 'anti-CCP' – which is one of the tests they do – was meant to be under five and came back at 659, and that was how they diagnosed me with rheumatoid arthritis."

Symptoms of osteoarthritis and rheumatoid arthritis

Joint pain and swelling are the main symptoms of both osteoarthritis and rheumatoid arthritis but there are some key differences in the way these two conditions present.

Osteoarthritis symptoms can also include:

• clicking or grating sensations in the joint
• worsening with physical activity (in the early stages).

Rheumatoid arthritis symptoms can also include:

• pain that’s worse in the mornings
• pain that’s sometimes symmetrical (like in both wrists)
• persistent fatigue.

While the precise causes of osteoarthritis and rheumatoid arthritis are unknown, getting older, being female, smoking and obesity are risk factors for the conditions, and family history can increase your likelihood of developing both conditions.

How are osteoarthritis and rheumatoid arthritis diagnosed?

Osteoarthritis and rheumatoid arthritis are diagnosed through physical examination and imaging studies, and may involve blood tests to check for inflammation and antibodies – including the anti-cyclic citrullinated peptide (anti-CCP) antibody test that Ali had to check for rheumatoid arthritis. X-rays are also used to measure the severity of the condition.

"Having a positive blood test [rheumatoid factor] does not always mean you have or will get rheumatoid arthritis as there are a number of situations where a test is false," notes Dr Claire Barrett, president of the Australian Rheumatology Association. "On the other hand, there are people who have rheumatoid arthritis in whom an antibody test is negative – so you need to see a rheumatologist to ensure the diagnosis of rheumatoid arthritis is correct."

If you have any arthritis symptoms, make sure you see your GP as soon as possible. Studies have shown an early diagnosis and treatment can make a big difference with rheumatoid arthritis, helping prevent joint damage and keeping you mobile.

Have you received a diagnosis of rheumatoid arthritis or osteoarthritis but want a second opinion? We can connect eligible members to a network of independent, Australia-based medical specialists for a free second opinion on a health condition you’re worried about^*. You’ll have the chance to ask questions so you can confidently make the best decision for your health.

What’s the best treatment for osteoarthritis and rheumatoid arthritis?

If you’re diagnosed with osteoarthritis, a team of healthcare professionals including a GP, specialist or physiotherapist, might recommend pain medication, devices to support your joint (such as braces) and exercises to improve your mobility and strength. You might also receive advice on supporting your mental wellbeing, managing pain and making lifestyle changes such as weight loss (if you’re overweight).

In advanced cases of osteoarthritis, you may need joint replacement surgery. HCF's No-Gap Joints program for primary hip and knee replacements gives eligible members peace of mind, with no out-of-pocket costs from hospital admission through to discharge and post-surgery rehab^{^} (excess may be payable under your policy). We've partnered with selected private hospitals and clinicians in NSW and Victoria to give greater flexibility and continuity of care while keeping costs down.

Professor Andrew Briggs, spokesperson for the Australian Physiotherapy Association, says surgery can sometimes be avoided through maintaining a healthy weight.

"There's emerging evidence that if you’re on the joint replacement waiting list and you engage in positive lifestyle changes that can be delivered by a multidisciplinary team – such as weight loss, physical activity and mental health support – then after a period of time, your condition can improve," says Prof Briggs. "And for a proportion of people, they don’t actually need to proceed to surgery, or it can be delayed."

Eligible HCF members⁺ can access the Osteoarthritis Healthy Weight for Life program, designed especially for people suffering from osteoarthritis of the knee and hip joints. The program aims to support you to reduce the pain in your joints, improve your mobility or prepare for hip or knee surgery.

Arthritis Australia also recommends physical activity to help manage rheumatoid arthritis, and your rheumatologist might prescribe a combination of medications to control pain and inflammation, minimise joint damage and block specific substances in the immune system.

"Rheumatoid arthritis is a complex chronic disease and the best outcome for you will be a combination of getting the right team, the right medical treatment, making the right lifestyle modifications and empowering yourself with the right information," says Dr Barrett.

Living with rheumatoid arthritis

For Ali, everyday life involves constant pain to some degree. When she experiences a 'flare' of inflammation, it can affect her ability to perform daily tasks, and when severe, it can stop her from sleeping, socialising and working.

"I’m quite lucky; my medication has managed to keep me pretty stable," she says. "I still have flares, but nothing as bad as what I had before I started medication. It’s a very invisible illness, and it’s quite hard to get your head around that when you’re in pain, you often don’t have anything that anybody can see."

Ali recommends getting a strong support network and, if possible, a job where you can work from home when commuting is too painful. Facebook communities help her feel less alone – although social media can be rife with unreliable advice, so she suggests checking with your doctor before trying anything new.

"I think being honest with your doctor is really important," she adds. "Keep a journal of when you have a flare, where it is, how long it lasts for … keep notes, take photos of your swelling. Be in control of your healthcare – that’s really important. And don’t be afraid to ask for help from everybody around you."

Need access to an online GP?

If you're experiencing joint pain, stiffness or any other health concerns, it’s important to speak to your doctor as soon as possible.

Our partnership with GP2U, an online video GP service, makes it easier for you to access telehealth services. All HCF members with health cover can access a standard online video GP consultation (up to 10 minutes) for a fee of $50.