Rheumatoid Arthritis vs Osteoarthritis on the NCLEX
Symmetry, morning stiffness duration, systemic signs, and the med ladder for each.
One is autoimmune and systemic, one is mechanical wear. Four contrasts answer nearly every question.
The four contrasts
Symmetry: RA is bilateral and symmetric, small joints first (hands, wrists). OA is asymmetric, weight-bearing joints (knees, hips, spine) plus the fingers. Morning stiffness: RA lasts more than an hour. OA resolves in under 30 minutes. Systemic signs: RA brings fatigue, low-grade fever, anemia, and rheumatoid nodules. OA has no systemic signs: it is local wear. Activity: OA pain worsens with use and eases with rest. RA often improves somewhat with gentle movement.
Hands tell the story
RA: boggy, warm, swollen joints; late deformities include swan-neck and boutonniere and ulnar drift. OA: bony, hard nodes: Heberden's at the DIP joints, Bouchard's at the PIP joints. Labs: RA shows positive RF, anti-CCP (most specific), elevated ESR and CRP. OA has no diagnostic labs; X-ray shows joint-space narrowing and osteophytes.
RA medications
Start disease-modifying therapy early to prevent joint destruction. Methotrexate is first-line: teach folic acid supplementation, strict contraception (teratogenic), no alcohol, and regular CBC and liver monitoring. Biologics (etanercept, adalimumab, and others) suppress immunity: screen for TB before starting and hold for active infection. NSAIDs and short steroid courses control symptoms but do not slow the disease.
OA management
No drug modifies OA. Acetaminophen or topical NSAIDs first, oral NSAIDs with GI and renal caution, intra-articular steroid injections for selected joints. The real therapy: weight loss (biggest modifiable factor for knees), low-impact exercise, PT, assistive devices, and joint replacement when function fails.
Frequently asked
Stiff hands for 15 minutes each morning, worse after gardening. RA or OA?
OA. Short stiffness, activity-related pain, no systemic features.
Why does an RA patient on a biologic need a TB test?
Biologics blunt the immune response that keeps latent TB contained. Screening comes before the first dose.
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