Compare conditions

Put any two — or three — conditions side by side, adult or pediatric, to spot the look-alike differences fast, row by row.

Osteoarthritis

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In one line

·The slippery cushion inside the joint has worn away, leaving bone rubbing on bone.

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Normal physiology

·Your joints are where two bones meet. A smooth, slippery cushion called cartilage covers the ends of the bones so they glide past each other without grinding. A thin lining called the synovium wraps the joint and makes a slippery oil (synovial fluid) to keep everything moving smoothly. Cartilage has no blood vessels, so it cannot really heal once it is damaged.

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What goes wrong

·Years of use — plus a little background inflammation — wear the cartilage down faster than the body can fix it. The bone underneath thickens and grows lumpy bumps, trying to spread out the load.

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Hallmark signs

·Pain in big joints — hips, knees, hands, or lower back
·Joint stiffness that loosens after you move around
·Pain that gets worse as the day goes on or after you use the joint a lot
·Hard, bony bumps on finger joints — Heberden nodes at the tips or Bouchard nodes in the middle
·Pain at the base of the thumb that makes pinching and gripping hard
·Joint swelling that feels firm, not squishy
·A grinding or crunching feeling (crepitus) when you move the joint
·Loss of range — you cannot bend or straighten the joint as far as before

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Red flags · escalate now

·Sudden, severe joint pain or swelling in one joint that comes on in hours — may be infection or gout instead.
·Fever, night sweats, or unexplained weight loss — raises concern for infection or a different type of arthritis.
·Numbness, tingling, or weakness below the painful joint — suggests a nerve is being pinched and needs urgent evaluation.
·Joint pain plus a new rash, eye redness, or belly symptoms — points toward autoimmune arthritis, not osteoarthritis.
·Pain so bad that it wakes you from sleep or keeps you from walking — may need joint replacement surgery soon.

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Workup

·X-ray of the painful joint (knee, hip, hand)
·Red blood cell (Erythrocyte) sedimentation rate (ESR) and C-reactive protein (CRP)
·Rheumatoid factor (RF) and anti-CCP antibody
·Joint aspiration (synovial fluid analysis) if there is swelling
·MRI of the joint (only if X-ray is normal but pain is severe)

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Treatment

·Weight loss and low-impact exercise (swimming, water aerobics, biking)
·Acetaminophen or NSAIDs (ibuprofen, naproxen, diclofenac)
·Topical NSAIDs (diclofenac gel) or capsaicin cream on the painful joint
·Intra-articular corticosteroid injection (triamcinolone, methylprednisolone)
·Intra-articular hyaluronic acid injection (viscosupplementation)
·Duloxetine (an SNRI antidepressant that blocks pain)
·Joint replacement surgery (total knee arthroplasty, total hip arthroplasty)

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NCLEX trap

·Osteoarthritis causes mild swelling or none at all — it is cartilage wearing down, not a hot immune attack. The joint may feel stiff or achy, but it will NOT be bright red, hot, or puffy like rheumatoid arthritis or an infected joint. Any redness or heat is a red flag for something else.
·Osteoarthritis stiffness lasts less than 30 minutes and melts away quickly once you start moving — overnight, fluid pools in the worn joint and makes it feel tight. Rheumatoid arthritis stiffness lasts over an hour because the immune system is actively inflaming the joint, not just fluid pooling. Time the stiffness to tell them apart.
·Age raises risk, but so do obesity (extra load crushes cartilage faster), old injuries (a torn meniscus or ACL sets up uneven wear), repetitive jobs (kneeling, lifting, or gripping tools every day), and genes (some families have weaker cartilage). Losing weight, building muscle around the joint, and moving gently can slow the wear down — it is NOT unstoppable.
·Early osteoarthritis hurts before the X-ray shows anything — cartilage does not show up on X-rays, so you diagnose it by the story (pain with use, stiffness under 30 minutes, a crackling feel or sound (crepitus) like gravel grinding) and the exam (bony bumps, limited range, pain with movement). X-rays confirm it later by showing narrowed joint space and bone spurs, but a normal film does NOT rule it out early.
·Start with physical therapy to strengthen muscles that support the joint, weight loss if the patient is overweight (every pound off the scale takes 4 pounds of pressure off the knee), acetaminophen for mild pain, and NSAIDs like ibuprofen for flares. Save steroid injections for when the joint swells badly, and save surgery (joint replacement) for when the patient cannot walk or do daily tasks anymore. Opioids carry high addiction risk and do NOT fix the upstream problem.
·Rheumatoid arthritis is the immune system attacking the joint lining (synovium), so you need disease-modifying drugs like methotrexate to shut down the immune attack. Osteoarthritis is cartilage wearing away from mechanical load and low-grade inflammation, so you need to reduce the load (lose weight, strengthen muscle, rest when sore) and control pain — completely different upstream breaks, completely different fixes.

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