Types of Arthritis: How to Tell Them Apart

“Arthritis” is not one disease. It is an umbrella term covering more than a hundred conditions that cause joint pain and swelling, and they are not treated the same way. Some are wear and tear. Some are your immune system attacking your own joints. One is caused by crystals.

Sorting out which one you have matters, because the treatment for each is different and a couple of them cause permanent damage if they are left alone too long.

The Two Main Categories

Almost everything falls into one of two groups, and the difference between them is the most useful thing on this page.

Mechanical arthritis is damage to the joint itself. Cartilage wears down, and bone starts rubbing on bone. Osteoarthritis is the main one.

Inflammatory arthritis is your immune system attacking healthy joint tissue. Rheumatoid arthritis, psoriatic arthritis and gout sit here.

They feel different, and you can often tell them apart from your own symptoms before any test is run.

Osteoarthritis

The common one. It builds up over years, and it tends to hit the joints that carry load or get heavy use: knees, hips, the base of the thumb, and the joints closest to the fingertips.

Typical pattern: pain that gets worse the more you use the joint and eases when you rest. Morning stiffness that lasts a few minutes and loosens up once you start moving. Often worse on one side than the other.

Age is the biggest risk factor, but so is joint injury and body weight. Every extra pound puts several times that load through a knee, which is why weight management is one of the few things that reliably changes the course of knee arthritis.

Rheumatoid Arthritis

An autoimmune disease, and a different animal from osteoarthritis.

Typical pattern: morning stiffness lasting more than an hour, which is the single most useful distinguishing feature. Swelling in the small joints of the hands and feet, usually symmetric, the same joints on both sides. Often joints that feel warm and puffy rather than just sore. Many people also feel generally unwell, tired, sometimes feverish.

Unlike osteoarthritis, this one gets better with movement and worse with rest.

Rheumatoid arthritis damages joints permanently, and the damage happens early. Starting treatment within the first several months of symptoms makes a real difference to what your hands look like in ten years. This is the type where waiting to see if it settles down costs you something.

Gout

Gout announces itself. A joint becomes intensely painful, red, hot and swollen over a few hours, often overnight, and often the big toe. Many patients describe not being able to tolerate a bedsheet touching it.

It is caused by uric acid crystals forming inside the joint. It usually hits one joint at a time.

Gout is very treatable, both the attack itself and the underlying uric acid level. It also travels with high blood pressure, kidney disease and metabolic problems, so a first attack is a reason to look at the rest of your health, not just the toe.

Psoriatic Arthritis

Occurs in some people with psoriasis, and occasionally shows up before the skin does.

Look for joint pain along with psoriasis patches, pitted or crumbling fingernails, and sometimes a whole finger or toe swelling up like a sausage rather than just the joint. It tends to be asymmetric, and it often involves the joints nearest the fingertips.

The Quickest Way to Tell Them Apart

If you take one thing from this page, take this.

Morning stiffness under 30 minutes that improves as you move points toward osteoarthritis, the wear-and-tear kind.

Morning stiffness over an hour, in symmetric small joints, with swelling points toward inflammatory arthritis, and that is the kind worth getting looked at sooner rather than later.

One joint suddenly red, hot and agonising points toward gout, or occasionally an infection.

When Not to Wait

Most joint pain can wait for a routine appointment. These cannot.

A single joint that is hot, red, badly swollen and painful, especially with a fever, needs to be seen the same day. An infected joint is a genuine emergency and can destroy the joint within days. If this is happening outside our office hours, our guide on where to go when you are sick covers the options.

Persistent swelling in several joints for more than six weeks also needs proper assessment rather than waiting, for the reason above about early treatment.

How It Gets Sorted Out

Usually with less testing than people expect.

The history does most of the work: which joints, how long the stiffness lasts, whether it is symmetric, what makes it better or worse. The examination adds to that.

From there we may run blood tests looking for markers of inflammation, antibodies associated with rheumatoid arthritis, and a uric acid level if gout is a possibility. X-rays show established joint damage, though they can look normal early on in inflammatory arthritis.

Treatment Depends Entirely on the Type

For osteoarthritis, the things that help most are not medications: strengthening the muscles around the joint, staying active, and weight reduction where relevant. Pain relief has a role, and joint replacement is a good option when the joint is worn out and other measures have run their course.

For rheumatoid and psoriatic arthritis, the goal is to switch off the immune attack, using disease-modifying medication rather than just pain control. This is where getting the diagnosis right early pays off.

For gout, the acute attack and the long-term uric acid level are treated separately, and skipping the second part is why some people keep having attacks.

Getting It Looked At

If your joints have been bothering you and you are not sure which of these it sounds like, that is a normal reason to come in. Much of the answer comes from the conversation.

You can book an appointment at our Rockville, Gaithersburg, or Columbia office, or read more about how we manage arthritis.