Arthritis Comparison: Osteoarthritis vs Rheumatoid Arthritis vs Gout — Joint Pattern, Labs, Treatment
An NCLEX question gives you a client with joint pain, morning stiffness, and a swollen first toe — and three answer choices with completely different medications. Picking the wrong arthritis means picking the wrong drug. The joint pattern, lab marker, and stiffness duration are your fastest discriminators.
Comparison
- Cartilage wear-and-tear; non-inflammatory
- Age, obesity, joint overuse
- Autoimmune synovitis; pannus destroys joint
- Women, genetic (HLA-DR4)
- Monosodium urate crystal deposition
- Hyperuricemia; purines, alcohol, diuretics
- ★Heberden (DIP) & Bouchard (PIP) nodes
- Asymmetric DIP; AM stiffness <30 min, eases at rest
- Symmetric small joints (MCP, PIP, wrist)
- AM stiffness >1 hr, eases with use; ulnar deviation
- ★Acute monoarticular — 1st MTP (podagra)
- Sudden nocturnal; red hot tender; tophi if chronic
- Normal ESR/CRP
- X-ray: joint-space narrowing, osteophytes
- ★RF + and anti-CCP +
- ↑ ESR/CRP; symmetric erosions on X-ray
- ★Synovial fluid: needle-shaped urate crystals
- Uric acid > 6.8 (may be normal in flare)
- Joint protection; heat; assistive devices
- Balance activity with rest
- Start DMARDs early to prevent erosion
- ROM exercises; splint in functional position
- Rest + elevate joint during acute flare
- Hydrate; avoid pressure on joint
- Acetaminophen first, then NSAIDs
- No DMARDs; joint replacement if severe
- Methotrexate is gold-standard DMARD
- NSAIDs for symptoms; biologics if needed
- Acute: colchicine, NSAIDs, or steroids
- Chronic: allopurinol or febuxostat
- Weight loss; low-impact exercise
- MTX: avoid alcohol, take folic acid
- Report sore throat/fever (immunosuppression)
- Avoid purines: organ meat, shellfish, beer
- Don't start/stop allopurinol during a flare
- Progressive disability → replacement eval
- Atlantoaxial (C1–C2) instability
- Vasculitis; severe systemic flare
- Urate nephrolithiasis; recurrent flares
- Chronic pain, joint deformity, disability
- Joint destruction; lung/eye, CV disease
- Tophi; chronic gouty arthritis; urate nephropathy
Osteoarthritis (OA)
- Cartilage wear-and-tear; non-inflammatory
- Age, obesity, joint overuse
Rheumatoid Arthritis (RA)
- Autoimmune synovitis; pannus destroys joint
- Women, genetic (HLA-DR4)
Osteoarthritis (OA)
- ★Heberden (DIP) & Bouchard (PIP) nodes
- Asymmetric DIP; AM stiffness <30 min, eases at rest
Rheumatoid Arthritis (RA)
- Symmetric small joints (MCP, PIP, wrist)
- AM stiffness >1 hr, eases with use; ulnar deviation
Osteoarthritis (OA)
- Normal ESR/CRP
- X-ray: joint-space narrowing, osteophytes
Rheumatoid Arthritis (RA)
- ★RF + and anti-CCP +
- ↑ ESR/CRP; symmetric erosions on X-ray
Osteoarthritis (OA)
- Joint protection; heat; assistive devices
- Balance activity with rest
Rheumatoid Arthritis (RA)
- Start DMARDs early to prevent erosion
- ROM exercises; splint in functional position
Osteoarthritis (OA)
- Acetaminophen first, then NSAIDs
- No DMARDs; joint replacement if severe
Rheumatoid Arthritis (RA)
- Methotrexate is gold-standard DMARD
- NSAIDs for symptoms; biologics if needed
Osteoarthritis (OA)
- Weight loss; low-impact exercise
Rheumatoid Arthritis (RA)
- MTX: avoid alcohol, take folic acid
- Report sore throat/fever (immunosuppression)
Osteoarthritis (OA)
- Progressive disability → replacement eval
Rheumatoid Arthritis (RA)
- Atlantoaxial (C1–C2) instability
- Vasculitis; severe systemic flare
Osteoarthritis (OA)
- Chronic pain, joint deformity, disability
Rheumatoid Arthritis (RA)
- Joint destruction; lung/eye, CV disease
★ marks the fact that sets a column apart.
Clinical Pearl
OA = big joints, no labs. RA = small joints, symmetric, RF+. Gout = great toe, uric acid crystals.
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