Arthritis Types: Osteoarthritis vs Rheumatoid vs Gout

Arthritis is not a single disease but an umbrella term covering more than 100 conditions affecting the joints. The three most common types — osteoarthritis, rheumatoid arthritis, and gout — have distinctly different causes, presentations, and treatments, making correct identification essential for appropriate management.

Osteoarthritis (OA) is the most common joint disease worldwide, characterized by cartilage breakdown, subchondral bone changes, and synovial inflammation. It affects primarily weight-bearing joints (knees, hips) and hands in older adults. Pain worsens with activity and improves with rest. Morning stiffness lasts less than 30 minutes. X-rays show joint space narrowing, osteophytes, and subchondral sclerosis.

Rheumatoid arthritis (RA) is a systemic autoimmune disease causing persistent synovitis, erosive joint damage, and extra-articular manifestations (nodules, vasculitis, cardiopulmonary involvement). It characteristically affects the small joints of hands and feet symmetrically, with pronounced morning stiffness lasting > 60 minutes. Positive rheumatoid factor and anti-CCP antibodies are diagnostic. Early DMARD treatment (methotrexate, biologics) is critical to prevent irreversible joint damage.

Gout is caused by monosodium urate crystal deposition in joints due to hyperuricemia. Attacks begin suddenly, often at night, with excruciating pain, swelling, redness, and warmth — classically in the first metatarsophalangeal joint ('podagra'), ankle, or knee. Serum uric acid > 360 μmol/L (6 mg/dL) defines hyperuricemia. Acute attacks are treated with NSAIDs, colchicine, or corticosteroids. Long-term urate-lowering therapy with allopurinol prevents recurrence.

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