Topic Overview

Many diseases in addition to rheumatoid arthritis may
cause joint pain.

  • Osteoarthritis: The
    illness most often confused with rheumatoid arthritis is osteoarthritis.
    Although these diseases share the symptom of severe joint pain with reduced
    mobility, they have distinct causes and treatments.

    • Osteoarthritis
      is caused by wear and tear over time or by injury to the joints, which results
      in the degeneration of the hard, smooth layer of cartilage that normally covers
      and protects the ends of the bones.
    • Unlike rheumatoid arthritis,
      osteoarthritis is not usually associated with activation of the
      immune system, so people with osteoarthritis do not
      have the systemic symptoms of rheumatoid arthritis such as fever and fatigue
      that are caused by the release of chemical messengers from immune cells.
    • Patients with osteoarthritis may develop bony enlargements of the
      affected joints, but they do not have the signs of inflammation around the
      joints, such as warmth, redness, and soft swelling.
    • Because
      rheumatoid arthritis is a systemic disease, which means that it spreads freely
      through the body as it follows the flow of immune cells in the bloodstream, it
      most commonly affects joints symmetrically on both sides of the body. By
      contrast, osteoarthritis is often more localized, especially when a joint
      becomes arthritic secondary to injury, and therefore osteoarthritis is more
      likely if the arthritis is on only one side of the body, or asymmetric.
    • Different joints are preferentially affected by the two diseases.
      Rheumatoid arthritis is most common in the small joints, such as the knuckles,
      wrists, elbows, ankles, toes, shoulders, and neck. Osteoarthritis very commonly
      affects the large weight-bearing joints in the hips and knees, as well as the
      thumb and the joints closest to the tips of the fingers.
  • Other joint diseases: Like
    rheumatoid arthritis, other
    autoimmune diseases can also attack the tissues of the

    • Lupus: Lupus
      most often occurs in young women, and it affects organs all over the body.
      Other symptoms of lupus include pleurisy, butterfly facial rash, sun-sensitive
      rashes, hair loss, oral ulcers, rash, and seizures.
    • Sjögren’s syndrome: Symptoms include dry eyes and dry
      mouth (sicca syndrome) and sometimes joint pain.
    • Sarcoidosis, which can also affect the lungs and other
      organs throughout the body
    • Some forms of polymyositis, an
      autoimmune disorder affecting the muscles
    • A class of diseases
      called the spondyloarthropathies, including
      reactive arthritis,
      psoriatic arthritis, and
      ankylosing spondylitis
  • Infections: If bacteria or
    viruses get into the joint space, they will initiate a local immune response
    leading to swelling of the joint and pain. Bacterial infections of joints will
    cause severe pain and swelling only in the single joint, because the infection
    tends to be localized. Viruses-especially hepatitis B and C, HIV, and
    parvovirus-can affect single joints but also can cause a generalized reaction
    that affects joints all over the body. Infection-associated arthritis generally
    resolves when the infection is treated.
  • Gout: Uric acid crystals that form in
    gout can get into the joint and cause periodic acute
    joint pain and swelling. When gout is treated with medicines, the arthritis
    that it causes goes away.
  • Pseudogout:
    Calcium pyrophosphate crystals get into the joint and cause acute pain and
    swelling. When treated with medicines, the pain disappears.
  • Polymyalgia rheumatica: This is seen in people older
    than 50, with a usually abrupt onset of pain and stiffness in the neck, both
    hips, shoulders, and buttocks.
  • Fibromyalgia:
    fibromyalgia syndrome can cause joint pain but can be
    distinguished from rheumatoid arthritis by the predominance of pain and tender
    points in soft tissue and the absence of swollen joints. Fibromyalgia is a
    poorly understood disorder in which it appears that the body’s perception of
    normal stimuli is altered so that widespread pain occurs, some of which is in
    the joints.
Examples of causes of joint pain by distribution of affected joints

Type of arthritis

Affects many joints on both sides of the body

Affects a few joints often only on one side of the body

Affects only one joint

Rheumatoid arthritisCommonUncommonRare
Polymyalgia rheumaticaCommonUncommonRare
Psoriatic arthritisCommonCommonUncommon
Viral infectionsCommonCommonUncommon
Bacterial infectionsRareUncommonCommon
Juvenile chronic arthritisUncommonCommonCommon

Reactive arthritis,
ankylosing spondylitis


Related Information


ByHealthwise Staff
Primary Medical Reviewer Anne C. Poinier, MD – Internal Medicine
E. Gregory Thompson, MD – Internal Medicine
Martin J. Gabica, MD – Family Medicine
Kathleen Romito, MD – Family Medicine
Specialist Medical Reviewer Nancy Ann Shadick, MD, MPH – Internal Medicine, Rheumatology

Current as ofOctober 10, 2017