Many diseases in addition to rheumatoid arthritis may
cause joint pain.
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.
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.
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
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.
SjÃ¶gren’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
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.
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.
The 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
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
ByHealthwise Staff Primary Medical ReviewerAnne C. Poinier, MD – Internal Medicine E. Gregory Thompson, MD – Internal Medicine Martin J. Gabica, MD – Family Medicine Kathleen Romito, MD – Family Medicine Specialist Medical ReviewerNancy Ann Shadick, MD, MPH – Internal Medicine, Rheumatology