Adapting Care for Osteoarthritis and Rheumatoid Arthritis

[arthr-: joint] + [-itis: inflammation]

Many different types of chronic joint pain can be classified as arthritis (over 100, in fact). Arthritis can sometimes feel like an inevitable part of aging with many people unaware of available treatment options outside of medications and surgery. It’s time to dispel some myths about two of the most common types of arthritis and let you know about a natural way to start feeling better!

Osteo-: Bone

Osteoarthritis (OA) typically occurs in weight-bearing joints like the knees and hips but could occur in any joint. OA is typically the reason people undergo total knee and hip replacement surgeries but here’s some food for thought: just because you’re a candidate for surgery doesn’t mean surgery is the only option you have left.

The Truth Behind the Myth

The number one thing you need to remember is that the presence of OA does not necessarily equate to pain. Health professionals will explain OA with terms like “wear & tear” because it’s easy for patients to visualize the problem. However, it’s really too simplistic an explanation because if we were truly wearing down our joints with each passing day, every single person without exception would have painful arthritis by a certain age, and that’s just not the case. Despite OA being the most common joint disorder in the USA, only 10% of men and 13% of women aged 60 and older experience symptomatic OA1.

Even more interestingly, radiographic findings are not guaranteed to correlate with symptom severity. So much so that a knee OA study was able to separate participants into high pain, low-grade OA and low pain/high-grade OA groups and found two major differences between them: psychosocial measures and central sensitization2. The psychosocial measures that were significant among the high pain/low-grade OA group were:

  1. Greater sleep disturbances
  2. Symptoms of depression
  3. Greater pain catastrophizing (cognitive distortion resulting in the onset and perpetuation of irrationally predicting a negative outcome and believing that if that negative outcome should happen, it would be a catastrophe – e.g. “Every step that is painful is wearing away more cartilage and eventually I’ll be bone on bone and it will be excruciatingly painful and I will need surgery”) *Ironically, the more you anticipate and fear pain, the more pain you experience.

Those psychosocial factors may or may not resonate with you, but what is almost certainly occurring in cases of high pain OA is central nervous system sensitization. This is a decrease in the activation threshold of neurons (it takes less stimulation to make the neuron fire) usually experienced as non-painful things becoming painful, painful things becoming more painful, and all of that pain taking longer to fade. Your body has certain neurons that are part of your internal “alarm system” which normally have a high activation threshold – i.e. your alarm system only goes off when a stimulus has the potential to harm you. However, with central sensitization, this threshold decreases to create a hypersensitive alarm system that creates a pain response even for stimuli that won’t harm you.

Physical Therapy for OA

Traditional treatment can often focus on short-term symptom management, but we prefer to take a holistic three-pronged approach with the goal of diminishing symptoms in the long-term rather than perpetually masking them. This involves desensitization training, optimizing joint loading, and addressing psychosocial factors.

Desensitizing your central nervous system can involve techniques to improve your tolerance to touch, helping your body to remember what pain-free movement feels like, and recalibrating your threshold for non-harmful stimuli. Since at its core OA is a joint loading problem (i.e. more pain with movement than with rest), another major component to treatment is optimizing the way you load your joints. Reducing overall joint load is achieved through weight loss while optimizing the angle of joint loading can be achieved with physical therapy. With efficient joint loading, your tissues are able to perform at their best and with greater ease of movement while allowing the load to be more evenly distributed between adjacent joints.

Finally, you may require one or more referrals to build a multidisciplinary team for addressing any contributing psychosocial factors. With regards to sleep disturbances, good sleep is a major necessity for healing and our physical therapists are also able to teach you strategies to achieve the most comfortable sleep in any position.

Request your free Sleep E-Book by emailing [email protected]

We would also love to know what you’d like to read about next, such as intra-articular treatment options for knee OA.

Rheumat-: Flow/Spread

Rheumatoid arthritis (RA) typically affects the small joints of the hands and feet causing the characteristic finger joint malalignment you often see among older women (prevalence is 3:1 female to male). RA is the most common type of autoimmune arthritis, which means the immune system is mistakenly sending inflammatory agents to attack the body’s own joints. The causes of most autoimmune conditions have not been definitively identified beyond a genetic link and basic anti-inflammatory medication on its own is not enough to combat this condition.

As such, everyone with RA should have a rheumatologist on their multidisciplinary healthcare team (maybe a dietitian too) since specialized medication is an important part of successful management. Often an individualized combination of medications is required that includes a disease-modifying antirheumatic drug (DMARD).

The Truth Behind the Myth

People often think of RA as an old person’s disease while in fact there are 9 different types of juvenile idiopathic arthritis affecting children as young as 2 (renamed from rheumatoid as only one type is similar to adult RA). It’s also possible to experience both OA and RA simultaneously. Finally, it’s not uncommon for people to want to rest and not aggravate their joints (or have been advised to do so by old-school specialists), but this actually does a disservice.

Those with RA have an associated increased risk for cardiovascular disease and exercise has been shown to decrease that risk along with improving RA-related symptoms, fatigue, and depression3. As reports on the standard of care for RA around the globe are being updated, exercise is being included in those recommendations. However, studies have found that simply educating patients on the benefits of exercise for RA only increases their knowledge but does not result in behavior change4. If you’re someone who’s not a regular exerciser, what would inspire you to start?

Physical Therapy for RA

There’s a lot physical therapists can do to improve comfort and the primary goal is to maintain function. Second to medication for reducing inflammation (and sometimes even on par) is movement. Using your muscles creates a pumping action that facilitates the flow of inflammation away from your joints in your low pressure venous and lymphatic systems. In addition to promoting your ability to participate in regular exercise to get your muscles pumping, our physical therapists also ensure you can complete the tasks you need to do (like lifting items and walking) as well as the activities you love to do (like swimming and dancing).

If you’ve been diagnosed with a form of arthritis or you’re experiencing any kind of joint pain, our FREE screening consultations exist to show you what your body’s full potential could be. Click here to let us join you on your journey to better health.

Blog image inside blog Adapting Care for Osteoarthritis and Rheumatoid Arthritis

Written by: Dr. Julia Melanson, PT, DPT

Edited by: April Oury, PT, MSPT, IOC, CFMT, FAAOMPT, Founder


  1.  Zhang, Y., & Jordan, J. M. (2010). Epidemiology of osteoarthritis. Clinics in geriatric medicine, 26(3), 355-369.
  2. Finan, Patrick H., et al. (2013). Discordance between pain and radiographic severity in knee osteoarthritis: findings from quantitative sensory testing of central sensitization. Arthritis & Rheumatism, 65(2), 363-372.
  3. Metsios, G. S., Stavropoulos-Kalinoglou, A., & Kitas, G. D. (2015). The role of exercise in the management of rheumatoid arthritis. Expert review of clinical immunology, 11(10), 1121-1130.
  4. John, H., Hale, E. D., Treharne, G. J., Kitas, G. D., & Carroll, D. (2012). A randomized controlled trial of a cognitive-behavioral patient education intervention vs a traditional information leaflet to address the cardiovascular aspects of rheumatoid disease. Rheumatology, 52(1), 81-90.

As always, consult with your Licensed Physical Therapist for individualized advice. For those in Illinois, visit your PT immediately without a prescription or referral.

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