When experiencing  joint pain, stiffness, or swelling, it can be challenging to identify the underlying cause. Joint pain may arise from several conditions, the most common being bursitis and arthritis. While both can produce overlapping symptoms, understanding their differences is essential for accurate diagnosis and effective treatment.

Arthritis encompasses a range of conditions that affect the joints, with osteoarthritis and rheumatoid arthritis being the most frequently diagnosed. Osteoarthritis is a degenerative condition characterised by the progressive breakdown of cartilage, leading to joint pain, stiffness, and over time decreased range of motion. Rheumatoid arthritis, in contrast, is an autoimmune disorder that causes the immune system to attack the synovial lining of the joints, resulting in chronic inflammation, joint damage, and systemic symptoms such as fatigue and fever. Rheumatoid arthritis produces more intense inflammatory symptoms than osteoarthritis and can simultaneously affect multiple joints.

Bursitis occurs when the bursae, tiny fluid-filled sacs cushion the bones, tendons, and muscles near joints, become inflamed. This condition is commonly associated with repetitive motion, overuse, or direct trauma to the affected area. However, it may also arise from infections or inflammatory disorders like gout. Unlike arthritis, which involves the joint, bursitis is localised soft tissue surrounding the joint. 

This post will examine the difference in pathophysiology, symptoms, diagnosis, and when to see a doctor about your joint pain. 

Pathophysiology of Bursitis and Arthritis

Bursitis, osteoarthritis, and rheumatoid arthritis have differing underlying mechanisms. These differences are driven by inflammation, crystal deposition, and joint structure degeneration, each resulting in specific pathophysiological changes.

• Bursitis

Bursitis develops when a fluid-filled sac known as a bursa becomes inflamed. Bursae are located throughout the body, cushioning and reducing friction between bones, skin, muscles, and tendons. Repetitive activities like certain sports, hobbies, or manual labour often trigger inflammation.

In some cases, bursitis can be linked to other factors, including diabetes, crystal deposition disorders such as gout, or infections. Though usually temporary, bursitis may recur periodically, primarily if the underlying cause is not addressed. If left untreated or secondary conditions are involved, it can become chronic.

• Osteoarthritis

Osteoarthritis is the archetypal form of arthritis commonly associated with aging and the long-term wear and tear of joints. This condition involves the progressive breakdown of cartilage. This crucial tissue provides padding and reduces friction between bones within a joint. As cartilage deteriorates, the bones may rub together, leading to pain, stiffness, and decreased joint mobility.

Osteoarthritis affects the entire joint, not just the cartilage, leading to changes in the bone and surrounding tissues. Contributing factors include age, repetitive joint use, previous joint injuries, obesity, and, in some cases, genetic predisposition. Although osteoarthritis cannot be reversed, interventions can help manage symptoms and slow its progression.

• Rheumatoid Arthritis

Rheumatoid arthritis differs fundamentally from osteoarthritis and bursitis as it is an autoimmune condition. This means the immune system mistakenly targets healthy tissues, specifically the synovium and the joints’ membrane lining. The resulting inflammation can cause joint swelling, pain, and eventual breakdown of the joint structure.

If left untreated, rheumatoid arthritis can lead to permanent joint damage. It may extend beyond the joints, potentially affecting organs such as the lungs or heart. Risk factors include genetic predisposition, smoking, periodontal disease, being female, and having a family history of the condition. Unlike osteoarthritis, rheumatoid arthritis is systemic and can present with symptoms such as fatigue, fever, and weight loss.

Autoimmune conditions, including rheumatoid arthritis, are chronic and cannot be cured. However, early diagnosis and targeted treatment can significantly reduce symptoms and prevent long-term complications.

Symptom Comparison Between Bursitis and Arthritis

Although bursitis, osteoarthritis, and rheumatoid arthritis can present with joint-related symptoms that may appear similar at first glance, each condition has distinct characteristics that set it apart. Understanding these differences is essential for proper diagnosis and treatment. Below is a detailed comparison of the symptoms associated with each condition:

Diagnosing Bursitis and Arthritis

Determining the cause of joint pain can be challenging, as the initial symptoms of bursitis, osteoarthritis, and rheumatoid arthritis may overlap. A thorough diagnosis typically requires the expertise of a healthcare professional, who will assess your condition through a combination of physical examination, symptom evaluation, and medical history.

If your joint pain is intermittent and linked to recent activities, bursitis may be the underlying cause. For instance, if your symptoms began shortly after engaging in repetitive movements such as playing tennis, gardening, or crawling on your hands and knees, it could indicate bursitis. This condition often presents with localised pain and swelling without systemic symptoms, which may resolve with rest and treatment.

Chronic joint pain, in contrast, may suggest osteoarthritis, mainly if it develops gradually over time and worsens with activity. Osteoarthritis often affects weight-bearing joints such as the hips and knees. Still, it can also involve the hands and other areas.

Rheumatoid arthritis, on the other hand, tends to present with migratory symptoms, where pain and swelling shift between joints. Persistent joint swelling, warmth, and the presence of subcutaneous lumps known as rheumatoid nodules can further point to rheumatoid arthritis. This condition often affects multiple joints symmetrically and may include systemic symptoms like fatigue and fever.

Your doctor may rely on a detailed history and physical examination to diagnose bursitis. If the diagnosis is unclear or to rule out related conditions such as infections, your doctor might order laboratory tests, such as blood work or fluid analysis from the affected bursa. Imaging techniques like ultrasonography may also be employed to confirm bursitis or detect associated conditions like tendinitis or cellulitis.

In cases of osteoarthritis and rheumatoid arthritis, diagnostic testing often involves more extensive imaging and laboratory studies. X-rays or MRI scans can reveal joint damage or inflammation characteristic of osteoarthritis or rheumatoid arthritis. Blood tests, such as rheumatoid factor (RF) or anti-cyclic citrullinated peptide (anti-CCP), may help confirm rheumatoid arthritis, alongside tests for markers of inflammation like C-reactive protein (CRP) or erythrocyte sedimentation rate (ESR).

Given the chronic nature of osteoarthritis and rheumatoid arthritis, your doctor might refer you to a rheumatologist for specialised care. These conditions often require a comprehensive treatment plan that includes medications, physical therapy, and long-term management strategies.

When To See A Doctor About Your Joint Pain

Persistent joint pain lasting several weeks or more should prompt a visit to your doctor. Early evaluation is crucial for determining the cause and initiating appropriate treatment. In some situations, immediate medical attention is necessary. Contact your doctor or seek urgent care if you:

• Lose the ability to move the affected joint.
• Notice significant swelling in the joint accompanied by redness in the surrounding skin.
• Experience severe symptoms that hinder your ability to perform daily activities.
• Additionally, joint pain accompanied by fever or flu-like symptoms should not be ignored, as these may indicate an infection requiring prompt medical intervention. A particular fever can signify a systemic issue that may exacerbate joint-related problems.

Key Takeaways
Understanding the distinctions between bursitis and arthritis is vital for addressing joint pain effectively. While bursitis often results from repetitive movements or trauma, leading to localised inflammation in the bursae, arthritis involves joint deterioration or autoimmune-driven inflammation, with systemic effects in conditions like rheumatoid arthritis. Accurate diagnosis hinges on recognising symptom patterns, conducting thorough medical evaluations, and utilising appropriate imaging or laboratory tests.

Early intervention not only alleviates discomfort but also prevents potential complications, such as chronic inflammation or joint damage. If you experience persistent or severe joint pain, swelling, or systemic symptoms, seek medical attention promptly to establish an accurate diagnosis and receive tailored treatment. If you have any questions about your joint pain, Don’t hesitate to contact Severn Clinics on 04 385 6446.