Joint discomfort is one of the most common reasons for seeking medical care in Spain. These symptoms can seriously complicate daily life, but not all joint pain is the same. Making an accurate diagnosis is crucial to identifying the underlying cause and determining effective treatment. While the symptoms may appear similar at first glance, the origin, intensity, timing, and accompanying features differ significantly among conditions like osteoarthritis, rheumatoid arthritis, and gout. Understanding these distinctions not only enables more precise diagnosis but also guides treatment in the right direction, improving a person’s quality of life. These nuances were explained by a rheumatology specialist from the university hospital Vithas Madrid Arturo Soria.
Mechanical vs. inflammatory: what is at the root of the problem?
First and foremost, it’s important to remember that pain is a subjective experience, shaped by personal background. Each person perceives it differently. Nevertheless, for clarity, joint pain can be broadly categorized as either mechanical or inflammatory. Pain is considered mechanical when it intensifies with physical activity or certain body positions, and eases with rest. For example, during movement, walking, or climbing stairs. This type is most commonly associated with osteoarthritis. On the other hand, inflammatory pain typically increases at rest, is accompanied by swelling and localized warmth, and peaks upon awakening or in the early morning hours—sometimes even waking a person up. This kind of pain is more characteristic of arthritis. In cases of rheumatoid arthritis, the pain is morning-dominant, linked to stiffness and, notably, is symmetrical—affecting joints on both hands, elbows, shoulders, knees, or feet. Gout pain appears suddenly and can be so intense that even the touch of clothing becomes unbearable.
Morning stiffness and pain at rest: warning signs
The nature of stiffness and the timing of pain are among the most important clues a patient can provide to a doctor. In osteoarthritis, stiffness is brief. It feels as though the joint is ‘rusty’ after a period of immobility, for example, when getting up from a chair after watching TV, but this sensation passes within a few minutes (less than half an hour). Stiffness with rheumatoid arthritis and other inflammatory diseases lasts much longer—over an hour. A person may wake up in the morning feeling ‘wooden.’ As for when pain occurs, with osteoarthritis it increases with movement, intensifying by the end of the day. In contrast, pain from inflammatory arthritis is more severe at rest, so it is stronger at the beginning of movement, on waking, or at night. A gout attack is not tied to a particular time of day. During examination, the doctor looks for several clinical signs that suggest osteoarthritis. These include crepitus—a ‘crunching’ or ‘clicking’ sensation felt or heard when the joint moves. Deformation is also important: Heberden’s or Bouchard’s nodes may appear on the fingers, and the knee or hip may look enlarged. Limited mobility, when the joint can no longer fully bend or rotate, is another key marker.
Diagnosis: from X-ray to blood tests
Accurate diagnosis—and equally important, ruling out other conditions—relies fundamentally on diagnostic testing. Blood tests help exclude rheumatoid arthritis or spondyloarthritis, as inflammatory markers are usually not elevated in osteoarthritis. X-rays are the main imaging tool for osteoarthritis. They can reveal joint space narrowing caused by cartilage wear, the presence of osteophytes (known as “bone spurs”), or subchondral bone sclerosis. Ultrasound is very useful to assess cartilage condition, detect joint effusion, or identify inflammation of the synovial membrane. Magnetic resonance imaging (MRI) is not the first-line method, but it can be helpful when other tests have not identified an inflammatory process.
Risk factors: who should pay special attention?
Osteoarthritis has its own clearly defined risk factors that differ from those of inflammatory diseases. Age is the most significant of them. Excess weight increases the load on weight-bearing joints (knees, hips, spine), accelerating their wear and tear. Genetic predisposition also plays a role: if the parents had osteoarthritis, the risk of developing it increases. Previous injuries, such as a bone fracture within the joint or meniscus damage, raise the risk of future osteoarthritis. Excessive or repetitive use of a joint, typical in certain sports or professions, can speed up the wear of cartilage tissue. Weakness in the surrounding muscles, such as the quadriceps, provides poor protection for the knee joint and increases pressure on the cartilage. Finally, anatomical features like differing leg lengths or deformities lead to uneven load distribution.
