Joint inflammation is a common source of discomfort, causing pain and stiffness. While the terms arthritis and bursitis are often used interchangeably, they affect distinct anatomical structures near a joint. Despite similar symptoms, a direct relationship exists where one condition can lead to the other. Understanding the connection between these two forms of inflammation is important for accurate diagnosis and effective management of joint pain.
Understanding Arthritis Versus Bursitis
Arthritis is a broad term referring to the inflammation of the joint itself, involving the cartilage and underlying bone structure. The two most common types are Osteoarthritis (OA), a “wear-and-tear” condition where cartilage breaks down, and Rheumatoid Arthritis (RA), an autoimmune disorder where the body attacks the joint lining. Arthritis generally results in deep, aching pain and stiffness that affects the movement of the entire joint.
Bursitis, in contrast, is the inflammation of a bursa, a small, fluid-filled sac that functions as a cushion and gliding surface. These sacs are located outside the joint, situated between bones, tendons, and muscles to reduce friction during movement. Bursitis most frequently occurs in larger joints like the shoulder, hip, and elbow, areas subject to repetitive motion or pressure. Unlike arthritis, bursitis is typically an acute condition that often resolves after rest or treatment.
When Arthritis Triggers Bursitis
Arthritis can lead to the development of secondary bursitis through two main pathways: mechanical stress and systemic inflammation. Chronic arthritis compromises the integrity of the joint, subsequently placing abnormal pressure on nearby bursae. This mechanical mechanism is often observed in cases of advanced Osteoarthritis.
In severe Osteoarthritis, the loss of cartilage and the formation of bone spurs alter the natural alignment and mechanics of a joint. This misalignment causes increased friction or compression on the adjacent bursa sac, irritating it until it becomes inflamed. The resulting bursitis is a complication arising from the underlying structural changes of the arthritic joint.
For inflammatory types of arthritis, such as Rheumatoid Arthritis, the mechanism is systemic rather than purely mechanical. Rheumatoid Arthritis involves an abnormal immune response that causes widespread inflammation throughout the body. This systemic inflammation can directly affect the bursa sac, leading to bursitis independent of mechanical stress or friction. The bursa becomes inflamed due to the infiltration of inflammatory cells, a direct consequence of the autoimmune disease activity.
Identifying Overlapping Symptoms
The co-occurrence of arthritis and bursitis in the same joint can complicate diagnosis because their symptoms overlap, including pain, swelling, and stiffness. Distinguishing the pain’s characteristics is a practical way to differentiate the conditions. Arthritis pain is described as a deep, pervasive ache within the joint that often worsens after periods of inactivity, particularly in the morning.
Bursitis pain is more superficial and highly localized, presenting as sharp tenderness directly over the affected bursa sac. Applying direct pressure to this specific point, such as lying on the side with hip bursitis, often causes an immediate flare-up of pain, which is not characteristic of arthritis. Clinicians rely on a physical exam to pinpoint this localized tenderness, confirming the presence of bursitis alongside existing arthritis.
Integrated Management Approaches
When bursitis develops as a secondary effect of arthritis, treatment requires a dual focus on the acute inflammation and the underlying chronic joint disease. Management must address the bursa inflammation while simultaneously controlling the primary arthritic process.
Common conservative methods involve nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce both the systemic inflammation from arthritis and the localized swelling of the bursa. Physical therapy is employed to restore proper joint mechanics, which helps relieve the abnormal pressure contributing to the bursitis. For persistent, localized pain, a corticosteroid injection directly into the inflamed bursa can provide short-term relief, complementing the long-term management of the arthritis.