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What’s the difference between bursitis and arthritis?

Peter H. Gott, M.D.

Dear Dr. Gott: Please discuss the difference between bursitis and arthritis.

I went to my orthopedic doctor because of pain in my hip. It starts in the joint and travels down the thigh and is especially painful at the tendon along the shinbone. I also have right-leg weakness when pressure is applied or when walking upstairs. He said the pain was caused by bursitis, not arthritis. He showed me an exercise to try and told me to continue my regular walks.

I take over-the-counter pain relievers, and I use castor oil and Castiva. Should I continue using these joint medicines, or should I use muscle creams to relieve the nighttime pain? I am 88 and do not consider this worthy of surgery, but it would be nice to sleep though the night. I’m tired of having to wake up to take another pill.

Dear Reader: Arthritis and bursitis can be difficult to differentiate. Arthritis is joint inflammation with associated degeneration of connective tissue and bone. Bursitis is inflammation of the bursa, a sac-like cavity surrounding joints that is filled with fluid that reduces friction caused by movement. There are more than 150 bursa in the body. Most people have heard the term “water on the knee.” This is often caused by bursitis.

Arthritis is common in weight-bearing joints such as the hips and knees. Bursitis is common in the shoulders, elbows, big toe and hips.

Direct trauma, joint infection or muscle stress and arthritis are common causes of bursitis. Arthritis is generally caused by age-related wearing of cartilage and connective tissues, leading to bone degeneration. It can also be caused by autoimmune disorders such as rheumatoid arthritis. Gout is a common cause of arthritis.

Treatment is similar for both arthritis and bursitis. Nonsteroidal anti-inflammatory drugs, such as ibuprofen or naproxen sodium, ice, rest and steroid injections make up the primary course of therapy. If infection is the cause, treatment with antibiotics is necessary. For severe cases that last longer than a few weeks or if you have major swelling, the bursa may need to be drained. In rare cases, removal may be necessary.

Return to your orthopedist and ask for an X-ray if you have not had one already. Bursitis will not show on the film, but other causes, such as arthritis, can be ruled out. Given your age, the most likely cause of your bursitis is age-related osteoarthritis. If you like, get a second opinion from another orthopedic specialist. You can then compare the results and go from there.

To give you related information, I am sending you a copy of my Health Report “Understanding Osteoarthritis.” Other readers who would like a copy should send a self-addressed, stamped No. 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

Dr. Gott writes for United Media. If readers would like to contact Dr. Gott, they may write him c/o United Media, 200 Madison Ave., Fourth Floor, New York, NY 10016.
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