Osteoarthritis
Wear-related joint disease causing pain and stiffness, most often in knees, hips and hands.
Overview
Osteoarthritis is the most common form of arthritis. Cartilage thins and bony changes develop, causing pain on use and morning stiffness lasting <30 minutes. Exercise, weight management and analgesia are first-line; joint replacement is highly effective when conservative measures fail.
Symptoms
- • Joint pain worse with activity
- • Brief morning stiffness
- • Crepitus
- • Reduced range of movement
- • Joint swelling
Risk factors
- • Age >50
- • Obesity
- • Previous joint injury
- • Female sex
- • Occupational joint loading
Causes
- • Cartilage degeneration
- • Previous injury
- • Genetic predisposition
🚨 Red flags — seek urgent care
- • Hot, swollen, red joint — exclude septic arthritis
- • Sudden inability to bear weight
- • Locking joint suggesting loose body
When to seek care
- • Pain limiting function
- • Failure of conservative treatment
- • Suspected joint infection — urgent
Diagnosis
- • Clinical: ≥45 years, activity-related joint pain, no or only short morning stiffness (<30 min)
- • No specific blood test — investigations only to exclude inflammatory arthritis (CRP, RF, anti-CCP)
- • Plain X-ray (joint space narrowing, osteophytes, subchondral sclerosis, cysts) if diagnosis unclear or surgery considered
Treatment
- • Core: exercise (strength + aerobic), weight loss if overweight, patient education
- • Topical NSAID (knee/hand) as first-line pharmacological option
- • Oral NSAID (lowest effective dose, with PPI cover) for limited periods
- • Intra-articular corticosteroid injection for short-term flare control
- • Joint replacement (hip, knee) for refractory severe symptoms
Prevention
- • Maintain healthy weight
- • Avoid joint injury; use appropriate footwear and biomechanics
- • Regular muscle-strengthening and aerobic exercise
- • Treat occupational risk factors
Complications
- • Chronic pain and loss of function
- • Falls and fractures
- • Sleep disturbance and low mood
- • Reduced cardiovascular fitness from inactivity
Education & self-care
This guidance is reviewed by Dr. Handel Emery, MD, FRCP (UK) and last updated 2026-06-08. It is educational and not a substitute for professional medical advice.
Frequently asked questions
Will exercise make it worse?
No — strengthening and low-impact exercise improve pain and function. A physiotherapist can tailor a programme.
Will exercise damage my joints?
No — appropriate exercise strengthens the muscles around the joint and reduces pain. Low-impact activities (swimming, cycling, walking) and resistance work are particularly helpful.
Are steroid injections useful?
They can provide short-term pain relief, especially in the knee, but repeated injections may accelerate cartilage loss. They are best used sparingly alongside core treatments.
When is joint replacement considered?
When pain and loss of function persist despite weight management, exercise, physiotherapy and analgesia, and significantly affect quality of life. Outcomes from hip and knee replacement are excellent in most patients.