Overview
Osteoarthritis is a condition that causes joints to become painful and stiff. It's the most common type of arthritis in the UK.
Symptoms of osteoarthritis
The main symptoms of osteoarthritis are joint pain and stiffness, and problems moving the joint. Some people also have symptoms such as: - swelling - tenderness - grating or crackling sound when moving the affected joints
The severity of osteoarthritis symptoms can vary greatly from person to person, and between different affected joints.
For some people, the symptoms can be mild and may come and go. Other people can experience more continuous and severe problems which make it difficult to carry out everyday activities.
Almost any joint can be affected by osteoarthritis, but the condition most often causes problems in the knees, hips and small joints of the hands.
You should see your GP if you have persistent symptoms of osteoarthritis so they can confirm the diagnosis and prescribe any necessary treatment.
Causes of osteoarthritis
As part of normal life, your joints are exposed to a constant low level of damage. In most cases, your body repairs the damage itself and you do not experience any symptoms.
But in osteoarthritis, the protective cartilage on the ends of your bones breaks down, causing pain, swelling and problems moving the joint. Bony growths can develop, and the area can become red and swollen.
The exact cause is not known, but several things are thought to increase your risk of developing osteoarthritis, including:
- joint injury – overusing your joint when it has not had enough time to heal after an injury or operation
- other conditions (secondary arthritis) – osteoarthritis can happen in joints severely damaged by a previous or existing condition, such as rheumatoid arthritis or gout
- age – your risk of developing the condition increases as you get older.
- family history – osteoarthritis may run in families, although studies have not identified a single gene responsible
- obesity – being obese puts excess strain on your joints, particularly those that bear most of your weight, such as your knees and hips
- being a woman – osteoarthristis is more common in women than men.
Diagnosing osteoarthritis
To help determine whether you have osteoarthritis, a GP will first ask you about your symptoms and examine your joints.
A GP may suspect osteoarthritis if:
- you're aged 45 or older
- you have joint pain that gets worse the more you use your joints
- the stiffness in your joints is not there in the mornings, or lasts less than 30 minutes
If your symptoms are slightly different, this may indicate another joint condition. For example, prolonged joint stiffness in the morning can be a sign of rheumatoid arthritis.
Further tests – such as X-rays or blood tests – are not usually necessary, but may be used to rule out other possible causes, such as rheumatoid arthritis or a fractured bone.
Treating osteoarthritis
Osteoarthritis is a long-term condition and cannot be cured, but it doesn't necessarily get any worse over time and it can sometimes gradually improve. A number of treatments are also available to reduce the symptoms.
Mild symptoms can sometimes be managed with simple measures including:
- regular exercise
- losing weight if you're overweight
- wearing suitable footwear
- using special devices to reduce the strain on your joints during your everyday activities
If your symptoms are more severe, you may need additional treatments such as painkillers and a structured exercise plan with a physiotherapist.
In a small number of cases, where these treatments haven't helped or the damage to the joints is particularly severe, surgery may be done to repair, strengthen or replace a damaged joint.
Living with osteoarthritis
As osteoarthritis is a long-term condition, it's important you receive support to help you cope with any issues such as reduced mobility, and advice on any necessary financial support.
Some people may find it helpful to talk to their GP or others who are living with osteoarthritis, as there may be questions or worries you want to share.
Preventing osteoarthritis
It's not possible to prevent osteoarthritis altogether. However, you may be able to minimise your risk of developing the condition by avoiding injury and living a healthy lifestyle.
Exercise
Exercise or a job that puts frequent strain on your joints and forces them to bear an excessive load can increase your risk of osteoarthritis.
Try to do at least 150 minutes of moderate aerobic activity (such as cycling or fast walking) every week, plus strength exercises on 2 or more days each week that work the major muscle groups, to keep yourself generally healthy.
Posture
It can also help to maintain good posture at all times and avoid staying in the same position for too long.
If you work at a desk, make sure your chair is at the correct height, and take regular breaks to move around.
Losing weight
Being overweight or obese can increase the strain on your joints and increase your risk of developing osteoarthritis. If you're overweight, losing weight may help lower your chances of developing the condition.
To find out whether you're overweight or obese, use the healthy weight calculator.
Read more about losing weight.
Want to know more?
Symptoms
The main symptoms of osteoarthritis are pain and stiffness in your joints, which can make it difficult to move the affected joints and do certain activities.
The symptoms may come and go in episodes, which can be related to your activity levels and even the weather. In more severe cases, the symptoms can be continuous.
You should see your GP if you have persistent symptoms of osteoarthritis so they can confirm the diagnosis and prescribe any necessary treatment.
Other symptoms you or your doctor may notice include:
- joint tenderness
- increased pain and stiffness when you have not moved your joints for a while
- joints appearing slightly larger or more "knobbly" than usual
- a grating or crackling sound or sensation in your joints
- limited range of movement in your joints
- weakness and muscle wasting (loss of muscle bulk)
Osteoarthritis can affect any joint in the body, but the most common areas affected are the knees, hips and small joints in the hands. Often, you'll only experience symptoms in 1 joint, or a few joints at any 1 time.
Osteoarthritis of the knee
If you have osteoarthritis in your knees, both your knees will usually be affected over time, unless it occurred as the result of an injury or another condition affecting only 1 knee.
Your knees may be most painful when you walk, particularly when walking up or down hills or stairs.
Sometimes, your knees may "give way" beneath you or make it difficult to straighten your legs. You may also hear a soft, grating sound when you move the affected joint.
Osteoarthritis of the hip
Osteoarthritis in your hips often causes difficulty moving your hip joints. For example, you may find it difficult to put your shoes and socks on or to get in and out of a car.
You'll also usually have pain in the groin or outside the hip. This is often worse when you move the hip joints, although it can also affect you when you're resting or sleeping.
Osteoarthritis of the hand
Osteoarthritis often affects three main areas of your hand:
- the base of your thumb
- the joints closest to your fingertips
- the middle joints of your fingers
Your fingers may become stiff, painful and swollen and you may develop bumps on your finger joints. Over time, the pain may decrease and eventually disappear altogether, although the bumps and swelling can remain.
Your fingers may bend sideways slightly at your affected joints or you may develop painful cysts (fluid-filled lumps) on the backs of your fingers.
In some cases, you may also develop a bump at the base of your thumb where it joins your wrist. This can be painful and you may find it difficult to perform some manual tasks, such as writing, opening jars or turning keys.
Treatment
There's no cure for osteoarthritis, but the condition does not necessarily get any worse over time. There are a number of treatments to help relieve the symptoms.
The main treatments for the symptoms of osteoarthritis include:
- lifestyle measures – such as maintaining a healthy weight and exercising regularly
- medication – to relieve your pain
- supportive therapies – to help make everyday activities easier
In a few cases, where other treatments have not been helpful, surgery to repair, strengthen or replace damaged joints may also be considered.
Lifestyle changes
Exercise
Exercise is one of the most important treatments for people with osteoarthritis, whatever your age or level of fitness. Your physical activity should include a combination of exercises to strengthen your muscles and exercises to improve your general fitness.
If osteoarthritis causes you pain and stiffness, you may think exercise will make your symptoms worse.
However, regular exercise that keeps you active, builds up muscle and strengthens the joints usually helps to improve symptoms.
Exercise is also good for losing weight, improving your posture and relieving stress, all of which will ease symptoms.
Your GP, or possibly a physiotherapist, will discuss the benefits you can expect from a exercise programme and can give you an exercise plan to follow at home.
It's important to follow this plan because there's a risk that doing too much exercise too quickly, or doing the wrong sort of exercise, may damage your joints.
Losing weight
Being overweight or obese often makes osteoarthritis worse, as it places extra strain on some of your joints.
To find out if you are overweight or obese, use the healthy weight calculator.
If you're overweight or obese, try to lose weight by doing more physical activity and eating a healthier diet.
Discuss any new exercise plan with your GP or physiotherapist before you start. They can help you plan a suitable exercise programme for you. Your GP and practice nurse can also advise about how to lose weight slowly and safely.
Pain relief medicines
Your doctor will talk to you about medicines to relieve pain from osteoarthritis.
Sometimes a combination of therapies, such as painkillers, exercise and assistive devices or surgery, may be needed to help control your pain.
The type of painkiller a GP may recommend for you will depend on the severity of your pain and other conditions or health problems you have. The main medications used are below.
Paracetamol
If you have pain caused by osteoarthritis, a GP may suggest taking paracetamol to begin with. You can buy this at supermarkets or pharmacies. It's best to take it regularly rather than waiting until your pain becomes unbearable.
When taking paracetamol, always use the dose a GP recommends and do not exceed the maximum dose stated on the pack.
Non-steroidal anti-inflammatory drugs (NSAIDs)
If paracetamol does not effectively control the pain of osteoarthritis, a GP may prescribe a non-steroidal anti-inflammatory drug (NSAID).
NSAIDs are painkillers that work by reducing inflammation.
Some NSAIDs are available as creams (topical NSAIDs) that you apply directly to the affected joints. Some topical NSAIDs are available without a prescription. They can be particularly effective if you have osteoarthritis in your knees or hands. As well as helping to ease pain, they can also help reduce any swelling in your joints.
Your doctor will discuss with you the type of NSAID you should take and the benefits and risks associated with it.
NSAID tablets may be needed if paracetamol and topical NSAIDs are not easing the pain. They may not be suitable for people with certain conditions, such as asthma, a stomach ulcer or angina, or if you have had a heart attack or stroke. If you're taking low-dose aspirin, ask your GP whether you should use a NSAID.
If your GP recommends or prescribes an NSAID to be taken by mouth, they'll usually also prescribe a medicine called a proton pump inhibitor (PPI) to take at the same time. NSAIDs can break down the lining in your stomach that protects it against stomach acid. PPIs reduce the amount of acid produced by the stomach, reducing the risk of damage to your stomach lining.
Opioids
Opioids, such as codeine, are another type of painkiller that may ease severe pain..
GP's will only presciribe opiods on a short-term basis because of side effects such as drowsiness, nausea and constipation.
You may be prescribed a laxative to take alongside it to prevent constipation.
Capsaicin cream
A GP may prescribe capsaicin cream if you have osteoarthritis in your hands or knees and topical NSAIDs have not been effective in easing your pain.
Capsaicin cream works by blocking the nerves that send pain messages in the treated area. You may have to use it for a while before it has an effect. You should experience some pain relief within the first 2 weeks of using the cream, but it may take up to a month for the treatment to be fully effective.
Apply a pea-size amount of capsaicin cream to your affected joints up to 4 times a day, but not more often than every 4 hours. Do not use capsaicin cream on broken or inflamed skin and always wash your hands after applying it.
Be careful not to get any capsaicin cream on delicate areas, such as your eyes, mouth, nose and genitals. Capsaicin is made from chillies, so if you get it on sensitive areas of your body, it's likely to be very painful for a few hours. However, it will not cause any damage.
You may notice a burning sensation on your skin after applying capsaicin cream. This is nothing to worry about, and the more you use it, the less it should happen. But avoid using too much cream or having a hot bath or shower before or after applying it, because it can make the burning sensation worse.
Steroid injections
Steroids are a type of medication that contain manmade versions of the hormone cortisol, and are sometimes used to treat particularly painful musculoskeletal problems.
Some people with osteoarthritis may be offered steroid injections when other treatments haven't worked.
The injection will be made directly into the affected area. You may be given a local anaesthetic first to numb the area and reduce the pain.
Steroid injections work quickly and can ease pain for several weeks or months.
Supportive treatments
In addition to lifestyle changes and medicines, you may benefit from a number of supportive treatments that can help reduce your pain and make everyday tasks easier.
Hot or cold packs
Applying hot or cold packs to the joints can relieve the pain and symptoms of osteoarthritis in some people. A hot-water bottle filled with either hot or cold water and applied to the affected area can be very effective in reducing pain.
Special hot and cold packs that can either be cooled in the freezer or heated in a microwave are also available, and work in a similar way.
Assistive devices
If osteoarthritis is causing mobility problems or making it difficult to do everyday tasks, several devices could help. Your GP may refer you to a physiotherapist or an occupational therapist for specialist help and advice.
If you have osteoarthritis in your lower limbs, such as your hips, knees or feet, your physiotherapist or occupational therapist may suggest special footwear or insoles for your shoes.
Footwear with shock-absorbing soles can help relieve some of the pressure on the joints in your legs as you walk. Special insoles may help spread your weight more evenly. Leg braces and supports also work in the same way.
If you have osteoarthritis in your hip or knee that affects your mobility, you may need to use a walking aid, such as a stick or cane. Hold it on the opposite side of your body to your affected leg so that it takes some of your weight.
A splint (a piece of rigid material used to provide support to a joint or bone) can also be useful if you need to rest a painful joint. Your physiotherapist can provide you with a splint and give you advice on how to use it correctly.
If your hands are affected by osteoarthritis, you may also need assistance with hand-operated tasks, such as turning on a tap. Special devices, such as tap turners, can make performing these tasks more manageable. Your occupational therapist can give you help and advice about using assistive devices in your home or workplace.
Manual therapy
Not using your joints can cause your muscles to waste and may increase stiffness caused by osteoarthritis. Manual therapy is a technique where a physiotherapist uses their hands to stretch, mobilise and massage the body tissues to keep your joints supple and flexible.
Find out more about physiotherapy
Surgery
Surgery for osteoarthritis is only needed in a small number of cases where other treatments haven't been effective or where your daily life is seriously affected.
If you need surgery for osteoarthritis, your GP will refer you to an orthopaedic surgeon. Having surgery for osteoarthritis may greatly improve your symptoms, mobility and quality of life.
However, surgery cannot be guaranteed to get rid of your symptoms altogether, and you may still experience pain and stiffness from your condition.
There are several different types of surgery for osteoarthritis.
Joint replacement
Joint replacement, also known as an arthroplasty, is most commonly done to replace hip and knee joints.
During an arthroplasty, your surgeon will remove your affected joint and replace it with an artificial joint (prosthesis) made of special plastics and metal. An artificial joint can last for up to 20 years, although it may eventually need to be replaced.
There's also a newer type of joint replacement surgery called resurfacing. This uses only metal components and may be more suitable for younger patients. Your surgeon will discuss with you the type of surgery that would be best.
Find out more about hip replacement and knee replacement.
Joint fusing
If joint replacement is not suitable for you, your surgeon may suggest an operation to fuse your joint in a permanent position, known as an arthrodesis.
This means your joint will be stronger and much less painful, although you will no longer be able to move it.
Adding or removing some bone around a joint
If you have osteoarthritis in your knees but you're not suitable for knee replacement surgery, you may be able to have an operation called an osteotomy. This involves your surgeon adding or removing a small section of bone either above or below your knee joint.
This helps realign your knee so your weight is no longer focused on the damaged part of your knee. An osteotomy can relieve symptoms of osteoarthritis, although you may still need knee replacement surgery eventually.
Complementary and alternative therapies
Some people with osteoarthritis try complementary or alternative therapies – such as acupuncture and aromatherapy – and find them helpful.
However, there's a lack of medical evidence to suggest they're effective and they generally are not recommended by the National Institute for Health and Care Excellence (NICE).
Nutritional supplements
A number of nutritional supplements have been used to treat osteoarthritis in the past, including chondroitin and glucosamine.
GPs no longer prescribe chondroitin and glucosamine on the NHS because there’s no strong evidence that they are effective as a treatment.
Generally, supplements can be expensive and NICE recommends that they should not routinely be offered on the NHS.
Rubefacients
Rubefacients are available as gels and creams that produce a warm, reddening effect on your skin when you rub them in. Several rubefacients have been used to treat joint pain caused by osteoarthritis.
However, research has shown that rubefacients have little effect in improving the symptoms of osteoarthritis and NICE therefore does not recommend their use.
Living with
With the right support, you can lead a healthy, active life with osteoarthritis. The condition does not necessarily get worse.
Living healthily
A good diet and regular exercise will help keep muscles strong and control your weight, which is good for osteoarthritis and also has other health benefits.
Find out more about:
- Eating a healthy diet
- Exercise
- Healthy weight
Taking your medicine
It's important to take your medicine as prescribed, even if you start to feel better.
Continuous medicine can sometimes help prevent pain, although if your medicines have been prescribed "as required", you may not need to take them in between painful episodes.
If you have any questions or concerns about the medicine you're taking or any side effects you think you may be experiencing, talk to your healthcare team.
It may also be useful to read the information leaflet that comes with the medicine, which will tell you about possible interactions with other drugs or supplements.
Check with your healthcare team if you plan to take any over-the-counter remedies, such as painkillers, or any nutritional supplements, as these can sometimes interfere with your medicine.
Regular reviews
Because osteoarthritis is a long-term condition, you'll be in regular contact with your healthcare team.
Having a good relationship with the team means you can easily discuss your symptoms or concerns.
The more the team know, the more they can help you.
Vaccinations
People with long-term conditions such as osteoarthritis are often encouraged to get an annual flu jab each autumn to protect against flu.
You may also be advised to get a pneumoccocal vaccination.
This is a one-off injection that protects against a serious chest infection called pneumococcal pneumonia.
Talking to others
Many people find it helpful to talk to other people who are in a similar position to them.
You may find support from a group or by talking individually to someone who has osteoarthritis.
Patient organisations have local groups where you can meet other people with the same condition.
The Versus Arthritis helpline is open Monday to Friday, 9am to 8pm. Call free on 0800 5200 520.
You can also email them at helpline@versusarthritis.org
Versus Arthritis also have an online forum, where you can communicate with other people who have osteoarthritis.
Work and money
If you have severe osteoarthritis and are still working, your symptoms may interfere with your working life and may affect your ability to do your job.
If you have to stop work or work part time because of your arthritis, you may find it hard to cope financially.
You may be entitled to 1 or more of the following types of financial support:
You may be eligible for other benefits if you have children living at home or if you have a low household income.