Health condition · Clinically reviewed
Arthritis, the guide that answers what to do next.
Osteoarthritis is not the same as rheumatoid arthritis - the difference decides everything about treatment. Here is how to tell which is which, and what modern management looks like.
Why trust this guide
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Clinically reviewed
Written by our editorial team and reviewed by a registered UK clinician before publication.
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Sourced from guidance
Every claim is checked against NICE, RCP or peer-reviewed sources you can see at the end.
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Current for 2026
Reflects current UK guidance on early diagnosis and modern biologic therapy.
Key facts
Arthritis at a glance.
The essentials, in plain English - what osteoarthritis, rheumatoid and psoriatic arthritis are, how they differ, and how each is treated in the UK today.
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Types
Osteoarthritis (wear-related), rheumatoid arthritis (autoimmune) and psoriatic arthritis - very different in cause and treatment.
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How common
Osteoarthritis affects around 10 million UK adults; rheumatoid arthritis around 400,000; psoriatic arthritis around 1 in 5 people with psoriasis.
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Pattern - OA
Worse with activity, improves with rest, morning stiffness under 30 minutes, larger joints and hands.
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Pattern - RA
Small joints on both sides, prolonged morning stiffness, warmth and swelling - especially the hands and feet.
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Diagnosis
Clinical exam, blood tests (CCP antibody, RF, CRP), imaging - MRI or ultrasound if inflammatory arthritis is suspected.
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Modern treatment
OA - exercise, weight, pain relief, surgery when needed. Inflammatory arthritis - early DMARDs (methotrexate), biologics if not enough.
Why this guide matters
Three arthritides, three different playbooks.
Getting the type right is the whole game - it decides whether the answer is exercise and weight, or a disease-modifying drug started this month.
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The pattern tells you the type
Which joints, when they hurt, and how long you are stiff in the morning - all point to what is going on.
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Early treatment protects joints
For inflammatory arthritis, weeks matter. DMARDs started promptly prevent long-term damage.
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Exercise is the main treatment for OA
It sounds counter-intuitive but it is the most effective single measure - tailored activity beats rest.
How the diagnosis is made
From first painful joint to a clear plan.
The steps a UK GP will normally follow, in order - so you know what to expect and why.
Phase 1 · Recognising
Pattern, examination and initial bloods
Phase 2 · Confirming
Imaging and specialist referral if needed
Phase 3 · Managing
Treatment by type, adjusted to target
- 01
Recognising
Pattern recognition
Which joints, how long stiff in the morning, and worse with rest or activity - all point to which type.
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Recognising
Focused examination
Warmth, swelling and specific joint patterns help distinguish inflammatory from mechanical.
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Recognising
Blood tests
CRP, ESR, rheumatoid factor, CCP antibody - and urate if gout is suspected.
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Confirming
Imaging when needed
X-rays for osteoarthritis; ultrasound or MRI for early inflammatory arthritis.
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Confirming
Rheumatology referral if inflammatory
Ideally seen within 3 weeks of persistent inflammatory symptoms.
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Managing
A treatment plan by type
OA - exercise, weight, pain relief, surgery when needed. RA/PsA - DMARDs started promptly.
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Managing
Treat-to-target
For inflammatory arthritis, adjusting therapy until disease activity is minimal.
Typical timeline: 3-8 weeks from first appointment to a settled plan.
Symptoms
What arthritis actually feels like.
The pattern is more telling than any single symptom - when it hurts, which joints, and how long you are stiff for in the morning.
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Joint pain
The pattern matters: OA gets worse through the day; RA is worst in the morning.
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Morning stiffness
Under 30 minutes usually OA; over an hour suggests inflammatory arthritis.
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Swollen joints
Boggy, warm swelling suggests inflammation - RA or PsA - not OA.
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Warmth or redness
Hot, red, exquisitely tender joint - think gout, septic arthritis or a flare.
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Unusual fatigue
A hallmark of active RA and PsA, often before joint symptoms are obvious.
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Both sides at once
Symmetrical hand or foot involvement is very suggestive of RA.
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Nail and skin changes
Pitting, thickened patches - psoriatic arthritis often follows or accompanies skin psoriasis.
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When to act now
Hot swollen joint with fever, sudden inability to bear weight, or persistent inflammatory symptoms - urgent review.
Treatment
How arthritis is treated in the UK.
Very different approaches for wear-related and inflammatory arthritis - here is what each option does, and when it is used.
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Exercise & physiotherapy
The single most effective treatment for osteoarthritis - especially for hip and knee OA.
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Weight management
Losing 5 kg reduces knee OA pain and function scores meaningfully.
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Topical NSAIDs
First-line for hand and knee OA - similar effect to oral NSAIDs with fewer side effects.
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Oral NSAIDs
Short courses for flares - not indefinite. Combine with a gastric protector if used regularly.
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Joint injections
Steroid injections offer short-term relief for OA flares and inflammatory arthritis.
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DMARDs (early)
Methotrexate is the cornerstone for RA and PsA - started promptly to prevent joint damage.
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Biologic therapy
Anti-TNF, IL-6, JAK inhibitors and others for RA and PsA not controlled on DMARDs.
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Joint replacement
Very effective for advanced hip and knee OA when conservative measures no longer work.
What this guide is based on
The sources behind every claim on this page.
UK national guidance and specialist society standards, current at the time of last review.
Key references
Guidelines and standards we relied on.
A quiet reminder
This guide is for information, not medical advice.
Your GP or rheumatology team knows your history and can tell you which parts apply to you. If in doubt, get seen.
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NICE. Osteoarthritis in over 16s: diagnosis and management (NG226).
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NICE. Rheumatoid arthritis in adults: management (NG100).
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Versus Arthritis. Patient information and support.
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British Society for Rheumatology. Guidelines library.
Red flags
When a painful joint becomes an emergency.
Most joint pain is chronic and can be managed patiently. These are the situations where waiting is the wrong call.
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Hot swollen joint with fever
Possible septic arthritis - call 111 or attend A&E urgently.
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Sudden inability to bear weight
Especially after minor injury - urgent orthopaedic assessment.
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Inflammatory pattern under 40
Especially with morning stiffness over an hour - suggests early inflammatory arthritis.
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Fatigue and weight loss
With joint pain - concerning for systemic inflammation. See a GP.
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New skin rash or eye redness
With joint pain - suggests reactive arthritis or psoriatic arthritis.
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Rapidly worsening joint
Deforming quickly - rheumatology assessment within weeks, not months.
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Numbness in hands or feet
Especially with joint disease - possible nerve involvement.
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Fever or unwell on biologic
Contact your rheumatology team same day - infection risk is higher.
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Pregnancy planning on DMARDs
Some drugs (methotrexate, leflunomide) must be stopped before conception - plan ahead.
Living with it
A long-term condition, but a very manageable one.
Four things that make the biggest difference day to day - movement, a flare plan, nutrition, and regular reviews.
A quiet reminder
Consistency beats intensity, every time.
Small, steady changes - kept up for months - do more than a heroic week that does not last.
- 01 Movement
Exercise is medicine
Even in painful joints, tailored activity reduces pain and improves function.
- 02 Flares
Have a plan
Know what steps you take when a flare starts - and when to contact your team.
- 03 Nutrition
No magic diet
A Mediterranean-style diet, weight management and oily fish help; supplements have less evidence.
- 04 Reviews
Regular reviews matter
For inflammatory arthritis, quarterly disease-activity scores guide treatment changes.
Frequently asked
Everything we get asked about arthritis.
Quick answers on types, diagnosis, DMARDs, biologics, joint replacement and when to seek help.
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What is the difference between osteoarthritis and rheumatoid arthritis?
Osteoarthritis is wear-related and worse with activity. Rheumatoid arthritis is autoimmune, causes prolonged morning stiffness, and often affects small joints on both sides. The treatments are completely different.
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How is arthritis diagnosed?
By pattern (which joints, morning stiffness, warmth) and examination. Blood tests (CCP, rheumatoid factor, CRP) and imaging (ultrasound, MRI) help identify inflammatory arthritis early.
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Do I need a scan?
X-ray for suspected osteoarthritis; ultrasound or MRI can pick up early inflammatory arthritis before X-rays change. A joint MRI is arranged if the diagnosis is unclear.
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What can I do at home for osteoarthritis?
Regular activity, weight management if needed, topical NSAIDs and paracetamol, and a written flare-management plan help most people.
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What are DMARDs?
Disease-modifying anti-rheumatic drugs - methotrexate is the cornerstone for rheumatoid and psoriatic arthritis. Started early, they prevent joint damage.
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What are biologics?
Injectable or infused antibodies that target specific parts of the immune system - anti-TNF, IL-6 and IL-17 inhibitors, plus JAK inhibitors taken as tablets.
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Will I need a joint replacement?
For most osteoarthritis, no. When conservative treatment stops working, hip and knee replacements are among the most successful operations in medicine.
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Is arthritis hereditary?
There is a genetic contribution to all types. It raises risk but does not determine it - lifestyle and other factors also matter.
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Which foods help arthritis?
A Mediterranean-style diet, oily fish and weight management have the strongest evidence. Supplements like glucosamine have modest evidence at best.
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How urgent is a rheumatology referral?
For suspected inflammatory arthritis, ideally seen within three weeks - starting DMARDs early prevents joint damage.