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Health condition · Clinically reviewed

Osteoarthritis, explained - from morning stiffness to when surgery makes sense.

The most common form of arthritis, and one of the most treatable - exercise and weight management do more than most people expect, well before any tablet or injection.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against NICE NG226 and peer-reviewed sources you can see at the end.

  • 03

    Current for 2026

    Reflects the 2022 NICE update on core treatments, injections and joint replacement thresholds.

Key facts

Osteoarthritis at a glance.

The essentials, in plain English - what it is, who gets it, and how it's managed under NICE guidance today.

  • What it is

    The most common form of arthritis - progressive cartilage loss with bony change in and around the joint, not simple "wear and tear".

  • Who it affects

    Usually over 45, more often women, and more likely with a family history, previous joint injury or being overweight.

  • Where it strikes

    Knees, hips, hands and spine are the classic sites - often more than one joint at a time.

  • How it is found

    Mostly a clinical diagnosis - typical age, activity-related pain and short morning stiffness, without needing a scan.

  • First-line care

    Exercise, weight management and education - proven to help more than any tablet on its own.

  • When surgery helps

    Joint replacement for severe hip or knee disease that keeps limiting daily life despite other treatment.

Why this guide matters

A joint disease, not just wear and tear.

Osteoarthritis is common, often misunderstood, and usually well managed without surgery. The three points below shape everything else on this page.

  • Exercise beats most drugs

    Structured strengthening and general activity is the single highest-evidence treatment - not a bolt-on to medication, the main event.

  • Diagnosis rarely needs a scan

    A typical story and examination in someone over 45 is usually enough - imaging is for uncertainty, not routine confirmation.

  • Surgery is a last step, not a first

    Joint replacement is reserved for severe disease that has not responded to conservative care - and it works remarkably well when the time is right.

Looking specifically for hip or knee osteoarthritis?

This page covers osteoarthritis in general - across knees, hips, hands and spine. For weight-bearing joint detail, including injections, hyaluronic acid and joint replacement timing, see our dedicated hip and knee osteoarthritis guide.

How the diagnosis is made

From first symptoms to a clear plan.

The steps a UK GP will normally follow under NICE NG226, in order - so you know what to expect and why.

  1. 01

    Assessing

    The story matters most

    Age over 45, pain that builds with activity and eases with rest, and stiffness that clears within 30 minutes - a very typical pattern.

  2. 02

    Assessing

    Which joints and how many

    Knees and hips affect walking; hands affect grip and fine tasks; the lower back and neck can also be involved.

  3. 03

    Assessing

    Clinical examination

    Range of movement, crepitus, bony swelling and any Heberden's or Bouchard's nodes at the finger joints.

  4. 04

    Confirming

    Usually no imaging needed

    NICE guidance says a typical presentation in someone over 45 does not need an X-ray to confirm the diagnosis.

  5. 05

    Confirming

    X-ray if uncertain

    Reserved for atypical features, a younger patient, or when the picture is not straightforward - joint space narrowing and osteophytes confirm it.

  6. 06

    Confirming

    Bloods if in doubt

    CRP, rheumatoid factor and urate rule out inflammatory or crystal arthritis when the pattern is not classic osteoarthritis.

  7. 07

    Planning

    Building a management plan

    Exercise, weight advice, topical treatment and - if needed - a referral to physiotherapy or orthopaedics.

Typical timeline: most people are diagnosed and started on a plan in a single GP appointment.

Symptoms

What osteoarthritis actually feels like.

The classic pattern of activity-related pain and short stiffness. And the features that mean it's time to look elsewhere.

  • Activity-related pain

    Worse with movement and weight-bearing, better with rest - the single most distinctive feature.

  • Short morning stiffness

    Under 30 minutes is typical - longer stiffness points towards an inflammatory arthritis instead.

  • Reduced range of motion

    Bending, kneeling, gripping or turning the neck becomes progressively harder over months to years.

  • Crepitus

    A grating, crunching or clicking sensation felt or heard as the joint moves.

  • Bony swelling

    Firm, bony enlargement rather than a hot, boggy swelling - most visible at the finger joints.

  • Heberden's and Bouchard's nodes

    Bony nodules at the end joints (Heberden's) and middle joints (Bouchard's) of the fingers - classic hand osteoarthritis.

  • Functional impairment

    Jars won't open, stairs get harder, walking distance shortens - the everyday cost that brings people to the GP.

  • Red flag - hot, swollen joint

    A hot, swollen joint with fever is not osteoarthritis until proven otherwise - same-day assessment to rule out septic arthritis.

Treatment

How osteoarthritis is treated under NICE NG226.

Core treatments for everyone first, then topical and oral options, then injections and surgery for the minority who need them.

  • Exercise and strengthening

    The mainstay of care for every patient, every joint - local muscle strengthening plus general aerobic fitness, kept up long-term.

  • Weight management

    Losing weight if overweight reduces load on hips and knees and measurably improves pain and function.

  • Patient education

    Understanding the condition and self-management options changes outcomes as much as many drug treatments.

  • Topical NSAIDs

    First-line for knee and hand osteoarthritis - ibuprofen or diclofenac gel, with fewer side effects than tablets.

  • Oral NSAIDs with cover

    Used if topical treatment is not enough, alongside a gastroprotective drug and with cardiovascular and kidney risk considered.

  • Paracetamol

    Limited evidence overall but may still help some people as an add-on, with a low side-effect burden.

  • Intra-articular steroid injection

    Useful for a painful flare - short-term relief that can help someone through a bad patch or rehabilitation.

  • Joint replacement surgery

    For severe hip or knee disease significantly affecting quality of life once conservative measures are exhausted - one of the most successful operations in medicine.

Considering hip or knee replacement, or want more on hyaluronic acid and PRP injections? Our hip and knee osteoarthritis guide covers weight-bearing joint treatment in more depth.

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 knows your joints and your history and can tell you which parts apply to you. If in doubt, get seen.

  • NICE. Osteoarthritis in over 16s: diagnosis and management (NG226).

  • Versus Arthritis. Patient information and support on osteoarthritis.

  • British Society for Rheumatology. Clinical guidance on joint disease.

  • National Joint Registry (NJR). Annual report on joint replacement outcomes.

Red flags

When joint pain needs urgent attention.

Most osteoarthritis is manageable in primary care. These are the situations that aren't - and where same-day or specialist assessment is needed.

  • Hot, swollen joint with fever

    Possible septic arthritis - needs same-day assessment, not a routine GP appointment.

  • Prolonged morning stiffness

    Over 30 to 60 minutes, especially with symmetrical small-joint involvement, suggests rheumatoid arthritis instead.

  • Sudden, severe single-joint pain

    Especially the big toe, ankle or knee - consider gout or another crystal arthritis rather than osteoarthritis.

  • Unexplained weight loss or fatigue

    Alongside joint pain, this warrants investigation for a systemic or inflammatory cause before assuming osteoarthritis.

  • Locking or giving way of the knee

    Suggests a loose body or meniscal problem rather than straightforward osteoarthritis - worth an orthopaedic opinion.

  • Neurological symptoms from the spine

    Leg weakness, numbness, or bladder or bowel change with back pain needs urgent same-day assessment.

  • Rapidly worsening joint damage

    A joint that deteriorates over weeks rather than years should prompt earlier imaging and specialist review.

  • Osteoarthritis under 45

    Unusually early disease deserves a look for an underlying cause - previous injury, a metabolic condition or joint dysplasia.

  • Post-injection infection

    Increasing pain, redness, warmth or fever in the days after a steroid injection needs same-day review.

Living with it

A manageable condition, with a clear ladder.

Four things that make the biggest difference day to day - staying active, building strength, watching weight, and knowing when to ask for more.

A quiet reminder

Rest is rarely the answer.

It feels counterintuitive when a joint hurts, but movement - the right kind, at the right pace - is what keeps it working.

  1. 01 Move

    Keep the joint moving

    Regular, moderate activity protects the joint far better than rest - little and often beats occasional bursts.

  2. 02 Strength

    Build the muscles around it

    Stronger quadriceps, hips or hand muscles take load off the joint itself and reduce pain over months.

  3. 03 Weight

    Small changes add up

    Even a modest, sustained weight loss meaningfully eases hip and knee symptoms - it does not need to be dramatic.

  4. 04 Plan

    Know your escalation path

    If exercise, weight loss and simple pain relief are not enough, ask about injections or a referral - you do not have to just live with it.

Frequently asked

Everything we get asked about osteoarthritis.

Quick answers on diagnosis, exercise, and when to consider surgery.

  • What is osteoarthritis?

    The most common form of arthritis - a joint disease involving progressive cartilage loss alongside bony change, most often in the knees, hips, hands and spine. It is a mechanical and low-grade inflammatory process together, not purely "wear and tear".

  • How is osteoarthritis diagnosed?

    Mostly on the history and examination alone. NICE guidance says a typical presentation - over 45, activity-related pain, no morning stiffness lasting more than 30 minutes - does not need an X-ray. Imaging or bloods are reserved for atypical or uncertain cases.

  • Is exercise safe if my joint already hurts?

    Yes - and it is the single most effective treatment available. Structured, appropriately paced exercise strengthens the muscles supporting the joint and reduces pain over time, whereas prolonged rest tends to make stiffness and weakness worse.

  • What is the difference between osteoarthritis and rheumatoid arthritis?

    Osteoarthritis causes activity-related pain with short morning stiffness and usually affects weight-bearing joints or the hands asymmetrically. Rheumatoid arthritis typically causes longer morning stiffness, symmetrical small-joint swelling, and is an autoimmune condition needing different treatment - see our rheumatoid arthritis guide.

  • Do I need a joint replacement?

    Only a minority of people with osteoarthritis do. It is considered for severe hip or knee disease that continues to significantly limit daily life despite exercise, weight management and medication - and it is generally very successful when it is the right option.

  • What can I do myself before seeing a doctor?

    Stay active within comfort, work on strengthening the muscles around the affected joint, manage your weight if you are carrying extra, and try a topical anti-inflammatory gel for knee or hand pain. See a GP if pain persists, worsens or starts limiting what you can do.

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