Osteoarthritis: symptoms, causes, treatment and exercise

The NHS says the main symptoms are joint pain and stiffness and problems moving the joint. Some people also have swelling, tenderness and a grating or crackling sound when moving the affected joints. Severity varies greatly from person to person and between joints. For some people symptoms are mild and come and go, whereas others have more continuous and severe problems that make everyday activities difficult.

NICE says symptoms may be mild or more severe, can vary between joints and over time, do not always get worse, and sometimes flare up and settle back down again.

The NHS says osteoarthritis is a long-term condition and cannot be cured, but it does not necessarily get any worse and can sometimes gradually improve. Mild symptoms can sometimes be managed with simple measures. More severe symptoms may need painkillers and a structured exercise plan with a physiotherapist.

NICE says that weight management and regular therapeutic exercise will improve quality of life and reduce pain. Arthritis UK says too much rest can increase stiffness and weaken muscles, whereas exercise can protect joints by strengthening the muscles that support them. It suggests taking paracetamol beforehand if pain makes it hard to get started, applying warmth if you overdo things, and pacing yourself so you do not do too much on a good day.

Arthritis UK says that if you are overweight, losing even a small amount can improve symptoms by reducing the load on joints such as hips and knees, and that being physically active alongside a healthy balanced diet can help reach and maintain a healthy weight. The NHS says to do at least 150 minutes of moderate aerobic activity a week plus strength exercises on 2 or more days to keep generally healthy. The sources read for this guide do not describe a specific osteoarthritis diet.

The NHS says that in osteoarthritis the protective cartilage on the ends of the bones breaks down, causing pain, swelling and problems moving the joint, and bony growths can develop. The exact cause is not known, but several things are thought to increase your risk.

• joint injury, including overusing a joint when it has not had enough time to heal after an injury or operation

• other conditions, such as rheumatoid arthritis or gout, that have severely damaged a joint (secondary arthritis)

• age, because risk increases as you get older

• family history, as osteoarthritis may run in families

• obesity, which puts excess strain on weight-bearing joints such as knees and hips

• being a woman, as it is more common in women than men

The NHS says a GP will ask about your symptoms and examine your joints, and may suspect osteoarthritis if you are 45 or older, have joint pain that gets worse the more you use your joints, and stiffness that is not there in the morning or lasts less than 30 minutes. Further tests such as X-rays or blood tests are not usually necessary, but may be used to rule out other causes such as rheumatoid arthritis or a fracture.

NICE Clinical Knowledge Summaries lists a joint X-ray if there is diagnostic uncertainty, atypical features or sudden worsening of symptoms.

Arthritis UK says osteoarthritis tends to occur in people over 45 and most often develops in the hips, knees, spine, hand joints and big toes. Osteoarthritis of the hands mainly affects women and often starts around the menopause, and osteoarthritis in the spine is called spondylosis. In the foot, it most often affects the big toe joint.

NICE Clinical Knowledge Summaries lists intra-articular corticosteroid injections as part of a structured treatment package offered through a musculoskeletal team, and orthopaedic referral if non-surgical management is unsuitable or ineffective after 3 months, or if there is diagnostic uncertainty or sudden worsening.

Arthritis UK says most people with osteoarthritis do not need surgery, and that it is usually only considered once other treatments have been tried. It adds that hyaluronic acid injections for knee osteoarthritis are not available on the NHS because the evidence for long-term effectiveness is mixed.

The NHS says it is important to receive support to cope with issues such as reduced mobility, and advice on any financial support, and that talking to your GP or others with osteoarthritis may help. NICE notes that people can use a decision support tool when deciding about knee osteoarthritis treatment. Arthritis UK suggests aids and supports, hot or cold therapy, comfortable footwear, and asking an occupational therapist how to adapt your home or workplace.

The NHS says to see your GP if you have persistent symptoms of osteoarthritis so they can confirm the diagnosis and prescribe any necessary treatment. Arthritis UK suggests speaking to your GP, physiotherapist or advanced practice nurse if you have joint pain, stiffness or swelling that interferes with daily routine, is not caused by anything obvious you have done, or comes with other symptoms such as feeling unwell.

On the NHS, osteoarthritis is usually managed in primary care with advice, exercise and painkillers, with referral to physiotherapy, a musculoskeletal team or orthopaedic surgeons if needed. Private physiotherapy, injections and joint replacement are also available to people who choose to pay or have insurance. NICE says people should be offered weight management and exercise whichever route they use, so ask how those will be supported.