Joint pain: causes, red flags and when to seek help

The NHS says you might feel pain in one joint, or more than one at the same time, such as the knees and hips, and that causes range from injury to longer-lasting problems such as arthritis. It notes that perimenopause and menopause can also cause aching joints because of lowered oestrogen.

A few questions do most of the sorting. Did it follow an injury or unusual exercise? Is one joint involved or several, and are both sides affected equally? Is it worse with use, or after rest? Does it come with swelling, warmth, redness or fever? And are you well in yourself or do you have tiredness, rash, weight loss or eye or bowel symptoms?

The NHS links pain, swelling or bruising after intense or repetitive exercise with a sprain or strain, pain that is worse when walking with stiffness after activity, usually over 45, with osteoarthritis, a warm swollen joint more painful when moved or pressed with bursitis, pain and stiffness on both sides of the body worse after not moving, such as on waking, with rheumatoid arthritis, a hot swollen toe joint, usually the big toe, with very bad pain coming on suddenly, often overnight, with gout, and a hot swollen joint that is difficult to move with a high temperature or feeling hot or cold and shivery with a joint infection (septic arthritis).

The NHS describes rheumatoid arthritis as causing joint pain, swelling and stiffness, usually in the small joints of the hands and feet first, often symmetrical, with throbbing aching pain that is often worse in the mornings and after inactivity. It says morning stiffness in osteoarthritis usually wears off within 30 minutes of getting up, but in rheumatoid arthritis often lasts longer. Swelling, warmth and redness can occur, and general symptoms such as tiredness, a high temperature, sweating, poor appetite and weight loss are possible.

Early assessment matters for inflammatory arthritis, because treatment started promptly protects joints. Prolonged morning stiffness, swelling of several small joints, or joint symptoms with a rash, psoriasis, red eyes or bowel symptoms warrant a GP review.

The NHS says to ask for an urgent GP appointment or get help from NHS 111 if you have joint pain and the skin around it is swollen and feels hot, or if you feel generally unwell, have a high temperature or feel hot, cold or shivery. A hot, swollen, very painful single joint, especially with fever, may be septic arthritis, which needs hospital assessment and often drainage and antibiotics.

It says to go to A&E or call 999 if you have very bad joint pain after a fall or injury, are unable to walk or put weight on a joint, your joint has moved out of place, or you have any tingling or no feeling in the area around the joint after an injury.

Joint pain in someone on chemotherapy, with a weakened immune system, or with a recent injection, joint replacement or skin wound is more worrying. Joint pain with a spreading rash and fever, particularly in a child, should be seen the same day.

The clinician will ask about onset, which joints, morning stiffness duration, swelling, injuries, work and sport, family history of arthritis, psoriasis, bowel disease and gout, medicines such as diuretics, and any fever, rash, weight loss or eye symptoms. They will look at and feel each joint for swelling, warmth and tenderness, check movement and compare sides, and look at the skin, nails and eyes.

The NHS advises seeing a GP if pain is stopping you doing normal activities or affecting sleep, if pain or swelling is getting worse or keeps coming back, if pain has not improved after treating it at home for 2 weeks, if joints are stiff for more than 30 minutes after waking, or if your child has joint problems.

Not every joint needs a test. Where inflammatory arthritis is suspected, blood tests can include markers of inflammation such as ESR and CRP, rheumatoid factor and anti-CCP antibodies, a full blood count and uric acid for gout. X-rays show wear and joint damage; ultrasound and MRI show inflammation and soft tissue. Fluid taken from a swollen joint with a needle can be examined for crystals or infection.

The NHS says treatment depends on the cause and may include strong painkillers, antibiotics for infection, physiotherapy, steroid injections, hospital referral for X-ray, scan or specialist treatment such as surgery, and advice about lifestyle changes such as more exercise.

The NHS suggests resting the affected joint if you can, placing an ice pack or frozen peas wrapped in a towel on the painful area for up to 20 minutes every 2 to 3 hours, asking a pharmacist or GP which painkiller to take, losing weight if overweight, and eating a healthy, balanced diet and exercising regularly. It says not to completely stop moving the joint and not to smoke.

Many people can refer themselves to NHS community musculoskeletal services for physiotherapy without a GP referral in many areas. Gentle strengthening and low-impact exercise such as swimming and cycling help most long-term joint conditions.