Osteoarthritis: Symptoms, NHS Diagnosis & Treatment

Osteoarthritis (OA) is the most common form of arthritis in the UK, affecting around 10 million people. It occurs when the protective cartilage on the ends of bones wears down over time. This guide covers NHS diagnosis, treatment, and living well with osteoarthritis.

What is Osteoarthritis?

Osteoarthritis is a degenerative joint disease characterised by the breakdown of cartilage — the smooth, protective tissue covering the ends of bones in a joint. As cartilage wears away, bones can begin to rub against each other, causing pain, stiffness, and reduced mobility.

Osteoarthritis is distinct from rheumatoid arthritis, which is an autoimmune condition. OA develops gradually, typically affecting people over the age of 45, though it can occur earlier, particularly following joint injuries or in those with obesity.

Symptoms of Osteoarthritis

The main symptoms of osteoarthritis include:

• Joint pain — worsens with activity, improves with rest (in early stages)
• Stiffness — particularly in the morning, usually lasting less than 30 minutes
• Reduced range of movement — difficulty fully bending or extending the joint
• Swelling — soft tissue swelling around the joint
• Crepitus — a grating, creaking, or crackling sensation when moving the joint
• Muscle weakness — particularly around the affected joint

Symptoms typically develop slowly and worsen over time. The severity varies widely — some people have mild symptoms that plateau, while others experience progressive deterioration.

NHS Diagnosis

NICE guidelines (CG177) state that osteoarthritis can be diagnosed clinically — without investigations — if you are over 45 years old, have activity-related joint pain, and have morning stiffness lasting no longer than 30 minutes.

If the diagnosis is unclear or symptoms are unusual, your GP may request an X-ray to assess the degree of joint space narrowing and other characteristic changes. Blood tests may be done to exclude inflammatory arthritis.

NHS Treatment Options

Exercise Therapy

Exercise is the most effective treatment for osteoarthritis and is recommended as the first-line intervention by NICE. Strengthening exercises (particularly quadriceps strengthening for knee OA) and aerobic exercise both reduce pain and improve function. A physiotherapist can create a tailored exercise programme.

Weight Management

For overweight or obese individuals, weight loss significantly reduces pain and disability from osteoarthritis. Every 1kg of weight lost reduces the load through the knee by approximately 4kg during walking.

Pain Relief

Paracetamol has limited evidence for OA but may be tried for mild pain. Topical NSAIDs (e.g., diclofenac gel) are recommended for knee and hand OA and are safer than oral NSAIDs. Oral NSAIDs may be used if topical treatment is ineffective, with gastroprotection. Opioids are not recommended for long-term management of osteoarthritis.

Intra-articular Injections

Corticosteroid injections into the joint can provide short-term pain relief (typically 4–8 weeks) and may be offered by your GP or specialist for flare-ups. They are generally limited to three or four per joint per year.

Self-Management Strategies

• Stay as active as possible — movement keeps joints mobile
• Use heat packs to soothe stiff joints
• Use cold packs during flare-ups to reduce swelling
• Wear supportive footwear and consider orthotic insoles
• Use walking aids when needed to reduce joint load
• Pace activities to avoid overloading joints
• Contact Versus Arthritis for support: 0800 5200 520

When Surgery May Be Needed

Surgery is considered when conservative treatments have failed and OA is significantly affecting quality of life. Options include:

• Total joint replacement — the most common surgical option for severe knee or hip OA
• Osteotomy — realigning bones to reduce pressure on a damaged joint surface
• Arthroscopic washout — not recommended by NICE for osteoarthritis

NHS waiting times for joint replacement can be long. You will typically be referred to an orthopaedic consultant by your GP once conservative management has been exhausted.

Frequently Asked Questions