Arthritis affects more than 10 million people in the UK, making it one of the most common long-term health conditions. Despite the name suggesting a single disease, arthritis is an umbrella term covering over 100 conditions that affect joints, surrounding tissues, and other connective tissues. The two most common types are osteoarthritis and rheumatoid arthritis.
Types of Arthritis
Osteoarthritis (OA)
Osteoarthritis is the most common form, affecting around 8.75 million people in the UK. It occurs when the protective cartilage that cushions the ends of your bones wears down over time, causing pain, stiffness, and swelling in the joints. OA most commonly affects the knees, hips, hands, and spine.
Rheumatoid Arthritis (RA)
Rheumatoid arthritis is an autoimmune condition affecting around 400,000 people in the UK. The immune system mistakenly attacks the lining of joints (the synovium), causing painful inflammation that can eventually cause joint destruction. RA often affects the hands, feet, and wrists first and tends to affect joints symmetrically (both sides at once).
Other Common Types
- Psoriatic arthritis — associated with the skin condition psoriasis; affects ~1 in 5 people with psoriasis
- Gout — caused by uric acid crystal build-up; causes sudden, severe joint pain (usually the big toe)
- Ankylosing spondylitis — mainly affects the spine; causes chronic back pain and stiffness
- Reactive arthritis — develops after an infection (e.g., gut or urinary infection)
- Juvenile idiopathic arthritis (JIA) — arthritis in children and young people under 16
Arthritis Symptoms
Osteoarthritis Symptoms
- Joint pain that worsens with movement and improves with rest (early stages)
- Stiffness after periods of inactivity, especially in the morning (usually <30 minutes)
- Swelling and tenderness around affected joints
- Grating or crackling sensation (crepitus) when moving the joint
- Reduced range of movement
- Hard, bony swellings (Heberden’s nodes on finger joints)
Rheumatoid Arthritis Symptoms
- Warm, swollen, painful joints — often worse in the morning
- Morning stiffness lasting more than 30 minutes (often 1–2 hours)
- Symmetrical joint involvement (both hands, both wrists)
- Fatigue — often severe and debilitating
- Fever and flu-like symptoms during flares
- Rheumatoid nodules — firm lumps under the skin (in ~20% of cases)
- Systemic effects — RA can affect the lungs, heart, and eyes
Causes and Risk Factors
Osteoarthritis Risk Factors
- Age — OA becomes much more common over 45
- Obesity — excess weight puts enormous extra load on weight-bearing joints (each extra kg = 4kg extra force on knees)
- Previous joint injury — sports injuries, fractures, or repetitive strain
- Genetics — a family history increases risk, especially for hand OA
- Sex — women are more likely to develop OA, especially after menopause
- Occupational factors — jobs involving heavy lifting, kneeling, or squatting
Rheumatoid Arthritis Risk Factors
- Sex — RA is 2–3 times more common in women
- Age — most commonly diagnosed between ages 40–60
- Genetics — HLA-DR4 gene variant increases risk significantly
- Smoking — the most important modifiable risk factor; doubles risk and worsens outcomes
- Hormonal factors — some evidence that hormonal changes trigger RA in genetically susceptible women
Diagnosis
Your GP will take a history, examine your joints, and arrange tests. There is no single test for arthritis — diagnosis is usually clinical, supported by investigations.
| Test | Osteoarthritis | Rheumatoid Arthritis |
|---|---|---|
| X-ray | Joint space narrowing, bone spurs, sclerosis | Joint erosions (later stages) |
| Rheumatoid factor (RF) | Negative | Positive in ~70% of cases |
| Anti-CCP antibodies | Negative | Highly specific for RA; positive in ~75% |
| CRP / ESR (inflammation) | Normal or mildly raised | Raised during active disease |
| MRI / Ultrasound | Can show cartilage damage | Shows synovitis and early erosions |
| Full blood count | Usually normal | May show anaemia of chronic disease |
NHS Treatment for Osteoarthritis
Non-Drug Treatments (First Line)
- Exercise — the single most effective treatment for OA; strengthening muscles around joints reduces pain significantly. Aim for low-impact activities: swimming, cycling, walking
- Weight loss — losing even 5–10% of body weight can dramatically reduce knee pain in overweight patients
- Physiotherapy — exercise prescription, manual therapy, walking aids
- Occupational therapy — joint protection techniques, assistive devices
- TENS (transcutaneous electrical nerve stimulation) — can help some patients
- Heat and cold therapy — hot water bottles, ice packs for acute flares
Medications
- Paracetamol — often first prescribed (though recent NICE guidance questions its effectiveness in OA)
- Topical NSAIDs (e.g., diclofenac gel) — applied directly to the joint; very effective for knee/hand OA with fewer side effects than oral NSAIDs
- Oral NSAIDs (e.g., ibuprofen, naproxen) — effective for pain and inflammation; use lowest effective dose for shortest time; take with food; avoid if you have stomach, kidney, or cardiovascular problems
- Opioid analgesics — for severe pain; not generally recommended for long-term use
- Intra-articular steroid injections — can provide 4–8 weeks of significant pain relief
- Hyaluronic acid injections — not routinely recommended on NHS; some private patients find benefit
Surgery
Joint replacement surgery (arthroplasty) is considered when conservative treatment fails and quality of life is significantly affected. The NHS performs over 200,000 hip and knee replacements per year. Modern knee replacements last 15–20+ years in most patients.
NHS Treatment for Rheumatoid Arthritis
NICE guidelines emphasise early aggressive treatment to prevent joint damage. RA treatment should be started by a rheumatologist as soon as possible after diagnosis.
Disease-Modifying Anti-Rheumatic Drugs (DMARDs)
- Methotrexate — first-line DMARD for RA in the UK; taken weekly (tablet or injection); requires regular blood monitoring; must avoid alcohol
- Hydroxychloroquine — often used in combination; requires annual eye checks
- Sulfasalazine — often combined with methotrexate (“triple therapy”)
- Leflunomide — an alternative to methotrexate
Biological Therapies (bDMARDs)
For patients who fail conventional DMARDs, NICE recommends biological therapies:
- TNF inhibitors: adalimumab (Humira), etanercept (Enbrel), infliximab (Remicade)
- Rituximab (B-cell depletion)
- Tocilizumab (IL-6 inhibitor)
- Abatacept (T-cell co-stimulation blocker)
JAK Inhibitors (Targeted Synthetic DMARDs)
Oral targeted therapies including baricitinib (Olumiant), tofacitinib (Xeljanz), and upadacitinib (Rinvoq) are now available on NHS for RA after NICE approval, offering a tablet alternative to injections.
Living With Arthritis: Practical Tips
- Stay active — rest makes stiffness worse; movement lubricates joints and strengthens supporting muscles
- Pace yourself — alternate activity with rest; don’t push through severe pain
- Protect your joints — use joint protection techniques; carry bags on your forearms rather than gripping with fingers
- Maintain a healthy weight — one of the most impactful things you can do for knee and hip OA
- Stop smoking — especially critical in RA (worsens severity and reduces response to treatment)
- Get emotional support — Versus Arthritis (0800 5200 520) offers free helpline and local support groups
- Apply for Personal Independence Payment (PIP) — if arthritis affects your daily life significantly
Useful UK resources: Versus Arthritis (versusarthritis.org) | NRAS (nras.org.uk) for rheumatoid arthritis | NHS app for repeat prescriptions and GP access
This article is for informational purposes only and does not constitute medical advice. Always consult your GP or rheumatologist for diagnosis and personalised treatment.
Related Health Guides on YourHealthXpert
Explore these related NHS-aligned health guides:
- Rheumatoid Arthritis — RA is an autoimmune form of arthritis with specific NHS treatments distinct from osteoarthritis
- Osteoporosis — arthritis and its treatments increase bone loss risk
- Back Pain — spinal arthritis (spondylosis) is a very common cause of back pain
- Gout — gout is a form of inflammatory arthritis caused by uric acid crystals
- Anxiety and Depression — chronic pain from arthritis significantly impacts mental health
- Vitamin D Deficiency — low vitamin D worsens musculoskeletal pain and is common in arthritis patients