Osteoarthritis
Osteoarthritis affects around 10 million people in the UK. Guide to OA causes, joint symptoms and diagnosis.
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Osteoarthritis UK: Symptoms, Joints Affected & Management
A clinically reviewed UK guide to osteoarthritis — who gets it, which joints are affected, what causes it, how it is diagnosed, and the treatments that actually work.
Osteoarthritis is the most common form of arthritis and the most common long-term joint condition in the UK, affecting around 10 million people. It affects the whole joint — not just the cartilage — and includes an active inflammatory element that explains why joints flare. It is manageable: the right mix of exercise, weight management and targeted treatment lets most people keep moving and cut their pain significantly.
What Is Osteoarthritis?
Osteoarthritis is a long-term joint condition. The smooth cartilage that caps the ends of your bones gradually wears down, and the bone underneath, the joint lining, the ligaments and the surrounding muscles all change too. It is not just “wear and tear” — that phrase is both inaccurate and unhelpfully gloomy. There is real biology going on, including low-grade inflammation that drives the painful flares.
That distinction matters. OA flares have a genuine inflammatory component, which is why anti-inflammatories help during a flare. But OA is not an inflammatory disease in the same way as rheumatoid arthritis — here the inflammation follows the structural change rather than causing it. So the treatment approach is different: keeping the joint moving and managing load is just as important as any medicine.
Who Gets Osteoarthritis?
OA becomes much more common with age. It is unusual before 45 and very common over 65. But it is not an inevitable part of getting older — plenty of people in their 80s have minimal OA, while some develop significant disease in their 40s or 50s. Age raises the risk; it does not cause the disease.
Women are affected more than men, especially for hand and knee OA, and the gap widens after the menopause. That pattern suggests oestrogen plays a protective role in joint health.
Joints Most Commonly Affected
| Joint | What it looks like in practice |
|---|---|
| Knee | The most common site. Usually the inner side of the knee first, and both knees are affected in about half of cases. Pain on stairs, squatting and long walks; stiffness after sitting still. |
| Hip | Deep pain in the groin or buttock, reduced movement, a change in how you walk. Often has a big impact on daily life, and hip replacement is common when it becomes severe. |
| Hand | The joints nearest the fingertips and the middle joints of the fingers, plus the base of the thumb. Bony bumps called Heberden’s and Bouchard’s nodes, weaker grip, and difficulty with fiddly tasks like buttons or jar lids. |
| Spine (facet joints) | Contributes to long-term back and neck pain. Bony spurs can narrow the spinal canal (spinal stenosis) and press on nerve roots. |
| Base of the big toe | Hallux rigidus. Pain when walking and pushing off, and a stiff, thickened joint. |
Causes and Risk Factors
- Age — the strongest single risk factor. Years of joint loading add up, and cartilage repairs itself less well as we get older.
- Obesity — closely linked to knee and hip OA. Every kilogram of body weight puts roughly 3–5kg of extra force through the knee when you walk, and fat tissue also releases inflammatory signals that affect joints independently of load.
- A previous joint injury — a torn ACL, a meniscal tear, or a fracture into the joint raises the risk of OA in that joint later on.
- Your job — work involving repeated kneeling, squatting, or heavy lifting is linked to knee and hip OA.
- Genetics — OA runs in families, especially hand and hip OA. First-degree relatives of someone with OA have roughly two to three times the risk.
- Joint alignment — bow legs or knock knees shift load onto one side of the joint, and hip dysplasia raises the risk of hip OA.
- Sex — women, particularly after the menopause, have higher rates of OA.
Symptoms
- Joint pain — usually a deep ache. Worse with activity and weight-bearing, better with rest. In severe OA it can hurt at rest and wake you at night.
- Morning stiffness — brief, typically under 30 minutes. If stiffness lasts longer than that in the morning, something inflammatory is more likely than OA.
- Stiffness after sitting still — sometimes called “gelling”. It eases quickly once you start moving.
- Crepitus — a grating, creaking or grinding feeling in the joint, caused by an uneven joint surface.
- Reduced movement — the joint feels stiff and does not go through its full range. How much this matters depends on which joint it is.
- Swelling — can happen, particularly at the knee. It is a mix of bony enlargement (osteophytes), inflammation of the joint lining, and fluid.
- Flares — bouts of extra pain and swelling lasting days to weeks, often after doing too much, a minor knock, or even a change in the weather.
OA symptoms vary hugely. What shows on an X-ray does not reliably match how much pain someone is in — some people with severe X-ray changes barely notice them, and vice versa. The measure that matters is function: how much is the pain affecting your daily life, your sleep and your quality of life?
Diagnosis
In most cases OA is diagnosed on the story alone, without any tests. NICE says OA can be diagnosed in an adult over 45 who has activity-related joint pain and either no morning stiffness or morning stiffness lasting under 30 minutes. An X-ray can confirm the diagnosis and grade how severe it is, but it is not needed to start treatment.
The classic X-ray changes spell out LOSS: Loss of joint space, Osteophytes, Subchondral sclerosis, Subchondral cysts. MRI is rarely needed to manage OA, but it may be used to look at meniscal or ligament damage in younger patients or when surgery is being considered.
Blood tests come back normal in OA. They are used mainly to rule out inflammatory arthritis — rheumatoid factor is negative, and CRP and ESR are normal in OA.
Disease Stages
| Kellgren & Lawrence grade | What the X-ray shows | What you may notice |
|---|---|---|
| Grade 1 — doubtful | Possible osteophytes; joint space normal | Occasional aching and mild stiffness |
| Grade 2 — mild | Definite osteophytes; joint space normal or slightly narrowed | Moderate pain with activity; brief morning stiffness |
| Grade 3 — moderate | Multiple osteophytes; joint space narrowed; sclerosis | Regular pain; limits daily activities; flares |
| Grade 4 — severe | Large osteophytes; marked joint space narrowing; deformity | Constant pain; significant disability; rest pain; surgery may be needed |
Treatment Overview
The backbone of OA treatment is not medicine. Exercise — on land or in water — has the best evidence of anything we do for OA and beats most medicines for long-term outcomes. For lower-limb OA, weight management is just as important.
| Treatment | Strength of evidence | Notes |
|---|---|---|
| Exercise therapy | Strong | Strengthening, aerobic and range-of-movement work. Reduces pain and improves function. Should be offered to everyone with OA. |
| Weight management | Strong (knee and hip) | Losing 5–10% of body weight produces meaningful symptom improvement in knee and hip OA. |
| Topical diclofenac gel | Strong | NICE first-line for knee and hand OA. Gets the NSAID to the joint with minimal systemic side effects. |
| Oral NSAIDs | Good | Effective for flares. Use the lowest effective dose, with a PPI if you are at risk of stomach problems. Naproxen or ibuprofen. |
| Paracetamol | Modest | NICE no longer recommends long-term paracetamol as first-line for OA, as the long-term benefit is limited. Still useful for acute flares alongside an NSAID. |
| Intra-articular steroid injection | Short-term benefit | Good for an acute flare. Effect lasts weeks to months. Given by a GP or specialist. |
| Joint replacement | Strong (end-stage) | Total knee and hip replacement are among the most cost-effective operations the NHS performs. Considered when conservative treatment has failed and quality of life is severely affected. |
Prescription diclofenac gel (NICE first-line for knee OA) and oral NSAIDs for OA flares: Prescription pain relief at Access Doctor →
For topical vs oral NSAID comparison for OA: Diclofenac gel guide → · NSAIDs compared →
When to Seek Help
- Joint pain that is significantly affecting your daily activities, sleep or quality of life
- A sudden severe worsening of a joint that was previously manageable — may be an acute flare, a crystal arthritis like gout, or bleeding into the joint
- A joint that becomes hot, red and acutely swollen — possible septic arthritis (an infected joint), which needs emergency assessment
- Progressive loss of joint function despite conservative management — ask about orthopaedic referral for joint replacement
Frequently Asked Questions
What is osteoarthritis?
Osteoarthritis is the most common joint disease in the UK, affecting around 10 million people. The cartilage that lines the joint gradually breaks down, and the bone, ligaments and joint lining change alongside it. There is also a low-grade inflammatory element, which is why joints can flare up and become painful and swollen for days or weeks at a time. The knee, hip, hands and spine are affected most often.
What causes osteoarthritis?
Age is the strongest risk factor, but OA is not simply a consequence of getting older — it involves active biological processes, and plenty of people in their 80s have little or no joint disease. Other key risks are obesity (especially for knee and hip OA), a previous joint injury, genetics, jobs that involve repeated kneeling or heavy lifting, and joint malalignment.
What is the best treatment for osteoarthritis?
Exercise is the single most evidence-based treatment for OA, and over the long term it does more good than most medicines. Losing weight matters just as much for lower-limb OA. For symptom relief, topical diclofenac gel is NICE first-line for knee and hand OA, with oral NSAIDs used for flares. Joint replacement is considered when severe disease has not responded to conservative management.
Is diclofenac gel good for osteoarthritis?
Yes. Topical diclofenac gel is recommended by NICE as first-line treatment for knee and hand OA. Because it is rubbed straight onto the joint, it reaches good local concentrations while far less of the drug is absorbed into the bloodstream than with oral NSAIDs — which means fewer stomach, kidney and heart side effects.
Can I get prescription treatment for osteoarthritis online?
Yes. Prescription diclofenac gel (2.32%) and oral NSAIDs such as naproxen or ibuprofen 600mg for OA are available at Access Doctor after an online consultation with a GPhC-registered pharmacist independent prescriber. GPhC pharmacy #9011198.
References
- NICE. Osteoarthritis: care and management. CG177. 2014 (updated 2022). nice.org.uk/guidance/cg177
- NICE CKS. Osteoarthritis. Updated 2023. cks.nice.org.uk
- NHS. Osteoarthritis. nhs.uk/conditions/osteoarthritis
- Versus Arthritis. Osteoarthritis. versusarthritis.org
Medical disclaimer: This article is for general information only and is not medical advice. Always speak to a qualified healthcare professional. In a medical emergency, call 999.
