Osteoarthritis

01

What it is

Osteoarthritis is a disorder of the whole joint, including cartilage, bone, lining, ligaments, muscles, and surrounding tissues. It commonly affects knees, hips, hands, spine, and feet, producing pain, stiffness, swelling, weakness, and reduced function. Symptoms and imaging findings do not always match: substantial changes can cause little pain, while severe symptoms can occur with modest imaging changes. Care should therefore focus on the person’s pain, function, goals, and participation.

Sources for this section: [1] [3]

02

Symptoms and how it may present

Osteoarthritis changes cartilage, bone, joint lining, ligaments, muscles, and other tissues. It most often affects knees, hips, hands, and spine. Pain typically relates to use, while stiffness may follow rest; symptoms and X-ray changes do not always match. Prior injury, age, genetics, joint loading, and higher body weight can contribute, but osteoarthritis is not an inevitable or uniform consequence of ageing.

Sources for this section: [1] [3]

03

Causes and risk factors

Risk is influenced by age, prior joint injury, repetitive loading, anatomy, muscle weakness, genetics, metabolic health, and—in weight-bearing joints—higher body weight. It is not simply cartilage “wearing out,” and ordinary movement does not automatically damage the joint. Avoidance caused by fear can weaken muscles and reduce capacity. Prevention and symptom management emphasize safe activity, injury prevention, occupational adaptation, and health support rather than blame.

Sources for this section: [1] [2]

04

Diagnosis and tests

Tests should answer a clinical question and be interpreted together with symptoms, examination, and history.

Diagnosis usually comes from symptoms and examination. Imaging is useful when the diagnosis is uncertain, symptoms are atypical, trauma is present, or a procedure is being planned, but repeated X-rays do not measure pain or dictate treatment. Monitoring focuses on function, sleep, work, mood, activity goals, medicine harms, instability, and whether inflammation or another condition needs consideration.

Sources for this section: [1] [2] [3]

05

Treatment options

The best option depends on severity, other conditions, likely benefit and harm, access, and personal priorities.

Education and tailored exercise are core treatment. Topical anti-inflammatory medicines may help accessible joints; oral NSAIDs can help but require attention to stomach, kidney, heart, blood-pressure, and bleeding risks. Injections may offer temporary relief for selected people. Joint replacement can substantially improve pain and function when severe symptoms persist despite appropriate non-surgical care.

Sources for this section: [2] [4]

06

Daily life and supportive care

Strength, aerobic activity, pacing, weight support when relevant, footwear, braces, walking aids, heat or cold, and occupational or physical therapy can make daily tasks easier. Glucosamine and viscosupplementation have not shown reliable benefit in many guidelines, opioids carry substantial harm, and stem-cell products lack convincing evidence. Food can support overall health but no diet rebuilds cartilage.

Sources for this section: [1] [2] [4]

07

Monitoring and follow-up

Follow trends that can change a decision rather than collecting measurements without a purpose.

Follow pain, stiffness, walking or hand function, sleep, work and caregiving demands, physical activity, medicine use and harms, falls, and progress toward personally meaningful tasks. Repeated imaging is usually not a useful measure of response. A flare plan can distinguish temporary symptom increases from warning signs. Review topical and oral pain medicines for stomach, kidney, cardiovascular, bleeding, and interaction risks, especially in older adults or people taking several medicines.

Sources for this section: [2] [3] [4]

08

Complications and long-term outlook

Osteoarthritis is long term, but symptoms do not always worsen steadily and many people improve function with exercise, rehabilitation, aids, pacing, pain treatment, and environmental changes. Joint replacement can substantially improve pain and function when symptoms are severe and non-surgical care is insufficient, but it has surgical risks and requires rehabilitation. Mental health, sleep, social participation, and confidence in movement are important outcomes alongside pain.

Sources for this section: [1] [2] [4]

09

When to seek urgent help

A suddenly hot, very swollen joint, fever, inability to bear weight after injury, a visibly deformed joint, new numbness or weakness, or calf swelling and breathlessness needs prompt evaluation. Gradual pain is not usually an emergency, but persistent night pain, unexplained weight loss, rapid decline, or symptoms inconsistent with osteoarthritis should be reassessed rather than attributed to ordinary wear.

Sources for this section: [1] [2] [3]

10

Questions to discuss with a care team

A guideline describes what tends to help groups of people, but it cannot decide what matters most in one person’s life. Revisit the plan when symptoms, function, other illnesses, pregnancy plans, medicine access, side effects, or personal priorities change. Ask for plain-language reasoning and say directly when cost, time, transport, caregiving, or treatment complexity makes a recommendation unrealistic.

• What evidence supports this diagnosis, and is there another condition we still need to rule out?
• What is the treatment goal, and how do the main options differ in benefit, harm, burden, and cost?
• What should be monitored, how often, and what result would change the plan?
• Which symptoms require a routine appointment, urgent assessment, or emergency care?

Sources for this section: [2] [4]