Osteoarthritis: Managing Joint Pain in the Knees, Hips and Hands
Osteoarthritis is the most common form of arthritis and a leading cause of pain and disability in older adults. It was once described as wear and tear, but we now understand it as a whole-joint condition in which cartilage thins, bone remodels and the lining of the joint becomes inflamed. It most often affects the knees, hips, hands, spine and the base of the thumb.
Who gets it and why
Risk rises with age, but osteoarthritis is not just a consequence of ageing. Other factors include:
- Previous joint injury, such as a torn ligament or meniscus
- Excess weight, which loads the knees and hips and also produces inflammatory chemicals
- Family history, especially for hand osteoarthritis
- Repetitive stress from certain jobs or sports
- Joint shape differences or malalignment
- Being female, particularly after menopause
Symptoms
- Pain that worsens with activity and eases with rest
- Stiffness after rest, usually lasting less than 30 minutes (longer stiffness suggests inflammatory arthritis)
- Reduced range of movement
- Swelling and a grating or crackling feeling
- Bony knobs at the finger joints
- A joint that seems to give way or lock
- Pain that may become constant in advanced disease and disturb sleep
Diagnosis
Doctors usually diagnose osteoarthritis from the history and examination. An X-ray can show narrowing of the joint space and bony spurs, but the appearance does not always match how much pain someone has. Blood tests are used to rule out other forms of arthritis such as rheumatoid arthritis or gout when the picture is unclear.
The core of treatment: exercise and weight
Exercise is the single most effective treatment, and the evidence is strong. It strengthens the muscles that support the joint, improves movement and reduces pain, often as well as medication. Suitable types include walking, cycling, swimming, water exercise, tai chi and targeted strengthening, ideally guided by a physiotherapist. Some discomfort during exercise is expected and is not a sign of harm.
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Weight loss has a large effect for knee and hip arthritis. Losing even 5 kg can reduce knee pain meaningfully, because each kilogram of body weight places about four kilograms of load across the knee when walking.
Pain relief
- Topical anti-inflammatory gels are an effective, low-risk first choice for knee and hand osteoarthritis.
- Oral anti-inflammatory drugs such as ibuprofen or naproxen help many people but carry stomach, kidney and cardiovascular risks, so use the lowest dose for the shortest time and ask your doctor, especially if you are older or have other conditions.
- Paracetamol has only a small benefit.
- Duloxetine is sometimes used for chronic knee pain.
- Heat and cold packs, walking aids such as a stick used in the opposite hand, and supportive footwear can help.
- Corticosteroid injections give short-term relief during flare-ups, but repeated use is discouraged.
- Hyaluronic acid and platelet-rich plasma injections have mixed evidence, and glucosamine and chondroitin supplements have shown little consistent benefit.
Everyday strategies
Pace your activities, alternate heavy and light tasks, and use joint-friendly tools such as jar openers and thick-handled utensils for hands. An occupational therapist can advise on splints, adaptations and ways to protect the joints.
Surgery
When pain and disability remain severe despite good non-surgical treatment, joint replacement of the knee or hip is one of the most successful operations in medicine, relieving pain and restoring function for most people for 15 to 25 years or more. Other procedures, such as osteotomy for younger patients with malalignment, may be appropriate. Arthroscopic washouts for degenerative knees are generally not recommended.
What to avoid
Resting a painful joint for long periods leads to weakness and more pain. Fear of damaging the joint by moving it is understandable but misplaced. Painkillers alone, without exercise, give limited benefit.
Looking after your wider health
Osteoarthritis is associated with a higher risk of low mood and cardiovascular disease, largely through inactivity and pain. Staying active benefits the joints, heart and mind together.
When to see a doctor
Seek medical advice if a joint becomes suddenly hot, red and swollen, particularly with fever, which could signal infection or crystal arthritis, or if pain is severe, constant or waking you at night.
This article is for general information and is not a substitute for professional medical advice. If you are worried about your health or have symptoms, speak to a doctor or other qualified health professional.