Osteoarthritis

Osteoarthritis is sometimes described as simple wear and tear, but it is better understood as an active process in which the whole joint, including the cartilage, the underlying bone and the lining, gradually changes and the joint's natural repair cannot keep pace. Why it develops in one person and not another is rarely down to a single cause. Things that make it more likely include:

• Increasing age and a previous joint injury or operation
• Excess weight, which loads the knees and hips in particular
• Family history, with the hands more often affected after the menopause
• Work or activities that repeatedly stress a joint

It is not an inevitable part of ageing, and many people with changes on a scan have few or no symptoms.

Osteoarthritis tends to develop slowly, and symptoms can vary. Typical features include:

• Joint pain that is often worse with activity and eases with rest
• Stiffness, particularly after rest, that usually settles within a short time of moving
• Reduced range of movement in the joint
• A grating or crackling sensation, and sometimes mild swelling

One of the most useful things a specialist assessment does is distinguish osteoarthritis from inflammatory arthritis, as the two are managed quite differently.

Diagnosis is usually based on your symptoms and an examination, supported by imaging where helpful. An important part of the assessment is making sure the pain is not due to an inflammatory or other condition that would need different treatment.

Ultrasound can help here, showing whether there is active inflammation in a joint and helping clarify the cause of the pain. Dr Borukhson uses point-of-care ultrasound during the consultation, so this can often be assessed in the same visit. You can read more on the ultrasound clinic page.

The aim is to reduce pain, maintain movement and keep you active. Treatment is individual but often combines exercise and strengthening, advice on managing load on the joint, and pain relief where needed. These measures, used consistently, can make a substantial difference.

Where a particular joint is troublesome, an ultrasound-guided injection may help settle it and support rehabilitation. Depending on what is most suitable for you, this may be a steroid injection to calm inflammation, or a hyaluronic acid injection, which aims to lubricate and cushion the joint. Which option is best is discussed with you, and any treatment plan is agreed together.

A great deal of osteoarthritis is managed well day to day, and staying active is one of the most effective things you can do. The aim is to keep the joint moving and the surrounding muscles strong rather than to rest it.

• Build up regular movement and strengthening, as set out in arthritis and exercise
• Reaching and holding a healthier weight eases load on the knees and hips, supported by sensible diet and arthritis choices
• Use heat, supportive footwear and pacing to manage flares and busy days
• Stay in work and hobbies where you can, adapting rather than stopping

Symptoms often grumble and settle over years rather than steadily worsening, and good spells are common. Most people keep their own joints for life.

Most osteoarthritis can be reviewed routinely, but some patterns deserve prompter attention because they suggest something other than simple wear. Arrange an urgent or same-day medical review if you notice:

• A joint that becomes hot, red and acutely swollen, especially with fever or feeling unwell, which can point to infection or gout
• Sudden severe pain or inability to bear weight or move the joint after a fall or injury
• Locking, giving way or true blocking of the joint that stops normal use

Make a routine appointment if pain disturbs sleep, limits walking or daily tasks, no longer responds to your usual measures, or you develop new early-morning stiffness lasting well over half an hour, which can suggest inflammatory rather than wear-related joint disease.

Osteoarthritis is common, but persistent joint pain should not simply be put down to age without assessment. A specialist review confirms the cause, rules out inflammatory arthritis, and sets out a clear plan to protect comfort and function.

Do I need an X-ray or scan before my appointment?

No, there is no need to arrange imaging in advance. The diagnosis usually rests on your symptoms and an examination, with imaging used where it genuinely adds information, and point-of-care ultrasound can often be performed during the consultation itself. If you already have X-rays or scan reports, it is helpful to bring them along.

How do I know my pain is osteoarthritis and not inflammatory arthritis?

Telling the two apart is one of the most valuable parts of a specialist assessment, because they are managed quite differently. The pattern of symptoms and the examination give strong clues, and ultrasound can show whether active inflammation is present in the joint. Pain that worsens with activity and stiffness that settles shortly after moving are typical of osteoarthritis.

Can I have an injection on the day of my appointment?

Often, yes. Because point-of-care ultrasound is used during the consultation, an ultrasound-guided injection can usually be carried out in the same visit where it is clinically appropriate, once it has been discussed and agreed with you. Depending on the joint and your circumstances, this may be a steroid injection or a hyaluronic acid injection.

Will exercise make my joints wear out faster?

No. Exercise and strengthening are a core part of treatment rather than something to avoid, and used regularly they can make a real difference to pain and function. Advice on managing the load on the joint is part of the same plan, so activity can be built up in a way that suits you.

Is osteoarthritis just a normal part of getting older?

Age and use play a part, but persistent joint pain should never simply be accepted as ageing without proper assessment. Confirming the cause matters because other conditions can mimic osteoarthritis, and much can be done to ease pain and keep the joint moving well at any age.