Is my pain inflammatory?
A few short questions about where your pain is and how it behaves, ending in the pattern it most resembles and the right next step: who to see, and how soon.
This check sorts pain by its pattern, not by its name. It never gives a diagnosis, and it is no substitute for being examined; what it can do is tell you whether what you describe looks like inflammation, which is worth an assessment soon, or like the far commoner patterns that settle with time and sensible care. No message reaches the practice, and nothing that identifies you is kept; the steps you take through the check are counted with the rest of the site's measurement, and our privacy policy says how to turn that off.
If you already have a diagnosis and this is a flare, our managing a flare guide is the better page. If the person in pain is a child, choose that answer first: the practice sees adults, and a child's joint has routes of its own.
What cannot wait
Before any question, check this list. If anything on it is true today, it comes first, whatever else is going on.
Treat any of these as a 999 or A&E emergency: call 999 and do not drive yourself to A&E.
- Severe illness with suspected sepsis: a high fever with shaking, confusion, rapid breathing, or feeling dramatically worse over hours
- With a fever or feeling unwell, a rash that does not fade when you press it, a stiff neck with eyes that cannot bear bright light, or skin, lips or tongue turning blue, grey, pale or blotchy, since these can be signs of meningitis or sepsis, as can a very bad headache, confusion or a first seizure with a fever or feeling unwell; on black or brown skin the rash and the change of colour may be easier to see on the palms of the hands or the soles of the feet
- A joint you cannot put weight on or move, or that has moved out of place, or, after a fall or injury, very bad pain or any tingling or numbness
- Numbness or tingling around the back passage, genitals or inner thighs, new difficulty passing urine or controlling your bladder or bowels, a change in feeling during sex, or pain, tingling, weakness or numbness in both legs, since these can mean pressure on the nerves at the base of the spine, which needs emergency treatment
- Back pain that began after a serious accident, such as a car crash or a fall from a height, or that comes with chest pain
- An eye that suddenly and completely loses its sight
- Sudden weakness or numbness on one side, a drooping face or difficulty speaking, a sudden severe headache, sudden confusion or a seizure, or sudden loss of vision, any of which can be a stroke, even if it stops after a short time, and giant cell arteritis can block an artery to the brain
- An arm or leg that has suddenly gone cold, pale, numb or very painful and stays so, since the artery feeding the limb can block
Any of these needs an assessment that is urgent, on the same day, from your GP or NHS 111:
- A joint that is hot and swollen, with a fever or feeling unwell, since an infected joint has to be ruled out at once, at A&E or through NHS 111
- A joint that has become hot and very swollen suddenly, or is worsening quickly, even without a fever, since an infected joint does not always announce itself with one
- Joint pain with a fever, or feeling hot, cold or shivery, or generally unwell, since an infection in or around a joint has to be found the same day
- A new red, painful eye, or sight that has blurred, dimmed or changed, which needs an eye casualty or urgent eye clinic the same day, as does an eye that light hurts, since the conditions this can turn out to be, psoriatic and reactive arthritis among them, can inflame the eye, as our uveitis guide explains
This check is written for adults. A child's hot, swollen joint is a question for a doctor the same day, and a limp or a painful joint with no obvious cause is for a GP: the first question's last answer gives the routes.
The questions
Where is the pain, mostly?
We start with where the pain mostly is, because each of the four sites has patterns of its own.
First, is any of these true today?
A few things need help today whatever else is true, so the checklist comes before the pattern; scan it for anything that is true now.
- A joint that is hot and swollen, with a fever or feeling unwell
- A joint that has become hot and very swollen suddenly, or is worsening quickly, even without a fever
- Joint pain with a fever now, or feeling hot, cold or shivery, or generally unwell
- You feel seriously unwell in yourself: confusion or slurred speech; skin, lips or tongue turning blue, grey, pale or blotchy; severe breathlessness or very fast breathing; or a rash that does not fade when pressed
- You cannot walk or put weight on the joint, it cannot be moved or looks out of place, or, after a fall or injury, there is very bad pain or any tingling or numbness
- None of these
First, is any of these true today?
Back pain has a short list of signs that need emergency or same-day help, and a longer list for a GP within days; the pattern questions come after them.
- Numbness or tingling around the back passage, genitals or inner thighs; new difficulty passing urine or controlling your bladder or bowels; a change in feeling during sex; or pain, tingling, weakness or numbness in both legs
- The pain began after a serious accident, such as a car crash or a fall from a height, or it comes with chest pain
- A fever, feeling hot, cold or shivery, or generally unwell with the pain; or severe pain that started suddenly or is getting worse quickly, including after a small strain or lift if you have osteoporosis or take steroid tablets
- Weight loss without trying; a past cancer; pain between the shoulder blades; or, if you are over 50, constant pain that is worse lying down at night and is not eased by changing position or by getting up
- None of these
First, is any of these true today?
This branch's readers are the ones who can have giant cell arteritis, whose signs need help today, so they come first beside the signs every branch asks; scan the list for anything true now.
- A new headache, a scalp that is tender, or pain in the jaw or tongue when chewing
- Sight that has blurred, doubled or dimmed, that is lost in part, or that faded and came back
- An eye that suddenly and completely loses its sight
- A joint that is hot and swollen, with a fever or feeling unwell
- A joint that has become hot and very swollen suddenly, or is worsening quickly, even without a fever
- Pain with a fever now, or feeling hot, cold or shivery, or generally unwell
- You feel seriously unwell in yourself: confusion or slurred speech; skin, lips or tongue turning blue, grey, pale or blotchy; severe breathlessness or very fast breathing; or a rash that does not fade when pressed
- You cannot walk or put weight on a leg, or a shoulder or hip cannot be moved, or, after a fall or injury, there is very bad pain or any tingling or numbness
- None of these
First, is any of these true today?
Widespread pain with a fever is where a serious infection can hide, so the same emergencies are asked first here.
- You feel seriously unwell in yourself: confusion or slurred speech; skin, lips or tongue turning blue, grey, pale or blotchy; severe breathlessness or very fast breathing; or a rash that does not fade when pressed
- A joint that is hot and swollen, with a fever or feeling unwell
- A joint that has become hot and very swollen suddenly, or is worsening quickly, even without a fever
- Pain with a fever now, or feeling hot, cold or shivery, or generally unwell
- You cannot walk or put weight on a joint, or a joint cannot be moved or looks out of place
- None of these
How many joints hurt?
One painful joint has different likely causes from several, and the guidelines refer them differently.
Where is it, mostly?
Low back pain has its own guideline test; the neck is answered by its own guide, and neck-and-shoulder stiffness over 50 by another branch.
Which is closest?
Pain and stiffness around the shoulders and hips on both sides has one pattern that is treated within days, and several that are not; the shape of it is what separates them.
- Stiffness and pain on both sides, worst on waking and lasting 45 minutes or more, that came on over days and has now lasted a week or more
- Weakness more than pain: the muscles have lost strength over weeks (stairs, standing from a chair, arms above your head)
- One or both shoulders or hips, worse on use or when you lie on that side, over months rather than weeks, without stiffness that lasts most of the morning
- As well as the shoulders and hips, the hands, wrists or feet are swollen, or stiff for more than half an hour in the morning
- Any of these with night sweats, weight loss without trying, or feeling unwell for weeks
- Aching everywhere, with poor sleep and tiredness, not only the shoulders and hips
- None of these fits
Alongside the pain, do you have any of these?
Aching everywhere can belong to several conditions, and what comes with it is what tells them apart.
- Night sweats, weight loss without trying, or feeling generally unwell for weeks
- A rash across the cheeks or after sun, mouth ulcers that keep returning, very dry eyes and mouth, or fingers that turn white then blue in the cold
- Muscle weakness: stairs, standing from a chair, arms above your head, built up over weeks
- Joints that are swollen or warm, or stiff for more than half an hour in the morning
- None of these: aching all over, with tiredness, unrefreshing sleep and poor concentration
How did the single joint begin, and what is it like now?
How fast a single joint began, and whether it is swollen, stiff or sore with use, points to very different causes.
- It flared up over a few days or less and is hot, red or swollen
- It has been swollen, or warm and tender to press, for more than a week or two
- It has been stiff for weeks, worst first thing and slow to loosen, but it is not visibly swollen
- It came on gradually, is worse with use and eases with rest, with little or no swelling
- It comes in attacks that settle completely, and the joint is normal in between
After you wake, how long do your joints take to loosen up?
How long the joints take to loosen up after waking is the clearest single dividing line between inflammation and wear: more than half an hour points one way, less the other.
Did the low back pain start before you were 45, and has it lasted more than three months?
The guideline's test for inflammatory back pain applies to pain that began before 45 and has lasted more than three months.
How old are you?
Polymyalgia rheumatica is very rare under 50, so the same picture under 50 is a question for a doctor rather than that pattern.
Do all of these apply: you are 50 or over; the pain and stiffness are worst around your shoulders and hips, on both sides; the stiffness lasts 45 minutes or more on waking and has been there a week or more; and getting out of a chair or turning in bed is hard?
Over 50, pain and stiffness worst around the shoulders and hips on both sides is a pattern of its own, and it is checked before the widespread-pain pattern is named.
Does any of these apply to you?
These are the clues that point persistent joint inflammation towards one family of conditions or another; none of them is a diagnosis.
- Psoriasis (yours, or a parent's, brother's or sister's), pitted or lifting nails, a whole finger or toe swollen like a sausage, a painful red eye (uveitis) now or in the past, or a parent, brother or sister with spondyloarthritis
- Crohn's disease or ulcerative colitis
- An infection in the weeks before the joints began: a gut, urinary or sexually transmitted infection, or a viral illness such as Covid
- Cancer immunotherapy (a checkpoint inhibitor), now or in the last months
- A rash across the cheeks or after sun, mouth ulcers that keep returning, very dry eyes and mouth, fingers that turn white then blue in the cold, or night sweats, weight loss without trying, or feeling unwell for weeks
- None of these
Which joint?
A single joint that aches with use and eases with rest usually has a cause particular to that joint, and each joint has its own guide.
Are any of the painful joints visibly swollen, or warm and tender when you press them?
Swelling, or warmth with tenderness when pressed, is inflammation of the joint lining until shown otherwise; stiffness without it is a question of its own.
Is there any swelling?
With little stiffness, the kind of swelling matters: soft and warm points to inflammation, hard bony knobbles to wear.
How many of these apply to you?
These are the nine features the guideline counts; three or more here is the point at which a GP should weigh them, since a GP can also test for the tenth.
- it started before you were 35
- it wakes you in the second half of the night and eases once you are up and moving
- pain in the buttocks, sometimes swapping sides
- it eases with movement
- it eases within two days of an anti-inflammatory such as ibuprofen or naproxen
- a parent, brother, sister or child with spondyloarthritis
- a joint that has been swollen, now or in the past
- pain where a tendon joins a bone, such as the heel or the elbow, now or in the past
- psoriasis, now or in the past
Which is closer?
Pain that eases with rest and aches with activity is the mechanical pattern; pain that is better for moving and stiff in the morning is not, even where the guideline's test is not met.
One more check before your answer: is any of these true today?
One more check for the over-50 shoulders-and-hips pattern, because the condition it can come with threatens sight and needs help today.
Over the last weeks, has it been there most days, or does it come in short attacks?
Inflammation that persists for weeks is referred urgently; attacks that settle completely are a pattern of their own.
Is the pain worse the more you use the joints, and easier after rest?
Pain that builds with use and settles with rest is the pattern of wear; pain that aches the same whatever you do is not.
How old are you?
From 45 wear becomes the likeliest cause of this pattern; between 45 and 55 the menopause can bring aching joints too, which is why we ask a woman's age band here and nowhere else.
Are your joints unusually flexible, or do they slip out of place or dislocate?
Under 45, unusually flexible joints, or joints that slip out of place, are a pattern of their own.
What the patterns mean
A child's joint
This check is written for adults, and the practice sees adults. A child's hot, swollen joint is a question for a doctor the same day, a limp or a painful joint with no obvious cause is for a GP, and some signs cannot wait at all.
Call 999 or go to A&E if a child has sudden pain in the hip, knee or thigh, cannot put weight on a leg, has a leg that has changed shape or points at an odd angle, feels generally unwell with a high temperature or feels hot, cold or shivery, has severe pain low in the tummy as well, or is getting worse. A hot, swollen joint needs an urgent GP appointment or NHS 111 the same day. A limp, or a joint problem with no obvious cause, is for a GP.
Our septic arthritis guide explains why a hot, swollen joint is never left to wait.
The guides that fit, nearest first
If you cannot tell how urgent something is, asking is never a mistake.
This cannot wait
A joint that is hot and swollen with a fever has to be seen today. Most hot joints turn out to be gout, pseudogout or a flare, and the one that is an infection is the one that must be found at once.
Any of these needs an assessment that is urgent, on the same day, from your GP or NHS 111:
- A joint that is hot and swollen, with a fever or feeling unwell, since an infected joint has to be ruled out at once, at A&E or through NHS 111
- A calf that is swollen, hot or painful, or a limb that is painful, swollen or discoloured, which can mean a clot; with breathlessness, chest pain, palpitations or feeling faint, this is a 999 or A&E emergency: call 999 and do not drive yourself to A&E
The guides that fit, nearest first
If you cannot tell how urgent something is, asking is never a mistake.
This cannot wait
A joint that has become hot and very swollen suddenly needs an answer the same day, whether or not you feel well in yourself. Without a fever that means an urgent GP appointment, NHS 111 or a specialist clinic that can see you that day; with a fever or feeling unwell it means the same day, either at A&E or by calling NHS 111.
Any of these needs an assessment that is urgent, on the same day, from your GP or NHS 111:
- A joint that has become hot and very swollen suddenly, or is worsening quickly, even without a fever, since an infected joint does not always announce itself with one
- A calf that is swollen, hot or painful, or a limb that is painful, swollen or discoloured, which can mean a clot; with breathlessness, chest pain, palpitations or feeling faint, this is a 999 or A&E emergency: call 999 and do not drive yourself to A&E
The guides that fit, nearest first
One of the clinics that can see you that day can be this one: same-day appointments are sometimes possible.
If you cannot tell how urgent something is, asking is never a mistake.
This cannot wait
Joint pain with a fever is a same-day question, because an infection in or around a joint has to be found or ruled out. A fever that spikes every day with a rash is a picture of its own, and the guides below describe it.
Any of these needs an assessment that is urgent, on the same day, from your GP or NHS 111:
- Joint pain with a fever, or feeling hot, cold or shivery, or generally unwell, since an infection in or around a joint has to be found the same day
The guides that fit, nearest first
If you cannot tell how urgent something is, asking is never a mistake.
This cannot wait
Sepsis is always a 999 or A&E emergency; its signs are a high fever with shaking; confusion or slurred speech; skin, lips or tongue turning blue, grey, pale or blotchy (on black or brown skin this may be easier to see on the palms of the hands or the soles of the feet); severe breathlessness or very fast breathing; feeling dramatically worse over hours; and a rash that does not fade when you press it. Call 999 and do not drive yourself to A&E.
The guides that fit, nearest first
If you cannot tell how urgent something is, asking is never a mistake.
This cannot wait
A joint that will not take your weight or cannot be moved, or that has moved out of place, is a 999 or A&E emergency whether or not there was an injury, whatever the cause; an infected joint does not always announce itself with a fever, and not being able to put weight on it is one of its signs. After a fall or injury, very bad pain, or any tingling or numbness, is a 999 or A&E matter as well, and short of those signs an urgent treatment centre can see the injury. A shoulder that is painful, bruised or swollen after it slipped out of place belongs here too.
Treat any of these as a 999 or A&E emergency: call 999 and do not drive yourself to A&E.
- Severe illness with suspected sepsis: a high fever with shaking, confusion, rapid breathing, or feeling dramatically worse over hours
- With a fever or feeling unwell, a rash that does not fade when you press it, a stiff neck with eyes that cannot bear bright light, or skin, lips or tongue turning blue, grey, pale or blotchy, since these can be signs of meningitis or sepsis, as can a very bad headache, confusion or a first seizure with a fever or feeling unwell; on black or brown skin the rash and the change of colour may be easier to see on the palms of the hands or the soles of the feet
- A joint you cannot put weight on or move, or that has moved out of place, or, after a fall or injury, very bad pain or any tingling or numbness
The guides that fit, nearest first
If you cannot tell how urgent something is, asking is never a mistake.
This cannot wait
Treat any of these as a 999 or A&E emergency: call 999 and do not drive yourself to A&E.
- Severe illness with suspected sepsis: a high fever with shaking, confusion, rapid breathing, or feeling dramatically worse over hours
- With a fever or feeling unwell, a rash that does not fade when you press it, a stiff neck with eyes that cannot bear bright light, or skin, lips or tongue turning blue, grey, pale or blotchy, since these can be signs of meningitis or sepsis, as can a very bad headache, confusion or a first seizure with a fever or feeling unwell; on black or brown skin the rash and the change of colour may be easier to see on the palms of the hands or the soles of the feet
- Numbness or tingling around the back passage, genitals or inner thighs, new difficulty passing urine or controlling your bladder or bowels, a change in feeling during sex, or pain, tingling, weakness or numbness in both legs, since these can mean pressure on the nerves at the base of the spine, which needs emergency treatment
- Back pain that began after a serious accident, such as a car crash or a fall from a height, or that comes with chest pain
Pressure on the nerves at the base of the spine, and an injury to the spine, are treated as emergencies because the hours matter.
The guides that fit, nearest first
If you cannot tell how urgent something is, asking is never a mistake.
This cannot wait
Any of these needs an assessment that is urgent, on the same day, from your GP or NHS 111:
- A fever, feeling hot, cold or shivery, or generally unwell, with the back pain, since an infection in the spine has to be found the same day
- Severe back pain that started suddenly or is getting worse quickly, including after a small strain or lift if you have osteoporosis or take steroid tablets, since a fracture has to be found the same day; on steroid tablets, pain in the abdomen or back that comes on suddenly and severely is a 999 or A&E emergency, since the pancreas can react to prednisolone: call 999 and do not drive yourself to A&E
An infection in the spine, or a fracture, is found the same day; neither is something to watch.
The guides that fit, nearest first
If you cannot tell how urgent something is, asking is never a mistake.
This cannot wait
Treat any of these as a 999 or A&E emergency: call 999 and do not drive yourself to A&E.
- Severe illness with suspected sepsis: a high fever with shaking, confusion, rapid breathing, or feeling dramatically worse over hours
- With a fever or feeling unwell, a rash that does not fade when you press it, a stiff neck with eyes that cannot bear bright light, or skin, lips or tongue turning blue, grey, pale or blotchy, since these can be signs of meningitis or sepsis, as can a very bad headache, confusion or a first seizure with a fever or feeling unwell; on black or brown skin the rash and the change of colour may be easier to see on the palms of the hands or the soles of the feet
- An eye that suddenly and completely loses its sight, since giant cell arteritis can starve the eye of blood, and the loss is usually permanent
- Sudden weakness or numbness on one side, a drooping face or difficulty speaking, a sudden severe headache, sudden confusion or a seizure, or sudden loss of vision, any of which can be a stroke, even if it stops after a short time, and giant cell arteritis can block an artery to the brain
Any of these needs an assessment that is urgent, on the same day, from your GP or NHS 111:
- A new headache, a scalp that is tender, or pain in the jaw or tongue when chewing, since each one can point to giant cell arteritis, which has to be treated the day it is suspected
- Sight that has blurred, doubled or dimmed, that is lost in part, or that faded and came back, which needs an eye casualty or urgent eye clinic the same day, since with giant cell arteritis these are the signs that the eye is at risk
Giant cell arteritis is found and treated the day it is suspected, because sight is what is at stake.
The guides that fit, nearest first
If you cannot tell how urgent something is, asking is never a mistake.
Back pain with a sign that needs a check
This pattern is worth an assessment soon. Here is why.
Weight loss without trying, a past cancer, pain between the shoulder blades, or, over 50, constant pain that is worse lying down at night and is not eased by changing position or getting up, are the signs that a GP should weigh within days, because each can point to a cause other than the back itself. Most turn out to be nothing of the kind, and the check is how that is known.
See a GP within days. Pain between the shoulder blades that comes with chest pain, sweating, feeling sick or breathlessness is a 999 or A&E emergency, as the back pain guide says. If your night pain is different, waking you in the second half of the night and easing once you are up and moving, that is another pattern: answer the question before this one again, choosing none of these, and the questions for it follow.
The guides that fit, nearest first
Once your GP has seen you, an assessment here can follow if the picture is still unclear.
If you cannot tell how urgent something is, asking is never a mistake.
A muscle-weakness pattern
This pattern is worth an assessment soon. Here is why.
Muscles that have lost strength over weeks, on the stairs, standing from a chair or lifting the arms, are a different question from pain and stiffness, and one that is investigated rather than watched.
See a GP within days. Difficulty swallowing, episodes of choking, or weakness getting worse fast, need help the same day, by the route the inflammatory myopathies guide gives.
The guides that fit, nearest first
No referral is needed to be seen here; next-working-day appointments can almost always be arranged, and same-day appointments are sometimes possible.
If you cannot tell how urgent something is, asking is never a mistake.
An attacks-that-settle pattern
This pattern is worth an assessment soon. Here is why.
Attacks of pain and swelling that settle completely, with the joints normal in between, are a pattern of their own. In some people it stays as it is; in some it goes on to rheumatoid arthritis, which is why an assessment while an attack is fresh is the most useful kind. If the attacks are hot and red at the base of the big toe, gout comes first among the causes.
See a GP within days, or book an assessment here.
The guides that fit, nearest first
No referral is needed to be seen here; next-working-day appointments can almost always be arranged, and same-day appointments are sometimes possible.
If you cannot tell how urgent something is, asking is never a mistake.
A stiffness-on-both-sides pattern in someone over 50
This pattern is worth an assessment soon. Here is why.
Stiffness and pain around both shoulders and hips, worst on waking and lasting 45 minutes or more, that came on over days in someone over 50, is the pattern of polymyalgia rheumatica. If that is what it is, treatment usually works within days, which is one reason to be seen soon; the other is the condition it can come with, giant cell arteritis, whose signs are in the lists below and need help today. Under 60 the guideline sends the picture to a rheumatologist rather than treating it in general practice.
See a GP within days, or book an assessment here.
Treat any of these as a 999 or A&E emergency: call 999 and do not drive yourself to A&E.
- Severe illness with suspected sepsis: a high fever with shaking, confusion, rapid breathing, or feeling dramatically worse over hours
- With a fever or feeling unwell, a rash that does not fade when you press it, a stiff neck with eyes that cannot bear bright light, or skin, lips or tongue turning blue, grey, pale or blotchy, since these can be signs of meningitis or sepsis, as can a very bad headache, confusion or a first seizure with a fever or feeling unwell; on black or brown skin the rash and the change of colour may be easier to see on the palms of the hands or the soles of the feet
- An eye that suddenly and completely loses its sight, since giant cell arteritis can starve the eye of blood, and the loss is usually permanent
- Sudden weakness or numbness on one side, a drooping face or difficulty speaking, a sudden severe headache, sudden confusion or a seizure, or sudden loss of vision, any of which can be a stroke, even if it stops after a short time, and giant cell arteritis can block an artery to the brain
Any of these needs an assessment that is urgent, on the same day, from your GP or NHS 111:
- A new headache, a scalp that is tender, or pain in the jaw or tongue when chewing, since each one can point to giant cell arteritis, which has to be treated the day it is suspected
- Sight that has blurred, doubled or dimmed, that is lost in part, or that faded and came back, which needs an eye casualty or urgent eye clinic the same day, since with giant cell arteritis these are the signs that the eye is at risk
The guides that fit, nearest first
No referral is needed to be seen here; next-working-day appointments can almost always be arranged, and same-day appointments are sometimes possible.
If you cannot tell how urgent something is, asking is never a mistake.
A spondyloarthritis-family pattern
This pattern is worth an assessment soon. Here is why.
Persistent joint inflammation with psoriasis, changed nails, a swollen finger or toe, a painful red eye or a close relative with spondyloarthritis points towards the psoriatic and related arthritides. The association is a clue, not a verdict, and the reason to act on it is that early treatment protects the joints and tendons.
See a GP within days for referral, which the guidelines make urgent for a new inflammatory arthritis, or book an assessment here. A red, painful eye now, or sight that has blurred, dimmed or changed, is for an eye casualty or urgent eye clinic the same day, as the block above says.
The guides that fit, nearest first
No referral is needed to be seen here; next-working-day appointments can almost always be arranged, and same-day appointments are sometimes possible.
If you cannot tell how urgent something is, asking is never a mistake.
A gut-linked inflammatory pattern
This pattern is worth an assessment soon. Here is why.
Persistent joint inflammation in someone with Crohn's disease or ulcerative colitis is usually linked to the bowel condition, and the two are treated together. The pattern can also involve the spine.
See a GP within days for referral, which the guidelines make urgent for a new inflammatory arthritis, or book an assessment here; tell whoever looks after your bowel condition as well. A red, painful eye now, or sight that has blurred, dimmed or changed, is for an eye casualty or urgent eye clinic the same day, as the block above says.
The guides that fit, nearest first
No referral is needed to be seen here; next-working-day appointments can almost always be arranged, and same-day appointments are sometimes possible.
If you cannot tell how urgent something is, asking is never a mistake.
An after-infection pattern
This pattern is worth an assessment soon. Here is why.
Joints that swell in the weeks after an infection usually settle over months, and are worth seeing early because a few need more than time. A gut, urinary or sexually transmitted infection points to reactive arthritis; a viral illness points to a viral arthritis, which fades on its own in most people.
See a GP within days. A single hot joint that started suddenly, a red or painful eye or any change in your sight, or pain passing urine or a genital rash, need help the same day, by the routes the reactive arthritis guide gives. If the illness was a virus, the viral arthritis guide carries the warning signs that belong to a viral illness itself, among them that an inflamed brain can bring on the stroke signs in the block above over hours, days or weeks rather than all at once.
The guides that fit, nearest first
No referral is needed to be seen here; next-working-day appointments can almost always be arranged, and same-day appointments are sometimes possible.
If you cannot tell how urgent something is, asking is never a mistake.
A pattern during cancer immunotherapy
This pattern is worth an assessment soon. Here is why.
Joints that become painful, swollen or stiff during or after a checkpoint inhibitor are a known effect of the treatment and are managed with your cancer team, who need to know at once.
Contact your cancer team first, without delay, through its 24-hour number.
The guides that fit, nearest first
Once your cancer team knows, an assessment here can follow alongside their care.
If you cannot tell how urgent something is, asking is never a mistake.
An early inflammatory arthritis pattern
This pattern is worth an assessment soon. Here is why.
A joint, or several, that has been swollen, warm or stiff for more than a week or two, with none of the clues above, is what the guidelines call suspected persistent synovitis, and they refer it urgently: within three working days where more than one joint, or the small joints of the hands or feet, are affected, and urgently too where symptoms have lasted three months. The reason is the window: treatment that starts inside the first twelve weeks changes the outcome. What it turns out to be, from rheumatoid arthritis to a viral arthritis that fades, is the work of the first assessment.
See a GP within days for the referral, or book an assessment here, where the joints are scanned in the same visit and the blood tests are arranged; our first appointment guide says what that involves.
The guides that fit, nearest first
- Early inflammatory arthritis
- Joint swelling
- Rheumatoid arthritis
- Viral arthritis
- Rheumatoid factor and anti-CCP antibodies
- Your first rheumatology appointment
No referral is needed to be seen here; next-working-day appointments can almost always be arranged, and same-day appointments are sometimes possible.
If you cannot tell how urgent something is, asking is never a mistake.
An inflammatory back pattern
This pattern is worth an assessment soon. Here is why.
Back pain that began before 45, has lasted more than three months, and carries three or more of the guideline's features is the pattern that is mistaken for ordinary back pain for years. The guideline counts these features, and a GP can add the one you cannot answer, a blood test; Crohn's disease or colitis, an eye that has been inflamed, and morning stiffness of more than half an hour are weighed beside them. Early assessment protects the spine.
See a GP for a spondyloarthritis assessment, or book an assessment here.
The guides that fit, nearest first
No referral is needed to be seen here; next-working-day appointments can almost always be arranged, and same-day appointments are sometimes possible.
If you cannot tell how urgent something is, asking is never a mistake.
Widespread pain with signs of illness
This pattern needs a doctor to look at it. Here is why.
Pain in many places with night sweats, weight loss without trying, or weeks of feeling unwell is for a GP within days; it can belong to several conditions, and no single one is the answer by itself.
See a GP within days. A fever now is a same-day matter, for your GP or NHS 111.
The guides that fit, nearest first
No referral is needed to be seen here; next-working-day appointments can almost always be arranged, and same-day appointments are sometimes possible.
If you cannot tell how urgent something is, asking is never a mistake.
A shoulders-and-hips pattern that is not yet clear
This pattern needs a doctor to look at it. Here is why.
Stiffness and pain around both shoulders and hips in someone under 50, or a picture that none of the answers fits, is not the pattern that is treated within days, and it can be several things, from the tendons to an inflammatory condition that has not declared itself.
See a GP, or book an assessment here, where the shoulders and hips are scanned in the same visit.
The guides that fit, nearest first
No referral is needed to be seen here; next-working-day appointments can almost always be arranged, and same-day appointments are sometimes possible.
If you cannot tell how urgent something is, asking is never a mistake.
A pattern with signs beyond the joints
This pattern needs a doctor to look at it. Here is why.
Joint pain with a rash across the cheeks or after sun, returning mouth ulcers, very dry eyes and mouth, fingers that turn white then blue in the cold, or weeks of feeling unwell can belong to several conditions, and blood tests and an examination are how they are told apart. None of them is the answer by itself.
See a GP within days, or book an assessment here.
The guides that fit, nearest first
- Lupus (SLE)
- Sjögren's syndrome
- Connective tissue disease (UCTD & MCTD)
- Raynaud's phenomenon
- Behçet's disease
- Positive ANA and autoimmune blood tests
No referral is needed to be seen here; next-working-day appointments can almost always be arranged, and same-day appointments are sometimes possible.
If you cannot tell how urgent something is, asking is never a mistake.
Prolonged stiffness without swelling
This pattern needs a doctor to look at it. Here is why.
Joints that are stiff for more than half an hour after waking, yet look normal, are worth an assessment, because inflammation in a joint lining can show on ultrasound before it shows on the outside. It can be anything from a mechanical pattern to the earliest stage of an inflammatory arthritis, and the first weeks are the time to find out which.
See a GP within days, to be examined and tested for inflammation, or book an assessment here, where the joints are scanned in the same visit.
The guides that fit, nearest first
- Joint pain without swelling
- Early inflammatory arthritis
- Point-of-care ultrasound (POCUS)
- Raised inflammatory markers (CRP & ESR)
No referral is needed to be seen here; next-working-day appointments can almost always be arranged, and same-day appointments are sometimes possible.
If you cannot tell how urgent something is, asking is never a mistake.
A back pattern that is not yet clear
This pattern needs a doctor to look at it. Here is why.
One or two of the guideline's features, or an inflammatory-sounding pattern that does not meet its test, can go either way: towards ordinary back pain that settles, or towards an inflammatory cause that declares itself later. A GP visit now is the right size of step, and the guideline itself says to go back if new features appear.
See a GP, and again if new features appear; or book an assessment here.
The guides that fit, nearest first
No referral is needed to be seen here; next-working-day appointments can almost always be arranged, and same-day appointments are sometimes possible.
If you cannot tell how urgent something is, asking is never a mistake.
A neck pattern
This pattern is common and usually settles. Here is what helps, and when to see someone.
A stiff or painful neck usually settles in a few weeks with movement and simple pain relief; in later life the wear of the neck's small joints is common and manageable.
See a GP if it has not gone after a few weeks. Pins and needles, numbness or weakness in an arm with the neck pain, or an arm that has gone cold or pale, needs help the same day, from your GP or NHS 111; an arm that has suddenly gone cold, pale, numb or very painful and stays so is a 999 or A&E emergency, as the block above says. A stiff neck with both shoulders, in someone over 50, is a different pattern: answer the first question again and choose the shoulders and hips.
The guides that fit, nearest first
If it is not settling, an assessment with ultrasound in the same visit can settle what is causing it.
If you cannot tell how urgent something is, asking is never a mistake.
A mechanical shoulders-and-hips pattern
This pattern is common and usually settles. Here is what helps, and when to see someone.
One or both shoulders or hips that hurt on use or when you lie on that side, over months, without stiffness that lasts most of the morning, are usually the tendons or the joint itself, and an examination, with ultrasound where it helps, shows which.
See a GP if it has not improved after two weeks.
The guides that fit, nearest first
If it is not settling, an assessment with ultrasound in the same visit can settle what is causing it.
If you cannot tell how urgent something is, asking is never a mistake.
A widespread-pain pattern without signs of inflammation
This pattern is common and usually settles. Here is what helps, and when to see someone.
Aching all over, with tiredness, unrefreshing sleep and poor concentration, and no swollen joints, is a pattern of its own. Fibromyalgia is the name doctors give it once other causes have been checked, and a GP is the first person to do that; the pattern is real, common and manageable. If your joints are unusually flexible or slip out of place, the hypermobility guide is the next page.
See a GP. Where the picture is unclear, an assessment here can check for an inflammatory cause with ultrasound in the same visit. The signs that would change the picture are in the block above and in the fibromyalgia guide's own lists.
The guides that fit, nearest first
If you cannot tell how urgent something is, asking is never a mistake.
A single-joint pattern: the knee
This pattern is common and usually settles. Here is what helps, and when to see someone.
Most knee pain is mechanical and settles over a few weeks with activity kept up, the knee kept moving and simple pain relief. Over 45, wear of the joint is the commonest cause of a knee that aches with use.
See a GP if, after two weeks of care at home, the knee is no better, if it is getting worse or keeps returning, or if it stops you doing normal things or sleeping. A knee that is badly swollen, that is very painful with no fall or injury, or that locks, gives way or clicks painfully so that you cannot carry on as normal, needs help the same day, from your GP or NHS 111, as the knee pain guide sets out; a knee that turns hot and swollen is answered by the hot-joint question above, and the other signs that would change the picture are in that guide's own lists.
The guides that fit, nearest first
If it is not settling, an assessment with ultrasound in the same visit can settle what is causing it.
If you cannot tell how urgent something is, asking is never a mistake.
A single-joint pattern: the hip
This pattern is common and usually settles. Here is what helps, and when to see someone.
Hip pain can come from the joint itself, from the tendons and bursa beside it, or from the back, and the pattern of where it hurts and what brings it on usually tells which. Over 45, wear of the joint is the commonest cause of a hip that aches with use.
See a GP if it stops you doing normal things or sleeping, is getting worse or keeps returning, or has not improved after two weeks of looking after it; new stiffness of more than half an hour in the morning is for a GP within days. A hip that suddenly becomes severely painful with no fall or injury needs help the same day, from your GP or NHS 111, as the hip pain guide sets out, and the other signs that would change the picture are in that guide's own lists.
The guides that fit, nearest first
If it is not settling, an assessment with ultrasound in the same visit can settle what is causing it.
If you cannot tell how urgent something is, asking is never a mistake.
A single-joint pattern: the shoulder
This pattern is common and usually settles. Here is what helps, and when to see someone.
Pain on reaching and lifting, with a shoulder that still moves freely, is usually the rotator cuff; a shoulder that is stiff in every direction and worst at night is more often a frozen shoulder. Both settle in time with the right exercises, and examining the shoulder, with ultrasound where it helps, tells them apart.
See a GP if it is getting worse or has not improved after two weeks. Sudden or very bad shoulder pain, or a shoulder that has become weak since a fall or a heavy lift, needs help the same day, from your GP or NHS 111, since a torn tendon or a break has to be found; a shoulder that is painful, bruised or swollen after it slipped out of place is a 999 or A&E emergency. Arm pain that comes on suddenly with pressure, heaviness or squeezing across the chest is a 999 or A&E emergency too, and arm pain brought on by exercise, stress, emotion or the cold, rather than by a particular movement of the arm, that stops within a few minutes of rest, needs NHS 111 the same day. Both shoulders at once, stiff on waking, in someone over 50, is a different pattern: answer the first question again and choose the shoulders and hips. The other signs that would change the picture are in the shoulder guides' own lists.
The guides that fit, nearest first
If it is not settling, an assessment with ultrasound in the same visit can settle what is causing it.
If you cannot tell how urgent something is, asking is never a mistake.
A single-joint pattern: the elbow
This pattern is common and usually settles. Here is what helps, and when to see someone.
A tender spot on the outer or inner elbow that hurts on gripping is usually a tendon problem, tennis or golfer's elbow, which settles over months with the load eased and the tendon worked gently. Where the same reader has heel pain, psoriasis or pain at several tendon sites, the pattern is inflammation where tendons join bone, and the enthesitis guide is the next page.
See a GP if it has not improved after two weeks. Sudden severe pain at the elbow during a heavy lift, perhaps with a snap, then bruising or weakness, needs help the same day, at A&E or an urgent treatment centre, or from your GP, since a torn tendon can need early surgery. Arm pain that comes on suddenly with pressure, heaviness or squeezing across the chest is a 999 or A&E emergency, and arm pain brought on by exercise, stress, emotion or the cold, rather than by a particular movement of the arm, that stops within a few minutes of rest, needs NHS 111 the same day; the elbow guide carries both. The other signs that would change the picture are in the elbow guide's own lists.
The guides that fit, nearest first
If it is not settling, an assessment with ultrasound in the same visit can settle what is causing it.
If you cannot tell how urgent something is, asking is never a mistake.
A single-joint pattern: the hand or wrist
This pattern is common and usually settles. Here is what helps, and when to see someone.
The hand's common causes each speak for themselves: pain on the thumb side of the wrist on gripping, a finger that catches or clicks, tingling that wakes you at night, or bony knobbles at the finger joints. Most settle with rest, a splint or a simple treatment, and an examination, with ultrasound where it helps, shows which it is.
See a GP if it stops you doing normal things, is getting worse, keeps returning, or has not improved after two weeks, for tingling, or a loss of feeling that has come on gradually, and at any stage if you have diabetes. Numbness that no longer clears, dropping things, a hand slowly growing weak, or a shrinking pad at the base of the thumb, is for a GP within days; with neck pain, any of these signs, or tingling or a loss of feeling that has come on gradually, needs help the same day, from your GP or NHS 111. A hand or an arm that has suddenly gone weak or numb is in the block above, a 999 or A&E emergency. The other signs that would change the picture are in the hand and wrist pain guide's own lists.
The guides that fit, nearest first
If it is not settling, an assessment with ultrasound in the same visit can settle what is causing it.
If you cannot tell how urgent something is, asking is never a mistake.
A single-joint pattern: the foot or heel
This pattern is common and usually settles. Here is what helps, and when to see someone.
Heel pain that is worst with the first steps of the day and eases as you get going is usually plantar fasciitis; pain in both heels with night waking, or at other tendon sites, is more often inflammation where tendons join bone. Both are seen on ultrasound.
See a GP if it has not improved after two weeks, if it is getting worse or keeps returning, if you have tingling, or a loss of feeling that has come on gradually, or if you have diabetes. A sudden severe pain in a tendon, or a snap with it, needs NHS 111 or an urgent treatment centre the same day. A foot or a leg that suddenly turns numb, or that suddenly turns weak with no snap, pop or sudden severe pain in it to explain it, is in the block above, a 999 or A&E emergency. The other signs that would change the picture are in the plantar fasciitis guide's own lists.
The guides that fit, nearest first
If it is not settling, an assessment with ultrasound in the same visit can settle what is causing it.
If you cannot tell how urgent something is, asking is never a mistake.
A wear pattern of the hands
This pattern is common and usually settles. Here is what helps, and when to see someone.
Hard, bony knobbles that have grown slowly at the finger joints or the base of the thumb are the wear of osteoarthritis, not inflammation. They can ache, and the thumb base can be sore on gripping, but they do not threaten the joints the way inflammation does, and much can be done for the pain and the grip.
A GP, or an assessment here, can confirm it and plan the care. Joints that turn soft, warm and swollen are a different matter: answer the questions again and choose that answer.
The guides that fit, nearest first
If it is not settling, an assessment with ultrasound in the same visit can settle what is causing it.
If you cannot tell how urgent something is, asking is never a mistake.
A mechanical back pattern
This pattern is common and usually settles. Here is what helps, and when to see someone.
Back pain that eases with rest and aches with activity, or followed a lift or a strain, is the commonest pattern there is, and most of it never needs a rheumatologist. Keeping moving, simple pain relief and a graded return to normal activity are what help.
See a GP if it has not improved after a few weeks. The signs that would change the picture are the ones in the block above and in the first list on the back pain guide.
The guides that fit, nearest first
If it is not settling, an assessment with ultrasound in the same visit can settle what is causing it.
If you cannot tell how urgent something is, asking is never a mistake.
Aching joints that look normal
This pattern is common and usually settles. Here is what helps, and when to see someone.
Joints that ache but look normal, with little stiffness and no swelling, are common and usually not arthritis. They can follow a virus, overuse, the menopause, a thyroid or vitamin D problem or some medicines, or be part of widespread pain; our joint pain without swelling guide runs through them.
See a GP if the pain stops you doing normal things or sleeping, keeps returning, or has not improved after two weeks. If the aching followed a viral illness, the viral arthritis guide carries that illness's own warning signs, among them that an inflamed brain can bring on the stroke signs in the block above over hours, days or weeks rather than all at once.
The guides that fit, nearest first
If it is not settling, an assessment with ultrasound in the same visit can settle what is causing it.
If you cannot tell how urgent something is, asking is never a mistake.
A wear-type pattern
This pattern is common and usually settles. Here is what helps, and when to see someone.
Joints that ache more with use and ease with rest, with no swelling and little morning stiffness, are the pattern of wear, which is common from 45 and manageable. Between 45 and 55 the menopause can bring aching joints too, and the two often overlap; both are usual, and both respond to the same care, with the menopause's own options worth asking a GP about.
See a GP if the pain stops you doing normal things or sleeping, keeps returning, or has not improved after two weeks.
The guides that fit, nearest first
If it is not settling, an assessment with ultrasound in the same visit can settle what is causing it.
If you cannot tell how urgent something is, asking is never a mistake.
A wear-type pattern
This pattern is common and usually settles. Here is what helps, and when to see someone.
Joints that ache more with use and ease with rest, with no swelling and little morning stiffness, are the pattern of wear, which is common from 45 and manageable. Movement, strength and, where it applies, weight are the mainstays, and they work.
See a GP if the pain stops you doing normal things or sleeping, keeps returning, or has not improved after two weeks.
The guides that fit, nearest first
If it is not settling, an assessment with ultrasound in the same visit can settle what is causing it.
If you cannot tell how urgent something is, asking is never a mistake.
A hypermobility pattern
This pattern is common and usually settles. Here is what helps, and when to see someone.
Joints that are unusually flexible, ache after activity and never swell are the hypermobility pattern, which is common in younger adults and is managed by strengthening the muscles that hold the joints steady.
See a GP for a routine appointment if the pain is troubling you, or if joints keep slipping out of place in the way you have come to know. A joint that swells with no injury behind it, and is still swollen after a week or two, is for a GP within days; after an injury, the joint hypermobility syndromes guide's lists give the routes, and a shoulder that is painful, bruised or swollen after it slipped out of place is a 999 or A&E emergency.
The guides that fit, nearest first
If it is not settling, an assessment with ultrasound in the same visit can settle what is causing it.
If you cannot tell how urgent something is, asking is never a mistake.
Sources and further reading
NHS: Joint pain, NHS: Rheumatoid arthritis - Symptoms, NHS: Osteoarthritis, NHS: Septic arthritis, NHS: Gout, NHS: Reactive arthritis, NHS: Psoriatic arthritis, NHS: Lupus, NHS: Sjögren's syndrome, NHS: Raynaud's, NHS: Joint hypermobility syndrome, NHS: Menopause and perimenopause, NHS: Menopause and perimenopause - Symptoms, NHS: Knee pain, NHS: Hip pain, NHS: Shoulder pain, NHS: Dislocated shoulder, NHS: Elbow and arm pain, NHS: Heart attack, NHS: Angina, NHS: Hand pain - Finger pain, NHS: Hand pain - Wrist pain, NHS: Hand pain - Thumb pain, NHS: Heel pain, NHS: Tendonitis, NHS: Back pain, NHS: Osteoporosis, NHS: Ankylosing spondylitis - Symptoms, NHS: Neck pain, NHS: Pins and needles, NHS: Polymyalgia rheumatica, NHS: Temporal arteritis (giant cell arteritis), NHS: Fibromyalgia, NHS: Encephalitis, NHS: Limping in children, NHS: Sepsis, NHS: Meningitis, NHS: When to go to A&E, NHS: When to go to an urgent treatment centre (UTC), NHS: Vision loss, NHS: DVT (deep vein thrombosis), NHS: Swollen ankles, feet and legs (oedema), NHS: Stroke - Symptoms, NHS: Subarachnoid haemorrhage, NHS: What to do if someone has a seizure (fit), NHS: Sudden confusion (delirium), NHS: Vasculitis, NHS: Acute pancreatitis, NHS: Prednisolone tablets and liquid, NICE: Rheumatoid arthritis in adults (NG100), recommendations, NICE: Spondyloarthritis in over 16s (NG65), recommendations, NICE: Rheumatoid arthritis in over 16s (QS33), quality statement 1: referral, NICE CKS: Rheumatoid arthritis, NICE CKS: Osteoarthritis, NICE CKS: Gout, differential diagnosis, NICE CKS: Knee pain, assessment, NICE CKS: Polymyalgia rheumatica, NICE CKS: Giant cell arteritis, NICE CKS: Back pain - low (without radiculopathy), NICE CKS: Axial spondyloarthritis (including ankylosing spondylitis), NICE CKS: Spondyloarthritis and psoriatic arthropathy, NICE CKS: Peripheral arterial disease, acute limb ischaemia, NHS England: 2025/26 NHS Payment Scheme, Annex C, guidance on best practice tariffs (early inflammatory arthritis, section 12).