Osteoarthritis – managing joint pain for the long term

Osteoarthritis is the gradual loss of cartilage cushioning a joint, most often the knees, hips, hands and lower back. It causes pain that is worse with use and better with rest, stiffness that eases within about half an hour of getting going, and sometimes creaking or swelling.

It is different from rheumatoid arthritis, which is an immune condition causing prolonged morning stiffness, symmetrical joint swelling and often fatigue and fever. That distinction matters because rheumatoid arthritis needs specific treatment early to prevent permanent damage — persistent stiffness lasting more than an hour each morning should be assessed rather than assumed to be wear.

The instinct is to rest a painful joint, and it is the wrong one. Muscle around the joint takes load off it, and inactivity weakens exactly that muscle. Exercise has stronger evidence for reducing osteoarthritis pain than any tablet.

1. 1Strengthen the muscles around the joint — for knees, that is mainly the thigh muscles. A physiotherapist can set this up.
2. 2Choose lower-impact movement: walking, cycling, swimming, water exercise.
3. 3Expect some discomfort during and after at first. Pain that settles within a day is acceptable; pain that lasts longer means too much too soon.
4. 4Lose weight if you are carrying extra. Each kilogram off is several kilograms less through the knee with every step, and this has some of the largest effects available.
5. 5Keep going. The benefit fades within weeks of stopping, which is why this is a habit rather than a course.

• Anti-inflammatory gels rubbed into the joint work reasonably well for knees and hands and carry far less risk than tablets — a good first choice.
• Anti-inflammatory tablets help but need caution with stomach, kidney, heart and blood pressure problems, and are for the shortest useful period rather than indefinitely.
• Steroid injections give relief for weeks to a few months and are used sparingly.
• Glucosamine and chondroitin have been studied extensively and the evidence for benefit is weak at best.
• Joint replacement is highly effective for advanced hip and knee osteoarthritis when other measures have been exhausted.

• Heat for stiffness, cold for a flare with swelling.
• Supportive, cushioned footwear — it changes the load through knees and hips more than most people expect.
• A walking stick used in the opposite hand to the painful leg genuinely reduces load.
• Raised seats, grab rails and long-handled tools reduce the movements that hurt most.
• Pace activity across the day and week rather than doing everything on a good day and paying for it.