What are the symptoms of arthritis?

There are many different causes of arthritis, and the symptoms, as well as which joints are affected, vary depending on the type. Here are some of the most common:

• Joint pain, tenderness, and stiffness.

• Inflammation in and around the joints.

• Restricted movement of the joints.

• Warm, red skin over the affected joint.

• Weakness and muscle wasting.

• Hard to use joints - for example, it is difficult to walk if the hip or knee is affected.

If you think you have arthritis find out what to do here. This will tell you if you need to see a doctor and how to treat it.

In this series of articles centred around arthritis you can read about arthritis causes, arthritis symptoms, and arthritis treatment - all written by one of our expert GPs.

The rest of this feature will take an in-depth look at the treatments of arthritis as, at Patient, we know our readers sometimes want to have a deep dive into certain topics.

What are the symptoms of arthritis?

Whilst all of the causes of arthritis lead to joint pain, the symptoms and the joints affected differ from type to type. See arthritis causes for more detail about the different types.

Osteoarthritis

Osteoarthritis, the most common cause of arthritis, mostly affects older people and is sometimes called wear and tear arthritis. Common symptoms of osteoarthritis include:

• Joint pain - typically made worse, or comes-on, when doing physical activity, such as walking or running.

• Joint stiffness - typically worse when the joint hasn't moved for a while, such as first thing in the morning, but improves within half an hour or so of starting movement.

• Cracking and creaking when moving a joint - some people with healthy joints have this too, and it's not a problem if there is no associated joint pain.

• Limited ability to move or use the joint as symptoms get worse.

• Changes in the shape of the joint - for example, people with hand osteoarthritis can get swellings around the knuckles.

• Occasional flare-ups of symptoms - when affected joints become more painful and swollen for a few days.

Osteoarthritis usually comes on slowly - the symptoms tend to have got worse gradually over months or years.

Osteoarthritis can affect any joint in the body, but most commonly affects the joints in the hands, the hips, the knees, and the spine - including the neck.

See osteoarthritis for more detail.

Inflammatory arthritis

Inflammatory arthritis is caused by different types of autoimmune conditions causing inflammation inside the joint.

These symptoms include :

• Pain in more than one joint.

• Tenderness, swelling, and warmth of affected joints.

• Usually, multiple joints are affected on both sides of the body - this can be symmetrical so the same joints are affected on both sides.

• Joint stiffness in the morning - in osteoarthritis this usually disappears within half an hour, joint stiffness in inflammatory arthritis often lasts longer.

• Symptoms in other parts of the body - such as fatigue, low-grade fevers, weight loss, or symptoms of problems in other organs, like redness and pain in the eyes.

The pattern of symptoms differs depending on the condition. For example:

• Rheumatoid arthritis - tends to cause painful, tender, warm, and swollen joints, usually starting in the small joints in the hands and the fingers.

• Ankylosing spondylitis - mainly causes lower back pain and stiffness, usually worse in the morning.

• Psoriatic arthritis - occurs in people with psoriasis and can cause pain, tenderness and swelling in one or more joints. It can also cause changes in the nails, and cause swelling of an entire finger or toe.

See arthritis causesfor other autoimmune conditions that cause arthritis

Gout

Gout comes on suddenly over a few hours, usually affecting only one joint at a time, and tends to last between three and 10 days. Symptoms of gout include:

• Severe pain in the joint.

• Tenderness of the affected joint - usually very painful to touch or to move.

• Swelling, warmth, and redness of the joint.

• Tophi - in the long-term, untreated gout causes whitish lumps under the skin

Gout typically affects the joint at the base of the big toe which is called podagra. However, other joints can also be affected, like the knee, ankle, or hands.

Calcium pyrophosphate deposition (CPPD) - or pseudogout - has very similar symptoms to gout, but it's more likely to affect the knee or wrist joints.

Septic arthritis (infection)

Septic arthritis - infection of a joint - usually only affects one joint at a time, and comes on suddenly, over hours to days.

Symptoms of septic arthritis include:

• Joint pain.

• Swelling, redness, and warmth of the skin over the affected joint.

• Fevers, high temperatures, or feeling shivery.

• Feeling generally unwell.

• Not being able to use the affected joint - for example, children with septic arthritis might limp, or refuse to walk, if their hip or knee joint is affected.

Septic arthritis can affect any joint, but is most common in the knee. It can sometimes be difficult to tell septic arthritis apart from other conditions, such as gout, so tests are needed if it is suspected.

Arthritis in children

Some types of arthritis can affect children. The most common types are grouped under the name juvenile idiopathic arthritis (JIA). JIA is caused by autoimmune problems and has some similarities to autoimmune joint conditions that affect adults. There are different types of JIA and symptoms include:

• Joint pain and swelling - sometimes in one or a few joints, and sometimes in many different joints.

• Joint stiffness - especially in the morning.

• Limping - or not using the affected arm or leg.

• A persistent fever.

• Unexplained rashes.

• Weight loss.

• Fatigue.

• Eye pain or redness.

What does arthritis feel like?

Because there are lots of different causes of arthritis, people experience it in very different ways. The common symptom is joint pain, but when this occurs what helps, and what makes it worse, differs depending on the type of arthritis.

Living with arthritis can be difficult, regardless of the cause. Pain, stiffness, and reduced ability to use the affected joints can make it difficult for people to exercise or do their daily tasks. Many causes of arthritis are long-term conditions, although treatment can help alleviate symptoms or, sometimes, stop the condition getting worse.

Patient picks for Arthritis

Bones, joints and muscles

How to treat osteoarthritis

Osteoarthritis is the most common cause of arthritis, and typically affects older adults. It causes pain and stiffness of affected joints. Osteoarthritis typically affects the knees, hips, hands and spine, although it can affect other joints too. Diagnosing osteoarthritis is based on typical symptoms and examination findings. Tests like X-rays and blood tests often aren't needed, but can sometimes be useful to look for other conditions. Osteoarthritis treatments include maintaining a healthy weight, exercise, pain-relieving medication such as non-steroidal anti-inflammatory drugs (NSAIDs), and sometimes other treatments such as joint injections and surgery.

by Dr Doug McKechnie, MRCGP

Bones, joints and muscles

Osteoarthritis

Osteoarthritis is a degenerative joint disease that causes pain and stiffness in joints. Symptoms may be helped by exercises, some physical devices and treatments and by losing weight if you are overweight. Anti-inflammatory painkillers and other medicines are sometimes advised. Joint replacement surgery is an option for severe cases.

by Dr Doug McKechnie, MRCGP

At what age does arthritis usually start?

What age arthritis comes on depends on the cause - for example:

• Juvenile idiopathic arthritis - affects children and young people.

• Rheumatoid arthritis - can affect all ages, but most commonly starts between the ages of 40 to 60.

• Gout - usually starts after the age of 40, although some people can develop it sooner.

• Osteoarthritis - the most common type of arthritis, tends to affect people over the age of 50, and is most common in older people.

When to see a doctor for arthritis symptoms

You should speak to a doctor if you have persistent symptoms of arthritis, like joint pain and swelling, that have lasted longer than a week, are unexplained, or are impacting your day-to-day life.

How is arthritis diagnosed?

Diagnosing arthritis depends on the type. The most important information comes from the symptoms - including how long they've been there, and how they've developed - and clinical examination of the joints. Using this information, clinicians can work out which type of arthritis is most likely, and therefore which tests,if any, are needed.

Osteoarthritis

There is no single test for osteoarthritis but it can can be diagnosed on the basis of the symptoms and findings from an examination. With typical signs and symptoms, testing usually isn't needed.

Tests are usually only useful to look for other causes of the symptoms - such as a broken bone - or in severe cases, as part of the preparation and planning for surgery. Blood tests aren't usually useful as the signs of osteoarthritis do not show up.

X-rays can show signs of osteoarthritis. However, what's seen on the X-ray doesn't always match up with the symptoms - sometimes they can be worse or better. It's also common to see signs of osteoarthritis in joints as we get older, and these can be seen in people with no symptoms of arthritis at all.

Autoimmune arthritis

There are different types of autoimmune and inflammatory arthritis, most of which are diagnosed in different ways. Many types of inflammatory arthritis don't have a specific test to confirm the diagnosis, but instead are diagnosed on the basis of symptoms, examination findings, and test results that are all suggestive of the condition.

Tests that might be done for someone with suspected inflammatory arthritis include:

Blood tests:

• Blood tests for inflammation - such as CRP or ESR, might be raised.

• Conditions linked with certain antibodies - for example, around seven in 10 people with rheumatoid arthritis have a detectable antibody called rheumatoid factor, and up to five in 10 people with rheumatoid arthritis have an antibody called anti-CCP when they first get the condition.

• Blood tests - looking for anaemia, kidney function and liver function.

Antibody tests are often done as part of the testing for inflammatory arthritis. However, they need to be interpreted carefully - some people with no symptoms at all have detectable antibodies, and some people with inflammatory arthritis don't have a detectable antibody. These tests are only useful when considered in the context of the symptoms and examination findings.

Scans and X-rays:

• X-rays can sometimes show joint and bone changes - for example, in rheumatoid arthritis, erosions of the bone can be seen. However, these can be normal early on in the condition.

• Ultrasound scans - can show inflammation of the lining of affected joints, and of tendons.

• MRI scans - can show inflammation changes in the bones and joints.

Gout

Gout can often be diagnosed on the basis of typical signs and symptoms. For example, it's usually quite straightforward to diagnose if it's causing pain, redness and swelling of the joint at the base of the big toe.

Tests can be useful if the diagnosis isn't clear, or to help with the monitoring and treatment of gout.

• • A needle can take fluid out of the infected joint - If a certain type of crystal is found in the fluid this confirms gout.

  • A blood test to check the level of uric acid in the blood - a high uric acid level, alongside typical signs and symptoms will suggest gout. However, during an attack of gout, the blood uric acid level can sometimes drop - so, if gout is strongly suspected, the uric acid level is often measured again a few weeks later if it was normal or low at the time of the first attack.

• People taking allopurinol or febuxostat should have their uric acid levels measured to ensure that the dose is correct.

• Other tests such as X-rays and ultrasound can be useful to look for other causes and sometimes can show signs of gout as well.

CPPD can be diagnosed by finding a different type of crystal in joint fluid samples, and can also sometimes be seen on X-rays and CT scans.

Septic arthritis

Tests for septic arthritis include:

• Taking a sample of joint fluid - to test for white blood cells and bacteria. If bacteria is found inside the joint, this confirms infection.

• Blood tests to look for inflammation - can be used to monitor the response to treatment.

• X-rays - can look for other conditions, such as a broken bone.

Further reading

• About Arthritis; Versus Arthritis.

• Arthritis Foundation.