What are the symptoms of osteoarthritis?

Osteoarthritis causes pain and stiffness in affected joints. It may be painful or difficult to move the affected joints. Osteoarthritis symptoms can affect people's day-to-day lives, making it difficult to perform daily tasks. This can affect people's quality of life. Some people get joint tenderness, joint swelling, and cracking or crunching noises when moving the affected joints.

If you think you may have osteoarthritis find out what to do here.

In this series of articles centred around osteoarthritis you can read about osteoarthritis treatment, osteoarthritis causes, and osteoarthritis symptoms - all written by one of our expert GPs. Osteoarthritis is one of the causes of arthritis. See here for more detail.

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

What are the symptoms of osteoarthritis?

Osteoarthritis symptoms differ from person to person. Some people have occasional symptoms that come and go. Other people have symptoms that are there constantly, and affect their day-to-day lives a lot.

Osteoarthritis can affect any joint in the body. Commonly affected joints are the hips, knees, hands, and spine. People usually have osteoarthritis symptoms in one or a few joints, but it's possible to have it in many joints as well.

There are several symptoms of osteoarthritis, including:

Joint pain

This is the main symptom of osteoarthritis. It typically occurs when moving the joint, and can be worse after using the joints for a while - for example, when doing physical activity such as walking or running, or at the end of the day. Despite this, exercise is a really important treatment for osteoarthritis, and can help reduce pain in the long run - see osteoarthritis treatment for more.

Joint stiffness

People with osteoarthritis often feel stiffness in the joints, particularly if they haven't moved their joints for a while, such as first thing in the morning, or after having sat still for a while. Joint stiffness is also seen in other forms of arthritis, like rheumatoid arthritis. Morning joint stiffness in osteoarthritis tends to get better within 30 minutes of getting up and walking, whereas in other types of arthritis it often takes longer to subside.

Bony lumps on joints

Osteoarthritis can cause painless bony lumps in affected joints. These are often seen in the fingers. The image below shows a typical change that can occur in osteoarthritis of the finger - Heberden's nodes, a bony swelling of the finger joint that's closest to the fingertip.

Heberden's and Bouchard's nodes

By Drahreg01, CC BY-SA 3.0, via Wikimedia Commons

Weakness and muscle wasting

Muscles around the affected joints can become weaker, and shrink. This can make the joint less stable. People might feel like the joint is 'giving way' or 'buckling' as a result.

Exercise, as part of osteoarthritis treatment, is helpful in strengthening muscles.

Grating, grinding, cracking or crunching sounds or feelings in joints

These can occur in affected joints on movement. The medical term for this is crepitus. In osteoarthritis, this can develop if the cartilage in the joint is damaged and roughened, causing it to click or grind when moving.

However, it's normal to have a bit of crepitus even in healthy joints, especially the knee. It's usually not a cause for concern on its own, unless there are other symptoms, such as pain or stiffness.

Joint swelling

Osteoarthritis can sometimes cause swelling of affected joints. It can sometimes cause joints to become red, warm, and swollen too, but this is less common than with other forms of arthritis.

Flare-ups

People with osteoarthritis often have times when symptoms of pain, stiffness, and sometimes joint swelling become worse. This usually lasts for several days. See osteoarthritis causes for more information on the causes of flare-ups.

Patient picks for Arthritis

Bones, joints and muscles

What causes 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

Reactive arthritis

Reactive arthritis is a type of arthritis in which you develop inflammation in joints after you have had an infection in some other part of the body. For example, after a bad bout of diarrhoea you might develop a sore knee a couple of weeks later. Symptoms commonly last between a few weeks and a few months. Anti-inflammatory medicines usually ease the pain. Other treatments are sometimes needed. This is an unusual condition that would usually be managed by a specialist.

by Dr Rosalyn Adleman, MRCGP

What does osteoarthritis feel like?

People experience osteoarthritis symptoms in different ways. In general, people often have an aching-type pain deep in the joint that improves with rest, alongside symptoms of joint stiffness when the joints have been rested for a time.

Because osteoarthritis can affect many different joints, the symptoms - and the effect they have - can differ depending on which joints are affected. For example:

• Osteoarthritis of the knee can cause pain and stiffness in the knee. Pain might be felt all round the knee, or just in one specific place, like the sides. It might be difficult to move the knee fully. Knee osteoarthritis might make it more difficult to walk, and you might adjust your walking pattern in a way that can put extra strain on other joints.

• Osteoarthritis of the hip can cause pain over the hip, the groin, the buttocks, or the lower back. Sometimes, the pain might affect walking, running, or standing. It can affect sex - some people find that certain sex positions are painful.

• Osteoarthritis of the hand can cause pain and stiffness in the fingers and thumb. It might make using the hands difficult - for example, opening jars or doing up buttons can be difficult.

• Osteoarthritis of the spine can cause pain in the back or neck. Sometimes, osteoarthritis can lead to pressure on the nerves coming out of the spine, or on the spine itself (spinal stenosis).

Can osteoarthritis spread?

Osteoarthritis isn't contagious and can't spread from person to person.

It often starts in one joint and may later affect other joints as well. One reason for this is that osteoarthritis in weight bearing joints, such as the hip or knee, can cause people to walk or stand differently, which can put extra stress on other joints, leading to further joint injury.

It's probably not the case that the osteoarthritis is spreading from joint to joint, but rather that the same thing that led to osteoarthritis in one joint is occurring again in other joints.

We don't really know how to prevent osteoarthritis from affecting other joints, once it's developed in one joint. However, it would be sensible to maintain a healthy weight - obesity is one of the strongest risk factors for osteoarthritis - to remain active, and to avoid overusing joints where there has been a previous joint injury.

At what age does osteoarthritis usually start?

Osteoarthritis is closely linked to older age. It usually starts after the age of 40. Younger people can also get osteoarthritis, although this is less common. In younger people, it's more likely to be linked to obesity, a joint injury, or certain types of physically-demanding job.

What's the difference between osteoarthritis and rheumatoid arthritis?

Osteoarthritis and rheumatoid arthritis are very different conditions.

Osteoarthritis is probably caused by repeated low-level joint damage, combined with problems with repairing the joint - sometimes called wear and tear arthritis. Inflammation can happen in joints affected by osteoarthritis - which is why treatments such as non-steroidal anti-inflammatory drugs (NSAIDs) can be useful - but the inflammation occurs in response to joint damage.

Rheumatoid arthritis, in contrast, is an auto-immune disease. In rheumatoid arthritis, the body's immune system mistakenly attacks the inside of joints, causing damage to the joints - so inflammation is the main cause of joint damage, unlike in osteoarthritis. Treatments for rheumatoid arthritis tend to be based on reducing the immune system's activity.

Both conditions cause joint pain and stiffness, but they tend to behave in different ways.

Osteoarthritis typically causes pain in one or a few joints. It tends to be worse on one side of the body - for instance, people might have one hip that is painful whilst on the other side they may have it milder or not at all. By contrast, rheumatoid arthritis tends to affect multiple different joints at once and usually, though not always, affects the same joints on both sides of the body. Rheumatoid arthritis typically starts in the small joints of both hands, and causes multiple joints to become red, swollen, painful, and warm.

It's usually fairly straightforward for doctors to decide if symptoms are due to osteoarthritis or rheumatoid arthritis, although sometimes it can be difficult, and tests or a second opinion might be needed.

When to see a doctor for osteoarthritis symptoms

How is osteoarthritis diagnosed?

Osteoarthritis can be diagnosed based on age, the symptoms, and the findings on clinical examination of the affected joints.

X-rays usually aren't needed to diagnose osteoarthritis, if the diagnosis is otherwise clear. However, they might be useful if there's uncertainty, and can look for other conditions, such as broken bones.

MRI scans might also be used, in some cases.Imaging tests like X-rays and MRI scans can show signs of osteoarthritis.

However, what's seen on the test doesn't always match up with the symptoms - sometimes the symptoms can be worse than the signs on the test, and also the opposite. 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.

Blood tests are normal in osteoarthritis. These are only useful if another condition is suspected - for example, blood tests might look for signs of another form of arthritis, such as rheumatoid arthritis, if it's thought to be a possibility.

Further reading

• Versus Arthritis.

• About Arthritis; Versus Arthritis.

• Osteoarthritis; NICE CKS, August 2022 (UK access only).

How is osteoarthritis diagnosed?

Osteoarthritis can be diagnosed based on age, the symptoms, and the findings on clinical examination of the affected joints.

X-rays usually aren't needed to diagnose osteoarthritis, if the diagnosis is otherwise clear. However, they might be useful if there's uncertainty, and can look for other conditions, such as broken bones. MRI scans might also be used, in some cases.

Imaging tests like X-rays and MRI scans can show signs of osteoarthritis. However, what's seen on the test doesn't always match up with the symptoms - sometimes the symptoms can be worse than the signs on the test, and vice versa. 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.

Blood tests are normal in osteoarthritis. These are only useful if another condition is suspected; for example, blood tests might look for signs of another form of arthritis, such as rheumatoid arthritis, if it's thought to be a possibility.