Joint pain and osteoarthritis: Signs and symptoms

Recognising joint pain and osteoarthritis

Osteoarthritis is a progressive condition¹ that can lead to significant physical² and psychosocial³ impacts for patients.

Here we review the signs and symptoms of osteoarthritis to help you recognise this condition.

Signs and symptoms of osteoarthritis

Osteoarthritis most commonly affects the knees, hips and hands.^4–7

Osteoarthritis is characterised by:^4,7–9

Activity-related joint pain/stiffness
Morning joint stiffness or stiffness after activity that normally resolves in 20–30 minutes
Possible swelling
Possible crepitus – a crackling, grating or crunching sound that occurs with joint movement
Impaired function

Knee pain most commonly develops slowly but can also have a sudden onset, and may be aggravated by climbing stairs or rising from a chair.⁹

Identifying osteoarthritis
A diagnosis of osteoarthritis in your patients may be made based on their symptomatic history and presentation of disease-related signs on clinical examination.^4,10,11 In patients older than 50 years, presence of the following symptoms and signs may be indicative of osteoarthritis:

Knee pain*^†

Short-lived morning joint stiffness*^‡

Functional limitation*

Crepitus*^‡

Restricted movement*

Bony enlargement*^‡

Bone margin tenderness^‡

No palpable warmth^‡

To help inform your diagnosis, consider asking your patients the following questions:

Where exactly is your pain? Is it one joint or any several joints affected?

How long has the joint been troubling you?

Describe the pain. Is it sharp? Or a dull ache? Does it feel sore? Or stiff?

Is there any swelling or tenderness in the joint?

Do you notice any noises when you move the joint?

Is the pain present all the time or does it only occur when you move, or perform any particular activity?

Does the joint feel stiff in the morning? If so, does this stiffness ease off once you start moving? How long does it take to improve?

Does the pain ease after you have rested? Or does resting make the joint stiff?

Have you lost any mobility in the joint? Can you still use it in the same way as you always could?

*Necessary according to the European League Against Rheumatism (EULAR) guidelines.^†Necessary according to the American College of Rheumatology (ACR) guidelines.^‡Three or more in addition to knee pain according to the ACR guidelines.
When to refer your patient for further care
Patients should be referred to a physician if they report:¹²

Persistent symptoms of osteoarthritis

Symptoms of gout including redness and heat in the joint

Swelling, warmth and stiffness after an injury
Further investigations that may be carried out

Whilst not necessary for initial diagnosis of osteoarthritis, plain radiography may be considered (in combination with clinical diagnostic criteria) for the diagnosis of atypical cases and/or morphological assessment.^9–11

Classical radiographical features of osteoarthritis include focal, non-uniform joint space narrowing; osteophytes; subchondral bone sclerosis and subchondral ‘cysts’. ^9–11

Plain radiography alone is not considered sufficient to make a diagnosis of osteoarthritis⁹ due to a poor correlation between disease symptoms and radiographic changes⁴ – particularly in early disease.¹¹

Understanding joint pain and osteoarthritis

Causes

Find out about the causes of joint pain and osteoarthritis.

Find out more

Management

Learn how joint pain and osteoarthritis can be managed.

Find out more

Overview of sprains and strains

Learn more about sprains and strains, and meet two patients with these conditions.

Find out more

Learn more

Voltaren Osteo Gel 12 Hourly with easy open cap

Up to 12 hours relief from mild osteoarthritis flare-up pain.¹³

Learn more

Panadol Osteo

Provides relief of osteoarthritis pain for up to 8 hours.^14,15

Learn more

Educational resources

Access detailed clinical information about pain.

Find out more

References

Chen D, et al. Bone Res 2017;5:16044.
King LK, et al. Arthritis Res Care 2018;70:71–9.
Iijima H, et al. BMC Psychology 2018;6:19.
National Intsitute for Health and Care Excellence. Osteoarthritis: care and management. Clinical guideline [CG177]. Available at: https://www.nice.org.uk/guidance/cg177.
Musumeci G, et al. Int J Mol Sci 2015;16:6093–112.
Mobasheri A, Batt M. Ann Phys Rehabil Med 2016;59:333–9.
Osteoarthritis Research Society International. Osteoarthritis: A serious disease, submitted to the U.S. Food and Drug Administration, 2016. Available at: https://www.oarsi.org/sites/default/files/library/2018/pdf/oarsi_white_paper_oa_serious_disease121416_1.pdf.
Sarzi-Puttini P, et al. Semin Arthritis Rheum 2005;35:1–10.
Lespasio MJ, et al. Perm J 2017;21:16–183.
Zhang W, et al. Ann Rheum Dis 2010;69:483–9.
Salehi-Abari I. Autoimmune Dis Ther Approaches 2016:3:118.
NHS Choices. Joint pain, 2019. Available at: http://www.nhs.uk/conditions/joint-pain/Pages/Introduction.aspx.
Voltaren Osteo Gel 12 Hourly. Patient Information Leaflet.
Panadol Osteo (paracetamol). Australian approved Product Information. Ermington: GSK Consumer Healthcare. Approved July 2018.
Bacon TH et al. Australian Pain Society 2001;63–4, Abstract E2 (GSK sponsored).

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