Osteoarthritis: how to relieve joint pain day to day

Osteoarthritis is far and away the commonest reason patients in their fifties and beyond come to see me about joint pain.

It affects around nine million people in the UK, most often the knees, hips, hands and lower back.

For decades it was described as a wear-and-tear disease, and patients were handed a fairly bleak prognosis. We now know the picture is much more hopeful.

Osteoarthritis is a dynamic condition in which the whole joint, cartilage, bone, ligaments and muscles, remodels over time, and the right combination of exercise, weight management and medication can leave many people comfortable for decades.

This guide walks through the day-to-day relief plan I build with my patients.

What is osteoarthritis, and what is not?

Osteoarthritis develops when the balance between cartilage wear and repair tips slowly towards wear.

The joint surface thins, the underlying bone reacts with small outgrowths called osteophytes, and the capsule becomes slightly thickened and tender.

The result is a joint that is stiff after rest, achy with prolonged use, and sometimes swollen after a busy day.

Mornings typically bring 15 to 30 minutes of stiffness that eases with movement, quite unlike the one to two hours of morning stiffness seen in inflammatory arthritis such as rheumatoid disease.

The NHS osteoarthritis page is a concise patient resource, and Versus Arthritis produces excellent in-depth material including self-management leaflets and exercise videos. I regularly send patients to both.

Who gets it?

Age is the largest single risk factor, but genetics, occupation, previous joint injury and body weight all play a significant part.

Women are affected more often than men, particularly in the hands and knees, and the postmenopausal years bring a noticeable uptick.

A knee that suffered a cruciate ligament injury in the twenties is more likely to develop osteoarthritis in the fifties.

Every surplus kilogram of body weight adds roughly four kilograms of load across the knee, which is why weight management is one of the highest-yield interventions available.

The foundations: exercise and weight

No tablet, injection or surgical procedure outperforms the combination of regular, appropriate exercise and a healthy weight. The NICE osteoarthritis guideline (NG226) puts therapeutic exercise at the very top of its recommendations, ahead of any medication. The key is consistency and graded progression, not intensity.

• Strengthening. For knee osteoarthritis, the quadriceps are king. Sit-to-stand from a kitchen chair, ten repetitions three times a day, takes under five minutes and rebuilds the muscle that takes load off the joint. For hip osteoarthritis, bridges, clams and side-lying leg raises help.
• Aerobic exercise. Walking, cycling and swimming are all excellent. Aim for 150 minutes a week of moderate activity, broken into sessions that suit you.
• Flexibility and balance. Tai chi and gentle yoga reduce falls, stiffness and pain scores in multiple trials.
• Weight loss. A 5 to 10 percent reduction in body weight in overweight patients produces clinically meaningful pain relief, often greater than any single drug.

Medication: a practical ladder

Medication is an adjunct to, not a replacement for, the foundations above. The British National Formulary is my reference for doses, and our general pain relief page has a broader overview. In osteoarthritis I work through this ladder:

Topical first, oral second

Topical NSAIDs such as diclofenac or ibuprofen gel rubbed into the affected joint three or four times a day are genuinely effective in knee and hand osteoarthritis, and carry a fraction of the systemic risk of tablets. NICE now recommends them as first line for these joints. I often prescribe them in combination with oral paracetamol and ask the patient to try this for two to four weeks before escalating.

Oral NSAIDs

When the pain warrants it, an oral NSAID is the next step, at the lowest effective dose for the shortest sensible period, with a proton pump inhibitor if there are any gastric concerns.

• Naproxen 250 to 500 mg twice daily is a sensible starting point with a relatively favourable cardiovascular profile.
• Diclofenac 50 mg two or three times daily is more potent but I reserve it for shorter courses, especially in patients with any cardiovascular risk.
• Etoricoxib 60 mg once daily and meloxicam 7.5 to 15 mg once daily are COX-2 selective options with less gastric toxicity, useful when the stomach is the limiting factor.

You can read more about this family of drugs on our NSAIDs page. Blood pressure, kidney function and gastric risk should be reviewed before starting any long-term course, and rechecked periodically if the drug becomes part of your routine.

Paracetamol

NICE has stepped back from recommending paracetamol as a standalone treatment in osteoarthritis because the evidence of benefit as monotherapy is weak.

In combination with topical or oral NSAIDs, however, it still has a role, and many patients find 500 mg to 1 g taken before a known difficult activity takes the edge off.

Opioids and adjuvants

Weak opioids such as codeine may occasionally help during a flare, but long-term opioid use in osteoarthritis is discouraged because of poor long-term outcomes, constipation, falls and dependence.

Duloxetine is a second line option for some patients with persistent pain despite other measures.

Injections and surgery

Intra-articular steroid injections offer useful short-term relief, typically two to ten weeks, during a significant flare.

They are not a long-term solution, and NICE advises caution about repeated use in the same joint.

Hyaluronic acid injections are no longer recommended by NICE on the NHS. Platelet-rich plasma remains investigational.

Joint replacement surgery, most commonly of the hip or knee, is reserved for patients whose symptoms are significantly affecting quality of life despite a proper trial of non-surgical measures.

Modern hip and knee replacements have excellent outcomes with 90 percent or more lasting well beyond 15 years.

Daily life tips that make a real difference

1. Warm up before activity. Five minutes of gentle movement before gardening, a walk or housework reduces pain afterwards.
2. Pace yourself. Break demanding tasks into shorter chunks with micro-breaks rather than pushing through and paying for it the next day.
3. Use assistive tools where sensible. A jar opener, long-handled shoe horn or kneeling pad in the garden is not a sign of giving in, it is a sign of being smart.
4. Heat and cold. A warm bath or wheat bag before bed eases morning stiffness. A cold pack on a swollen knee after a busy day calms things down.
5. Good footwear. Well cushioned trainers for walking, and avoiding high heels, reduce knee and hip loads significantly.
6. Sleep. Poor sleep amplifies pain perception. A consistent wind-down routine is part of the treatment plan.
7. Mental health matters. Low mood, anxiety and pain feed each other. Cognitive behavioural therapy has good evidence in chronic musculoskeletal pain.

When to see your GP sooner rather than later

Book an appointment if you notice:

• A hot, swollen joint with systemic illness, which may indicate infection or crystal arthritis.
• Morning stiffness lasting more than an hour, particularly in multiple small joints, which raises the possibility of rheumatoid or another inflammatory arthritis.
• Significant unexplained weight loss, fever or night sweats alongside joint pain.
• A knee or hip that is giving way repeatedly or locking.
• Pain that is preventing work, sleep or basic activities despite sensible self-care.

Supplements and alternative therapies

Patients frequently ask about glucosamine, chondroitin, turmeric and CBD.

The honest summary is that the evidence is weak for all of them, though a minority of patients report benefit.

They are generally safe in recommended doses but can be expensive and should not replace the foundations. Acupuncture may provide modest short-term relief for some.

Hydrotherapy, where available, is genuinely helpful, particularly in hip and knee arthritis.

The bottom line

Osteoarthritis is a condition you can live well with. Put the foundations, exercise and weight, firmly in place. Layer topical NSAIDs first, oral NSAIDs second, and use paracetamol as a supporting act. Keep opioids on the fringes. Know when to ask for a steroid injection or a surgical opinion. Most of my osteoarthritis patients, given these tools and a bit of persistence, find that joint pain stops running their day. Our pages on musculoskeletal conditions and pain relief expand on related problems and medication choices.

Common questions patients ask me about osteoarthritis

Will exercise make my joints worse?

No, and this is the most important myth to lay to rest. Cartilage thrives on load, within reason.

Appropriate exercise strengthens the muscles that protect the joint, lubricates the cartilage through joint fluid movement and improves pain scores in every decent trial.

The worry that walking wears out the knees is simply not borne out by the evidence.

The right dose is enough to feel mildly challenged but not to leave you in agony the next day.

Should I use a stick or a knee brace?

A walking stick held in the opposite hand to the painful hip or knee unloads the joint by up to 25 percent and is a simple, evidence-based intervention.

Soft sleeves give proprioceptive feedback and warmth, which some patients find helpful. Rigid braces are reserved for instability or specific mechanical issues.

Does the weather really affect my joints?

Many patients swear their joints predict rain. The evidence is mixed, but cold, damp days genuinely stiffen tissues and make movement harder.

Warm clothing, a good pair of gloves and a deliberate warm up before going out all help during British winters.

What about glucosamine, turmeric and CBD?

The honest answer is that the evidence for all three is weak.

Some patients report benefit, and they are generally safe in recommended doses, but they are not a substitute for the foundations of exercise and weight management.

If you want to try one, do so for three months, note any clear difference, and be ready to stop if it is not helping.

Is cracking or clicking in the joints a bad sign?

Usually not. Painless clicks are common in osteoarthritic joints and reflect minor changes in cartilage surface and joint fluid. New, painful locking or giving way, on the other hand, deserves assessment.

Should I push through pain or stop?

A useful rule of thumb is the two hour rule.

If an activity leaves pain that persists more than two hours afterwards or into the next day, it was too much.

Drop the intensity or duration by 20 percent and try again. Steady, slightly challenging work beats boom and bust every time.

A week by week plan for a new flare

When a patient arrives with an osteoarthritis flare, this is the plan I typically build with them.

1. Week 1. Topical NSAID gel four times daily plus paracetamol 1 g four times a day. Relative rest: maintain essential activity, reduce volume by half. Heat before activity, ice after if swollen. Short daily walks.
2. Week 2. Begin or resume strengthening: sit-to-stands, bridges, clams. Review whether an oral NSAID is needed. Consider a physiotherapy self-referral.
3. Week 3 to 4. Return to baseline activity and add low impact aerobic work: cycling, swimming or brisk walking. Review pain diary with the GP if no improvement.
4. Beyond four weeks. If pain is still dominating daily life, discuss steroid injection or an orthopaedic referral. Reinforce long-term exercise and weight plans.

Osteoarthritis is a marathon, not a sprint. Each small habit layered on top of the last is what, over months and years, keeps my patients out of the operating theatre and living the life they want.