Not simple wear and tear, and not a reason to stop moving. The most effective treatment is the one people are most afraid of.
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Osteoarthritis is the commonest form of arthritis, affecting the knees, hips, hands and spine most often. It is not simply wear and tear — the whole joint is involved, and the body is actively remodelling it rather than passively eroding.
The single most damaging sentence in this field is "you're bone on bone". People hear it, conclude the joint is finished, stop using it, lose muscle, and get worse. It is worth knowing that X-ray findings correlate poorly with how much pain someone is in. Plenty of people have severe changes on a scan and no symptoms at all; plenty of people are in real pain with a near-normal X-ray.
Which is why NICE now says: do not routinely order imaging to diagnose osteoarthritis. In someone 45 or over with activity-related joint pain and either no morning stiffness or stiffness lasting under half an hour, the diagnosis can be made without a scan. Scanning tends to produce a frightening picture that does not change the treatment.
And the treatment, unglamorously, is exercise. It is more effective than any tablet, it does not wear the joint out, and it is the thing people are most reluctant to do because they have been told the joint is worn away.
Not the pain, usually — the loss of confidence. Avoiding stairs, no longer walking as far, giving up an activity. That withdrawal accelerates the whole thing, which is why it is worth naming early.
Cartilage thins, the underlying bone thickens and forms spurs, the joint lining becomes mildly inflamed, and the surrounding ligaments and muscles change. It is an active process in the whole joint, not simply erosion from use.
That last point matters most. Resting a joint to protect it is precisely the wrong instinct.
Diagnose osteoarthritis without imaging if the person is 45 or over, has activity-related joint pain, and has either no morning stiffness or morning stiffness lasting no longer than 30 minutes.
That is the whole test. An X-ray is not required, and NICE advises against routine imaging because it does not change management and frequently produces alarming-sounding findings that do not match how someone feels.
Imaging is worth doing when the diagnosis is genuinely uncertain, when something else is suspected, or when surgery is being planned. Not to confirm what the history already tells you.
Not needed to diagnose osteoarthritis, and there is no blood test for it. CRP, ESR and rheumatoid factor are done to exclude inflammatory arthritis where the pattern suggests it — prolonged morning stiffness, symmetrical small joint swelling, feeling systemically unwell.
This is well suited to remote care, and more so than most people assume — because NICE says the diagnosis is clinical and does not require a scan.
Prescribe opioids. Not codeine, not tramadol, not morphine — for this or anything else. NICE specifically advises against strong opioids in osteoarthritis, because the benefit is minimal and the harm is not. That coincides with our position, which is that we do not prescribe them at all.
NICE recommends therapeutic exercise as a first-line treatment for everyone with osteoarthritis, and its effect on pain and function is larger than that of any medication.
The benefit stops when you stop. This is maintenance, not a course of treatment.
Where you are overweight, losing 5 to 10% produces a clear improvement in pain and function — and any loss helps, so this is not all-or-nothing.
NICE says do not use scoring tools, or arbitrary thresholds for age, weight or smoking status, to decide whether to refer someone for joint replacement.
Referral should be considered when symptoms substantially affect quality of life and non-surgical treatment has not worked. If you have been refused a referral on the basis of your BMI or your age alone, that is not consistent with the guideline, and it is reasonable to say so.
We will not sell you a scan you do not need. For most people with typical osteoarthritis, an X-ray adds worry and nothing else.
This page follows NICE guideline NG226 on osteoarthritis in over 16s: diagnosis and management, published in 2022, alongside NICE Clinical Knowledge Summaries and NICE NG100 on rheumatoid arthritis for the differential.
NICE notes that radiographic findings correlate poorly with symptoms, and that imaging may lead to inappropriate concern about structural damage without altering management.
Reviewed against NICE NG226, NG100 and NICE CKS guidance current at the date shown above.
No — and this phrase does a great deal of harm. X-ray appearances match symptoms poorly: many people with severe changes have no pain, and many with real pain have near-normal scans.
What the joint can do matters far more than what it looks like, and strengthening the muscles around it improves both pain and function regardless of the X-ray.
Usually not. NICE says do not routinely image to diagnose osteoarthritis. Age 45 or over, activity-related pain, and short-lived morning stiffness is enough.
Scans are for when the picture is atypical or surgery is being planned — not to confirm what the history already shows.
No — the opposite. Cartilage has no blood supply and depends on movement to get its nutrients. Resting a joint weakens the muscles supporting it and makes things worse.
Expect some ache for the first fortnight, which NICE specifically advises warning people about, because that is when most people give up.
Recreational runners actually have lower rates of knee osteoarthritis than non-runners. Running does not cause it in healthy joints.
If you already have it, running may or may not suit you, but you do not need to give it up as a precaution.
Because NICE no longer recommends it routinely for osteoarthritis — only for infrequent short-term use. The benefit turned out to be very small.
Topical anti-inflammatory gel is now first line for knee and hand osteoarthritis, and it is what many people should have been offered instead.
NICE says do not offer it. The evidence does not support a meaningful benefit, and it is not cheap.
The money is better spent on decent shoes, or a few physiotherapy sessions.
Not opioids. NICE advises against strong opioids in osteoarthritis — the benefit is minimal and the harms are real — and we do not prescribe them at all.
Topical and oral anti-inflammatories, exercise, and injections during a flare are what genuinely help.
Not according to the guideline. NICE explicitly says not to use thresholds for BMI, age, sex or smoking status to determine referral for joint replacement.
Referral should be based on how much symptoms affect your life and whether non-surgical treatment has worked. That is worth raising directly, in writing.
No. Noisy joints are extremely common and are not a marker of damage.
Crepitus without pain needs nothing done about it, and worrying about the sound leads people to move less, which does cause harm.
The clearest clue is morning stiffness. Under 30 minutes suggests osteoarthritis; an hour or more suggests inflammatory arthritis.
Symmetrical swollen small joints, fatigue and feeling unwell point the same way — and suspected rheumatoid arthritis should be referred urgently, because early treatment changes the long-term outcome.
August 30, 2026
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If your problem turns out to be genuinely outside what we can do remotely, the doctor will tell you straight away, point you to the right service, and refund your fee in full. We would rather do that than fill twenty minutes to justify the charge.
Call 999 or go to A&E — do not book an online appointment and do not wait for a reply to an email. For urgent problems that are not emergencies, NHS 111 is available 24 hours a day, online or by phone, and can direct you to the right service.
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