Osteoarthritis
The most common kind of arthritis. The whole joint changes over time (cartilage, bone, lining and the muscles around it), causing pain and stiffness. More than 500 million people have it worldwide. It isn’t simply “wear and tear”, and moving usually makes it feel better, not worse.
Osteoarthritis by joint
- Knee osteoarthritisThe most common joint, with the strongest evidence for exercise and weight loss.
- Hip osteoarthritisGroin or thigh pain and stiffness, trouble with socks and shoes.
- Hand and thumb-base osteoarthritisKnobbly finger joints and a sore, weak pinch grip.
- Foot and big toe osteoarthritisA stiff, sore big toe (hallux rigidus) or an aching midfoot.
- Shoulder osteoarthritisA deep ache and gradually lost movement in the ball-and-socket joint.
- Neck osteoarthritis (cervical spondylosis)Neck stiffness; occasionally a pinched nerve down the arm.
Not osteoarthritis? Pain on the outside of the hip is usually a tendon problem (outer hip pain). Pain shooting down the back of the leg below the knee may be sciatica. Aches all over with tiredness and poor sleep may be fibromyalgia. A sudden hot, red, swollen joint may be gout or infection.
Symptoms. Pain when you use the joint that eases with rest, stiffness after rest that loosens within about half an hour, creaking or grinding, bony swelling and less movement. It tends to come and go in flares.
Who gets it. More likely with age, in women, after a joint injury or operation, with higher body weight (especially for knees) and when it runs in the family. In Australia, osteoarthritis is the most common type of arthritis, affecting about 2 million people.
How it’s diagnosed. Usually from your story and an examination, without X-rays or scans, if you’re 45 or over, have joint pain with activity, and any morning stiffness lasts 30 minutes or less. Scans are for unusual features or when surgery is being considered.
The osteoarthritis ladder
The same ladder works for most joints. Steps 1 and 2 are the real treatment at every stage, even if you also need the others. Each joint page has the details.
- Step 1 · Self-careExercise and strengtheningStrengthening the muscles around the joint, plus walking, cycling or water exercise, most days.
- Works
- Knees: pain down about as much as anti-inflammatory tablets, without the side effects. Hips: smaller, about 7 points out of 100 on average. Hands: small gains in pain and grip
- Cost
- Free, or about $5–20 a session for a pool or gym
- How long
- 6–12 weeks to feel it; keep going for life
- Watch for
- Some soreness is normal. Fine if it settles within 24 hours.
Joints are like teenagers: they do better with a bit of structure and regular exercise.
- Step 2 · Self-careWeight loss, if above a healthy weightLess load on knees, hips and feet with every step.
- Works
- Knees: losing about 10% of body weight roughly halved pain in an 18-month trial. Any weight loss is likely to help, and 10% likely beats 5%
- Cost
- Free; weight-loss medicines are private scripts, often several hundred dollars a month
- How long
- Months
- Watch for
- Weight-loss medicines: nausea, constipation; not in pregnancy.
Not about looks. Purely an engineering problem.
- Step 3 · PharmacyAnti-inflammatory gel (diclofenac or ibuprofen)Rubbed on joints near the skin, such as knees and hands.
- Works
- Knees: about 1 in 10 more people get good relief than with a dummy gel. Hands: about as good as tablets, with fewer side effects
- Cost
- About $15–30 a tube
- How long
- 2 weeks to judge; use as needed
- Watch for
- Skin redness or itch.
Paracetamol does very little for arthritis. Try the gel first.
- Step 4 · PharmacyAnti-inflammatory tablets, short termIbuprofen or naproxen, or celecoxib on prescription, at the lowest dose for the shortest time.
- Works
- Modest pain relief in the short term; useful for flares
- Cost
- Pharmacy about $5–15; celecoxib under the $25 PBS co-payment
- How long
- Days to a couple of weeks
- Watch for
- Stomach bleeds, kidney and heart risks. Not safe for many people: check with your GP or pharmacist.
A flare tool, not a lifestyle.
- Step 5 · Allied healthPhysio, exercise physiology or a GLA:D programA tailored plan, or a structured group program for hip and knee arthritis run by trained physios.
- Works
- GLA:D registry: hip pain about a quarter lower at 3 and 12 months, and fewer people taking painkillers (no comparison group)
- Cost
- About $90–130 a session; Medicare rebates for up to 5 allied health visits a year with a GP care plan. GLA:D about $400–700 for the program
- How long
- 6–8 weeks of sessions, then keep going at home
- Watch for
- Choose someone who gets you moving, not just massaged.
Paying someone to make you do squats is surprisingly good value.
- Step 6 · ProcedureSteroid injectionAn injection into the joint for a bad flare, or to help you get going with exercise.
- Works
- Modest relief compared with a saltwater injection, lasting about 2–4 weeks on average
- Cost
- From bulk-billed to a few hundred dollars, depending on the clinic and whether ultrasound is used
- How long
- Weeks
- Watch for
- Not a long-term fix. Rare infection. Raised blood sugar for a few days in people with diabetes.
A pause button, not a fix.
- Step 7 · SpecialistJoint replacement or other surgeryFor severe pain and disability despite at least 3 months of good non-surgical care. Common for hips and knees; also for shoulders, and fusion for the big toe.
- Works
- Most people have much less pain. Long term, about 1 in 10 people after a hip replacement and about 1 in 5 after a knee replacement still have troublesome pain
- Cost
- Free in the public system (expect a wait); private out-of-pocket costs vary from hundreds to several thousand dollars
- How long
- Months of rehab
- Watch for
- Clots, infection, stiffness. Being fitter beforehand helps recovery.
The top rung. The exercises on rung 1 still come with you.
Save your money
Popular, heavily marketed or often asked about, but the evidence is weak or says no.
- Glucosamine and chondroitinNo better than a dummy treatment for knees, and a 2-year trial in hips found no benefit. NICE advises against glucosamine.
- Hyaluronic acid (“gel”) injectionsNICE advises against them for osteoarthritis. Often hundreds of dollars a course.
- PRP and stem cell injectionsA large good trial in knees found PRP no better than a dummy injection. For other joints, mostly case reports. Stem cells can cost thousands.
- Arthroscopy (“clean-out”) for arthritic kneesNICE advises against it unless the knee is truly locking. No better than exercise, with the risks of an operation.
- Acupuncture and dry needlingNICE advises against them for osteoarthritis because the benefits are too small or uncertain.
- Routine paracetamol and opioidsLittle pain relief for arthritis. NICE says not to use them routinely, and opioids add dependence risk.
What you can do
- Aim for 150 minutes of activity a week. On bad days, do less rather than stopping.
- Pace yourself: break big jobs into smaller chunks, with rests in between.
- Learn your flare plan: what to cut back, what to keep doing, and what medicine to use.
- Find your joint: knee, hip, hand, foot, shoulder or neck.
See your GP if
- Pain stops you sleeping, working or doing what you enjoy
- You need anti-inflammatory tablets most days
- A joint keeps swelling, locks or gives way
- Morning stiffness lasts more than an hour, or knuckles and wrists are swollen (this can point to an inflammatory arthritis)
See a doctor the same day for a hot, red, swollen joint, especially with fever or feeling unwell, or if you suddenly can’t put weight on a leg. Joint infection needs urgent treatment.
Common questions
Is osteoarthritis just wear and tear?
No. It’s an active process in a living joint, and joints respond well to the right load. Movement and strength usually ease the pain, while long rest tends to make stiffness worse.
Do I need an X-ray to know I have it?
Usually not. If you’re 45 or over with activity-related joint pain and short morning stiffness, the diagnosis can be made from your story and an examination. X-ray changes often don’t match how much pain you have.
Is exercise safe if my joints are sore?
Yes. It’s the main treatment at every stage. Some soreness during or after is normal, and pain that settles within 24 hours is OK.
Does glucosamine help?
Not in good-quality studies. Glucosamine and chondroitin are no better than a dummy treatment for knees, and a 2-year trial found no benefit for hips.
Helpful resources
- GLA:D AustraliaStructured 6-week education and exercise program for hip and knee arthritis, run by trained physios. Paid; check your health fund. Australia.
- MyOA (Arthritis Australia)Trusted osteoarthritis information, plus symptom tracking and goal-setting tools. Free, Australia.
- Arthritis AustraliaInformation sheets and the free Arthritis Infoline (1800 011 041) for questions and local support. Free, Australia.
- Knee osteoarthritis exercise handoutPrintable, one page, with sets and progressions. Free, from us.
Evidence and more information
- NICE: Osteoarthritis diagnosis and management (2022)
- ACSQHC: Osteoarthritis of the Knee Clinical Care Standard (2024)
- Arthritis and Rheumatology: Global osteoarthritis trends, 1990 to 2019 (2022)
- ABS: Arthritis in Australia, National Health Survey 2022
- Cochrane: Exercise for knee osteoarthritis (2024)
- Cochrane: Exercise for osteoarthritis of the hip (2026)
- JAMA: IDEA trial of diet and exercise for knee osteoarthritis (2013)
- RMD Open: Evidence review for the EULAR hand osteoarthritis recommendations (2018)
- BMC Musculoskeletal Disorders: GLA:D registry results for hip and knee (2017)
- AAFP summary: Glucosamine for hip osteoarthritis, 2-year trial (2008)
- BMJ Open: Long-term pain after hip and knee replacement (2012)
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