How to manage arthritis pain

Written by Dr Sean Leo, a consultant orthopaedic surgeon whose clinical focus is the knee, sports injuries and the lower limb.

Last updated: 9 October 2026.

Arthritis pain is managed with several steps together. For osteoarthritis (OA), the most common type, NICE (the UK’s National Institute for Health and Care Excellence) names therapeutic exercise and weight management, if appropriate, along with information and support, as the core treatments.^[1] Medicines and injections can be added, and joint replacement is considered when non-surgical care is ineffective or unsuitable.^[1]

• What causes arthritis pain?
• How is osteoarthritis diagnosed?
• How does exercise help arthritis pain?
• Does weight affect arthritis pain?
• Can heat, cold or aids help?
• Which medicines can help?
• What about injections into the knee?
• When is joint replacement considered?
• Can treatment change the course of osteoarthritis?
• Frequently asked questions
• When is urgent help needed?
• What should I do next?

What causes arthritis pain?

Arthritis is a general term for more than 100 conditions that affect the joints.^[2] OA is the most common form of arthritis and affects an estimated 302 million people worldwide.^[3] OA involves the whole joint: the cartilage, the bone and the joint lining can all change, which leads to pain, stiffness, swelling and loss of normal joint function.^[3] You may hear OA called “wear and tear”. The American College of Rheumatology (ACR) guideline describes it as a disease of the whole joint instead.^[3]

More on what raises the risk of OA

The exact cause of OA is not known, but several things are thought to increase the risk.^[4]

• Joint injury: overusing a joint that has not had enough time to heal after an injury or operation.^[4]
• Other conditions: OA can happen in joints severely damaged by a previous or existing condition, such as rheumatoid arthritis or gout.^[4]
• Age: the risk increases as you get older.^[4]
• Family history: OA may run in families, although studies have not identified a single gene responsible.^[4]
• Obesity: being obese puts excess strain on the joints, particularly those that bear most of your weight, such as the knees and hips.^[4]
• Sex: OA is more common in women than in men.^[4]

How is osteoarthritis diagnosed?

OA is usually diagnosed from your story and an examination.^[1][4] A doctor will ask about your symptoms and examine your joints.^[4] NICE advises diagnosing OA clinically, without imaging, in people who are 45 or over, have activity-related joint pain, and have either no morning joint-related stiffness or morning stiffness that lasts no longer than 30 minutes.^[1] NICE advises against routine imaging to diagnose OA unless there are atypical features or features that suggest an alternative or additional diagnosis.^[1]

Prolonged morning stiffness can be a sign of a different type of arthritis, such as rheumatoid arthritis.^[4] Read about the main types of arthritis.

How does exercise help arthritis pain?

Exercise is one of the core treatments that guidelines name for OA.^[1] The ACR strongly recommends exercise for knee, hip and hand OA.^[3] NICE advises offering therapeutic exercise tailored to the person, for example local muscle strengthening and general aerobic fitness.^[1]

• Exercise for knee and hip OA can include walking, strengthening and aquatic exercise (exercise in water), and the ACR found no hierarchy of one over another.^[3]
• Tai chi, a mind-body practice of slow, gentle movements with deep breathing and relaxation, is strongly recommended for knee and hip OA.^[3]
• Yoga is conditionally recommended for knee OA.^[3] A conditional recommendation is one that most informed patients would choose to follow, but some would not.^[3]
• Exercise is associated with better outcomes when it is supervised, and NICE advises considering supervised sessions.^[3][1]
• Most people with OA are likely to benefit from referral to physical therapy or occupational therapy at various times during the course of the disease.^[3]

Joint pain may increase when you start exercising. NICE advises that regular, consistent exercise, even if it first causes some pain or discomfort, will be beneficial for the joints.^[1] Pain that is sudden and severe is different and may need urgent help, as described below.^[9]

Does weight affect arthritis pain?

For people with overweight or obesity, weight loss is one of the core treatments, and it is associated with a lower load on the knee.^[1][7] The ACR strongly recommends weight loss for people with knee or hip OA who are overweight or obese.^[3] NICE advises that any amount of weight loss is likely to be beneficial, and that losing 10% of body weight is likely to be better than 5%.^[1]

• A systematic review of seven studies in adults with knee OA and obesity found that a 5% to 10% weight loss significantly improved pain, self-reported disability and quality of life (physical).^[5] The adults had mild to moderate knee OA, and the results for physical function were inconclusive.^[5]
• When you walk across level ground, the force on your knees is the equivalent of 1½ times your body weight.^[6] The force on each knee is two to three times your body weight on stairs, and four to five times your body weight when you squat.^[6]
• An analysis of an 18-month diet and exercise trial in 142 sedentary, overweight and obese older adults with knee OA found that each unit of weight lost was associated with an approximately 4-unit reduction in knee-joint forces.^[7]

These are findings from groups of people, and they do not predict the result for any one person. Read more in the article on weight loss and knee osteoarthritis.

Can heat, cold or aids help?

Guidelines include several simple measures.^[1][3]

• Locally applied heat or cold is conditionally recommended for knee, hip and hand OA.^[3]
• NICE advises considering walking aids, such as walking sticks, for people with lower limb OA.^[1] The ACR strongly recommends a cane for people with knee or hip OA whose disease is having a large enough impact on walking, joint stability or pain to warrant an assistive device.^[3]
• NICE advises against routinely offering insoles, braces, tape, splints or supports unless there is joint instability or abnormal biomechanical loading, and exercise is ineffective or unsuitable without them.^[1] The ACR strongly recommends tibiofemoral knee braces (braces for the main joint between the thigh bone and shin bone) for people with knee OA whose disease in one or both knees is having a large enough impact on walking, joint stability or pain to warrant an assistive device.^[3]

Guidelines differ on braces, so this is a decision to make with your clinician.^[1][3] Read more in the article on knee braces for arthritis.

Which medicines can help?

Medicines are added to exercise and weight management, not used instead of them.^[1]

• NICE advises that medicines are used alongside non-drug treatments and to support therapeutic exercise, at the lowest effective dose for the shortest possible time.^[1]
• NICE advises offering a topical NSAID (a non-steroidal anti-inflammatory drug that is applied to the skin) to people with knee OA.^[1] The ACR strongly recommends topical NSAIDs for knee OA.^[3]
• If topical medicines are ineffective or unsuitable, NICE advises considering an oral NSAID, taking account of possible gastrointestinal, renal, liver and cardiovascular toxicity (effects on the gut, kidneys, liver and heart) and the person’s risk factors.^[1]
• NICE advises explaining to people with OA that there is no strong evidence of benefit for paracetamol.^[1]

Check with your doctor or pharmacist before taking any medicine.

What about injections into the knee?

Injections are one option after other steps, and they can support exercise rather than replace it.^[1]

• NICE advises considering a corticosteroid injection into the joint when other medicines are ineffective or unsuitable, or to support exercise.^[1]
• Corticosteroid injections give short-term relief, typically lasting weeks.^[1]
• Guidelines disagree about hyaluronic acid injections for the knee, so the decision is individual.^[1][3][8]

More on injections

The ACR strongly recommends corticosteroid injections for knee and hip OA, and trials have shown short-term benefit in knee OA.^[3] A report raised the possibility that some steroid preparations, or a certain frequency of injections, may contribute to cartilage loss, and the ACR panel was uncertain of the clinical significance of this finding.^[3]

On hyaluronic acid, NICE advises against offering intra-articular hyaluronan injections (injections into the joint) for OA.^[1] The ACR conditionally recommends against them for knee OA.^[3] The OARSI (Osteoarthritis Research Society International) guideline lists intra-articular hyaluronic acid among its treatments for knee OA, with the recommendation depending on a person’s other health conditions.^[8]

Read more in the article on knee injections.

When is joint replacement considered?

Joint replacement is considered when OA is having a large effect on daily life and other care has not worked.^[1] NICE advises considering referral for joint replacement for people with hip, knee or shoulder OA if their joint symptoms (such as pain, stiffness, reduced function or progressive joint deformity) are substantially impacting their quality of life and non-surgical management (for example, therapeutic exercise, weight loss, pain relief) is ineffective or unsuitable.^[1] NICE advises using clinical assessment, instead of systems that numerically score severity of disease, when deciding whether to refer.^[1]

Read about total knee replacement and partial knee replacement.

Can treatment change the course of osteoarthritis?

OA is a long-term condition. It does not necessarily get any worse over time, it can sometimes gradually improve, and a number of treatments are available to reduce the symptoms.^[4] The ACR notes that no effective disease-modifying agents (medicines that change the course of the disease) have yet been identified for OA, and that preventive strategies for now focus on weight management and injury prevention.^[3]

Frequently asked questions

What is the first thing to try for arthritis pain?

For OA, guidelines start with therapeutic exercise, weight management if appropriate, and information and support.^[1] Heat or cold and walking aids can be added.^[3][1]

Do I need an X-ray or MRI scan to diagnose osteoarthritis?

Often not. NICE advises diagnosing OA clinically, without imaging, in people who are 45 or over with activity-related joint pain and either no morning stiffness or stiffness lasting no longer than 30 minutes.^[1]

Is it safe to exercise when my joints hurt?

NICE advises that joint pain may increase when you start therapeutic exercise, and that regular, consistent exercise is beneficial for the joints.^[1] Sudden severe pain, or a joint that is hot, red and swollen, needs urgent help.

When should I see a doctor about joint pain?

See a doctor if you have unexplained pain, swelling or stiffness in your joints that does not go away in a few days.^[9]

When is urgent help needed?

The list below covers the signs that should not wait for a routine appointment.

What should I do next?

For anyone whose arthritis pain is not settling, or who is unsure which type of arthritis they have, an assessment is a sensible next step. It brings together the patient’s story, an examination and any tests that help. It looks at the structure involved, the patient as a whole person and the goal they want to return to. An appointment supports an informed decision. It is not a commitment to surgery.

• Read about the main types of arthritis and about whether running causes knee arthritis.
• Arrange a knee assessment when you are ready.
• Browse the Knee Hub for other knee problems, or more articles.
• Read more about Dr Sean Leo, who is named as the author of this page.

References

1. NICE. Osteoarthritis in over 16s: diagnosis and management. NICE guideline NG226. 2022. https://www.nice.org.uk/guidance/ng226
2. Foster AL, Boring MA, Lites TD, Croft JE, Odom EL, Fallon EA. Distribution of Arthritis Subtypes Among Adults With Arthritis in the United States, 2017-March 2020. Prev Chronic Dis. 2025;22:E28. doi:10.5888/pcd22.240393. PMID:40539903.
3. Kolasinski SL, Neogi T, Hochberg MC, et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Care Res (Hoboken). 2020;72(2):149-162. doi:10.1002/acr.24131. PMCID:PMC11488261.
4. NHS. Osteoarthritis. https://www.nhs.uk/conditions/osteoarthritis/
5. Chu IJH, Lim AYT, Ng CLW. Effects of meaningful weight loss beyond symptomatic relief in adults with knee osteoarthritis and obesity: a systematic review and meta-analysis. Obes Rev. 2018;19(11):1597-1607. doi:10.1111/obr.12726. PMID:30051952.
6. Harvard Health Publishing. Why weight matters when it comes to joint pain. 2019. https://www.health.harvard.edu/pain/why-weight-matters-when-it-comes-to-joint-pain
7. Messier SP, Gutekunst DJ, Davis C, DeVita P. Weight loss reduces knee-joint loads in overweight and obese older adults with knee osteoarthritis. Arthritis Rheum. 2005;52(7):2026-2032. doi:10.1002/art.21139. PMID:15986358.
8. Bannuru RR, Osani MC, Vaysbrot EE, et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage. 2019;27(11):1578-1589. doi:10.1016/j.joca.2019.06.011. PMID:31278997.
9. NHS. Arthritis. https://www.nhs.uk/conditions/arthritis/