Osteoarthritis (OA) is the most common form of arthritis. It is a condition in which joint cartilage gradually wears down over time, leading to pain, stiffness and reduced movement. Unlike inflammatory arthritis, osteoarthritis is primarily a degenerative (wear-related) joint condition, although mild inflammation may occur in some cases.
What Happens in Osteoarthritis?
Healthy joints are covered with smooth cartilage that allows movement without friction. In osteoarthritis, cartilage becomes thinner, bone edges may thicken, joint space narrows and mild inflammation can develop. This leads to pain and stiffness, particularly with use. It commonly affects the hands, knees, hips and spine.
Osteoarthritis of the Hands
Hand osteoarthritis commonly affects finger joints (DIP and PIP joints) and the base of the thumb. Symptoms include bony swelling (Heberden's and Bouchard's nodes), stiffness after inactivity, reduced grip strength and discomfort during use. In some patients, hand OA can appear inflamed and swollen, which may resemble inflammatory arthritis — specialist assessment helps differentiate the two.
Knee Osteoarthritis
Knee OA is common and may present with pain on walking or climbing stairs, swelling after activity, stiffness after sitting and reduced range of motion. Weight, previous injury and genetics all influence progression. Knee OA is increasingly seen in sedentary populations and those with higher BMI.
Spine Osteoarthritis
Spinal OA (spondylosis) can affect the neck and lower back, causing localised pain, stiffness and, in some cases, nerve irritation. Spinal OA differs from inflammatory back conditions such as axial spondyloarthritis, which requires different management.
Differentiating from Inflammatory Arthritis
Both osteoarthritis and inflammatory arthritis may cause joint pain, stiffness and swelling. However, inflammatory arthritis typically causes prolonged morning stiffness (over 30–60 minutes), warm swollen joints, raised inflammatory markers and symmetrical joint involvement. Correct diagnosis is important because treatment strategies differ significantly.
What Is Inflammatory Osteoarthritis?
Some patients, particularly with hand OA, develop a more inflamed pattern known as inflammatory osteoarthritis. This may cause redness, warmth, more severe swelling and sudden pain flares. It can resemble autoimmune arthritis but is a variant of osteoarthritis. Management focuses on symptom control rather than immune suppression. Hydroxychloroquine has been studied in inflammatory hand OA with variable response.
Treatment of Osteoarthritis
Management focuses on pain control, function and joint protection. Strengthening exercises and low-impact aerobic activity are central to management. Reducing excess weight significantly reduces knee joint stress. Pain relief options include paracetamol (with limited benefit in some), short-term NSAIDs when appropriate, and topical anti-inflammatory gels. For knee or inflamed joints, corticosteroid injections may provide temporary relief. Joint replacement may be considered when symptoms are severe and function is significantly limited.
Long-Term Outlook
Osteoarthritis progresses slowly over time. With structured management — including exercise, weight control and appropriate pain strategies — many patients maintain good function and quality of life. Accurate diagnosis remains essential to ensure inflammatory arthritis is not missed.
Frequently Asked Questions
What is the difference between osteoarthritis and rheumatoid arthritis?
Osteoarthritis is wear-related, while rheumatoid arthritis is an autoimmune inflammatory disease causing prolonged morning stiffness and joint swelling. Treatment approaches differ significantly.
Is osteoarthritis inflammatory?
Osteoarthritis is primarily degenerative, but mild inflammation can occur. Some patients develop an inflammatory variant, especially with hand osteoarthritis.
Can osteoarthritis cause swelling?
Yes, though swelling is usually less pronounced than in inflammatory arthritis. Persistent or significant swelling should be evaluated by a specialist.
What is the best treatment for knee osteoarthritis?
The most effective initial treatments include strengthening exercises, weight management, physiotherapy and appropriate pain relief. In selected cases, joint injections or surgical referral may be considered.
Do joint injections help osteoarthritis?
Corticosteroid joint injections can provide temporary relief of pain and swelling, particularly in knee osteoarthritis. They reduce inflammation but do not reverse cartilage wear.
