Joint Pain

Joint pain has many causes, and the first distinction is mechanical versus inflammatory. Osteoarthritis pain worsens with use and eases with rest, morning stiffness lasts under 30 minutes, and it typically affects knees, hips, hands and the spine. Inflammatory arthritis — rheumatoid, psoriatic, axial spondyloarthritis — produces morning stiffness lasting over an hour, improves with movement, often affects joints symmetrically, and can come with swelling, fatigue and systemic features. That distinction determines everything about treatment, and inflammatory arthritis needs early specialist referral because early disease-modifying therapy changes long-term outcomes. Osteoarthritis is the most common form, affecting a substantial proportion of adults over 60 and increasingly recognised as a disease of the whole joint rather than simple cartilage wear. Low-grade synovial inflammation, subchondral bone change and altered biomechanics all contribute, which is why radiographic severity correlates only loosely with pain. The most effective interventions are unglamorous. Structured exercise — both strengthening and aerobic — has the strongest evidence base of anything available, including drugs, and is recommended as core treatment by every major guideline. In knee osteoarthritis with overweight, weight loss of 10% or more produces clinically meaningful symptom improvement. Supplements are widely used with mixed support. Glucosamine and chondroitin have produced inconsistent results, with the largest independent trials broadly negative. Omega-3 has reasonable evidence in rheumatoid arthritis, where it reduces tender joint counts and NSAID requirement, but only small effects in osteoarthritis. Curcumin has modest supporting data for knee osteoarthritis pain.

• •Pain worsening with use and easing with rest (mechanical pattern)
• •Morning stiffness lasting under 30 minutes (osteoarthritis)
• •Morning stiffness over an hour, easing with movement (inflammatory)
• •Joint swelling or warmth
• •Reduced range of motion
• •Crepitus — grinding or crackling
• •Joint instability or giving way
• •Symmetrical small-joint involvement in rheumatoid arthritis
• •Fatigue and systemic symptoms in inflammatory disease

• •Osteoarthritis
• •Rheumatoid arthritis
• •Psoriatic arthritis and axial spondyloarthritis
• •Gout and pseudogout
• •Prior joint injury or surgery
• •Excess body weight loading the knees and hips
• •Occupational repetitive loading
• •Genetic predisposition
• •Infection — septic arthritis, a medical emergency
• •Fibromyalgia, in which pain is widespread rather than joint-localised

Osteoarthritis involves progressive cartilage matrix degradation driven by matrix metalloproteinases, alongside subchondral bone remodelling, osteophyte formation and low-grade synovitis. Mechanical load and inflammatory signalling reinforce each other. Rheumatoid arthritis is a distinct autoimmune process in which synovial inflammation, driven by TNF-alpha and interleukin-6, produces a proliferative pannus that erodes cartilage and bone — a mechanism that responds to targeted immunosuppression in a way osteoarthritis does not.