Osteoarthritis symptoms and flare patterns

Osteoarthritis is the most common type of arthritis in the UK. It can affect any joint but often involves the knees, hips, hands, and spine. Symptoms usually develop gradually and can fluctuate over time, with periods of flare ups and improvement.

Many people worry that osteoarthritis means the joint is “wearing out” and that exercise will make things worse. In reality, a structured plan focusing on movement, strengthening, pacing, and appropriate pain relief can significantly improve pain and day-to-day function.

These articles are intended as educational sources, not diagnostic nor taking place of a proper medical assessment. If you need help with ongoing joint concerns, please book a GP appointment.

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How osteoarthritis commonly presents

Osteoarthritis symptoms vary depending on the joint affected, but common patterns include:

Joint pain that worsens with activity and improves with rest
Stiffness after rest, often easing within 30 minutes
Reduced range of movement or flexibility
A sensation of grating, clicking, or creaking within the joint
Intermittent swelling, particularly after increased activity
Difficulty with stairs, walking distance, standing from sitting, or grip strength

Pain can be mild and intermittent, or more persistent and limiting during flare ups.

Seek urgent medical advice if you develop:

A hot, very painful swollen joint, especially with fever
Sudden inability to weight bear after trauma or a fall
Rapidly worsening redness, swelling, or severe pain
New severe pain with feeling generally unwell

These symptoms may indicate infection, fracture, or another urgent problem and need same day assessment.

Why osteoarthritis happens

Osteoarthritis involves changes across the whole joint over time. Cartilage may become less resilient, the underlying bone can remodel, and surrounding tissues such as ligaments, the joint lining, and muscles may contribute to symptoms.

It is not simply “wear and tear”. Pain and stiffness are influenced by:

Joint loading and biomechanics
Muscle strength and joint control
Inflammation within the joint lining during flare ups
General health, sleep, stress, and activity levels

This is one reason why symptoms can fluctuate.

Which joints are commonly affected

Knee osteoarthritis

Often causes pain when walking, climbing stairs, squatting, or getting up from a chair. Swelling after activity is common.

Hip osteoarthritis

May cause pain in the groin, buttock, or thigh. People may notice stiffness when putting on socks, getting in and out of a car, or walking uphill.

Hand osteoarthritis

Can cause pain, stiffness, reduced grip strength, and bony swelling at finger joints.

Spine osteoarthritis

May contribute to stiffness and recurrent back or neck pain. It is often one factor among several.

Osteoarthritis flare ups: why they happen and what they mean

A flare up is a period when pain, stiffness, or swelling is noticeably worse than usual. Flare ups are common and do not necessarily mean the joint has suddenly deteriorated.

Common triggers include:

A sudden increase in activity, lifting, or walking distance
Reduced movement due to illness, busy periods, or travel
Minor knocks, twists, or awkward movements
Poor sleep or increased stress
Stopping regular strengthening exercises

A flare is often best managed with short term symptom control and a return to a paced plan, rather than complete rest.

How a GP assesses osteoarthritis

A GP assessment focuses on confirming the likely diagnosis and ruling out other causes of joint pain.

A GP will usually ask about:

Which joint is affected and how symptoms started
Pattern of pain and stiffness
Swelling, locking, giving way, or instability
Impact on walking, sleep, work, and daily activities
Symptoms that suggest inflammatory arthritis or infection

Investigations in osteoarthritis

Osteoarthritis is often diagnosed clinically, especially when symptoms and pattern are typical.

When imaging may be helpful

A GP may consider an X-ray if:

Diagnosis is uncertain
Symptoms are severe, rapidly worsening, or not responding to management
A referral pathway requires imaging
Surgery is being considered

Blood tests

Blood tests are not usually needed for osteoarthritis, but may be requested if symptoms suggest inflammatory arthritis or another systemic cause.

Self care and lifestyle measures that actually help

For most people, the most effective long term approach includes:

Strengthening exercises

Strengthening the muscles around the joint is one of the best ways to reduce pain and improve function, particularly for knee and hip osteoarthritis.

Regular low impact activity

Walking, cycling, swimming, and structured home exercise can reduce stiffness and maintain mobility.

Pacing and activity planning

Avoid the boom and bust cycle, where you do too much on a good day and then flare. Aim for steady, consistent activity and build gradually.

Weight management where relevant

Even small reductions in weight can reduce load through the knee and hip joints and improve pain over time.

Supportive measures

Footwear, insoles, and simple changes to how you move or lift can help reduce strain.

Medical treatments a GP may recommend

Treatment is individual and based on symptoms, function, and risk factors. Options may include:

Topical anti-inflammatory gels for some joints
Short term oral pain relief if appropriate
Physiotherapy referral and targeted rehabilitation
Review of work and activity modifications
Referral for specialist opinion if symptoms remain significantly limiting

If pain is affecting sleep, mood, or daily function, it is reasonable to seek review. You do not need to “push through” severe pain.

Expert physio insights by AccessGP Lead Physiotherapist, Sonali Talwar

Sonali is an experienced physiotherapist working with AccessGP. In her clinical practice, a common misconception is that osteoarthritis means you should stop using the joint to prevent further damage. In reality, joints often feel better when the surrounding muscles are stronger and movement is consistent.

Physiotherapy focuses on improving joint control, building strength in the muscles that support the joint, and helping patients manage flare ups with pacing rather than complete rest. Small improvements in strength and confidence often translate into meaningful improvements in walking, stairs, and daily activities.