Symptoms

Joint pain worse with activity, improved with rest (unlike inflammatory arthritis)
Morning stiffness lasting less than 30 minutes (shorter than rheumatoid arthritis)
Joint swelling, particularly bony enlargement (Heberden's/Bouchard's nodes in hands)
Reduced range of movement
Crepitus (grinding/crackling sensation)

Osteoarthritis vs Rheumatoid Arthritis

Feature	Osteoarthritis	Rheumatoid Arthritis
Morning stiffness	<30 minutes	Often >1 hour
Pattern	Worse with activity	Worse with rest, improves with movement
Blood tests	Usually normal	Raised inflammatory markers, positive RF/anti-CCP often
Joint distribution	Weight-bearing joints, hands (distal)	Small joints symmetrically, proximal hand joints

Treatment Approach

Treatment	Evidence
Regular exercise (strengthening, low-impact)	Strong: core treatment, reduces pain and improves function
Weight loss if overweight	Strong: significantly reduces knee/hip OA symptoms
Paracetamol/NSAIDs (topical or oral)	Moderate symptom relief
Steroid injections	Short-term relief for flares
Joint replacement surgery	Highly effective for severe hip/knee OA not responding to conservative treatment

Exercise Helps, Not HarmsMany people mistakenly avoid exercise fearing it will worsen joint damage: in fact, regular appropriate exercise is one of the most effective treatments for osteoarthritis, strengthening supporting muscles and reducing pain.

Is osteoarthritis just 'wear and tear' that can't be helped?

While cartilage damage doesn't reverse, symptoms and function can be significantly improved with the right combination of exercise, weight management, and pain control: it's not simply something to 'live with' untreated.

Does cracking my knuckles cause osteoarthritis?

No. Studies have found no association between habitual knuckle cracking and the development of arthritis in the hands.

Why blood tests are normal in osteoarthritis

Osteoarthritis is a clinical diagnosis made from the history, examination and, where needed, an X-ray. There is no blood test for it, and that is not a gap in the testing: it is a diagnostic feature. Inflammatory markers such as CRP and ESR are characteristically normal, and rheumatoid factor and anti-CCP are negative. When blood tests are ordered in someone with joint pain, the purpose is to exclude inflammatory arthritis, gout and other causes, not to confirm osteoarthritis.

This matters because a positive rheumatoid factor in someone whose pattern is clearly osteoarthritic is more likely to be a false positive than a second diagnosis; the antibody is found in a small proportion of healthy people and more often with age.

What distinguishes it at the bedside

Stiffness after rest lasting under 30 minutes, versus the prolonged morning stiffness of inflammatory arthritis.
Pain worse with use and towards the end of the day, rather than worst on waking.
Bony rather than soft swelling, with crepitus on moving the joint.
Distribution: knees, hips, the base of the thumb and the end finger joints, sparing the wrists and knuckles that rheumatoid disease favours.
Absence of systemic features: no fever, weight loss or fatigue attributable to the joints.

What actually helps

Exercise has the strongest evidence of anything available, and it is the intervention most often skipped because pain makes movement counterintuitive. Strengthening the muscles around the joint, particularly the quadriceps for knee osteoarthritis, reduces pain and improves function, and the benefit persists only while the exercise continues. Weight loss produces a disproportionate reduction in knee loading and is among the most effective measures where relevant. Topical NSAIDs are a reasonable first drug choice for knee and hand osteoarthritis with fewer systemic risks than tablets. Glucosamine and chondroitin have been studied extensively with, at best, marginal effects.

When to reconsider the diagnosis

Hot, red, acutely swollen joints, fever, rapid deterioration, night pain that wakes you, or new symmetrical small-joint involvement all suggest something other than osteoarthritis and warrant reassessment. So does osteoarthritis appearing unusually young or in joints it rarely affects, such as the shoulder or ankle without prior injury, which can point to an underlying metabolic or inflammatory condition.

References

The clinical information on this page is drawn from peer-reviewed sources indexed by the US National Library of Medicine. Links go to the source so you can read it yourself.

Arthritis. In: StatPearls. Treasure Island (FL): StatPearls Publishing. NCBI Bookshelf NBK518992

Osteoarthritis: Complete Guide