Patient guide · Getting the diagnosis right
These are different conditions with different treatments, and they are often confused. The clearest clue is what your joints do with rest. Osteoarthritis usually hurts more with use and settles with rest. Inflammatory arthritis, such as rheumatoid arthritis or axial spondyloarthritis, is usually worse after rest and in the early morning, and eases once you get moving.
Osteoarthritis happens as the cartilage that cushions a joint wears down over time and the whole joint changes. Inflammatory arthritis is different: the immune system attacks the joints by mistake. That difference in cause is why the treatments are not interchangeable.
| Osteoarthritis | Inflammatory arthritis | |
|---|---|---|
| What is happening | Cartilage wears down and the whole joint changes | The immune system attacks the lining of the joints by mistake |
| Pain pattern | Usually worse with use, better with rest | Usually worse with rest, better with movement |
| Morning stiffness | Worst first thing or after sitting, usually eases within about half an hour | Often lasts more than half an hour. Inflammatory back pain lasts more than 30 minutes and can wake you in the second half of the night |
| Which joints | Most often knees, hips, and hands | Often the small joints of the hands, wrists, and feet, frequently the same joints on both sides. Axial spondyloarthritis affects the low back and buttocks |
| Swelling | Some swelling, and bony knobs on the fingers | Soft joint swelling that lasts. A whole swollen finger or toe can occur |
| How it starts | Slowly, over years, and becomes more likely with age | Can begin at any age. Axial spondyloarthritis usually starts before age 45 |
| Feeling unwell with it | Not usually | Tiredness or feeling generally run down is common |
| Main treatments | Movement and exercise, reaching a healthy weight, pain relief, and sometimes an injection | Medicines that work on the cause of the inflammation, started early |
No single line in this table settles the question on its own. People have both conditions, symptoms overlap, and the pattern matters more than any one feature.
For osteoarthritis, the strongest treatments are movement and exercise, reaching a healthy weight, and learning ways to manage it. For rheumatoid arthritis, treating early, in the first months after symptoms start, gives the best chance of protecting the joints and feeling well. Time matters more in the inflammatory conditions, which is why a delayed diagnosis costs more there.
Bring this to your family doctor, who can arrange blood tests and a referral if needed. Our contact page sets out how referrals reach the clinic.
The osteoarthritis guide, the rheumatoid arthritis guide, and the axial spondyloarthritis guide go into each condition properly. If osteoarthritis is the answer, the Osteoarthritis Clinic covers treatment options.
Osteoarthritis pain is usually worse with use and better with rest. Inflammatory arthritis is usually the other way round: worse with rest and in the early morning, and better once you get moving.
In osteoarthritis, stiffness is worst first thing in the morning or after sitting and usually eases within about half an hour. In rheumatoid arthritis, morning stiffness that lasts more than half an hour is a classic sign. In axial spondyloarthritis, inflammatory back pain lasts more than 30 minutes and improves with movement.
Yes. Having osteoarthritis does not protect you from developing an inflammatory arthritis, and the two can affect different joints in the same person. That is one reason a new pattern of swelling deserves assessment rather than being put down to arthritis you already know about.
It changes the treatment. Osteoarthritis is managed mainly with movement and exercise, reaching a healthy weight, and pain relief. Inflammatory arthritis is treated with medicines that work on the cause of the inflammation, and in rheumatoid arthritis starting treatment in the first months after symptoms begin gives the best chance of protecting the joints.
Joint swelling that lasts for several weeks should always be checked. So should morning stiffness lasting more than half an hour, swelling in the same joints on both sides, a swollen finger or toe, back pain before age 45 that is worse with rest and better with movement, or joint symptoms with unexplained tiredness.