Back Pain Doctor
Arthritis: An Overview
Written by Dr Joshua Hatch, Musculoskeletal GP, RACGP Fellow, Diploma in Musculoskeletal Medicine (FSEM UK).
Arthritis simply means inflammation of a joint, and it causes pain, swelling and stiffness. Although each type has a different cause, the symptoms and much of the treatment overlap. Any joint can be affected, but arthritis is especially common in weight-bearing joints such as the knee, hip and spine. There is no cure, but many treatment options help manage pain and keep people active.
There are four broad categories. Osteoarthritis (the most common) is the gradual wearing of the smooth cartilage that cushions the joint, from ageing, overuse or previous injury, and often forms bone spurs. Inflammatory arthritis results from an overactive immune system (such as rheumatoid or psoriatic arthritis) or crystal build-up (gout and pseudogout), and usually needs specialist rheumatology care. Post-traumatic arthritis develops after a joint injury such as a fracture that damages the cartilage surface. Septic arthritis is a joint infection (typically a hot, red, acutely tender, swollen joint), which is a medical emergency needing urgent treatment. Diagnosis rests on the history, examination and, where needed, X-rays, blood tests or joint-fluid analysis.
For the common wear-and-tear forms, assessment confirms the diagnosis and builds a practical plan centred on rehabilitation. Exercise, weight management, activity modification and simple pain relief are the foundations, with other options considered where symptoms persist. It also looks for features of an inflammatory or infective cause that needs specialist or urgent care, and makes clear when a surgical opinion, such as about joint replacement, becomes worthwhile.
Common symptoms
- Joint pain, swelling and stiffness
- Tenderness and pain when pressure is placed on the joint
- A grating feeling or sound (crepitus) with movement
- Reduced ability to move the joint, and weakness in the surrounding muscles
Commonly seen in
Evidence for twelve treatment options in arthritis: an overview
This is not a fixed ladder or a package of treatments. Every option is assessed independently against this diagnosis, including treatments with limited direct research that may still be reasonable for a clearly defined tissue target. The evidence level, likely benefit, risks, cost and alternatives are weighed at consultation.
Foundation: diagnosis, education and rehabilitation
The part of care with the broadest relevance. For many people it is enough on its own; other options are judged against it, not automatically added after it.
Diagnosis, education and progressive rehabilitation Working out what is driving the pain, explaining what your imaging does and does not mean, and building a graded loading plan you can actually follow. Core care
What it involves
Assessment to identify the likely pain source, an explanation of what the diagnosis means, adjustment of the loads that aggravate it, and a progressive strength and conditioning plan, with weight management where that is clinically relevant.
What the evidence shows
Exercise is the core treatment, and it performs as well as the tablets. A network meta-analysis of 152 randomised trials and 17,431 patients found exercise gave the same pain relief and functional improvement as oral anti-inflammatories and paracetamol, with a far better safety profile (Weng, Br J Sports Med 2023). EULAR (Moseng, Ann Rheum Dis 2024) and the American College of Rheumatology (Kolasinski, Arthritis Rheumatol 2020) both make exercise, education and weight management the core of non-pharmacological care. An individual-participant meta-analysis of 31 trials and 4,241 patients is clear about the size of it: the average effect is small and of questionable clinical importance, and those with more pain and worse function at the start benefit most (Holden, Lancet Rheumatol 2023).
Pairing reviewed 2026-09-02.
Where it fits
Worth being straight about: the average effect is modest, and it is larger for people who are struggling more to begin with. What it does have over the alternatives is that it is safe to keep doing, and it works on the things a joint injection cannot: strength, capacity and weight.
Muscle and symptom-modifying options
Useful only when the examination identifies the tissue they target or when short-term pain control creates a useful rehabilitation window.
Wet needling and trigger point injection (trigger point injection) A fine needle into a tender band of muscle, with a small volume of dilute glucose solution injected through it. Only if relevant
What it involves
The needle is placed into the tender muscle band and a small volume of 5% glucose with a very dilute local anaesthetic (0.02-0.08%) is injected. Often done in the same visit as your assessment, and usable where the tender area sits deeper. Dry needling (the same technique with nothing injected) is not offered here.
What the evidence shows
Trigger-point injection reviews address confirmed myofascial pain and find heterogeneous, generally low-certainty results; they do not establish the technique as treatment for the underlying diagnosis. Condition reviewed: arthritis overview.
Evidence source: Debrosse et al., trigger-point injection systematic review (2022)
Pairing reviewed 2026-08-30.
Where it fits
For arthritis overview, this may be considered only when examination finds a separate tender muscle band reproducing part of the pain. It does not treat the primary pathology and is used to help movement or rehabilitation.
Ultrasound-guided injections Guidance means the needle can be seen reaching the target. What goes into the needle depends on the diagnosis. Short-term relief
What it involves
The injection is performed under ultrasound so the needle can be watched into the target structure. What is injected is decided by the diagnosis, and corticosteroid is used sparingly, for the reasons set out below.
What the evidence shows
How well a corticosteroid injection works depends on which joint and which kind of arthritis. In knee osteoarthritis, 27 trials in 1,767 people show a modest benefit that peaks in the first weeks and has gone by six months (Jüni, Cochrane Database Syst Rev 2015), and in hip osteoarthritis an ultrasound-guided injection added to advice and education improved pain over six months in a trial of 199 people (Paskins, BMJ 2022). The American College of Rheumatology strongly recommends corticosteroid injection for knee osteoarthritis and only conditionally for the hand (Kolasinski, Arthritis Rheumatol 2020). It does not carry over to every joint: at the base of the thumb, triamcinolone injected under imaging guidance was no better than saline in a double-blind trial of 40 people (Meenagh, Ann Rheum Dis 2004). In rheumatoid arthritis, injecting an inflamed knee worked better than giving the same dose into muscle in a double-blind trial of 60 people (Konai, Clin Exp Rheumatol 2009). In gout it is recommended by guidelines, but a Cochrane review found it has never been tested in a randomised trial (Wechalekar, Cochrane Database Syst Rev 2013).
Pairing reviewed 2026-10-02.
Where it fits
Most useful when one painful, swollen joint is stopping you from exercising. The page for each joint sets out what the evidence shows at that site. Used sparingly: see the note on cortisone.
V-ACTOR vibration therapy (vibration therapy) Low-frequency vibration applied over tender muscle. Not a shockwave, despite sharing the machine. Plausible: no studies
What it involves
A vibration handpiece is moved over the tender muscle and fascia for a few minutes. It runs from the same STORZ MASTERPULS icon console as radial shockwave but is a separate handpiece delivering a different, gentler form of energy. No needles, no anaesthetic, no downtime.
What the evidence shows
No published clinical trial of this device in this condition. It is a vibration handpiece delivered from the same console as radial shockwave, and the rationale is myofascial rather than tendon- or bone-directed.
Pairing reviewed 2026-08-30.
Where it fits
A comfort measure used within a session where muscular tightness is limiting movement. Never the reason for the appointment, and not a substitute for the treatments that do have evidence.
Energy-based treatment options
Radial pressure wave, focused shockwave and EMTT have different targets and different evidence. They are assessed separately rather than treated as one category.
Radial or focused shockwave? Read the overviewRadial shockwave (radial pressure wave) Broad treatment across tender muscle and fascia, close to the surface. Knee trials; focused did better
What it involves
A handpiece is moved over the tender tissue while ballistic pressure pulses are delivered, using a transmitter head chosen for the tissue, including heads shaped for fascia and for the muscle either side of the spine. The pulse is strongest at the skin and weakens with depth, so this is mainly a myofascial treatment, though it can reach deeper in some areas. No anaesthetic, no downtime, usually a course of sessions about a week apart.
What the evidence shows
The radial form of shockwave has been tested against a sham or placebo device in osteoarthritis at the knee, with mixed results. In 104 people all doing the same physiotherapy and home exercise, adding three weekly radial sessions gave better pain, function and walking scores than a sham device up to three months (Uysal, Int Orthop 2020), and in 89 people every treated dose reduced pain more than placebo at four weeks, the higher energy doing more (Zhang, J Rehabil Med 2021). Against that, in 105 women with severe, long-standing knee arthritis, three low-energy radial sessions were no better than placebo for the main outcome, pain on movement at three months (Imamura, J Rehabil Med 2017). Where the two devices have been compared directly the focused form did better, at the knee in 42 people (Ko, Int J Environ Res Public Health 2022) and at the hip in 148 (Şah, J Pers Med 2022). A search on 11 November 2026 for randomised trials and meta-analyses of radial shockwave in osteoarthritis returned seven records: five knee trials and two animal studies. It did not retrieve the hip trial above, so it is not a complete count, and no trial of a radial device at any other joint is known to this review.
Pairing reviewed 2026-11-11.
Where it fits
Worth discussing for knee arthritis pain, and for the tender muscle around an arthritic joint, alongside exercise and weight management. Where a deeper joint is itself the target, the focused form has the better head-to-head results. It does not rebuild cartilage, and the trials stop at three months.
Focused shockwave (ESWT) A true shock wave converging at depth: for tendon, joint, ligament and bone. Strongest in the knee
What it involves
A focused system generates an acoustic shock wave that converges at a focal point set at a defined depth, concentrating the energy where the target is. This is the form used for tendon, joint, ligament and bone. Typically four to six sessions about a week apart, no anaesthetic and no formal downtime.
What the evidence shows
Shockwave has real trial evidence in osteoarthritis, concentrated at the knee. There, an umbrella review of eight meta-analyses found it better than sham treatment for pain, by 2.0 points out of 10, and for function and range of movement (Tang, Int J Surg 2024). At the hip, a 148-person trial found focused shockwave better than both radial and sham treatment at eight weeks (Şah, J Pers Med 2022), and in cervical spondylosis a 320-person sham-controlled trial found less pain and disability after focused treatment (Li, Medicine 2024). At the smaller joints, the shoulder, elbow, wrist, thumb, ankle and big toe, no randomised trial has been done.
Pairing reviewed 2026-10-04.
Where it fits
A non-invasive option for arthritis pain where the joint itself is the target, with the evidence strongest at the knee and thinner elsewhere. It reduces pain and improves function alongside exercise and weight management; it does not rebuild cartilage.
EMTT (magnetotransduction therapy) High-energy magnetic pulses applied over the area. Usually painless, no contact. Plausible: no studies
What it involves
You sit with the applicator positioned over the area for a short session. It is usually painless and needs no gel or skin contact. It is usually given as a course, commonly alongside shockwave.
What the evidence shows
There are no published randomised trials of EMTT in this condition, or in any musculoskeletal condition, that could be identified. The supporting work is laboratory work: EMTT increased tenocyte proliferation, migration and collagen expression in cultured human tendon cells (Mancini, Int J Mol Sci 2025). The nearest human evidence for a related electromagnetic therapy is negative. A randomised trial of pulsed electromagnetic field therapy added to eccentric exercise for Achilles tendinopathy found no improvement in outcome scores or tendon neovascularity over eccentric exercise alone (Ko, Orthop J Sports Med 2024).
Pairing reviewed 2026-08-30.
Where it fits
Offered only as an adjunct alongside treatment that does have evidence, never as the plan itself, and only after that gap is explained. Much of the EMTT literature is manufacturer-affiliated, which is part of why it is described this way.
Biologic and joint injection options
Each injection is assessed independently for the named diagnosis. Cost, uncertainty, likely benefit, risks and alternatives are part of the decision.
Platelet-rich plasma (PRP) Your own blood, concentrated and injected under ultrasound guidance. Strongest in the knee
What it involves
Blood is taken from your arm, spun to concentrate the platelets, and injected into the target under ultrasound guidance in the same appointment.
What the evidence shows
How well PRP is supported depends on which joint. The knee has by far the most evidence: pooling 18 placebo-controlled trials in 1,995 people, PRP improved function more than a dummy injection by a clinically meaningful margin from one to twelve months, and pain at three and six months (Bensa, Am J Sports Med 2025), although the largest Australian trial, in 288 people, found no difference from saline in pain or cartilage volume at twelve months (Bennell, JAMA 2021). At the hip, PRP has a small edge over hyaluronic acid in pooled trials (Zhang, Pain Res Manag 2026) but was no better than saline in the one placebo-controlled trial (Topaloglu, Turk J Phys Med Rehabil 2024). At the ankle and at the base of the thumb it did no better than saline (Paget, JAMA 2021; Evans, JB JS Open Access 2025). At the shoulder one trial found it equal to hyaluronic acid (Kirschner, Clin J Sport Med 2022), and at the elbow, wrist and big toe it has not been trialled. Expert bodies are split: the authors of the Australian trial noted that most clinical guidelines do not recommend PRP for knee osteoarthritis, while a European sports-orthopaedic consensus regards it as a valid option for mild to moderate knee arthritis (Laver, Knee Surg Sports Traumatol Arthrosc 2024). In knee trials, complications - nearly all mild to moderate and self-limiting - were about twice as common after PRP as after comparison injections (Fucaloro, Arthroscopy 2025).
Pairing reviewed 2026-10-08.
Where it fits
Worth discussing mainly for knee osteoarthritis that has not responded to exercise, weight management and simple pain relief. At other joints the evidence is weaker or negative, and the page for each joint says what has been found there. It is not expected to regrow cartilage.
Prolotherapy (dextrose) A course of dextrose injections into and around the structure and its attachments. Strongest in the knee
What it involves
Hypertonic dextrose is injected at the tender ligament and tendon attachments, and into the joint where relevant, usually as a series of treatments a few weeks apart.
What the evidence shows
How well prolotherapy is supported depends on the joint. The knee has the most evidence: pooling 14 randomised trials in 978 people, dextrose prolotherapy did better than placebo injection and non-injection care for pain, function and quality of life, with marked differences between trials and a risk of bias that the authors say calls for caution (Chen, Clin Rehabil 2022). In the hand, a double-blind trial in finger and thumb-base arthritis reduced pain on movement more than a dummy injection (Reeves, J Altern Complement Med 2000), and pooled hand trials favour dextrose at six months or more (Chen, Am J Phys Med Rehabil 2024). At the hip there is one small trial against exercise, in arthritis from hip dysplasia (Gül, Med Sci Monit 2020), and at the shoulder, elbow, wrist and big toe there are no studies. A systematic review across joints found the trials to date at high risk of bias (Waluyo, J Rehabil Med 2023), and a 2025 orthopaedic review judged the evidence insufficient for routine use at the hip and knee (Seah, J Bone Joint Surg Am 2025).
Pairing reviewed 2026-10-12.
Where it fits
Prolotherapy is offered here. It is most worth discussing for knee and hand arthritis that has not settled with exercise, weight management and simple pain relief; at other joints the evidence is thinner or absent, and each joint's page says what has been found there. It is a way to make the exercise program possible, not a substitute for it, and it does not regrow cartilage.
Viscosupplementation (hyaluronic acid) A gel-like injection into an arthritic joint. Widely used, and genuinely contested. Little or no benefit over placebo
What it involves
One or a short series of hyaluronic acid injections into the joint under ultrasound guidance.
What the evidence shows
Hyaluronic acid has been tested against a dummy injection at several joints, and the results range from a very small effect to none. In the knee, the 24 large placebo-controlled trials (8,997 people) show pain reduced by 2 mm on a 100 mm scale more than placebo - less than patients can feel - with more serious adverse events than placebo (Pereira, BMJ 2022). In the hip, five placebo-controlled trials in 591 people show no benefit on pain or function (Liao, Med Sci Monit 2019), including the largest, in 357 people (Brander, Osteoarthritis Cartilage 2018). At the big toe, a Cochrane review found at moderate certainty that a single injection gives no clinically important benefit over placebo (Munteanu, Cochrane Database Syst Rev 2024), and at the shoulder a 300-person trial found a difference from saline that was not statistically significant (Kwon, J Shoulder Elbow Surg 2013). Guideline bodies disagree at the knee - the American College of Rheumatology and Arthritis Foundation do not recommend it, while OARSI and the United States Veterans Affairs guideline do (Sabha, Osteoarthr Cartil Open 2021) - and the higher-quality guidelines consistently recommend against it at the hip (Gibbs, Osteoarthritis Cartilage 2023).
Pairing reviewed 2026-10-08.
Where it fits
Considered only for arthritis inside a joint, mainly the knee, as a non-steroid option when corticosteroid is unsuitable or has already been used repeatedly. The small average effect is stated beforehand, and the page for each joint sets out what has been found there.
Nerve-targeted options
Relevant when examination identifies a superficial neuropathic pattern or a compressed peripheral nerve, not simply because pain is present.
Lyftogt perineural therapy (perineural injection therapy) A series of small dilute dextrose injections just under the skin, over tender superficial nerves. Only if relevant
What it involves
Small injections of low-concentration dextrose, usually 5%, placed just beneath the skin along tender superficial nerves. Given as a series of short sessions.
What the evidence shows
Perineural dextrose evidence is concentrated in diagnosed peripheral compression neuropathies, particularly the upper limb; no direct evidence was identified for this diagnosis itself. Condition reviewed: arthritis overview.
Evidence source: Perineural dextrose for upper-limb entrapment neuropathy review (2025)
Pairing reviewed 2026-08-30.
Where it fits
For arthritis overview, perineural treatment may be considered only if a separate superficial neuropathic pain pattern is found on examination. It is not treatment of the primary diagnosis.
Ultrasound-guided nerve hydrodissection Fluid placed around a nerve to free it from the surrounding tissue. Only if relevant
What it involves
Under ultrasound, fluid is placed in the plane around the nerve to separate it from the tissue that is tethering or compressing it.
What the evidence shows
Hydrodissection evidence is concentrated in ultrasound-confirmed peripheral nerve entrapment, especially carpal tunnel syndrome; no direct evidence was identified for this diagnosis itself. Condition reviewed: arthritis overview.
Evidence source: Buntragulpoontawee et al., hydrodissection injectate review (2021)
Pairing reviewed 2026-08-30.
Where it fits
For arthritis overview, hydrodissection may be considered only if ultrasound and examination identify a separate compressed or tethered peripheral nerve. It is not treatment of the primary diagnosis.
This is general information only and suitability is assessed individually. Treatments with limited or condition-dependent evidence may still be discussed, but only with clear explanation of the uncertainty, the expected benefit, risks, cost and alternatives. Red flags, progressive neurological symptoms or suspected serious pathology require a different pathway.
Every treatment above is described in full on the non-surgical treatments page, including what each one is used for and what the evidence supports. Ratings apply to the named diagnosis; an adjacent muscle, tendon, joint or nerve problem is assessed as a separate target. The method behind the ratings, and the treatments not offered, are set out on the evidence page.
Corticosteroid injection is reviewed separately for each diagnosis.
Cortisone reliably reduces pain in the short term, and that can be genuinely useful when pain is stopping you sleeping or moving enough to rehabilitate. Beyond that window the picture changes. A systematic review of 41 randomised trials and 2,672 participants found that corticosteroid injection reduced pain in the short term but that the effect reversed at intermediate and long term; in pooled analysis for lateral epicondylalgia the short-term effect was large (SMD 1.44, 95% CI 1.17 to 1.71) while no intervention was favoured at 26 weeks (-0.40, -0.67 to -0.14) and at 52 weeks (-0.31, -0.61 to -0.01) (Coombes, Lancet 2010). In a randomised trial in lateral epicondylalgia, 83 per cent of the corticosteroid group had completely recovered or much improved at one year against 96 per cent given a placebo injection, and recurrence ran at 54 per cent against 12 per cent; adding physiotherapy made no significant difference at one year (Coombes, JAMA 2013). In joints, repeated corticosteroid injections have been associated with cartilage loss. It does not repair anything.
So treatment plans are not built around it. Where an injection is the right call, the specific diagnosis and target are reviewed, what is being injected and why is discussed, the number is kept low, and it is paired with the loading work that changes the longer-term course.
When it might still be considered
- Pain severe enough to block rehabilitation
- A clear inflammatory or bursal target on imaging
- A specific short-term goal: a trip, a procedure, a return to work
- Diagnostic use, where the response shows where the pain is coming from
When a cortisone injection is worth doing, and when it is not
Other general conditions
Pain in the same area can come from more than one source, and the label matters less than what the examination and history point to. These are the other guides for this region.
Frequently asked questions
What are the main types of arthritis?
Is there a cure for arthritis?
How do I know which type I have?
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