Osteoarthritis | Pona ngoikore

Also known as OA, degenerative arthritis or degenerative joint disease

Key points about osteoarthritis

  • Osteoarthritis (pona ngoikore) is the most common form of arthritis. It causes pain, swelling, and reduced movement in the joints.
  • Changes affect all parts of the joint including cartilage (the slippery tissue that covers the ends of bones), joint linings and ligaments and muscles. 
  • Joints commonly affected are hands, fingers, knees, hips, spine (neck and lower back).
  • Osteoarthritis is more common in people who are older but can affect younger people.
  • Being overweight or having a joint injury puts you at greater risk.
  • Exercise and weight loss (if required) with other treatments can help improve mobility and daily functioning, reduce pain and flares, and prevent your osteoarthritis from worsening.
Closeup of arthritic hands

Changes with osteoarthritis affect all parts of a joint. Cartilage is a firm rubbery material that covers the end of each bone and provides a smooth, slippery surface for movement. With osteoarthritis the cartilage can become softer, then pitted, and eventually be lost from the bone ends. Bone can become thicker and spurs can form at joint margins, often where tendons or ligaments attach. Joint linings can become inflamed and thickened. Muscles around the joint can become weaker and nerves can become more sensitive. These changes can reduce movement and result in pain.

Osteoarthritis most commonly affects the knee joint, followed by the hip, and then other joints such as the small joints of the hands and the spine.

Previously osteoarthritis was thought to be a result of normal wear and tear during a person’s lifetime. But researchers now recognise that several factors lead to its development, including:

  • Being overweight over a long period of time.
  • Damage by joint injury, such as a fracture or torn cartilage.
  • Infection in the joint or bone.

Some forms of osteoarthritis do run in families, especially the form that affects the finger joints. However, in general, heredity is not a major reason for having osteoarthritis. The precise causes and mechanisms leading to osteoarthritis are still unknown.

Osteoarthritis progresses slowly and develops over many years. It is often very mild and does not always have many symptoms even though x-rays may show joint changes. Sometimes, however, the symptoms are more pronounced and may include any or all of the following:

Symptoms Description
Pain and stiffness
  • Joint pain can increase with use of the joint. It does not indicate increased damage to the joint.
  • Stiffness usually occurs when the joint has been rested.
  • Swelling occurs when irritation of the synovial membrane (joint lining) causes an outpouring of extra joint fluid – just as your eye produces tears when irritated. But in the joint, the extra fluid cannot escape as easily, and so it causes swelling.
  • This most often occurs in the knees.
Creaking or cracking
  • Creaking or cracking sensations with joint movement may reflect a loss of the cartilage and the smooth gliding movement of the joint that cartilage should provide or soft tissues moving past each other.
Bony growths
  • As a result of the changes in the affected joint, the ends of the bones can change shape, forming bony spurs called osteophytes.
  • These may be felt as hard and bony swellings. They are especially apparent when osteoarthritis affects the finger joints.
Muscle weakness
  • The joint may feel unstable as if it is about to give way.

These symptoms can make it difficult for people with osteoarthritis to carry out many of their regular activities and can cause sleep problems, anxiety, depression, tiredness or fatigue.

If you are concerned about symptoms of osteoarthritis, see your doctor without delay. The sooner osteoarthritis is diagnosed the sooner treatment can be begun to help reduce pain, maintain mobility and prevent damage from getting worse.

See your doctor immediately if you develop any of the following:
  • Sudden pain, redness, swelling, and tenderness in a joint.
  • Pain in the joint following an injury.
  • Pain in the joint that continues (is persistent) despite resting the joint.
  • Pain in the joint that is so severe that you cannot weight bear on the joint such as when standing or walking.

These symptoms could be signs of more serious conditions such as fracture, infection in the joint or bone, or other forms of arthritis such as rheumatoid arthritis.

Your doctor will ask what you are able to do and what makes your pain worse. A physical examination will be carried out with close attention to your affected joints. There are no specific blood tests for osteoarthritis, but tests may be made to exclude other forms of arthritis.

X-rays are not needed to diagnose osteoarthritis but can be helpful in some instances. X-ray findings are not a good guide to how severe symptoms may become and X-ray findings do not correlate with the amount of pain or impairment someone experiences.

Treatments for osteoarthritis cannot cure the condition, but can help with:

  • reducing the pain
  • maintaining your ability to work or do activities you enjoy
  • reducing how often your joints become more inflamed and painful (flares)
  • preventing joint changes from getting worse.

Your doctor or physiotherapist is likely to advise a treatment that takes into account the severity of the disease, what joints are affected, your symptoms, other medical problems, your age, occupation and everyday activities. 

Changes to your lifestyle

How you manage day-to-day activities can make a big difference in the impact osteoarthritis has on your lifestyle. Most of the loss of mobility in the early stages of osteoarthritis can be reversed with a programme of exercises and losing weight if necessary.

  • Regular exercise is one of the best treatments to reduce pain and stiffness, reduce your usage of medicines, improve muscle strength, balance, mood and quality of life.
  • If you are overweight, weight loss of approximately 10% can result in symptom improvement comparable to the effect of joint replacement surgery.
  • Read more about exercise and weight loss.



Medication for osteoarthritis focuses mainly on pain relief. Usually, the approach is to try milder pain relief medications first, such as paracetamol and gels or sprays, and if that does not provide relief, move to the stronger pain relief medications such as NSAIDs, or steroid injections in some cases. This approach reduces the risk of side effects.


Paracetamol is recommended for mild pain. It has a low risk of side effects when used at the recommended dose of 4 grams per day (which equates to 8 x 500 mg tablets, or 6 X 665 mg tablets per day).

  • You may need lower doses (3 grams per day), if you are dehydrated, weigh less than 50 kilograms, have liver problems or have a high alcohol intake.
  • Taking paracetamol at regular times (every 6 hours) is likely to be most helpful, although some people may prefer to use it as needed, only when the pain arises. 
  • If paracetamol does not provide adequate pain relief when used alone, it can be combined with other pain relief options like NSAIDs or opioids.

When taking paracetamol it is important to:

  • avoid any over-the-counter products which contain paracetamol, such as cold and flu medicines
  • maintain your alcohol intake within recommended limits 
  • use dosing aids such as pillboxes to assist with taking the correct doses at the correct times. Taking your paracetamol dose it too soon after the previous dose or taking more than your daily limit, can cause serious liver problems.


Creams or gels (called topical pain relief)

These are useful for people with mild-to-moderate pain, especially when the pain is limited to a few joints or to a specific area such as the knee or finger joints.


Non-steroidal anti-inflammatory (NSAID) creams or gels

NSAID creams or gels such as diclofenac and ibuprofen can be bought over-the-counter from your pharmacy. They are not subsidised – you have to pay the full price.

  • These are used by applying a small amount of the cream or gel to the affected joint 3 to 4 times daily. 
  • You are likely to feel improvements in your symptoms within the first week of treatment, and there may be further improvements in the following weeks.
  • Using creams or gels can cause side effects such as stomach bleeding but the risk is lower than when taking NSAID tablets or capsules. The main side effects of NSAID gels or sprays is redness or itching on the affected area.

Capsaicin cream

Capsaicin cream is another example of topical pain relief. It is available on prescription with special approval.

  • Apply a small amount of cream to the affected joint 4 times daily. You may get a burning sensation which eases quickly.
  • It’s important to wash your hands after applying capsaicin cream to avoid transfer to other areas such as the eyes and mouth.
  • You may require treatment for 1 to 2 weeks before you experience a reduction in pain. You can then reduce applications to two times a day.
  • Talk to your doctor or pharmacist about whether capsaicin cream is suitable for you. Read more about capsaicin.


NSAID tablets or capsules 

Common examples of NSAIDs include ibuprofen (Ibugesic®, I-Profen®, Nurofen®), diclofenac (Voltaren®), naproxen (Noflam®, Naprosyn®) and celecoxib (Celebrex®).

  • These are useful for people with ongoing pain and discomfort despite treatment with paracetamol, in people with severe symptoms or during a flare.
  • NSAIDs are effective in reducing the signs of inflammation including redness, warmth, swelling and pain.
  • These can cause serious side effects such as stomach bleeding, increased risk of heart attacks and stroke and kidney problems. They are not suitable for everyone and are usually not recommended as a long-term treatment but some people may need to take them on an ongoing basis.
  • Check with your doctor or pharmacist if NSAIDs are suitable for you. These should be used at the lowest possible dose for the shortest possible time. Read more about the safe use of NSAIDs.


Steroid injection into the joints

These are also called intra-articular corticosteroid injections. Examples include triamcinolone, dexamethasone and methylprednisolone.

  • These steroids are given as injections into the painful joint. 
  • They may provide short-term pain relief, usually for a month, but do not improve joint function or stiffness.
  • They are most useful for treating flares.
  • Repeating steroid injections every three months does not reduce pain and may cause increased cartilage loss. Regular steroid injections are not recommended.
  • Injections in the joints have a very small risk of causing infection.


Weak opioids such as codeine or tramadol

Opioid medication does not improve your ability to do your daily activities more than other pain-relieving medications. Opioid medications may provide small improvements in pain and function but these need to be balanced against the side effects. Side effects include falls, drowsiness, constipation and addiction. Opioids are not recommended for the management of chronic pain. Read more about opioid painkillers


Complementary or alternative therapies 

Complementary or alternative treatments are not usually recommended in the treatment of osteoarthritis, due to a lack of quality evidence or evidence that they are ineffective. Some people may find them beneficial, possibly due to a placebo effect. Examples of therapies include:

  • acupuncture
  • heat or cooling, such as a hot bath or cooling pack on the affected joint. There is little evidence regarding whether these methods are effective but they are often used because they have a low risk of adverse effects.
  • TENS (transcutaneous electrical nerve stimulation) may be helpful if given in a healthcare setting but the use if TENS machines at home has not proven to be helpful.
  • Glucosaminechondroitin and fish oil have been suggested for use in osteoarthritis. The evidence shows that glucosamine and fish oil probably does not reduce symptoms, and that chondroitin might reduce pain a little. 

If you are considering the use of complementary or alternative treatments, it is important to consider the risks, benefits and costs. Read more about the considerations if you are using complementary or alternative therapy.



If joint changes, pain and disability are all severe and a comprehensive management programme including the above measures is not helping, a joint replacement may be necessary. See: Knee replacement and  Hip replacement 

The following links have more information about osteoarthritis. Be aware that websites from other countries may have information that differs from New Zealand recommendations.

Osteoarthritis management – a team approach(external link) NPS MedicineWise, Australia, 2017
Osteoarthritis(external link) Arthritis NZ, 2014
Arthritis - exercises to keep you moving(external link) Arthritis NZ, 2014
NZSL videos about osteoarthritis Platform Trust, in partnership with Deafradio and Healthify NZ, 2022


Information for people with knee arthritis [PDF, 871 KB] University of Otago, NZ, 2021
Osteoarthritis management – A team approach(external link) NPS MedicineWise, Australia, 2017
Osteoarthritis(external link) Arthritis NZ, 2017
What is osteoarthritis?(external link) National Institute of Arthritis and Musculoskeletal and Skin Diseases, 2014 Available in the following languages: English(external link) Chinese(external link) Korean(external link) Vietnamese(external link)
Arthritis – exercises to keep you moving(external link) Arthritis NZ
Diet and osteoarthritis(external link) The Association of UK Dietitians, 2022


Arthritis apps

New Zealand Sign Language osteoarthritis videos produced by Platform Trust, in partnership with Deafradio and Healthify NZ.

These videos are NZSL translations of Healthify pages on osteoarthritis.

On this page, you can find videos about:

  • Osteoarthritis – overview
  • How does osteoarthritis affect joints?
  • What causes osteoarthritis?
  • What are the symptoms of osteoarthritis?

Osteoarthritis – overview

(Platform Trust, in partnership with Deafradio and Healthify NZ, 2022)
Visit our key points about osteoarthritis information.

How does osteoarthritis affect joints?

(Platform Trust, in partnership with Deafradio and Healthify NZ, 2022)
Visit our how does osteoarthritis affect joints information.

What causes osteoarthritis?

(Platform Trust, in partnership with Deafradio and Healthify NZ, 2022)
Visit our what causes osteoarthritis information.

What are the symptoms of osteoarthritis?

(Platform Trust, in partnership with Deafradio and Healthify NZ, 2022)
Visit our what are the symptoms of osteoarthritis information.

  1. Managing pain in osteoarthritis – focus on the person(external link) BPAC, NZ, 2018
  2. Towheed T, Maxwell L, Anastassiades TP, Shea B, Houpt J, Welch V, Hochberg MC, Wells GA. Glucosamine therapy for treating osteoarthritis(external link). Cochrane Database of Systematic Reviews (2005)
  3. Singh JA, Noorbaloochi S, MacDonald R, Maxwell LJ. Chondroitin for osteoarthritis(external link). Cochrane Database of Systematic Reviews (2015)
  4. Symptomatic management of osteoarthritis(external link), Best Practice Advisory Centre, NZ, 2008

Clinical pathways

Osteoarthritis – care and management in adults(external link) NICE Guidance, UK
Osteoarthritic hip pain(external link) Bay of Plenty, Bay Navigator, NZ 
Osteoarthritic knee pain(external link) Bay of Plenty, Bay Navigator, NZ

Other clinical resources

Exercise for osteoarthritis pain: how strong is the evidence?(external link)  Alberta College of Family Physicians (ACFP), Canada, 2020 
Exercise for osteoarthritis pain – how strong is the evidence?(external link) Tools for Practice, Alberta College of Family Physicians, 2020
Symptomatic management of osteoarthritis(external link)  Best Practice Journal (BPJ) and Best Practice Advisory Centre NZ, 2008
Oral or transdermal opioids for osteoarthritis of the knee or hip(external link) - Cochrane Database of Systematic Reviews, updated 2014 

Continuing education resources

Managing osteoarthritis - much more than just a joint replacement(external link) Dr Mark Fulcher, Goodfellow Unit
Clinical pointers – managing osteoarthritis in primary care(external link) March 2016, (30minutes) BMJ Learning
CME topics relating to osteoarthritis(external link)Medscape


Rupesh Puna discusses foot pain throughout the lifespan. He uses a case-based approach highlighting four common conditions: Sever’s disease, Morton’s neuroma, plantar fasciitis and osteoarthritis of the foot.

(external link) (Goodfellow Podcast, 2020)

Osteoarthritis – Dan Exeter(external link) Goodfellow Unit, 2016
"Dr Dan Exeter talks about non-surgical management of osteoarthritis. Dan is a sport and exercise physician based at Axis Sports Medicine clinic in Auckland. He is medical director for Athletics New Zealand and a senior lecturer at the University of Auckland."



what is osteoarthritis nih

What is osteoarthritis?

National Institute of Arthritis and Musculoskeletal and Skin Diseases, 2014

Available in the following languages:

osteoarthritis a team approach nps medicinewise

Osteoarthritis management – A team approach

NPS MedicineWise, Australia, 2017



Arthritis NZ, 2017

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Credits: Healthify editorial team. Healthify is brought to you by Health Navigator Charitable Trust.

Reviewed by: Dr Ben Darlow, Musculoskeletal Physiotherapy Specialist Wellington, Senior Lecturer and researcher, Department of Primary Health Care and General Practice, University of Otago, Wellington (June 2018)

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