Arthritis and MSK Specialists: Who to See and When

MSK stands for musculoskeletal: bones, joints, muscles, tendons and nerves. Several professions work in that space and they overlap:

• MSK physiotherapist: assesses and diagnoses joint and soft tissue problems, treats with exercise, education and hands-on therapy, and refers on when something needs a medical or surgical opinion. In the UK you can see one directly without a GP referral.
• Rheumatologist: a doctor specialising in inflammatory and autoimmune joint disease, including rheumatoid arthritis, psoriatic arthritis, axial spondyloarthritis, gout and lupus. They manage the medication that controls the disease itself.
• Orthopaedic surgeon: manages structural problems and performs joint replacement and other surgery. Usually the right referral once conservative treatment has been tried properly, or when there is clear structural damage.
• GP with an extended role or advanced practitioner in MSK: the triage layer in many NHS services, deciding which of the above you need.
• Podiatrist and occupational therapist: footwear, orthotics, joint protection and adaptations, particularly useful in hand and foot arthritis.

Osteoarthritis is the wear-and-adaptation type that affects knees, hips, hands, feet and the spine. It typically causes pain related to activity, stiffness after rest that eases within about half an hour, and gradual change over years. The right first stop is usually an MSK physiotherapist, since the core treatments are exercise-based.

Inflammatory arthritis behaves differently: prolonged morning stiffness lasting an hour or more, swelling in several joints (often the small joints of the hands and feet), symptoms that are worse with rest and better with movement, fatigue, and sometimes involvement of skin, eyes or bowel. This needs a medical assessment quickly, because early treatment with disease-modifying medication changes the long-term picture. See your GP promptly and ask about rheumatology referral.

Physiotherapy still plays a part in inflammatory arthritis for strength, function and pain, alongside the medical management rather than in place of it.

NICE is unambiguous on this. Its guideline on osteoarthritis in over 16s names therapeutic exercise and weight management, where appropriate, as the core treatments, alongside good information and support. It also notes that exercise has a clinically important benefit and a better safety profile than common alternatives such as analgesia, and that supervised exercise is likely to be more beneficial than unsupervised exercise (NICE NG226).

That last point is the practical case for seeing someone. Most people know exercise helps. The value of an MSK specialist is in choosing the right exercises for your joint, setting a dose that is challenging enough to change something, working around flare-ups, and keeping you progressing over months.

NICE also advises against routine imaging to diagnose osteoarthritis where the clinical picture is typical, because X-ray findings correlate poorly with symptoms. Our article on whether you need a scan explains why a normal or an alarming-looking image often changes nothing about the plan.

A surgical referral makes sense when pain is severe and persistent despite genuine conservative treatment, when it disturbs sleep regularly, when function is significantly limited, or when a joint locks, gives way or has clear mechanical failure. NICE's position is that a poor response to non-surgical management, rather than an X-ray grade or an age threshold, is what should trigger the referral conversation.

Going into surgery stronger also produces a better result, so exercise-based care is worth continuing even once a referral is made. Our post on hip replacement rehab covers what that looks like either side of an operation.

• A single hot, red, very painful swollen joint, especially with fever or feeling unwell, which needs urgent assessment.
• Morning stiffness lasting an hour or more, or swelling in several joints, particularly the small joints of the hands and feet.
• Unexplained weight loss, night sweats or persistent fever alongside joint pain.
• New severe pain after a fall or trauma.
• Progressive weakness, numbness, or problems with bladder or bowel control alongside back pain.

A physiotherapist screens for these at assessment and will send you on when they appear, so an appointment is not a wasted step if you are unsure.

The idea that arthritis means going easy on the joint is the most costly misunderstanding that walks into this clinic. It usually arrives attached to an X-ray report and the phrase "wear and tear", and it persuades people to stop doing the very thing that keeps a joint tolerable. The health walk schemes running across East and West Sussex are full of people managing arthritic knees and hips by walking on them week in and week out, which sits much closer to the evidence than resting does.

NICE recommends therapeutic exercise as a core treatment for osteoarthritis, including strengthening the muscles around the joint, and that holds whatever the X-ray shows, because the link between imaging findings and how much a joint actually hurts is famously loose. The specialist question is a separate one. Hot, swollen joints, morning stiffness lasting more than an hour, or several joints flaring at once point towards inflammatory arthritis and a rheumatologist, and spotting which conversation you are in is the first job of an assessment.

No GP referral is needed to start, so you can book an assessment directly.

Do I need a GP referral to see an MSK physiotherapist?
No. Self-referral to private physiotherapy is normal in the UK. Our page on referrals covers the exceptions, mainly insurance requirements.

Will exercise wear my joints out faster?
Appropriately dosed exercise does the opposite. Cartilage and bone respond to load, and stronger muscles reduce the stress the joint has to absorb, which is why NICE names therapeutic exercise as a core treatment for osteoarthritis.

Can a physiotherapist tell which type of arthritis I have?
An MSK physiotherapist can recognise the patterns that suggest inflammatory arthritis and will refer you for the blood tests and specialist opinion needed to confirm it. Diagnosis of inflammatory disease itself sits with a doctor.