Osteoarthritis is a mechanical condition in which cartilage and the bone beneath it change under load, and it is asymmetric, activity-related, and accompanied by morning stiffness lasting under 30 minutes. Rheumatoid arthritis is an autoimmune disease in which the immune system attacks the joint lining, and it is symmetrical, affects the small joints of the hands and feet, and produces morning stiffness lasting over an hour along with fatigue. Gout, psoriatic arthritis and axial spondyloarthritis make up most of the rest.
Working out which specialist to see once you have a name for it is covered separately in PhysioHub’s guide to arthritis and MSK specialists.
Three questions separate most cases: which joints, how long the morning stiffness lasts, and how fast it came on.
| Type | Joint pattern | Morning stiffness | What gives it away |
|---|---|---|---|
| Osteoarthritis | Asymmetric, load-bearing: knees, hips, thumb base, end finger joints | Under 30 minutes | Worse after activity, better with rest, builds over years |
| Gout | One joint at a time, classically the big toe | Not the pattern | Comes on over hours, often overnight, red and untouchable |
| Rheumatoid arthritis | Symmetrical, small joints of hands and feet, knuckles and wrists | Over an hour | Eases with movement, systemic fatigue, both sides equally |
| Axial spondyloarthritis | Lower back, buttocks and sacroiliac joints, starting under 45 | Over 30 minutes | Back pain better with exercise and worse with rest, wakes you in the second half of the night |
| Psoriatic arthritis | Asymmetric, end finger joints, whole digits swelling | Around 45 minutes | Skin or nail psoriasis, a finger or toe swollen along its whole length |
The single most useful distinction is what movement does. Mechanical joint pain is worse for using the joint and better for resting it. Inflammatory joint pain is worse for resting and better once you get going, which is why an inflammatory back is stiffest at 5am and looser by mid-morning.
This is a documentary review of published guidance and UK prevalence data rather than a diagnosis. The five types here were selected on how often they present in the UK population, using the figures in Versus Arthritis’ State of Musculoskeletal Health: osteoarthritis affects around 10 million people, of whom roughly 5.4 million have knee osteoarthritis and 3.2 million hip osteoarthritis; around 450,000 adults have a recorded diagnosis of rheumatoid arthritis; around 220,000 have axial spondyloarthritis; and around 190,000 have psoriatic arthritis.
Gout is placed second because it is the most common inflammatory arthritis in the UK, more common than rheumatoid arthritis. No prevalence figure is quoted for it here, because the figure was not verified for this review.
The clinical descriptions follow NICE guideline NG226 on osteoarthritis and NICE guideline NG65 on spondyloarthritis. Evidence checked in August 2026.
What this cannot do, and it is worth naming plainly: the patterns below overlap in real people, several of these conditions can coexist in the same person, and blood tests are normal in a meaningful proportion of people who genuinely have inflammatory arthritis. This page narrows the question. It does not answer it.
Ask what movement does to it. Better for moving and worse for sitting still points to inflammation. Worse for use and better for rest points to a mechanical problem.
Time the morning stiffness properly. Measure it to the point where the joints move normally, which is a later moment than simply feeling awake. Under 30 minutes and over an hour sit either side of the most useful dividing line in this whole subject.
Look at symmetry. The same two knuckles on both hands is a very different signal from one thumb base and one knee.
Note the speed of onset. Hours means crystals or infection. Weeks means inflammation. Years means osteoarthritis.
Check the skin, nails and eyes. Psoriasis, nail pitting and episodes of a painful red eye each pull the answer towards the inflammatory group, and people rarely connect them to a joint problem on their own.
What it is
Osteoarthritis is a condition of the whole joint in which cartilage thins, the bone underneath remodels and the joint margins grow new bone. Calling it wear and tear is misleading, because it is an active process the joint drives rather than a tyre wearing down.
Who it suits as an explanation
Pain that has built over years, is worse after a long walk or a day in the garden, and eases with rest. Stiffness after sitting that clears in a few minutes of moving. Knees, hips, thumb bases and the end joints of the fingers.
What it involves
Diagnosis in over-45s with activity-related pain and morning stiffness under 30 minutes is clinical, and NICE is explicit that imaging is not needed to make it. Management is led by exercise, with weight management where relevant, and topical or oral anti-inflammatories as an adjunct.
What the evidence supports
Therapeutic exercise is the core treatment in NG226, offered to everyone with osteoarthritis, and the guidance is direct that it can increase joint pain at first and should be continued anyway. Strength and aerobic work both have evidence behind them.
Limits and cautions
X-ray findings and symptoms correlate poorly in both directions, so a report describing severe changes does not settle how much pain you should expect, and a normal film does not rule the condition out.
Why it ranks first
At around 10 million people in the UK it is more common than every other type on this list combined, and it is the default explanation for joint pain over 45 until something in the pattern argues otherwise.
What it is
Gout is caused by monosodium urate crystals forming inside a joint when uric acid levels stay high. The crystals trigger an intense inflammatory response, which is why a gout attack is out of proportion to anything that happened to the joint.
Who it suits as an explanation
A single joint that becomes agonising over a few hours, usually overnight, often the base of the big toe, red and hot enough that the weight of a duvet is unbearable. It settles over one to two weeks even untreated, then returns.
What it involves
Diagnosis is clinical, supported by serum uric acid measured after the attack has settled rather than during it, since levels can be normal mid-attack. Definitive diagnosis is by identifying crystals in joint fluid. Treatment covers the acute attack and, separately, urate-lowering therapy to prevent the next one.
What the evidence supports
Gout is one of the few types of arthritis where the underlying cause is fully understood and treatable. Sustained urate-lowering treatment prevents attacks and dissolves deposits, which makes it unusual on this list.
Limits and cautions
A single hot, red, swollen joint with fever needs same-day medical assessment, because a septic joint presents identically and is a surgical emergency. Never assume gout because it looks like the last attack.
Why it ranks second
It is the most common inflammatory arthritis in the UK, and it is the one most often mistaken for an injury, because the onset is sudden and there is usually no history of anything happening.
What it is
Rheumatoid arthritis is a systemic autoimmune disease in which the immune system attacks the synovium, the lining of the joint. Because the antibodies circulate in the blood, the disease reaches joints on both sides of the body at once, which is the origin of its symmetry.
Who it suits as an explanation
Swollen, tender knuckles and wrists on both hands, morning stiffness lasting more than an hour, fatigue that is disproportionate to the joint pain, and symptoms that ease as the day goes on.
What it involves
Assessment includes inflammatory markers, rheumatoid factor and anti-CCP antibodies, which are the most specific of the three. Treatment is disease-modifying drugs started early, managed by a rheumatology team.
What the evidence supports
Time to treatment is the single biggest modifiable factor in long-term outcome, which is why persistent symmetrical small-joint swelling is an urgent referral rather than something to monitor. Exercise alongside medical treatment is safe and beneficial, covered in exercising with rheumatoid arthritis.
Limits and cautions
Around a quarter of people with rheumatoid arthritis are seronegative, meaning rheumatoid factor and anti-CCP are both negative while the disease is real and active. A negative blood test does not close the question.
Why it ranks third
At around 450,000 UK adults it is far less common than osteoarthritis, and it carries the highest cost of a delayed diagnosis of anything on this list.
What it is
Axial spondyloarthritis is inflammatory arthritis of the spine and sacroiliac joints. Inflammation at the points where ligament and tendon attach to bone drives new bone formation, which over years can reduce spinal movement.
Who it suits as an explanation
Back and buttock pain that started before 45, has lasted more than three months, improves with exercise, does not improve with rest, and wakes you in the second half of the night.
What it involves
Assessment includes MRI of the sacroiliac joints, which shows inflammation years before an X-ray shows anything, along with CRP and HLA-B27 status. NICE NG65 sets referral criteria based on the inflammatory back pain pattern rather than on test results.
What the evidence supports
Exercise is the core treatment rather than an add-on, and NICE recommends referral to a specialist physiotherapist for an individualised, structured exercise programme, with hydrotherapy considered as an adjunct.
Limits and cautions
The average delay from first symptom to diagnosis in the UK is measured in years, largely because inflammatory back pain in a young adult is read as mechanical. HLA-B27 is a risk marker rather than a diagnostic test, and plenty of people who carry it never develop the condition.
Why it ranks fourth
At around 220,000 people it is uncommon, and it is the type most reliably missed, because the presenting complaint is back pain in someone young enough that nobody suspects arthritis.
What it is
Psoriatic arthritis is inflammatory arthritis associated with psoriasis, involving both the joint lining and the entheses where tendons anchor into bone.
Who it suits as an explanation
Joint pain in someone with psoriasis, particularly where a whole finger or toe swells along its length rather than at one knuckle, or where the end joints of the fingers are involved alongside pitted or lifting nails.
What it involves
Diagnosis is clinical and rests on recognising the pattern in the context of skin or nail changes. There is no single confirmatory blood test, and inflammatory markers are normal in a substantial minority.
What the evidence supports
Skin disease and joint disease do not track each other, so mild psoriasis is entirely compatible with significant joint involvement. Anyone with psoriasis and persistent joint symptoms warrants assessment rather than reassurance based on how the skin looks.
Limits and cautions
Psoriasis on the scalp, behind the ears, in the navel or in the natal cleft is frequently missed by the person who has it, and nail changes are commonly attributed to fungal infection.
Why it ranks fifth
At around 190,000 UK adults it is the least common of the five, and it is the one where the clue is somewhere other than the joint.
| Type | Mechanism | Symmetrical | Better for movement | Blood test confirms it | Onset |
|---|---|---|---|---|---|
| Osteoarthritis | Mechanical | No | No | No | Years |
| Gout | Crystal | No | No | Supportive only | Hours |
| Rheumatoid arthritis | Autoimmune | Yes | Yes | Often, not always | Weeks to months |
| Axial spondyloarthritis | Autoimmune | Central | Yes | Supportive only | Months to years |
| Psoriatic arthritis | Autoimmune | No | Yes | No | Weeks to months |
Read the middle three columns together. Symmetrical, better for movement and with a supportive blood test puts you firmly in the inflammatory group and makes this a rheumatology question. Asymmetric, worse for movement and with nothing on bloods puts you in the mechanical group, where the treatment is loading the joint properly.
If one joint became agonising over a few hours and you have no injury to explain it, treat it as gout or infection until proven otherwise, and seek same-day care if you also feel feverish or unwell.
If the same knuckles on both hands are swollen and stiff for more than an hour each morning, ask your GP about rheumatoid arthritis specifically. This is the referral where speed changes the outcome.
If you are under 45 with back pain that eases when you move and wakes you at 4am, ask about inflammatory back pain by name. Mechanical back pain does not behave this way.
If you have psoriasis anywhere and a joint has been sore for weeks, mention both in the same sentence to whoever sees you, because the connection is regularly missed.
If pain has built over years in a knee, hip or thumb and is worse after you use it, this is most likely osteoarthritis, and the most useful next step is a loading programme rather than a scan.
If several of these describe you at once, that is common and it is not a contradiction. Osteoarthritis frequently develops in a joint previously damaged by inflammatory arthritis.
The question people actually arrive with is whether what they have is arthritis at all, or something that will settle. That question is answerable in a single appointment far more often than people expect, because the three things that separate these conditions are all available in a room: which joints are involved, what happens to the pain over the first ten minutes of moving, and how long ago it started.
What testing adds is the part that is genuinely hard to self-assess. Swelling in a knuckle is often felt rather than seen, and telling joint-line swelling from soft tissue thickening around it decides whether the next step is a loading programme or a phone call to a GP asking for inflammatory bloods. In the Uckfield clinic that distinction is the single most useful thing an assessment produces for someone with hand or foot pain, because the two answers lead in opposite directions.
Where you are not yet sure whether this is a physiotherapy problem or a medical one, a free discovery and triage call will get you pointed at the right route.
What is the difference between osteoarthritis and rheumatoid arthritis?
Osteoarthritis is a mechanical condition of cartilage and bone that develops over years, affects joints asymmetrically, is worse after activity and produces morning stiffness lasting under 30 minutes. Rheumatoid arthritis is a systemic autoimmune disease in which the immune system attacks the joint lining, affects small joints symmetrically on both sides, eases with movement and produces morning stiffness lasting over an hour alongside fatigue.
Can you have osteoarthritis and rheumatoid arthritis at the same time?
Yes, and it is common. Years of inflammatory damage from rheumatoid arthritis change the joint surface, and osteoarthritis then develops in that joint on top of the original disease. The two need different treatments running side by side, so having one diagnosis does not explain every new symptom.
Which blood tests are used for inflammatory arthritis?
The usual set is ESR and CRP for inflammation, rheumatoid factor and anti-CCP antibodies for rheumatoid arthritis, HLA-B27 where axial spondyloarthritis is suspected, and serum uric acid for gout measured once an attack has settled. None of these confirms a diagnosis on its own, and normal results do not rule inflammatory arthritis out.
How long should morning stiffness last with osteoarthritis?
Under 30 minutes, and usually only a few minutes once you are moving. Stiffness that consistently lasts longer than an hour is the pattern associated with inflammatory arthritis and is worth reporting to a GP rather than accepting as part of ageing.
Does a normal X-ray mean I do not have arthritis?
No. X-rays show structural change rather than inflammation, so early rheumatoid arthritis and early axial spondyloarthritis are both usually invisible on a plain film. MRI shows inflammation in the sacroiliac joints years before an X-ray does. For osteoarthritis, NICE advises that a diagnosis can be made clinically in over-45s without imaging at all.
Which type of arthritis is the most common in the UK?
Osteoarthritis, by a wide margin. Versus Arthritis puts it at around 10 million people in the UK, compared with around 450,000 with rheumatoid arthritis, 220,000 with axial spondyloarthritis and 190,000 with psoriatic arthritis. Gout is the most common of the inflammatory types.
Does arthritis always get worse over time?
Not in the way most people assume. Osteoarthritis symptoms fluctuate and frequently improve with a loading programme even when the X-ray does not change, so structural progression and symptom progression are separate things. Inflammatory arthritis is progressive when untreated, which is exactly why early diagnosis and disease-modifying treatment matter so much.
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