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Arthritis

Pain, stiffness and swelling in the joints. Arthritis is a family of more than 100 conditions — from osteoarthritis to rheumatoid arthritis and gout — that affects about 1 in 5 U.S. adults. There is no cure, but movement, the right diagnosis and good treatment help most people stay active.

What is arthritis?

“Arthritis” literally means joint inflammation (NIAMS). It isn’t one disease but a general term for more than 100 conditions that affect the joints, the tissues around them and other connective tissues (CDC, Arthritis Foundation). Some types also affect other organs, such as the eyes, heart, lungs, kidneys or skin (NIAMS, Arthritis Foundation).

How common is it?

Arthritis affects about 1 in 5 U.S. adults — about 54 million people — and is a leading cause of work disability. People with other long-term conditions such as obesity, diabetes and heart disease often have arthritis too (CDC). It can happen at any age, but the risk rises as you get older; about 1 in 3 veterans has arthritis (CDC).

The main types

  • Osteoarthritis (OA) is the most common type, affecting about 33 million U.S. adults. It most often affects the hands, hips, back and knees, and is common after 45 — but it is not a normal part of aging (CDC). A separate MBHA guide to osteoarthritis is on the way.
  • Rheumatoid arthritis (RA) is an autoimmune disease: the immune system attacks the lining of the joints, which can damage cartilage and bone over time (NIAMS). It is the most common autoimmune type of arthritis, often affects the small joints of the hands and feet on both sides of the body, and can also affect the eyes, heart and lungs (American College of Rheumatology). Women are two to three times more likely to have it (CDC).
  • Gout happens when urate (uric acid) builds up and forms needle-shaped crystals in a joint (NIAMS). Flares often start suddenly at night, commonly in the big toe, with severe pain, swelling, redness and warmth (NIAMS, CDC). Men are more likely to get gout than women (CDC).
  • Psoriatic arthritis inflames the joints and the places where tendons and ligaments attach to bone. Most people who get it already have the skin condition psoriasis. Signs include sausage-like swelling of a whole finger or toe, pitted or crumbling nails, heel pain and sometimes eye inflammation (NIAMS).
  • Lupus is an autoimmune disease that can affect many parts of the body. It can cause arthritis — painful, swollen joints and morning stiffness — along with fever, tiredness and rashes such as a “butterfly” rash across the cheeks and nose. Women get it about nine times more often than men, usually between ages 15 and 45 (NIAMS).
  • Ankylosing spondylitis inflames the joints and ligaments of the spine (NIAMS) — see our ankylosing spondylitis guide.

Other types include reactive arthritis after an infection, infectious (septic) arthritis, and arthritis in children (NIAMS, Arthritis Foundation). See our guide to juvenile arthritis (JIA).

Inflammatory arthritis vs. “wear-and-tear” arthritis

Osteoarthritis used to be thought of as simple wear and tear on cartilage. Doctors now know it is a disease of the whole joint, and that inflammation plays a part in it too (Arthritis Foundation, ACR). Still, the two groups tend to behave differently:

Why early diagnosis of inflammatory arthritis matters

With inflammatory arthritis, time counts. In RA, joint damage can begin within the first year or two and generally can’t be reversed, so early diagnosis and treatment are very important (NIAMS). The CDC says it is best to diagnose and treat RA early to avoid joint damage and worsening symptoms (CDC), and early treatment of psoriatic arthritis is linked to better outcomes and less damage (NIAMS). The Arthritis Foundation calls early diagnosis and treatment of autoimmune and inflammatory types “critical” (Arthritis Foundation). Even for gout, early diagnosis helps you start treatment quickly (CDC).

Symptoms

Symptoms vary by type but usually include joint pain and stiffness (CDC), along with swelling, warmth or redness around a joint, tenderness and less movement (MedlinePlus, Cleveland Clinic). Some types come and go in flares (Cleveland Clinic).

How it’s diagnosed

Knowing which type you have is what guides the right treatment (NIAMS). Providers use your health and family history, a physical exam, X-rays and lab tests as needed (CDC):

Rheumatologists are doctors trained as experts in diagnosing and treating arthritis (CDC).

A hot, swollen joint with fever needs urgent care. A joint that suddenly becomes very painful, swollen, warm and red — especially with fever or chills — may be infected (septic arthritis) (Arthritis Foundation, MedlinePlus).

A gout flare can look similar, and only a doctor can tell them apart — often by testing fluid from the joint (MedlinePlus, ACR). Don’t wait for a routine appointment, and don’t try to treat it at home or with complementary approaches.

When to see a doctor: if joint pain lasts more than 3 days or is severe and unexplained; if a joint is badly swollen, hard to move, or red or hot; or if you have a fever or lose weight without trying (MedlinePlus). Also see a provider if joint pain gets in the way of daily life, stiffness is getting worse, or flares are becoming more frequent (Cleveland Clinic). If you might have inflammatory arthritis, ask about a rheumatologist (CDC).

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) Physical activity, weight loss for knee and hip OA, physical and occupational therapy, NSAIDs (including skin gels for knee OA), DMARDs and biologics for RA, urate-lowering medicines for gout, joint injections and, if needed, joint replacement. Physical therapy about $50–$350+ a session without insurance; a knee replacement about $20,000–$35,000+ uninsured (cost guide). CDC-recognized self-management workshops about $25–$35. No cure, but treatment lets most people lead active lives. With RA and other inflammatory types, early treatment helps prevent lasting joint damage.
Chiropractic Joint mobilization or manipulation, mainly for osteoarthritis of the hip, knee or spine, plus exercise advice. Not a treatment for inflammatory arthritis. About $50–$200 a visit without insurance ($15–$75 with); first evaluations $100–$250. Fair short-term evidence for hip and knee OA in a chiropractic review, but the 2019 OA guideline found little benefit over exercise alone. Neck manipulation can be dangerous with RA.
Acupuncture A course of needle treatments for osteoarthritis pain, alongside standard care. About $125–$230 for a first visit and $90–$185 for follow-ups; community clinics about $50–$90. Modest pain relief in knee OA trials; much of the effect is also seen with sham needling. A conditional (weak) guideline recommendation for OA; no clear benefit shown for RA.
Herbal medicine Turmeric, glucosamine and chondroitin, fish oil and capsaicin cream are the most commonly tried. Cost estimate being researched. Mostly weak or negative evidence; the 2019 OA guideline recommends against glucosamine. Several products interact with medicines. Never a substitute for RA or gout medicines.
Massage therapy Gentle massage for comfort, mainly for knee or hand osteoarthritis, with your doctor’s OK. About $60–$120 for 45–60 minutes with a private therapist, or $50–$90 at clinics, gyms and spas. Short-term relief of knee pain in some trials, but benefits faded over a year and the 2019 OA guideline leans against it. Very little research for hands.
MBHA Wellness Coach A walking or activity plan, weight, sleep, joint protection, CDC-recognized self-management programs, mood and quitting smoking. Cost estimate being researched. CDC-recognized workshops about $25–$35; the Walk With Ease guidebook is free for U.S. residents. Supports — never replaces — medical care. Activity, weight and self-management are among the best-proven steps for arthritis.

Approach 1 of 6

Conventional medicine (AMA)

There is no cure for arthritis, but it can be treated and managed, and treatment depends on the type (CDC). The goals are to ease pain and inflammation, improve how your joints work, and prevent further damage (MedlinePlus). For osteoarthritis, U.S. care follows the 2019 guideline from the American College of Rheumatology (ACR) and the Arthritis Foundation, which stresses shared decision-making (ACR/Arthritis Foundation, 2019).

1. Physical activity — a core treatment

2. Weight loss for knee and hip osteoarthritis

Weight loss is strongly recommended for people with knee or hip OA who have overweight or obesity. Losing 5% or more of body weight can help, benefits keep growing with more loss, and it works better combined with exercise (ACR/Arthritis Foundation, 2019). For a 250-pound person, 5% is about 12 pounds (CDC).

3. Physical and occupational therapy, and aids

Physical therapy strengthens the muscles around affected joints (CDC), and occupational therapy helps with everyday and work tasks; braces, splints and assistive devices can also help (NIAMS). For knee or hip OA that affects walking, the guideline strongly recommends a cane, and knee braces or a thumb-base splint for the right kind of OA (ACR/Arthritis Foundation, 2019).

4. Pain relievers

5. Medicines for inflammatory arthritis

  • Rheumatoid arthritis: disease-modifying antirheumatic drugs (DMARDs) are the main treatment. They can slow RA, control swelling and prevent joint deformity. If they aren’t enough, biologics (a type of DMARD that blocks specific parts of the immune system) may be added (CDC), and JAK inhibitors are another option (NIAMS). Steroids may be used at the lowest dose that works (NIAMS). Many people change medicine at least once, and regular rheumatology follow-up is key (ACR).
  • Psoriatic arthritis is also treated with DMARDs (Cleveland Clinic).
  • Gout: flares are eased with anti-inflammatory medicines, colchicine or steroids. For frequent flares or tophi (crystal lumps), long-term urate-lowering medicines — xanthine oxidase inhibitors, uricosurics or, for hard cases, uricase — prevent flares when taken consistently (NIAMS, ACR).

We don’t list doses; your doctor will tailor any medicine to you.

6. Joint injections

Steroid injections into the joint are strongly recommended for knee and hip OA and give short-term relief (ACR/Arthritis Foundation, 2019). They may also be used for a gout flare (NIAMS).

7. Joint replacement

Surgery is usually considered only when other treatments haven’t worked (CDC, Cleveland Clinic) — for example, joint replacement for severe damage, or when pain limits everyday activities (MedlinePlus, NIAMS).

What it costs

  • Physical therapy: about $50–$350 or more a session without insurance, or a $10–$75 copay or 10%–50% coinsurance with it (cost guide: CostHelper). Medicare Part B covers medically necessary outpatient PT; you pay 20% of the approved amount after the deductible (Medicare.gov).
  • Knee replacement: about $20,000–$35,000 or more without insurance; with insurance, out-of-pocket costs range from hundreds to several thousand dollars (cost guide: CostHelper). Ask your hospital for a written estimate.
  • CDC-recognized programs: self-management workshops cost about $25–$35, and the Walk With Ease guidebook is free for U.S. residents (CDC). The Arthritis Foundation helpline (1-800-283-7800) can help you find programs (CDC).
  • Prescription arthritis medicines: MBHA cost estimate being researched.

What to expect

Current treatments allow most people with arthritis to lead active and productive lives (NIAMS). For RA, the goal is remission or close to it (NIAMS); finding the right medicine can take a few tries (Arthritis Foundation).

Find a medical doctor in our directory

Approach 2 of 6

Chiropractic

Chiropractic care doesn’t treat the inflammation behind rheumatoid arthritis, gout, psoriatic arthritis or lupus. Its possible role is in osteoarthritis — and the evidence depends on the joint.

What the research says

  • Hip and knee osteoarthritis: a 2012 review by chiropractic researchers rated the evidence for manipulative therapy as fair for short-term relief and limited for the long term, and called for larger, better trials (review, JMPT, 2012).
  • The 2019 OA guideline looked at manual therapy (including mobilization and manipulation) added to exercise, and found little extra benefit over exercise alone for knee and hip OA, so it conditionally recommends against it (ACR/Arthritis Foundation, 2019).
  • Back and neck pain in general: spinal manipulation may bring small improvements in low-back pain and can help acute neck pain (NCCIH). These studies weren’t specifically about arthritis.
  • Inflammatory arthritis: we found no good evidence that chiropractic treats RA, psoriatic arthritis, gout or lupus. For ankylosing spondylitis, rheumatology guidelines strongly advise against spinal manipulation — see our ankylosing spondylitis guide.

Safety: rheumatoid arthritis and the neck

RA can loosen the joint between the top two bones of the neck (atlanto-axial subluxation). Manual treatments aimed at the upper neck in someone with this problem can have serious consequences, including paralysis and death, so clinicians need to screen for it before any hands-on treatment (case report, Manual Therapy, 2013). Serious problems after spinal manipulation are rare, but the risk may be greater in people with underlying health problems (NCCIH).

As a precaution, MBHA suggests: get your doctor’s OK first; tell the chiropractor what type of arthritis you have and whether you have osteoporosis; if you have RA or another inflammatory arthritis, avoid neck manipulation; and don’t let chiropractic care delay a rheumatology visit if you have signs of inflammatory arthritis.

What it costs

Find a chiropractor in our directory

Approach 3 of 6

Acupuncture

Acupuncture is one of the most studied complementary approaches for osteoarthritis, especially of the knee. The results are encouraging but modest.

What the research says

  • Osteoarthritis: in a 2018 review, acupuncture relieved OA pain better than no treatment (10 studies, 2,413 people) and better than sham acupuncture (9 studies, 2,376 people), but the gap over sham was smaller. Most participants had knee OA, and the pain relief was comparable to that of NSAIDs. For hip OA, two sham-controlled studies found little or no difference (NCCIH).
  • Guideline: the 2019 ACR/Arthritis Foundation guideline conditionally (weakly) recommends acupuncture for knee, hip and hand OA. It notes that the benefit is largely a “contextual” effect plus a small difference between real and sham needling, that the strongest evidence is for the knee, and that the risk of harm is minor (ACR/Arthritis Foundation, 2019).
  • Mixed results: one 2014 Australian study found needle and laser acupuncture modestly better than no treatment, but not better than sham laser (NCCIH).
  • Rheumatoid arthritis: eleven studies found no clear evidence of benefit (NCCIH).

In short: acupuncture may offer some extra relief for knee OA pain, used alongside — not instead of — exercise and medical care.

Safety

Relatively few complications have been reported. Problems have come from non-sterile needles and poor technique; in the U.S., needles must be sterile and single-use, and most states license acupuncturists (NCCIH). MBHA suggests telling your acupuncturist if you take a blood thinner or have a joint replacement.

What it costs

Published examples run about $125–$230 for a first private visit and $90–$185 for follow-ups; community clinics about $50–$90 a visit (The Pricer). A course of several sessions can add up.

Find an acupuncturist in our directory

Approach 4 of 6

Herbal medicine

Many supplements are sold for joint pain. The evidence is mostly weak or negative, and some products interact with arthritis medicines. For RA and other inflammatory arthritis, medical treatment can slow or prevent joint damage, so never use a supplement in place of it (NCCIH).

Turmeric (curcumin)

Early evidence for curcumin taken by mouth for knee OA is positive, but better studies are needed; it’s unclear whether curcumin ointment helps. Turmeric can upset the stomach, liver damage has been reported with highly absorbable curcumin products, and supplements may be unsafe in pregnancy (NCCIH).

Glucosamine and chondroitin

  • The large U.S. GAIT trial gave 1,583 people with knee OA glucosamine, chondroitin, both, an anti-inflammatory drug (celecoxib) or a placebo for 24 weeks. Overall, the supplements did not reduce pain significantly better than placebo, while celecoxib did. An exploratory look at people with moderate-to-severe pain suggested the combination might help them (GAIT trial, NEJM, 2006).
  • A two-year follow-up of 572 GAIT participants found no treatment slowed joint narrowing by a meaningful amount compared with placebo (GAIT, Arthritis & Rheumatism, 2008, NCCIH).
  • The 2019 guideline strongly recommends against glucosamine for knee, hip and hand OA, and against chondroitin for knee and hip OA, though it conditionally recommends chondroitin for hand OA based on a single trial (ACR/Arthritis Foundation, 2019).
  • Safety: both have been linked to a higher bleeding risk in people taking warfarin, and glucosamine may raise blood sugar in some people (NCCIH).

Fish oil (omega-3s)

For RA, reviews suggest omega-3-rich foods may ease pain and swollen, tender joints, but the evidence is low quality (NCCIH). Talk with your provider first if you take a blood-thinning medicine or are allergic to fish or shellfish (NCCIH). For OA, only one trial exists, and the 2019 guideline conditionally recommends against fish oil (ACR/Arthritis Foundation, 2019).

Capsaicin cream

Capsaicin, from chili peppers, is rubbed on the skin. The 2019 guideline conditionally recommends it for knee OA (the benefits are small) but against it for hand OA, partly because of the risk of getting it in your eyes (ACR/Arthritis Foundation, 2019). It can irritate the skin (NCCIH).

Products to be careful with

Before you take any supplement, show it to your doctor or pharmacist — especially if you take a blood thinner, a DMARD, a biologic or another immune-suppressing medicine, have diabetes, or are pregnant (NCCIH, NCCIH, NCCIH). Never stop or change a prescribed medicine on your own (NCCIH). We don’t list doses here.

Approach 5 of 6

Massage therapy

Many people with arthritis find massage soothing for stiff muscles around sore joints. It is a comfort measure; it doesn’t change the course of the disease.

What the research says

  • Knee osteoarthritis: the NIH says massage may have short-term benefits for knee pain; five of six studies found short-term relief (NCCIH). In a 2019 U.S. trial of 222 adults, eight weekly one-hour massages improved pain, stiffness and function more than light touch or usual care at 8 weeks, but by one year there was no difference between the groups. Side effects were minimal (trial, J Gen Intern Med, 2019).
  • Guideline: the 2019 ACR/Arthritis Foundation guideline conditionally recommends against massage for knee and hip OA because studies were small and at high risk of bias — though the patients on its panel felt strongly that massage helped them (ACR/Arthritis Foundation, 2019).
  • Hands: research is very limited. A 2014 study of 20 adults with hand arthritis compared massage plus a pain-relieving cream with massage alone, with no untreated comparison group (study, J Bodyw Mov Ther, 2014).
  • Rheumatoid arthritis: one 2013 study of 42 people suggested moderate-pressure massage may reduce pain and improve grip strength in the arms and shoulders (NCCIH).

Safety

The risk of harm appears low, but rare serious problems — including a blood clot, nerve injury or broken bone — have been reported, sometimes with vigorous or deep-tissue work and in older adults (NCCIH, NCCIH). Massage therapists working with arthritis need to understand the special needs of affected joints (NCCIH). MBHA suggests choosing gentle pressure, telling your therapist about your arthritis and any joint replacement, and skipping massage over a joint that is hot or swollen — and don’t use massage to put off seeing a provider (NCCIH).

What it costs

Find a massage therapist in our directory

Approach 6 of 6

MBHA Wellness Coach

The CDC names five self-care steps for arthritis: learn self-management skills, be active, keep a healthy weight, see your provider, and protect your joints (CDC). An MBHA Wellness Coach can help you turn them into daily habits — alongside, never instead of, your medical care.

An activity plan you’ll stick with

  • Physical activity is safe for people with arthritis. Adults should aim for at least 150 minutes a week of moderate activity plus muscle-strengthening on 2 days, and older adults should add balance activities. Even 5 or 10 minutes at a time counts (CDC).
  • Joint-friendly choices include brisk walking, cycling, swimming and water exercise, dancing, tai chi and light gardening. Some pain or stiffness is normal at first and should improve over time; if it doesn’t, or symptoms are severe, contact your provider (CDC).
  • Walk With Ease is a CDC-recognized walking program; U.S. residents can get a free guidebook to start at their own pace (CDC).

Weight

For adults with overweight or obesity, even a small weight loss can lower arthritis pain and disability (CDC). A coach can help you set realistic goals; the CDC points to the MyPlate Plan for daily food targets, and notes that physical activity helps keep weight off (CDC). For gout, weight loss and limiting alcohol, sugary drinks, red and organ meats and some seafood can reduce flares (NIAMS, CDC).

Sleep and stress

Adequate sleep and stress-reducing activities are part of arthritis self-care (MedlinePlus); sleep and stress can also affect weight (CDC). With RA, balance rest and exercise — more rest when RA is active, more exercise when it isn’t (NIAMS).

Protecting your joints

Self-management education programs

CDC-recognized workshops — such as the Chronic Disease Self-Management Program, the Chronic Pain Self-Management Program and Tomando Control de su Salud in Spanish — teach you to cope with symptoms, fatigue and stress (CDC). They are low-cost (about $25–$35) (CDC), and some are offered remotely (CDC). The 2019 OA guideline strongly recommends self-management programs (ACR/Arthritis Foundation, 2019). For help finding one, call the Arthritis Foundation helpline at 1-800-283-7800 (CDC).

Mood and connection

RA can limit activities and lead to social isolation (CDC). If you feel isolated, anxious or depressed, reach out to your clinician, a social worker or a support group (NIAMS).

Smoking and rheumatoid arthritis

Smoking raises the risk of getting RA, can make arthritis worse, and makes it harder to stay active (CDC); quitting is strongly advised (ACR). Free help is available at 1-800-QUIT-NOW, or text QUITNOW to 333888 (CDC).

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This page is for education only and is not medical advice. Costs are typical U.S. ranges and estimates; yours will depend on your provider, location and insurance. Talk with your doctor before starting, stopping or combining any treatment. In an emergency, call 911. See our disclaimer.

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