Seeking professional help
About one in six of all consultations with GPs is for joint or muscle pain. In a one-year period about a half of people aged over 50 have a spell of knee pain, though only one in three of them see their doctor about their problem. Many people who have painful joints do not consult their doctor. There can be several reasons for this. Some think that there is little that their doctor can do or that their problem is not serious enough to warrant a visit to the doctor. Others find their pain comes and goes and when it has gone they forget about it.
“I should go to the doctors really. If it’s paining me, I think I will go to the doctors, but by the time (I come to make an appointment), well it’s gone off then you see, and I have forgotten all about it.”
If someone has concerns about their condition, or despite doing their usual things to manage the problem it continues to have quite an effect on their life, then it is a good idea to consult a doctor. It is not wasting a doctor’s time. You should seek help if you have significant changes to your symptoms, for example if pain worsens and does not respond to your usual remedies, or your joints become hot and swollen, or you feel generally unwell. Most of the time people manage a joint problem by themselves but sometimes they may need to consult their GP. Pharmacists, nurses, physiotherapists, podiatrists (chiropodists) occupational therapists and NHS Direct are other sources of health advice.
Making a diagnosis
People often go to the doctor first with pain, stiffness or restricted movement in a joint. When making a diagnosis doctors look for certain signs and symptoms:
- Joint pain following activity and which gets better with rest
- Short-lived stiffness in the morning or after rest
- Reduced range of movement of the joint
- Bony swelling
They also check that other symptoms are not present in order to make sure that there is not a more serious diagnosis which may need fast referral for treatment by a specialist. The GP also has to rule out other common reasons for joint pain, such as gout, by taking a careful history and examination. Doctors may say that a patient has ‘a touch of arthritis’ or an ‘arthritis type’ joint pain. What this means is that they have ruled out other diagnoses and they are going to treat the joint pain as osteoarthritis.
As we have seen in the previous chapter, not all patients who have OA-type pain and stiffness have changes to their joints which show up on an X-ray, and not all those who have X-ray evidence of joint damage experience pain. However, whether there is X-ray evidence of OA or not, doctors manage this kind of joint pain in the same way. Doctors question the need to routinely do clinical tests to confirm a diagnosis if the tests make no difference to the way they treat the symptoms.
So, X-rays have only a limited role to play in the diagnosis and ongoing care of the vast majority of patients who have OA. GPs request an X-ray of a joint if the results of the X-ray will help decide on a course of treatment. For example, a GP may arrange for an X-ray before referring a patient for joint replacement surgery, to see how much the joint is affected.
What can the GP do?
Firstly, a GP can diagnose the type of joint pain and decide whether this is an OA-type problem that can be managed within general practice, or something that needs further investigation by a specialist. If it is the former, then a GP can discuss the kinds of things that patients can do to help maintain their independence, prevent their joint problem worsening and manage the pain.
If pain is the main problem, then a GP may prescribe painkillers, but this is not the only way of managing pain. You should also be advised how any other conditions you might have could affect your joint pain and its treatment. Reassurance and advice may be all that you need. If, though, the problem continues or worsens, then you should go back to your doctor to check that OA is still the likely diagnosis, or what other treatment could be offered.
GPs can refer you to other therapists in the primary health care team, such as physiotherapists, occupational therapists (OTs), podiatrists (chiropodists) and dieticians, or to exercise schemes such as exercise on referral. For the small number of people whose joint problems cause severe pain and disability, and do not respond to treatment, the GP can refer the person to specialist care.
National Institute for Health and Care Excellence (NICE) OA guidance was updated in 2014
Your GP should discuss with you the following options as part of a self-management plan.
Written information on OA
- Weight loss if you are overweight
- Suitable footwear
- Pain relief
Specialist care includes nurse specialists, physiotherapists or GPs who have an interest in musculoskeletal pain, rheumatologists, orthopaedic surgeons or pain management programmes.
Community physiotherapists, practice nurses, occupational therapists, podiatrists and pharmacists
Physiotherapists are skilled at diagnosing and treating, stiff and painful joints. They have been in short supply in general practice, and after being referred, patients often had to wait a long time to see one. The position is changing. Patients can now refer themselves to a physiotherapist. The physiotherapist is likely to become the first port of call for people who have problems with their joints. In some areas there is also a telephone service called Physio Direct. Patients can be assessed and receive advice over the phone and, if necessary, offered an appointment with a physiotherapist or referred to other services.
Nurses who work at GP surgeries also see patients with chronic conditions like joint pain, and can offer support and advice. OTs (occupational therapists) can advise on painful joints in the hand, and podiatrists (chiropodists) on painful joints in the foot. If you want to find out which medicines are best for easing joint pain, then your local pharmacist can help.
If you are in a position to pay for your own treatment, there are a large number of physiotherapists and podiatrists (chiropodists) across the UK offering treatment at private clinics, as well as many who will treat people in their own homes.
Things to remember
- Most people’s joint pain can be managed in general practice.
- GPs diagnose OA by looking for certain signs and symptoms and ruling outother musculoskeletal conditions.
- X-rays of joints are not useful in the diagnosing and management of most patients’ OA
- If symptoms worsen or new ones arise then people should seek medical advice
- Apart from GPs there are other health professionals who can give advice about joint pain and its management. Physiotherapists have particular expertise.