Health Insights · Physiotherapy & MSK
Joint pain: working out the cause
Joint pain covers everything from a worn knee to an autoimmune disease. Two questions do most of the sorting: is it inflammatory or mechanical, and is it one joint or many. The answers point in quite different directions, and getting them right early matters most for the inflammatory group.
Seek urgent assessment if you have
- a single hot, red, swollen joint, particularly with fever — possible septic arthritis
- joint pain with fever and feeling systemically unwell
- inability to move or weight bear on a joint after injury
- joint pain with a rash that does not fade under a glass
- rapidly progressive swelling over hours to days
- joint pain with a recent tick bite or foreign travel
A hot, swollen, painful joint is septic arthritis until proven otherwise. It destroys cartilage within days and needs joint aspiration and antibiotics the same day. Gout can look identical — and cannot be distinguished without aspirating the joint. In an emergency call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
Inflammatory or mechanical?
- Inflammatory — prolonged morning stiffness, joint swelling and warmth, pain that eases as you move, waking in the second half of the night, fatigue, and a good response to anti-inflammatories. Points to rheumatoid arthritis, psoriatic arthritis, axial spondyloarthritis, lupus, gout or reactive arthritis.
- Mechanical — brief stiffness, pain worse with activity and better with rest, no swelling or only bony swelling, crepitus. Points to osteoarthritis, tendon problems or injury.
One joint or many?
- One joint, acute — septic arthritis, gout, pseudogout, injury, or the start of an inflammatory arthritis.
- Few joints, asymmetrical — psoriatic arthritis, reactive arthritis, spondyloarthritis.
- Many joints, symmetrical, small joints of hands and feet — rheumatoid arthritis, lupus, viral arthritis.
- Many joints, weight-bearing and hands, over years — osteoarthritis.
- Widespread pain without swelling, with fatigue and poor sleep — fibromyalgia.
Persistent small-joint swelling needs referring within weeks
If the small joints of your hands or feet have been swollen for more than a few weeks, with morning stiffness over 30 minutes, that warrants urgent rheumatology referral — even if your blood tests are normal, because a third of people with rheumatoid arthritis have negative antibodies and inflammatory markers can be normal. Treatment started within about twelve weeks of symptoms beginning substantially alters the long-term outcome. This is the group where delay costs most.
What gets tested
- Inflammatory markers — CRP and ESR
- Full blood count, kidney and liver function
- Rheumatoid factor and anti-CCP
- Urate for gout — though it can be normal during an attack
- ANA where lupus or connective tissue disease is suspected
- HLA-B27 where spondyloarthritis is suspected
- Ultrasound, which detects synovitis and effusion far more sensitively than examination alone
- Joint aspiration where infection or crystals need excluding
What helps most conditions
Helps
- Keeping the joint moving — rest stiffens and weakens it
- Strengthening the muscles around the joint
- Losing excess weight, which disproportionately reduces load on knees and hips
- Topical anti-inflammatory gel for superficial joints
- Getting inflammatory arthritis assessed early rather than managing pain
Unhelpful
- Prolonged rest or immobilisation
- Waiting months to see if swelling settles
- Glucosamine and chondroitin, which have little evidence
- Repeated steroid injections into the same joint
- Assuming joint pain over 50 must be wear and tear
Why come to us. The distinction that matters — inflammatory or mechanical — is made by examination plus a few tests, and we can do both in one visit. We take CRP, ESR, full blood count, rheumatoid factor, anti-CCP, urate and ANA in-house with results explained the same visit, and perform ultrasound on site to detect synovitis. Where it is inflammatory we refer to rheumatology with the workup complete; where it is mechanical, physiotherapy and guided injection are available here.
Private assessment for joint pain in East London
Joint pain has many causes, from wear-and-tear and injury to inflammatory arthritis, and the right assessment guides treatment. A private GP in East London can examine you, arrange blood tests and imaging, and our private physiotherapy clinic in London can treat mechanical problems. A hot, swollen, very painful joint with fever needs prompt assessment to exclude infection. Tower Bridge Hospital is on Whitechapel Road in East London, a short journey from Canary Wharf and the City, with same-day appointments and no referral required.
Joint pain in London: common questions
When should joint pain be investigated?
Persistent pain, swelling, morning stiffness, or several joints affected may indicate inflammatory arthritis and should be assessed.
What tests help with joint pain?
Blood tests for inflammation and specific conditions, plus imaging where needed, help identify the cause.
When is joint pain urgent?
A single hot, swollen, very painful joint with fever needs prompt assessment to rule out infection.
Can physiotherapy help?
Yes — for many mechanical and wear-related causes, physiotherapy is central to treatment.
Inflammatory or mechanical — answered in one visit
Full arthritis panel and ultrasound on site. 7 days a week.