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Conditions · Joint & Structural

Joint Arthritis

Joint arthritis — degenerative or inflammatory — affects the shoulder, hip, knee, or other peripheral joints, and evaluated and treated as part of a broader, function-first approach to joint pain.

A person holding their painful knee with both hands, with an inset X-ray showing joint space narrowing highlighted in red.

Understanding Joint Arthritis

Osteoarthritis — wear-related cartilage breakdown — is the most common cause of joint arthritis, but inflammatory arthritis (rheumatoid, psoriatic, and related conditions) is a distinct category, usually co-managed with rheumatology. The two patterns look different: osteoarthritis typically causes pain that worsens with activity and brief morning stiffness, while inflammatory arthritis often involves symmetric joints and morning stiffness lasting an hour or more.

X-rays showing joint space narrowing and osteophyte (bone spur) formation support an osteoarthritis diagnosis, while labs and a rheumatology referral come into play when the pattern suggests an inflammatory process instead.

Care Pathway

How treatment typically progresses

1

Start with Conservative Care

Medications

NSAIDs (oral or topical) are typically first-line, with acetaminophen as an alternative. For inflammatory arthritis, disease-modifying medication managed by rheumatology is the primary treatment, with pain management playing a supporting role.

Physical Therapy & Exercise

Joint-specific strengthening and range-of-motion work — quadriceps strengthening for knee arthritis, rotator cuff strengthening for shoulder arthritis — along with low-impact conditioning to maintain function without overloading the joint.

Activity & Behavior Modifications

Activity modification and weight management, particularly for weight-bearing joints like the knee and hip, along with assistive devices (braces, canes) where appropriate.
2

If Conservative Care Isn't Enough

Regenerative Treatment: Platelet-Rich Plasma (PRP)

PRP injected directly into the joint supports the body's healing response — an option some patients pursue before or instead of a corticosteroid injection, particularly for earlier-stage arthritis. The evidence base is growing, particularly for knee osteoarthritis.

Genicular Nerve Radiofrequency Ablation

For knee arthritis, once a diagnostic genicular nerve block confirms the pain generator, genicular nerve radiofrequency ablation disables those sensory nerves for longer-lasting relief than an injection alone.

Shoulder Radiofrequency Ablation

For shoulder arthritis pain that responds well to a diagnostic block but keeps recurring, shoulder radiofrequency ablation targets the sensory nerves supplying the joint for more durable pain control.

Hip Radiofrequency Ablation

Similarly, for hip arthritis, hip radiofrequency ablation is an option for patients who get good but temporary relief from diagnostic injections and aren't ready for — or aren't candidates for — joint replacement.

Peripheral Nerve Stimulation

For arthritis pain that persists despite the steps above, peripheral nerve stimulation places a small stimulation lead along the nerve supplying the joint, offering longer-term relief without the larger step of joint replacement.

Joint Replacement (Surgical Referral)

For advanced structural arthritis that hasn't responded to the above, referral for joint replacement is the appropriate next step — outside interventional pain's scope, but an important part of the full picture.

This progression applies to osteoarthritis. Inflammatory arthritis is primarily rheumatology-led, with interventional pain playing a supporting role alongside disease-modifying treatment rather than driving the primary plan.

How We Build Your Plan

The clinical reasoning behind this recommendation

1

What's the diagnosis?

A history and exam localized to the affected joint, correlated with X-rays showing joint space narrowing and osteophyte formation for osteoarthritis, with labs and a rheumatology referral when the pattern instead suggests inflammatory arthritis.

2

What's the mechanism?

In osteoarthritis, cartilage breaks down faster than it's repaired, increasing bone-on-bone friction and triggering inflammation within the joint. Inflammatory arthritis instead involves the immune system attacking joint tissue directly — a fundamentally different process requiring different primary management.

3

What are the options?

Activity modification and physical therapy, targeted joint injections (corticosteroid or regenerative), joint-specific radiofrequency ablation or peripheral nerve stimulation for patients who respond well to diagnostic blocks but need longer-lasting relief, and referral for joint replacement when structural damage is advanced and less invasive options no longer provide meaningful relief.

4

Why this approach?

Because osteoarthritis and inflammatory arthritis need different primary treatment approaches, distinguishing them matters before deciding on an interventional plan — treating inflammatory arthritis with only local joint measures would miss the systemic disease actually driving it.

5

What are the tradeoffs?

Joint injections can provide meaningful, if temporary, relief and help patients delay or avoid surgery, but they don't reverse the underlying joint damage. Radiofrequency ablation and peripheral nerve stimulation extend that relief further for appropriately selected patients, without the invasiveness of surgery. For advanced structural arthritis, joint replacement offers the most complete and durable solution, though it's a bigger surgical step reserved for patients who've exhausted less invasive options.

Prognosis

Chronic, but with a genuinely effective definitive option in reserve

Osteoarthritis is a chronic, generally progressive condition that doesn't reverse — but it's very manageable for a long time with conservative care and injections, and joint replacement is available as a highly effective definitive option when it's eventually needed. It's genuinely one of the more successful surgeries in medicine when the timing is right. Inflammatory arthritis, when properly managed with disease-modifying treatment, can often be controlled well too — though that management is primarily a rheumatology-led process.

Related Treatments

Treatment options for this condition

Platelet-Rich Plasma (PRP)

Learn more →

Peripheral Nerve Blocks

A diagnostic block (e.g., genicular, suprascapular) confirms candidacy before radiofrequency ablation.

Learn more →

Peripheral Nerve Ablation

Includes genicular nerve RFA for the knee, and joint-specific RFA for the shoulder and hip.

Learn more →

Peripheral Nerve Stimulation

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Sources & Further Reading⌄
  • Aletaha D, Neogi T, Silman AJ, et al. "2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative." Ann Rheum Dis. 2010;69(9):1580-1588. These are the current ACR/EULAR classification criteria, superseding the 1987 criteria, and support morning stiffness lasting more than an hour, along with symmetric joint involvement, as a classic pattern suggesting inflammatory arthritis rather than osteoarthritis, which typically causes stiffness that resolves within 30 minutes and pain that worsens with activity. View source →
  • Platelet-rich plasma for joint osteoarthritis has a growing evidence base, particularly for knee osteoarthritis, though published systematic reviews and meta-analyses vary in their conclusions, and it's generally considered complementary to, rather than a replacement for, established conservative care.
  • Carender CN, Hegde V, Levine BR, Huddleston JI, Cohen-Rosenblum A. "Highlights of the 2024 American Joint Replacement Registry Annual Report." Arthroplasty Today. 2025. This current national registry data — covering more than 4.3 million hip and knee replacements from roughly 5,000 surgeons — continues to reflect a well-established track record of high patient satisfaction and durable pain relief for appropriately selected patients with advanced structural arthritis. View source →

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