Osteoarthritis Pain Diary: What to Write Down

Weeks pass between appointments, and by then the bad joint days have blurred into "it comes and goes". A pain diary keeps which joint hurt, how much, how long it stayed stiff and what you had just done. In Sam's symptom diary you log joint pain once a day as mild, moderate or severe, and the monthly report, which you create yourself once its requirements are met, counts your symptom days. Below: what a good diary holds, what your doctor and physio will ask, and when not to wait.

What goes into an osteoarthritis pain diary?

The NHS Fife pain management service hands its patients a simple daily diary. You mark your pain from 0 (no pain) to 10 (worst pain) and write down what you were doing. You note any pain medicine and when you took it. A last line covers sleep and how you felt. For osteoarthritis, a few joint details make the diary far more useful:

• The date, on good days too. A blank day later reads as pain-free or forgotten, and nobody can tell which.
• The joint and side: "right knee", "left hip", "base of the right thumb".
• Pain on one scale that you always use the same way, such as 0 to 10.
• What you did before it hurt, and how long: stairs, getting up, two hours at a desk, gardening, opening a jar.
• Morning stiffness in minutes: how long until the joint moves freely after you get up.
• Swelling, and whether the joint felt warm.
• Pain at rest or at night.
• What you took or tried, and whether things got better, worse or stayed the same.
• What you could not do: the stairs without a break, the walk to the shop, opening a bottle.

Example: "Tue, right knee, 6/10 after three flights of stairs, stiff 10 minutes on waking, swollen, not warm". Ask the practice beforehand which period they want to see. The Fife team adds that a diary kept for a short spell around a change, such as new activity or new medication, can show whether the change helped. Whether paper or an app suits you better is covered in symptom diary: paper template or app.

Why does the appointment start with your symptoms, not the X-ray?

The NHS says X-rays and blood tests are not usually needed; NICE wants care to follow symptoms and function. NICE guideline NG226 lets doctors confirm osteoarthritis without imaging in people aged 45 or over with activity-related joint pain and morning stiffness that is absent or lasts no longer than 30 minutes. These are cues for your doctor, not a home test: even if all three fit, only your doctor can diagnose it, and if one does not fit, that is not an all-clear. For X-rays, blood tests and who to see: What doctor treats osteoarthritis? Diagnosis and tests.

Osteoarthritis or inflammatory arthritis: what should you write down about stiffness?

In English, arthritis is the umbrella term. The NHS lists osteoarthritis as the most common type, next to gout, rheumatoid arthritis and others. In osteoarthritis the protective cartilage on the ends of the bones breaks down. It most often affects the knees, hips and small joints of the hands. Rheumatoid arthritis is an autoimmune disease: the immune system attacks the cells that line the joints by mistake.

The NHS joint pain page describes patterns you can write down. In short:

The NHS also notes that prolonged morning stiffness can be a sign of rheumatoid arthritis. That is a cue for your doctor, not a test to run at home. So write the minutes down, not just "stiff", and raise long stiffness at your appointment. Which condition you have is for your doctor to work out. Two inflammatory types are compared in gout or rheumatoid arthritis.

What will your doctor and physiotherapist ask?

A GP will first ask about your symptoms and examine your joints, says the NHS. EULAR, the European rheumatology association, wants the first assessment of hip or knee osteoarthritis to look wider. It covers physical and psychological state, daily activities and work, plus social and environmental factors. Expect questions like these:

• Which joints hurt, since when, and on which side?
• When does it hurt: walking, on stairs, getting up, at rest, at night?
• How long are you stiff in the morning?
• What can you no longer do at home or at work?
• How are you sleeping, and how are you coping?
• What have you taken or tried, and what did it change?

Sleep is on the list for a reason. The NHS counts joint pain that disturbs your sleep as a reason to see a GP.

A physiotherapist adds function. For hip and knee osteoarthritis, the research society OARSI recommends a core set of three tests. They are chair stands in 30 seconds, a fast-paced 40-metre walk and a stair climb. Which tests your physio uses is up to them. Your diary fills in the weeks between sessions. Numbers help most: "stairs to the second floor with one break", "15 minutes to the shop, knee 5/10 afterwards". In many areas, you may be able to get NHS physiotherapy through community musculoskeletal services without a GP referral. To prepare the rest of the visit, use the doctor appointment checklist for a chronic condition.

Should pain from exercise go in the diary?

Yes, especially that. NICE recommends therapeutic exercise tailored to the person for everyone with osteoarthritis. EULAR recommends an exercise plan for all people with hip or knee osteoarthritis, on its top level of evidence. NICE also says joint pain may increase at the start of therapeutic exercise. Regular exercise will still benefit the joints in the long run, it adds. If pain rises sharply after exercise or lasts longer than usual, raise it with your doctor or physiotherapist.

A diary shows you and your physiotherapist how pain responds over the weeks. Note the session, your pain afterwards and your pain the next morning. If the agreed plan is not working within the agreed time, NICE advises seeking follow-up. The same applies if you are struggling with the plan. Entries let you say that with numbers. How much and what kind of exercise suits your joint is for your doctor or physiotherapist to settle.

How do you record a flare?

NICE describes a flare as a temporary worsening of pain, swelling and stiffness. It is worse than normal and may affect sleep, activity and wellbeing. The NHS notes that arthritis flare-ups can last several days. See your GP if pain or swelling keeps getting worse or keeps coming back.

For the appointment, three facts matter: when the flare began, how long it lasted and what came before it. If pain and swelling in one joint came on suddenly and badly, the joint turned red or hot, or you had a fever, chills or felt generally unwell, do not wait for the appointment (see the last section).

What does Sam keep, and what stays on paper?

Sam's symptom diary offers Joint pain, Morning stiffness, Swelling and Muscle cramps. Each symptom gets one entry per day: mild, moderate or severe. For joint pain and swelling you tap a body region. The regions are coarse, such as "Joints" or "Left thigh"; there is no knee or hip. To name a specific joint, add your own symptom under "Other", for example "Left knee". If it is among your five most logged symptoms, it appears there under that name. Missed days can be added later in Health History.

From Apple Health, steps, exercise minutes and flights climbed sit in the same app as a trend. Further walking readings, for example walking speed and step length, sit in the Walking Stability group. It is off by default; you switch it on under Customize Metrics. Sam then shows the latest reading with a chart. These are estimates from your iPhone or Apple Watch, not a clinical test. If you tap a reading, a generated "What This Means" text may compare the latest reading with earlier ones; it is not a finding about your gait or joints. More in Apple Watch and osteoarthritis.

As-needed medicines from your medication list can be ticked off on today's symptom sheet under "Took something?". There is no reminder for them. From the 1st of a month you create the report for the previous month yourself. It shows symptom days on a calendar, your five most logged symptoms, activity and sleep. It needs notifications allowed, Apple Health access and a chronic condition entry. From the second report on, you also need to have logged how you felt on at least 15 of the last 30 days; symptom entries do not count toward that. It has no walking readings and no medication list. Its activity page prints general movement tips that know nothing about your joints. Settle what suits you with your physiotherapist.

Paper keeps what the symptom diary cannot: the 0-to-10 scale, stiffness minutes, times of day, activities and what helped. What else Sam shows for this condition is on the osteoarthritis page.

When should you not wait for your next appointment?

See your GP soon if joint pain stops you doing normal activities or disturbs your sleep. The same goes if pain or swelling is getting worse or keeps coming back. It also applies if your joints are stiff for more than 30 minutes after waking. That is how the NHS puts it.

Get urgent help from a doctor or an urgent-care service for:

• Sudden severe pain and swelling in one joint.
• A red or hot joint.
• Joint pain with a fever, chills or feeling generally unwell.

In the UK that means an urgent GP appointment or NHS 111. In an emergency call your local emergency number (112 in the EU, 999 in the UK, 911 in the US). NICE lists a hot, swollen joint among the features that do not fit typical osteoarthritis.

Go to the emergency department straight away, or call your local emergency number, for:

• Very bad joint pain after a fall or injury.
• A joint that has moved out of place.
• Tingling or numbness around an injured joint.
• Not being able to walk or put weight on a joint.

Do not wait for it to pass. Sam is not built for this: it replaces neither an emergency call nor an examination.

Log your joint days in Sam and bring the monthly report

You arrive with counted joint days instead of an impression, with no tallying the night before.

• Instead of a notebook left at home: you tap joint pain, stiffness or swelling as mild, moderate or severe. A custom symptom such as "Left knee" works too.
• Instead of a second app for steps: steps and exercise minutes from Apple Health sit in the same app.
• Instead of a tally sheet: you create the monthly report yourself; the PDF shows symptom days on a calendar and your five most logged symptoms.

The symptom diary keeps no minutes, times of day or 0-to-10 scale, so paper stays useful for those. From the second report on, you must have logged how you felt on at least 15 of the last 30 days; symptom entries do not count. More on the osteoarthritis page.

Try Sam for free

Sam is a wellness companion, not a medical device. The app does not diagnose, treat, cure or prevent any condition or health state. Always consult qualified professionals for medical decisions.

Related reading

• Symptom diary: paper template or app?
• Doctor appointment checklist for a chronic condition
• Medication list for your doctor: what to include
• Gout or rheumatoid arthritis? Key differences
• What doctor treats osteoarthritis? Diagnosis and tests
• Apple Watch and osteoarthritis: what walking data shows

Sources

Updated: October 2026

• NICE: Osteoarthritis in over 16s: diagnosis and management (NG226), Recommendations (2022)
• Moseng T et al.: EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis: 2023 update. Ann Rheum Dis 2024;83:730-740
• NHS: Osteoarthritis (reviewed 20 March 2023)
• NHS: Septic arthritis (reviewed 3 September 2026)
• NHS: Joint pain (reviewed 26 February 2026)
• NHS: Arthritis (reviewed 19 January 2026)
• NHS: Physiotherapy (reviewed 3 April 2025)
• NHS: Rheumatoid arthritis (reviewed 8 March 2023)
• NHS Fife Pain Management Service: Daily pain diary (PDF) (issued April 2024)
• Dobson F et al.: OARSI recommended performance-based tests to assess physical function in people diagnosed with hip or knee osteoarthritis. Osteoarthritis Cartilage 2013;21:1042-1052 (abstract)
• Apple: Measuring Walking Quality Through iPhone Mobility Metrics (PDF) (May 2022)
• Weston V, Coakley G: Guideline for the management of the hot swollen joint in adults with a particular focus on septic arthritis. J Antimicrob Chemother 2006;58:492-493