Osteoarthritis Pain Diary: Joint Pain, Stiffness and Steps Over Time

In osteoarthritis the protective cartilage on the ends of the bones breaks down. It usually develops over years and most often affects the knees, hips and small joints of the hands. Rheumatoid arthritis is an autoimmune disease in which the immune system attacks the lining of the joints, and the NHS names prolonged morning stiffness as a possible sign of it. In English both are called arthritis, which is why the two get mixed up. Your doctor tells them apart. For two inflammatory types there is a separate article: Gout or rheumatoid arthritis.

NICE's guideline says everyone with osteoarthritis should be offered therapeutic exercise tailored to their needs, and that people should be told joint pain may increase when they start and that regular exercise is expected to benefit their joints long term. The 2023 EULAR recommendations likewise say everyone with hip or knee osteoarthritis should be offered exercise matched to their function and preferences. How much and what kind suits your knee is for your doctor or physiotherapist, and Sam does not replace that advice. The app shows your steps from Apple Health, and whether they hurt, you log as a symptom.

NICE's guideline lets doctors recognize osteoarthritis from history and examination alone, without imaging, in people aged 45 or over with activity-related joint pain and either no morning stiffness or stiffness lasting no longer than 30 minutes. The NHS notes that prolonged morning stiffness can be a sign of rheumatoid arthritis. These are cues for clinicians, not a test to run at home: if morning stiffness lasts, raise it with your doctor, who can place it for you. Sam records morning stiffness as a daily entry (mild, moderate, severe), not in minutes; note the duration separately if it matters.

A pain diary is most useful for what can be counted later: which days had symptoms, how bad, and where. In the symptom diary you pick joint pain, morning stiffness or swelling, rate each as mild, moderate or severe, and tap a body region for joint pain. There is no time of day, note or 0-to-10 pain scale. To name a specific joint, add a custom symptom in free text, such as 'Left knee'. Paper or app: Symptom diary: template or app.

That is up to you. Counts from your log help in the conversation: on how many days of the month you logged joint pain, which symptoms came up most, how much you moved, and which medication you take when. The monthly PDF report, which you create yourself, holds symptom days, your five most logged symptoms, activity and sleep, but no walking readings and no medication list. You keep that list in Sam's medication list; what belongs on it is covered in Medication list to bring to the doctor. Which tests or treatment make sense is for your doctor to decide.

Many people say it does. In a survey across six European countries (Timmermans et al., BMC Musculoskeletal Disorders, 2014), about two thirds of older adults with osteoarthritis reported that weather affects their joint pain. A large UK smartphone study of chronic pain (Dixon et al., npj Digital Medicine, 2019) found links with humidity, pressure and wind that were statistically clear but modest. Sam gives no finding on whether weather plays a role for you; the symptom diary shows which days you had symptoms.

Sam gives no finding on joints, gait or X-rays and makes no diagnosis. Walking speed, step length, walking asymmetry and the six-minute walk are estimates that your iPhone or Apple Watch store in Apple Health, not a clinical test; Sam shows the latest reading with a chart once you switch on the Walking Stability group under Customize Metrics; the group is off by default and not in the monthly report. If you tap a reading, a generated text under What This Means may compare the latest reading with your earlier readings; it is not a finding about your gait or joints. Sam has no body region for a single joint such as the knee or hip, no 0-to-10 pain scale and no imaging. More on walking data in Apple Watch and osteoarthritis: what walking data shows.

Sudden severe pain and swelling in one joint, a red or hot joint, or joint pain with a fever or chills should be checked urgently by a doctor or an urgent-care service; in an emergency call your local emergency number. After a fall or injury, very bad joint pain, a joint you cannot put weight on, or tingling or numbness around the joint should go straight to emergency care. NICE lists a hot, swollen joint among features that do not fit typical osteoarthritis, and the NHS names a swollen, hot joint and joint pain with a high temperature or feeling shivery as reasons to get urgent help. Sam is not built for this: it replaces neither an emergency call nor an examination.