Abstract This paper examines the meanings of symptoms for people with osteoarthritis. The study comprised 27 in-depth interviews with men and women aged between 51 and 91 years (median age = 76) and draws on previous sociological work about experiences of chronic illness, disability and ageing. In particular, the distinction proposed by Bury between ‘meaning as significance’ (the significance and connotations associated with illness) and ‘meaning as consequence’ (problems created for the individual by activity restriction and social disadvantage), provides a useful framework to examine the biographical aspects of symptoms. We found that older respondents portrayed their symptoms as a normal and integral part of their biography, but they also talked about the highly disruptive impact of symptoms on their daily lives. We consider how these co-existing accounts of meaning make sense in the context of cultural connotations of ageing and the implications for meeting health care needs of older people with osteoarthritis.