The Stages of Osteoarthritis

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Osteoarthritis (OA) is a joint disease that affects the cartilage between the bones. The cartilage breaks down, which causes the bones to rub against each other. Although OA can affect any joint in the body such as in the spine, hands, or hips, it is most common in the knees.

OA is a progressive disease, so symptoms can get worse over time. It is possible to classify OA into stages to determine the best treatment plan. Healthcare professionals evaluate your symptoms, X-rays, blood tests, and other laboratory tests to figure out the OA stage.

The amount of time it takes to reach the more severe levels of OA varies greatly and depends on the individual. The disease moves slowly for some people and may take years to reach stage four, but others may see it progress quickly with worsening symptoms in several months. 

The main stages of OA are:

  • Stage 0 (pre-osteoarthritis)
  • Stage 1 (early or doubtful)
  • Stage 2 (mild or minimal)
  • Stage 3 (moderate)
  • Stage 4 (severe)
woman with pain in her knees

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What Is Osteoarthritis

OA is considered the most common type of arthritis. Arthritis is a condition that causes pain and inflammation in the joints. OA can cause joint stiffness, pain, tenderness, inflammation, and swelling because of cartilage loss between the bones. Other names for OA include wear-and-tear arthritis, degenerative arthritis, and degenerative joint disease (DJD).

Stage 0 (Pre-Osteoarthritis)

Stage zero is considered pre-osteoarthritis (pre-OA) and describes a normal, healthy knee before the disease manifests. However, this stage can also describe a pre-early stage of OA where the disease is not evident but cellular changes are starting to occur that will damage the joints eventually.

Symptoms and Signs

You usually do not have any visible symptoms or signs of OA during this stage. However, it is possible that cellular changes are happening that may lead to problems later.

Diagnosis 

It may be possible to diagnose pre-osteoarthritis through an MRI. Arthroscopy with probing, also called keyhole surgery, may also be used. Arthroscopy is a minimally invasive procedure where a small scope is inserted into the joint to examine it.

Treatment

Treatment will vary and may depend on other health factors. Your doctor may recommend over-the-counter (OTC) medications, supplements, and lifestyle changes. You should discuss all of the treatment options for pre-OA with your doctor.

Stage 1 (Early or Doubtful)

Stage one of OA is considered early or doubtful. You may begin to lose some of the cartilage between your joints. However, the space between your joints is not getting smaller at this point. You may start to develop bone spurs, which are growths on the ends of the bones.

Symptoms and Signs

Some people do not have any serious symptoms or signs during stage one. Others may start to experience mild pain in the joints.

Diagnosis 

Most people do not seek treatment during stage one because they are not showing any symptoms, so diagnosis can be difficult. Your doctor may do a physical exam and order an MRI, X-rays, and other laboratory tests.

Treatment

Treatment during stage one is not invasive and focuses on lifestyle changes, supplements, and over-the-counter medications. Lifestyle changes may include exercise, weight loss, yoga, and tai chi.

Supplements may include glucosamine and chondroitin, and OTC medications may be nonsteroidal anti-inflammatory drugs.

Stage 2 (Mild or Minimal)

During stage two of OA, bone spurs can grow and may become painful. The space between joints may begin to narrow a little. Enzymes can begin to break down cartilage more.

Symptoms and Signs

The symptoms of OA in stage two can vary. Some people may start to experience more pain when they are very active. They may have trouble bending or straightening the joints. Sometimes, the pain and stiffness are serious enough that patients seek help from a doctor.  

Diagnosis 

Your doctor may order X-rays to check for bone spurs and other problems. The X-rays may show bone spurs, but the cartilage may continue to look normal. Diagnosis may also include a physical exam, symptom check, and other tests.

Treatment

Your doctor may recommend OTC medications such as nonsteroidal anti-inflammatory drugs for pain. You may also need to make lifestyle changes like losing weight and doing low-impact exercises.

Other treatment options may include strength training and supplements. You may need to wear braces, shoe inserts, wraps, or knee supports.

Stage 3 (Moderate)

Stage three of OA is considered moderate, and the cartilage between the bones begins to show signs of wear. The space between joints becomes visibly narrower. Bone spurs may increase and grow.

Symptoms and Signs

Most people have frequent pain when moving, walking, or doing other activities that use the joints. Stiffness in the joints may appear in the morning and after sitting. Swelling in the joints may also be visible.

Diagnosis 

Diagnosis during stage three includes checking your symptoms and doing a physical exam. You may also have X-rays and an MRI.

Treatment

Your doctor may start treatment during stage three with OTC medications like nonsteroidal anti-inflammatory drugs for pain. If they are not enough, your doctor may prescribe stronger drugs, including codeine and oxycodone. You may need hyaluronic acid or corticosteroid injections into the joints for pain relief.

Lifestyle changes, such as losing weight and exercising, continue to be important during stage three. You may also need physical therapy.

Stage 4 (Severe)

The amount of cartilage in stage four is much lower and may be completely gone. The space between the joints is much smaller, and there is less synovial fluid to lubricate the joints. Bone spurs are much larger.

Symptoms and Signs

Most people have a lot of pain when using their joints. Daily activities may be difficult or impossible to do. Stiffness, swelling, and inflammation can also be severe.

Diagnosis 

During stage four, diagnosis includes a symptom check, physical exam, lab tests, X-rays, and MRI. 

Treatment

By stage four, non-invasive treatments and lifestyle changes may not be enough. Your doctor may recommend an osteotomy or bone realignment surgery to reduce pain. Arthroplasty or knee replacement surgery is another option.

A Word From Verywell

Although OA is a progressive disease, the amount of time it takes to reach specific stages can vary from person to person. Your individual experience with OA will be different. Your OA symptoms may also vary based on your age, weight, medical history, and other health factors. 

At each stage of OA, it is important to discuss your symptoms and treatment options with a doctor. Although you may begin treatment with noninvasive options such as OTC medications and lifestyle changes, you may need stronger alternatives if symptoms continue to get worse. 

Discuss the potential side effects of each treatment with your doctor. It is important to understand all of your choices before making a decision on how you will manage OA.

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