The 4 Stages of Osteoarthritis

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There are four stages of osteoarthritis (OA): early, mild, moderate, and severe. You can also be diagnosed with a stage called pre-osteoarthritis.

OA is a progressive joint disease caused by cartilage breakdown. It is the most common form of arthritis. OA can affect any joint in the body but occurs most often in the knees.

It can take anywhere from several months to several years to reach an advanced stage of OA. Your medical provider will assess your symptoms, X-rays, blood tests, and other laboratory tests to define your OA stage and subsequent treatment plan.

This article explains more about the four stages of osteoarthritis and how each one is treated.

The Main Stages of Osteoarthritis (OA)

Ellen Lindner / Verywell

Stage 0 (Pre-Osteoarthritis)

Stage zero is considered pre-osteoarthritis (pre-OA) and describes a normal, healthy joint before the disease manifests. However, this stage can also describe an early stage of OA when damage is beginning to occur on a cellular level, without clinical signs or symptoms.

Symptoms and Signs

You usually wouldn't have any noticeable symptoms or detectable signs of OA during this stage. You may have experienced several healed or healing injuries of one or more of your joints at this stage, or you might be overusing one or more joints.

Changes to the joint lining that may lead to problems later could be happening at this stage.


The joint changes of pre-OA might not be apparent with imaging tests yet, but it may be possible for pre-OA to be diagnosed with an MRI examination.


Treatment of pre-OA will vary and depends on other health factors. Your healthcare provider may recommend over-the-counter (OTC) medications, supplements, and lifestyle changes.

Avoiding injury, overuse, and damage to your joints could prevent the progression of OA.

You should discuss all of the treatment options for pre-OA with your healthcare provider.

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 wouldn't be 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 symptoms or signs during stage one. Others may start to experience mild pain in the joints.


Your healthcare provider may do a physical exam and order an MRI, X-rays, and laboratory tests if there is a concern about your joints.


Most people do not seek treatment during stage one because they do not experience any symptoms. 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.

If you have pain, OTC medications may include nonsteroidal anti-inflammatory drugs (NSAIDs).

Stage 2 (Mild or Minimal)

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

Symptoms and Signs

The symptoms of OA in stage two can vary. Some people may start to experience more pain during activity or after a period of increased activity. You may have trouble bending or straightening the affected joints. Sometimes, the pain and stiffness can impair movement.  


Your healthcare provider 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 relies on an assessment of your symptoms, a physical exam, and other tests.


Your practitioner may recommend OTC medications, such as NSAIDs, 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 a brace, shoe insert, wrap, or knee support.

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. More bone spurs may develop and they can enlarge.

Symptoms and Signs

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


Diagnosis during stage three relies on symptoms and a physical exam. You may also have X-rays and an MRI.

Arthroscopy, a minimally invasive procedure, may be used in the diagnosis as well. Diagnostic arthroscopy involves the insertion of a small scope into the joint to examine it.


Your healthcare provider may start treatment during stage three with OTC medications, like NSAIDs for pain. If they are not enough, your practitioner may prescribe pain medication for you. 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 the affected joints in stage four is much lower—and in some cases, it 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 affected joints. Daily activities may be difficult or impossible to do. Stiffness, swelling, and inflammation can also be severe.


During stage four, diagnosis relies on symptoms, physical exam, lab tests, X-rays, and MRI. 


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


Osteoarthritis is a progressive disease that is generally broken down into four stages. The amount of time it takes to reach subsequent stages can vary from person to person.

At each stage of OA, it's important to discuss your symptoms and treatment options with a healthcare provider. 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. 

3 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Lana Bandoim
Lana Bandoim is a science writer and editor with more than a decade of experience covering complex health topics.