The Stages of Osteoarthritis

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Osteoarthritis (OA) is a joint disease that affects the cartilage between the bones. With OA, the cartilage breaks down, causing pain and swelling, and may impair mobility. Although OA can affect any joint in the body, such as the spine, hands, or hips, it is most common in the knees.

OA is often progressive, and the symptoms can get worse over time. OA can be classified into stages, which helps direct the treatment plan. Your medical providers will assess your symptoms, X-rays, blood tests, and other laboratory tests to define your OA stage.

The amount of time it takes to reach an advanced stage of OA varies. For some people, the disease worsens slowly and may take years to reach stage four, but others may see it progress quickly within 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)
The Main Stages of Osteoarthritis (OA)

Ellen Lindner / Verywell

What Is Osteoarthritis

OA is considered the most common type of arthritis. Arthritis includes chronic conditions that can involve joint tenderness, pain, inflammation, swelling, and/or stiffness.

OA is non-inflammatory arthritis that arises due to cartilage breakdown, which causes joint stiffness, tenderness, and swelling. 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 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.

Diagnosis 

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

Treatment of pre-OA will vary and depends on other health factors. Your doctor 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 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 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.

Diagnosis 

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

Treatment

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.  

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

Treatment

Your doctor 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 

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.

Treatment

Your doctor may start treatment during stage three with OTC medications, like NSAIDs for pain. If they are not enough, your doctor 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.

Diagnosis 

During stage four, diagnosis relies on symptoms, 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 subsequent stages can vary from person to person. 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 about how you will manage your OA.

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  1. Kolasinski SL, Neogi T, Hochberg MC, et al. 2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee. Arthritis Care Res (Hoboken). 2020;72(2):149-162. doi:10.1002/acr.24131

  2. Ryd L, Brittberg M, Eriksson K, et al. Pre-Osteoarthritis: definition and diagnosis of an elusive clinical entity. Cartilage. 2015;6(3):156-165. doi:10.1177/1947603515586048

  3. Lespasio MJ, Piuzzi NS, Husni ME, Muschler GF, Guarino A, Mont MA. Knee osteoarthritis: A primer. Perm J. 2017;21:16-183. doi:10.7812/TPP/16-183