Severe Osteoarthritis: Risk Factors, Staging, Symptoms

Living With Stage 4 Joint Damage

Close-up of an old wrinkled hand holding a cane.

Carmen Martínez Torrón / Getty Images

Osteoarthritis is the most common type of arthritis affecting the joints. Osteoarthritis symptoms can range from mild to severe and can progress over time. Severe osteoarthritis is often a painful, life-limiting condition that can affect any joint in the body.

In a healthy person, cartilage normally covers the ends of your bones where the joint forms. With severe osteoarthritis, the cartilage erodes and bone rubs on bone. When your bones rub together, the shape of your joint can change, resulting in joint deformity and joint instability.

This might result in the development of an inflamed synovium (a soft tissue that lines the joints and other structures), osteophytes (bone spurs), contracted (shortened) ligaments, as well as muscle weakness around the affected joint.

This article discusses severe osteoarthritis, risk factors, symptoms, and treatment.


7 Risk Factors for Developing Osteoarthritis

Who Develops Osteoarthritis?

Osteoarthritis can affect any joint in the body, including the hands, feet, knees, and hips. The specific joints affected and the severity can vary from person to person, and so can the causes.

Some people might develop osteoarthritis because of genetics, while some might develop it due to an injury. Certain conditions, like rheumatoid arthritis, can also increase your risk of developing osteoarthritis.

Osteoarthritis is most common in people over the age of 65. According to the Arthritis Foundation:

  • 45% of adults will develop symptoms of knee osteoarthritis.
  • 25% will develop hip osteoarthritis.
  • 40% will develop osteoarthritis in at least one hand by age 85.


As you would expect, severe osteoarthritis typically causes more pain than the early stages of osteoarthritis do.

With severe osteoarthritis, pain can occur with activity and motion, as well as when you are at rest. The range of motion of your affected joints will likely be severely limited if you have severe osteoarthritis.

You may also experience joint buckling or locking. Joint locking might sound like just a nuisance, but there can be serious consequences if a joint buckles or locks. For example, a knee joint that buckles can cause a fall that might result in a fractured hip.

Other symptoms may include:

  • Stiffness upon waking
  • Swelling around the joints after periods of prolonged use
  • Clicking or cracking joint noises
  • Joint pain that worsens as the day progresses
  • Difficulty performing everyday tasks
  • Increased incidents of falling and tripping


Not every osteoarthritis case progresses to an advanced stage. Some people develop a mild form that eventually stabilizes. With severe osteoarthritis, the joint damage is not reversible. In these cases, joint replacement surgery is often the best option for regaining functionality and independence.

If you have mild osteoarthritis, your healthcare provider may prescribe a range of medications—including analgesics, nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and hyaluronic acid—or therapies to help manage pain and prevent severe osteoarthritis from developing.

If you are overweight, your healthcare provider may suggest you lose weight to help protect your joints from stress. Your healthcare provider may also recommend physical therapy or exercise to help strengthen the muscles around your joints.

If your symptoms are severe or restricting your mobility, you can use an assistive device—like a cane—to make getting around less painful.

Frequently Asked Questions

  • What are the stages of osteoarthritis?

    Osteoarthritis haș five stages ranging from asymptomatic (stage 0) to severe (stage 4). 

    • Stage 0 is asymptomatic or pre-osteoarthritis
    • Stage 1 involves mild joint pain with no serious symptoms test 
    • Stage 2 is mild or minimal with pain upon activity and stiffness
    • Stage 3 is moderate with frequent pain, stiffness in the morning or after sitting, and possible visual swelling of joints 
    • Stage 4 is severe with high pain upon joint usage that mails daily activities very difficult, joint stiffness and severe swelling and inflammation
  • What is considered severe osteoarthritis?

    In severe or advanced osteoarthritis, the cartilage in the joints has worn away. This causes pain, stiffness, swelling, and difficulty performing everyday tasks. With osteoarthritis, pain and stiffness is common first thing in the day and typically lessen after a while. With severe osteoarthritis, joint pain worsens as the day goes on. 

  • Why is my osteoarthritis getting worse?

    Osteoarthritis is a degenerative disease that worsens over time.

  • What is the prognosis for severe osteoarthritis?

    Severe osteoarthritis will continue to worsen over time. Treatment may help to relieve symptoms for a while, but the pain will likely return. Advanced osteoarthritis in some joints—like the knee, hip, or shoulder—may be treated with joint replacement surgery.

  • Is severe osteoarthritis a disability?

    Severe osteoarthritis may qualify you for disability. If your joint pain is so great that you cannot walk, write, or otherwise work, you may be able to apply for permanent disability.

2 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.
  1. Arthritis Foundation. Osteoarthritis Causes.

  2. Arthritis Foundation. Arthritis by the numbers: Book of trusted facts & figures.

Additional Reading

By Carol Eustice
Carol Eustice is a writer who covers arthritis and chronic illness. She is the author of "The Everything Health Guide to Arthritis."