The 4 Stages of Osteoarthritis: Understanding the Progression

Osteoarthritis (OA) is often referred to as “wear and tear” arthritis. It is the most common chronic joint condition, affecting millions of people worldwide. Unlike an acute injury that heals over time, OA is a degenerative disease, meaning it progresses and changes as time goes on.

For patients dealing with joint pain, understanding this progression is vital. Knowing where you stand on the severity scale can help you and your pain management specialist determine the most effective treatment plan to preserve mobility and quality of life.

Medical professionals generally classify osteoarthritis into four distinct stages using the Kellgren-Lawrence scale. This guide will walk you through what happens during each stage, the symptoms to look for, and the treatment options available.

Stage 1 of Osteoarthritis: Minor (Doubtful)

At Stage 1, the joint is showing the very first signs of wear, though many patients will not even realize they have the condition yet.

What is happening inside the joint?

During this initial phase, there may be very minor bone spur growth. Bone spurs, or osteophytes, are bony projections that develop along bone edges. At this stage, the cartilage—the smooth tissue that cushions the ends of your bones—remains mostly intact. There is usually no narrowing of the joint space.

Symptoms

Because the wear is minimal, you will likely feel little to no pain. Most people in Stage 1 do not experience discomfort or profound stiffness. Consequently, this stage is rarely diagnosed clinically unless an X-ray is taken for an unrelated injury.

Management

• Supplements: Taking Glucosamine and Chondroitin may help protect cartilage.

• Exercise: Low-impact exercises (swimming, walking) strengthen the muscles around the joint to reduce pressure.

Stage 2 of Osteoarthritis: Mild (Minimal)

Stage 2 is often the point where patients first seek medical advice. This is considered the “mild” stage, but it is the threshold where diagnostic X-rays will clearly show the presence of osteoarthritis.

What is happening inside the joint?

X-rays will now reveal more significant bone spur growth. While the cartilage is still present and the distance between the bones (joint space) is generally normal, the cartilage layer is beginning to break down. The soft tissues surrounding the joint may also begin to harden slightly.

Symptoms

You may start to notice specific symptoms, including:

• Pain after activity: The joint may ache after a long walk or a run.

• Stiffness: You might feel stiff upon waking up or after sitting for prolonged periods.

• Tenderness: The area may feel sensitive to the touch.

Management

At this stage, the goal is to stop the progression.

• • Weight Management: Losing excess weight relieves significant pressure on weight-bearing joints like knees and hips.

  • Physical Therapy: Specific exercises can improve stability.

  • Bracing: Shoe inserts or knee braces can help align the joint and relieve stress.

Stage 3 of Osteoarthritis: Moderate (Moderate)

When OA reaches Stage 3, it is classified as “moderate.” The disease has progressed significantly, and the impact on daily life becomes noticeable.

What is happening inside the joint?

The cartilage surfaces between the bones are eroding noticeably. The gap between the bones (joint space) is narrowing. As the cartilage thins, the bones are no longer cushioned effectively. The joint may also become inflamed, causing the synovial fluid (which lubricates the joint) to increase, leading to swelling (often called “water on the knee”).

Symptoms

• Frequent Pain: Pain is no longer just post-activity; it may occur during movement or simple tasks like walking up stairs or kneeling.

• Morning Stiffness: Stiffness in the morning becomes more pronounced.

• Popping/Snapping: You may hear or feel grating sensations (crepitus) when moving the joint.

• Swelling: Visible swelling may occur after activity.

Management

Conservative treatments often need to be escalated in Stage 3.

• OTC Medication: NSAIDs (like ibuprofen) are commonly used for pain and inflammation.

• Viscosupplementation: This involves injecting hyaluronic acid into the joint to lubricate it and reduce friction.

• Corticosteroids: Steroid injections can provide temporary but powerful relief from intense pain and inflammation.

Stage 4 of Osteoarthritis: Severe (Severe)

Stage 4 is the most advanced stage of osteoarthritis. At this point, the condition is considered “severe,” and non-surgical treatments may no longer provide adequate relief.

What is happening inside the joint?

The joint space is dramatically reduced or non-existent, leading to a “bone-on-bone” phenomenon. The cartilage is almost completely gone. The bone ends are rubbing against each other, leading to significant deformity and the production of large bone spurs. The natural fluid that lubricates the joint may have decreased drastically or disappeared.

Symptoms

• Chronic Pain: Pain is severe and constant. It hurts to move the joint, and it may even hurt while resting or sleeping.

• Limited Range of Motion: The joint may become stiff and immobile. You may be unable to straighten or bend the joint fully.

• Instability: The joint may feel like it is going to give out (buckling).

• Deformity: In knees, this can lead to a “knock-kneed” or “bow-legged” appearance.

Management

When quality of life is severely compromised, aggressive intervention is required.

• • Osteotomy: A surgery to realign the bone and shift weight away from the damaged area (usually for younger patients).

  • Arthroplasty (Joint Replacement): Total or partial joint replacement is the gold standard for Stage 4 OA. The damaged bone and cartilage are removed and replaced with metal and plastic components.

  • Radiofrequency Ablation: A procedure to dull the nerve endings that send pain signals from the joint.

If you are experiencing joint pain, stiffness, or clicking sounds, do not wait until the pain is unbearable. Consult with a specialist at PMIR today to determine your stage and create a plan to protect your joints for the future.