Osteoarthritis progresses through stages 1 to 4, each with its own set of symptoms, diagnostic challenges, and treatment options.

Osteoarthritis (OA) is the most common form of arthritis, affecting millions of people worldwide. It occurs when the protective cartilage that cushions the ends of the bones wears down over time. Although OA can damage any joint, the disorder most commonly affects joints in the hands, knees, hips, and spine.

This article looks at the different stages of OA and the associated symptoms and treatment.

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Pre-OA refers to the very early changes in the joint that could eventually lead to OA. At this stage, a person may not experience symptoms of OA, such as joint pain, stiffness, and reduced function. This phase is crucial for intervention because early changes may be reversible or their progression slowed.

Symptoms of pre-OA

A person might experience minor pain or discomfort in the joint after intense activity or prolonged use but not the persistent pain typical of later stage OA. There may be some stiffness after periods of inactivity or upon waking, which resolves quickly with movement.

Treatment of pre-OA

To slow the progression of OA, people can engage in regular, low impact exercise to strengthen the muscles around the joint, maintain flexibility, and reduce overall stress on the joint. Weight management is also crucial to lessen the load on weight-bearing joints.

Can autologous chondrocyte implantation help treat early OA?

Autologous chondrocyte implantation (ACI) is a treatment that involves taking a sample of tissue from a person’s joints and using it to grow new cartilage cells, chondrocytes, in a laboratory. Around 3 weeks later, a healthcare professional injects the new cells back into the damaged joint, where they develop into new cartilage. ACI is particularly helpful for early stage arthritis.

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Stage 1, or “mild” OA, involves minor wear and tear in the joints without significant symptoms or loss of function.

Symptoms of stage 1 OA

Symptoms may be mild, with intermittent aches and pains. Minor wear on the joint components may occur, but the cartilage is usually healthy enough to function correctly. People may experience slight discomfort in the joint after a long day of use or heavy activity.

Treatment of stage 1 OA

Treatment for stage 1 OA may not be necessary or it may focus on prevention strategies. Doctors may recommend lifestyle measures, such as incorporating low impact exercises, maintaining a moderate weight, and eating a balanced, nutritious diet.

Stage 2, or “moderate” OA, represents a progression from the early, almost symptomless stage of the disease. At this stage, individuals may start to notice more symptoms relating to the affected joints, although these symptoms are generally mild and do not significantly impair daily activities.

Symptoms of stage 2 OA

People may start to experience prolonged aches and occasional severe pains affecting the whole joint. Stiffness or soreness might appear after sitting for long periods or upon waking in the morning. The skin around the joint may feel warm and the area may be swollen.

Treatment of stage 3 OA

Treatment often includes over-the-counter (OTC) pain relief medication and nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and inflammation. Physical therapy and strengthening exercises can also be beneficial.

Learn more about physical therapy for OA.

Stage 3, or “advanced” OA, involves more significant deterioration of the cartilage and changes in the bone, leading to noticeable symptoms and discomfort. At this stage, symptoms become more persistent and may start to interfere with daily activities.

Symptoms of stage 3 OA

People with stage 3 OA experience constant aches and pains affecting the whole joint. Bearing weight on the joint may be particularly painful. Swelling and stiffness may occur due to soft tissue inflammation around the joint. The muscles may look smaller and feel weak, and the joint may have a limited range of motion.

Treatment of stage 3 OA

Treatment at stage 3 may include higher doses of OTC pain relievers, prescription medications, and possibly injections into the joint, such as corticosteroids or hyaluronic acid. Physical therapy continues to be important for maintaining mobility.

Read about types of arthritis injections.

Stage 4, or “severe” OA, involves extensive damage to the cartilage and changes in the bone that can greatly affect mobility and quality of life. The symptoms at stage 4 are persistent and severe, and surgery may be necessary.

Symptoms of stage 4 OA

At stage 4, pain and discomfort become constant, affecting a person’s quality of life. Joint stiffness and significant loss of motion are common, and individuals may have difficulty performing daily tasks.

Treatment of stage 4 OA

At this stage, surgical options, including joint replacement surgery, may be necessary. Nonsurgical treatments, such as medications and lifestyle modifications continue to play a role but are often insufficient to manage symptoms effectively.

Learn more about arthritis surgery.

To determine a person’s OA stage, a doctor may:

  • discuss symptoms and any prior joint injuries
  • perform a physical examination to assess pain levels, joint mobility, and the presence of any swelling or tenderness
  • order an X-ray, which may show bone spurs or osteophytes, which are growths on the bones in and around joints
  • order an MRI scan to examine the hard and soft tissues within the joint

Once doctors have gathered the information from these tests and examinations, they can suggest the stage of OA someone has.

Read about some natural treatments for OA.

Arthritis resources

To discover more evidence-based information and resources for arthritis, visit our dedicated hub.

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Osteoarthritis progresses through four stages, ranging from mild to severe. Over time, cartilage wears away, inflammation increases, and symptoms become more apparent.

To diagnose and stage OA, doctors may order X-rays or an MRI scan to assess the extent of joint damage.

Treatment may include over-the-counter (OTC) or prescription pain relief medications, steroid injections, and surgery in the most severe cases.