What Are The 4 Stages of Osteoarthritis?

Symptoms of osteoarthritis most frequently affect the fingers, feet, knees, hips, and spine, and less commonly, the elbows, wrists, shoulders, and ankles.

The four stages of osteoarthritis are:

  • Stage 1 – Minor
    • Minor wear-and-tear in the joints
    • Little to no pain in the affected area
  • Stage 2 – Mild
    • More noticeable bone spurs 
    • The affected area feels stiff after sedentary periods
    • Patients may need a brace
  • Stage 3 – Moderate
    • Cartilage in the affected area begins to erode 
    • The joint becomes inflamed and causes discomfort during normal activities 
  • Stage 4 – Severe
    • The patient is in a lot of pain
    • The cartilage is almost completely gone, leading to an inflammatory response from the joint
    • Overgrowth of bony spurs (osteophytes) may cause severe pain

What Is Osteoarthritis?

Osteoarthritis is the most common type of arthritis that frequently develops with age. It is a chronic condition in which the cartilage between bones that cushions the joints wears down and as it does, the bones rub against each other causing pain, stiffness, swelling, and reduced joint motion. Osteoarthritis most commonly affects the hands, knees, hips, feet, and spine, though it can affect nearly any joint in the body.

What Are Symptoms of Osteoarthritis?

Symptoms of osteoarthritis typically begin after age 40 and can vary widely. Symptoms of osteoarthritis most frequently affect the fingers, feet, knees, hips, and spine, and less commonly, the elbows, wrists, shoulders, and ankles.

Symptoms of osteoarthritis include: 

  • Joint pain 
    • Worsens with activity and is relieved by rest
    • In severe cases, joint pain occurs even at rest or at night
    • Pain is felt over or near the affected joint but it may sometimes be felt in other areas
  • Joint stiffness
    • Morning stiffness is a common symptom 
    • Stiffness usually goes away within 30 minutes of rising, but it may come back throughout the day if a person is inactive
    • Stiffness may occur in cold, damp, or low-pressure weather
  • Joint swelling (effusion) 
  • Crackling or grating sensation (crepitus) 
  • Changes in joint shape 
  • Bone spurs (osteophytes)

What Causes Osteoarthritis?

Primary osteoarthritis is the breakdown of cartilage over time. Risk factors for developing osteoarthritis include:

  • Advancing age 
    • Rare in people under 40 years
    • At least 80% of people over age 55 have some X-ray evidence of osteoarthritis
  • Gender 
    • Women are two to three times more likely than men to develop osteoarthritis 
  • Obesity
  • Occupation 
    • Occupations that require frequent squatting and kneeling, such as dock work, shipyard work, mining, cotton processing, carpentry, farm work, construction work, and other activities that involve heavy lifting, prolonged standing, or walking several miles each day
  • Joint injury or trauma
  • Sports 
    • Wrestling, boxing, pitching in baseball, cycling, gymnastics, soccer, and football
    • Noncompetitive running does not seem to increase the risk of developing osteoarthritis

How Is Osteoarthritis Diagnosed?

Osteoarthritis is diagnosed based on a number of factors, including the patient's age, history, and symptoms. Tests used to diagnose osteoarthritis or rule out other conditions may include:

  • X-rays of the affected joints
  • Arthrocentesis (joint fluid analysis) in which joint fluid is removed and analyzed to determine the cause of joint swelling and pain
  • Arthroscopy is a surgical procedure in which a tube with a camera is inserted into the joint space to visualize the joints and surrounding tissues (damage may also sometimes be repaired through the arthroscope)
  • Laboratory tests may be used to rule out other conditions if it is suspected something else may be causing symptoms
  • Imaging tests may be helpful if there is lack of clarity around a source of joint pain other than osteoarthritis

What Is the Treatment for Osteoarthritis?

Treatment for osteoarthritis includes lifestyle modifications, medications, and/or surgery. 

Lifestyle modifications used to treat osteoarthritis include:

  • Weight loss for patients who are overweight
  • Physical therapy 
  • Exercise programs 
  • Orthoses to help to keep joints aligned and functioning correctly such as splints and braces
  • Assistive devices such as canes, walkers, electric-powered seat lifts, raised toilet seats, and tub and shower bars 
  • Arthritis education and support 

Medications used to treat osteoarthritis include:

Surgery is usually the last resort used to treat severe osteoarthritis that significantly limits a person’s activities and that does not respond to other treatments. Types of surgery for osteoarthritis include: 

  • Realignment surgery to realign bones and other joint structures that have become misaligned because of chronic osteoarthritis
  • Fusion surgery is used to permanently fuse two or more bones together at a joint and may be indicated when the joints are badly damaged and joint replacement surgery is not appropriate
  • Joint replacement surgery is used to replace a damaged joint with an artificial (prosthetic) joint