The Stages of Osteoarthritis Progression

As osteoarthritis progresses over time, symptoms and treatment options can change.

By Chris Iliades, MD

Medically reviewed by Niya Jones, MD, MPH

One in seven Americans has some type of arthritis — osteoarthritis is the most common form of the disease. In fact, osteoarthritis is the leading cause of disability in elderly people

Osteoarthritis starts to affect your joints before you even notice any symptoms. By the time the first symptoms of stiffness and pain occur, changes in the joint may have already reached an advanced stage.

Treatment and outcome can depend on which joints are affected. “The majority of pains due to friction [because of] bony thickening get better with time. Worn hip and knee joints tend to gradually deteriorate and may need surgery, but wear in hand joints can heal without pain,” says Jonathan Edwards, MD, professor of connective tissue medicine at University College London, in England.

Osteoarthritis: The Early Stages
The first changes that osteoarthritis typically cause occur when the cartilage that coats the ends of your bones and cushions your joints starts to thin out. The smooth surface of cartilage and a lubricating fluid inside the joint allow joints to move easily and painlessly, but a combination of age, overuse, and possibly an inherited tendency to develop osteoarthritis can cause this cartilage to gradually wear down. Cartilage has no nerves but as friction starts to affect the bone underneath, the first symptoms of osteoarthritis begin to show up.

Early osteoarthritis treatment involves staying active while avoiding overuse of any particular joint. Losing weight also helps dramatically, by reducing additional stress on joints.

Osteoarthritis: Moderate Stage
Jack Stassen, a farmer in Cape Cod, Mass., who suffers from osteoarthritis says, “I first noticed pain and stiffness in my knees about 20 years ago, after working all day in the orchard." He notes that early in the course of his disease, “the pain would always go away with rest.”

As osteoarthritis progresses, however, “pain tends to worsen as the day goes on, rather than loosen up. Sudden catching or giving way of knee joints is common. Worn hip and knee joints may become painful even to stand on,” notes Dr. Edwards.

When cartilage wears down, the bones underneath become thicker and reactive tissue, known as bony spurs, form along joint margins. In older people, especially if osteoarthritis limits physical activity, muscles eventually become weaker, providing less support for the joints.

Osteoarthritis treatment at this stage usually involves starting medication. The most commonly used medications are nonsteriodal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen. NSAIDs are effective in relieving osteoarthritis pain and decreasing joint swelling and inflammation, but their use may be limited by stomach irritation..

At age 62, Stassen remains physically active despite the fact that he has significant joint pain. He notes that his “doctor says my osteoarthritis would be much worse if I wasn’t active.”

Osteoarthritis: Late Stage
In the later stages of osteoarthritis all the joint structures are affected. Healthy lubricating fluid is lost and the joint affected by osteoarthritis may fill with inflammatory fluids that stretch the joint capsule, causing swelling, more pain, and stiffness. Stronger pain medication may be needed. In some cases, the best osteoarthritis treatment may be surgery to replace the joint.

“Most joint replacement surgery goes like a dream,” says Edwards. “The best way to ensure a rapid recovery is to be as fit as you can before surgery. No smoking, slim down to an ideal weight, and get plenty of exercise of a sort you can manage. All being well, you should be up on your feet in just a few days and ready for most activities within a month or two.”

Osteoarthritis is a progressive disease, and there is no cure. But there are still many ways to manage osteoarthritis effectively. Most people can alleviate their osteoarthritis symptoms with a combination of weight control, exercise, and medication. In cases where osteoarthritis requires surgery, joint replacement surgery has been shown to relieve pain and improve joint function. If you have been diagnosed with osteoarthritis, talk to your doctor about all of the available treatment options so that you can keep moving forward.

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