The Four Stages Of Osteoarthritis

Osteoarthritis (OA) is the most commonly diagnosed type of arthritic joint disease, affecting over 32.5 million adults in the US.¹

OA most commonly affects the following joints:

• Hips

• Hands

• Feet

• Spine

• Knees

Osteoarthritis affects joint functionality, and it can trigger devastating pain and even disability in some cases once it progresses to advanced stages. The comforting news is that OA symptoms are treatable, especially when diagnosed in its early stages.

What are the causes of osteoarthritis?

Osteoarthritis occurs when the cartilage cushioning the ends of the joints gradually wears off. The current scientific view suggests that OA doesn’t only involve the articular cartilage but the whole joint organ, including the bones underneath the cartilage and the synovium.²

Cartilage is a firm, slippery tissue that lubricates the joints to ensure frictionless motion. Once the cartilage deteriorates completely, the joint bone will rub on the neighboring bone, resulting in a lot of pain and discomfort. OA can be primary (due to getting older, for example) or secondary (due to abnormal mechanics or trauma which can affect both younger and older people).

The risk factors of osteoarthritis

The risk factors that could increase the risk of OA include:

Age

Studies reveal the risks of getting OA increase with age.³ Experts believe this could be due to changes in the cells and the extracellular matrix of joint tissues over time.

Joint injury or overuse

Joint injury can cause severe stress on the joint, and injuries from an accident or sports can increase the risk of OA. Joint overuse in strenuous activities involving bending can also damage the joints and increase the risk of OA.

Gender

Studies reveal women are more likely to develop OA than men.⁴ The most affected women are aged 50 and over. Hormonal factors could play a role in this, but studies have not been fully conclusive.

Obesity

The extra weight carried by obese people puts a lot of stress on the joints. The most affected joints are those that bear the most weight, such as the hips and knees.

Race

Some studies indicate that OA could be more prevalent in certain races. For example, OA was found to exist in Native Americans more frequently than in the general population, while knee OA is more prevalent in black people than other groups, particularly in women.⁵

Genetics

If you have a family member with OA, you are at a higher risk of developing the condition than someone who doesn't.

Bone deformities

Some people born with malformed joints or defective cartilage are at a higher risk of developing OA.

Certain metabolic conditions

Some metabolic diseases such as diabetes and hemochromatosis may increase your risk of developing OA.

The four stages of osteoarthritis

Stage 1: Early/doubtful osteoarthritic stage

Stage 1 of OA is typically considered an early or doubtful stage. Stage 1 OA patients may develop some minor wear and tear and suspicion of bone spur growths on the end of the joints.

You may also start losing some cartilage between your joints. However, this stage is unlikely to cause pain or discomfort.

Signs and symptoms

Most people don't exhibit any symptoms or signs during stage one OA. However, some patients may experience mild pain in the joints.

Diagnosis

Stage one diagnosis is carried out by a qualified healthcare professional, who will usually conduct a physical exam to establish the symptoms. Most physicians are not likely to investigate further at this stage, particularly in the absence of other symptoms or alarming personal or family medical history.

Treatment

Most stage 1 OA patients typically don't seek any treatment because of the absence of symptoms. However, you may prefer some non-invasive treatment if you are concerned about your joints. These include:

• Lifestyle changes such as weight loss, regular practicing of certain types of exercise, and yoga, as some other exercises could worsen the condition

• Over-the-counter medications such as nonsteroidal anti-inflammatory topical creams

• Use of recommended supplements like glucosamine and chondroitin

Stage 2: Mild/minimal osteoarthritic stage

In stage 2 OA, the bone spur growths in the joint will be more apparent, with possible narrowing of the joint space. You may start experiencing some mild joint pain.

Essentially, enzymes such as metalloproteinases start breaking down the cartilage and cause the region around your joints to feel stiff, uncomfortable, and painful, especially after physical exercise, on waking, or not using the joint for extended periods.

Signs and symptoms

Symptoms of stage 2 OA can vary from one person to another. For some people, pain may manifest during or after physical activity. Others may have challenges bending or straightening the affected joints. Other symptoms include stiffness and discomfort after rising in the morning.

Diagnosis

Stage 2 OA can be diagnosed by X-ray images that allow the doctors to check the condition of the joint. The X-rays may show bone spurs even though your cartilage may look normal.

The doctors may also assess your symptoms, conduct a physical exam, and order other tests, such as blood tests and bone scanning, to confirm the diagnosis and exclude other conditions such as rheumatoid arthritis and multiple myeloma.

Treatment

When your physician diagnoses OA at this early stage, they will provide a plan to help manage the symptoms and possibly stop or slow the progression of the joint disease.

Your healthcare practitioner may recommend several treatment options such as:

• OTC medications like NSAIDs, preferably topical cream for mild pain, and oral medication for moderate pain

• Strength training for increased joint stability

• Supplements and nonpharmacologic therapies

• Wearing a brace, knee support, wrap, or shoe insert that protects the knee from stress

Stage 3: Moderate osteoarthritic stage

Stage 3 OA is typically considered the moderate stage. During this stage, X-rays show:

• Definite narrowing of the joint space

• More prominent bone-spur formation

• Possible damage to the bony ends of the joint

• Some connective tissue (sclerosis) in the joint

This is due to the erosion of the cartilage surface between bones and fibrillations that narrows the gap between the bones. As the disease progresses, degradation products such as proteoglycan, and collagen fragments are released into the synovial fluid, where they can be detected with some tests.

Signs and symptoms

Most people in stage 3 osteoarthritis may experience joint inflammation, which causes frequent pain when exercising or performing activities using the affected joint. You may also experience some joint stiffness after lack of use for a long time and when you wake.

Other symptoms include popping or snapping sounds in the joints and possibly swelling around the joint.

Diagnosis

Your physician will rely on your symptoms, a physical exam, and an X-ray to diagnose stage 3 OA. They may order blood tests or MRIs.

Depending on your symptoms, the healthcare team may prefer arthroscopy to confirm the diagnosis.⁶ Arthroscopy is a minimally invasive diagnostic procedure involving the insertion of a small scope on your joint to examine it for symptoms of arthritis.

Treatments

An orthopedic doctor may recommend over-the-counter NSAIDs or pain-relief therapies to suppress the symptoms. Previously, opioids such as tramadol were prescribed in case of severe pain, although recent guidelines recommend against their use as they are not more effective in improving pain or function and can cause severe side effects.

Other treatment options include:

• Lifestyle changes such as weight loss, regular low-impact exercise, yoga

• Intra-articular injections of hyaluronic acid, platelet-rich plasma, or corticosteroid injections into the joints for short-term pain relief. However, regular injections of hyaluronic acid for knee OA are not recommended.

Stage 4: Severe osteoarthritic stage

Stage 4 OA is considered the severe or advanced level of the disease. In stage 4 OA, the joint space between your bones reduces considerably, and the bone spur becomes large in size, with apparent deformity of the bone ends and formation of a large area of connective tissue in the joint. The breakdown of the cartilage also triggers a chronic inflammatory response and decreased synovial fluid that usually lubricates the joints. This results in friction, massive pain, and discomfort when you are walking or doing any other activity that requires the movement of your joints.

The production of synovial metalloproteinases, cytokines, and tumor necrosis factor (TNF) may also increase and diffuse back into the cartilage to further destroy the soft tissues around the joint.

The advanced level of OA results in the progression of the size of the spur, which triggers unbearable pain and discomfort. This can hamper your ability to engage in daily movements such as walking, bending, or descending stairs.

Signs and symptoms

The primary symptom of stage 4 OA is excruciating pain whenever a person is using their affected joints. You may also experience severe stiffness, swelling, and inflammation in your joints.

Diagnosis

Stage 4 OA diagnosis involves physical exams, lab tests, X-rays, and MRI.

Treatments

Stage 4 OA is considered an advanced disease that won't likely respond to non-invasive treatments and lifestyle changes. Available treatments for stage 4 OA include the following surgeries:

Bone realignment surgery

Bone realignment surgery or osteotomy is one of the most preferred treatments for severe OA of the knee. During the procedure, the physician cuts the bone above or below your knee to shorten, lengthen or change its alignment.

The goal of the surgery is to shift the body's weight away from the point where bone-spur growth and damage have occurred. However, this surgery is typically recommended for people below 60 years old with specific mechanical issues and who meet certain anatomical conditions.

Total knee replacement (TKR)

Total knee replacement (TKR) or arthroplasty may also be recommended for severe stage 4 OA, characterized by persistent pain and decreased knee function. During the procedure, the surgeon removes damaged joints and replaces them with a plastic and metal device. Although the newer knee may last for several decades, you may require additional surgeries or even another knee replacement during your lifetime.

This surgery also carries the possibility of serious complications such as blood clots and infection and requires a long recovery time and physical therapy afterward.

Osteoarthritis complications

Osteoarthritis is a condition that worsens over time if not diagnosed and treated early. Chronic joint pain and stiffness can become severe enough to impact your daily activities. Other complications that may result from OA-induced pain and disability include depression and sleep disturbance.

Managing osteoarthritis

With the right treatment in the early stages, the progression of the disease can be halted, allowing the joint to heal. This is particularly true in younger people, for whom OA can become stable for many years.

Although osteoarthritis can impact the quality of your life, people live with OA for decades. It is not a systemic disease that can affect other organs or progress to be fatal.

Early diagnosis and treatment can help slow the progression of the disease. Taking good care of yourself is an effective way to prevent joint complications. This includes keeping a healthy body weight, controlling blood sugar, being physically active, and more.

The CDC has established an arthritis program that provides five self-management strategies for managing osteoarthritis and its symptoms.⁷

Master self-management skills

You can join a self-management education class to equip yourself with various self-management skills. The classes are designed to increase your confidence in controlling your symptoms and living well. The CDC recommends a selection of self-management education programs⁸.

Get physical

Experts advise that adults should engage in 150 minutes per week of moderate physical activity to prevent disease progression. Some of the recommended moderate- and low-impact activities include walking, swimming, or biking.

Talk to your doctor

If you are experiencing joint pain and other OA symptoms, talk to your doctor. You can play an integral role in managing your OA by attending regular appointments with your doctor as per the recommended treatment plan.

Losing weight

If you are overweight or obese, losing weight can help relieve pressure on the affected joints, especially weight-bearing joints such as the hips and knees. For people living with OA, reaching or maintaining a healthy weight can help relieve pain, improve function and slow the progression of OA substantially.

Protect your joints

As mentioned earlier, joint injuries can cause or worsen the symptoms of OA. When engaging in physical activities, opt for those that are easier on your joints, such as:

• Walking

• Cycling

• Swimming

You should also wear protective gear when engaging in strenuous or aggressive sporting activities.

The lowdown

Osteoarthritis (OA) is a painful condition affecting many people. Fortunately, there is a broad range of treatments including physical therapy, OTC medications designed to help relieve pain caused by OA, and surgery.

If you suspect you have osteoarthritis, it is crucial that you get an early diagnosis and treatment for the disease. At each stage of the OA, your doctor will assess the symptoms and provide the ideal treatment options that prevent further progression.