How Osteoarthritis Progresses

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Close-up of young Caucasian female runner holding need in pain

Osteoarthritis—often simply called arthritis—is the most common cause of disability in the United States. This disease is characterized by the breakdown of the cartilage in the joints. Cartilage provides cushioning between the bones of a joint, so when it breaks down, pain, swelling, and decreased movement can occur. Osteoarthritis is a degenerative joint disease, which means it typically gets worse with time as the cartilage continues to degenerate.

Osteoarthritis progresses at different rates between people, but most people, even if they don’t realize it, experience mild, moderate and severe osteoarthritis stages. When you know the signs and symptoms of each stage, you can take steps to slow disease progression and improve symptoms.

Mild Osteoarthritis

In the early stages of osteoarthritis, the affected joints will occasionally feel stiff and uncomfortable. Moving the joint after a period of inactivity (say, first thing in the morning) may be challenging, but the pain doesn’t linger, and joint movement often improves throughout the day. X-rays may show some damage to the bones of the joint but the space between the bones is normal.

At this point, there’s a lot you can do to slow joint degeneration. Losing weight (even a few pounds) can dramatically improve symptoms and slow disease progression, as less weight equals less stress on the joints. Regular exercise can help as well, by building up the muscles around the joint. (Exercise also facilitates weight loss.)

Changing your eating habits may help as well. Decreasing your intake of red meat, processed and fried foods and salty and sugary snack foods may decrease inflammation in your body, improving symptoms. Add in anti-inflammatory foods, including green tea, fatty fish (such as salmon and tuna) and leafy greens.

Mild osteoarthritis may not require medical treatment. You can usually manage discomfort with over-the-counter (OTC) pain relievers. Nonsteroidal anti-inflammatory drugs (NSAIDS) are best because they decrease inflammation. OTC options include ibuprofen and naproxen.

People who have moderate osteoarthritis frequently have pain when moving affected joints. Everyday activities, such as walking or slipping an arm into a shirt, may be difficult and painful.

At this stage, doctors can see a narrowing of the space between the bones of the joint on an X-ray; this is a sign cartilage has deteriorated. You can’t undo the damage that’s already been done, but you can slow the progression of osteoarthritis by losing weight if you’re overweight and engaging in regular physical exercise. (If your joint pain makes movement difficult, ask your healthcare provider to suggest some exercises. Many people find swimming comfortable because the water cushions the joints.)

Adopting Mediterranean-style eating habits—more fruits, veggies, fish and whole grains, and less red meat and processed foods—may also slow disease progression. A 2016 study of 4000 people with osteoarthritis found that those who ate a Mediterranean diet were much less likely to become frail over the course of 8 years than affected individuals who ate a typical American diet.

Medical treatment of moderate osteoarthritis may include OTC and prescription medicine, as well as corticosteroid or hyaluronic acid injections in the affected joints.

Severe Osteoarthritis

Osteoarthritis is classified as severe when pain and limited movement becomes a near-constant problem. At this point, there’s almost no space between the bones of the joint and inflammation is chronic. For many patients with severe osteoarthritis, surgical intervention, including joint replacement surgery, may be the best option. A healthy diet and exercise as tolerated may also help decrease symptoms.

Your healthcare provider can help you understand the osteoarthritis stages and develop a treatment plan that fits your stage and lifestyle.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2019 Oct 8
  1. What is Osteoarthritis? Arthritis Foundation. https://www.arthritis.org/about-arthritis/types/osteoarthritis/what-is-osteoarthritis.php
  2. Osteoarthritis. National Health Service. https://www.nhs.uk/conditions/osteoarthritis/
  3. Stopping Osteoarthritis Progression. Arthritis Foundation. https://www.arthritis.org/living-with-arthritis/tools-resources/expert-q-a/osteoarthritis-questions/osteoarthritis-progression.php
  4. Exercise: Rx for Overcoming Osteoarthritis. Harvard Medical School. https://www.health.harvard.edu/staying-healthy/exercise-rx-for-overcoming-osteoarthritis
  5. Mediterranean Diet for Osteoarthritis. Arthritis Foundation. https://www.arthritis.org/about-arthritis/types/osteoarthritis/articles/mediterranean-diet-oa.php
  6. Arthritis in Knee: 4 Stages of Osteoarthritis. Illinois Bone & Joint Institute. https://www.ibji.com/arthritis-in-knee-4-stages-of-osteoarthritis/
  7. Osteoarthritis of the Hip (Hip Osteoarthritis). UW Medicine Orthopedics and Sports Medicine. http://www.orthop.washington.edu/patient-care/articles/hip/osteoarthritis-of-the-hip-hip-arthritis.html


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