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Everything You Should Know About Advanced Osteoarthritis

What is advanced osteoarthritis?

Key points

  1. Advanced osteoarthritis is the most severe form of osteoarthritis. It’s also called stage 4 osteoarthritis.
  2. Osteoarthritis is a progressive condition, meaning it gets worse over time. There may be some ways to slow the progression.
  3. You may need surgery if you have advanced osteoarthritis.

Osteoarthritis (OA) is a chronic degenerative disease. It causes damage to your joints, including those in your:

  • hands and fingers
  • knees
  • hips
  • lower back
  • neck

Treatment for OA focuses on managing your symptoms. The disease can’t be reversed.

The progressive degeneration of OA has been classified into four stages. The first stage, with no joint damage, is called Stage 0.

Stage 4 is the most advanced and severe stage of OA. Here are some signs of stage 4 OA:

  • your cartilage is worn away
  • the space between the bones in your joint is greatly reduced
  • your joint is warm and inflamed
  • the normal lubricating fluid of your joint is decreased, although the joint may be swollen
  • you have more bone spurs and bone rubbing against bone at the joint

People with advanced OA have pain and discomfort moving the joint. The pain is often severe. It can be debilitating and prevent you from carrying out your daily activities.

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Progression

How quickly does osteoarthritis progress to stage 4?

The progression of OA depends on the severity of the disease at your diagnosis, the joints involved, and your general health. There aren't any drugs yet that can stop the deterioration. However, following a therapy regimen early in the disease can help slow the rate of degeneration.

Progression to stage 4 can take years or even decades. For very advanced OA, pain management and surgery or joint replacement may be recommended.

A review study found that OA of the knee progressed more rapidly in people who:

  • were older
  • had a high body mass index (BMI)
  • had more than one joint involved

A 2007 study noted that BMI affected the progression of knee OA, but not hip OA, although other studies have linked osteoarthritis of the hip and obesity.

Symptoms

What are the symptoms?

Pain and stiffness, especially in the morning, are the main symptoms of OA. If you have stage 4 OA, these symptoms can be severe and disabling.

Other symptoms include:

  • loss of flexibility in the joint
  • grating or crackling noise when you move the joint
  • bone spurs, which feel like hard lumps, around the joint
  • swelling around the joint

If your hands are involved, it may be hard to do things that require dexterity or grasping. If your knee or hip joints are involved, it may be extremely hard to walk, climb stairs, or lift objects.

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Causes

What causes osteoarthritis to progress?

The cause of osteoarthritis is now thought to be a combination of these factors:

Genetics

Your genes may be involved in the development of osteoarthritis, though researchers are still working to fully understand this connection. It may be that you have an abnormality in the makeup of your cartilage, or that your bones fit together abnormally at the joint.

Weight

Extra weight can put pressure on your hips and knees, which can cause the cartilage in your joints to deteriorate faster. The Arthritis Foundation reports a link between being overweight and an increased risk of OA of the hand. Excess fat tissue is thought to produce chemicals that inflame and damage your joints.

Past injuries

Joint injuries or repetitive motion can lead to cartilage breakdown and OA. If the muscles supporting your joints are imbalanced or weak, this can also lead to cartilage breakdown.

Prevention

Can you slow the progression of osteoarthritis?

How to slow the progression of OA is not fully understood, although there are many standard therapies that can help at earlier stages of the disease.

  • Physical therapy and exercise can help you strengthen the muscles around the affected joint.
  • Weight loss can take pressure off your lower body joints.
  • Regular exercise and stretching can improve flexibility, relieve stiffness, and improve your overall physical condition.
  • Knee braces, hand splints, shoe orthotics, or other appliances, such as a cane, can help stabilize your joints.

Learn more: Osteoarthritis prevention »

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Treatment

How is advanced osteoarthritis treated?

In earlier stages of OA, you may find relief from physical therapy, regular exercise, weight loss, and assistive devices that help with your stability.

As your condition progresses to the advanced stages, your doctor may recommend additional treatments, including:

  • cortisone injections to relieve pain in the joint
  • hyaluronic acid injections to cushion the knee and provide pain relief
  • pulsed electromagnetic field stimulation for OA of the knee
  • electrical nerve stimulation for pain relief
  • acupuncture for pain relief
  • massage therapy for the affected area
  • applying heat or cold to the painful joint to increase blood flow and ease pain
  • supplements, such as glucosamine or chondroitin sulfate, which may bring relief for some people (though studies show mixed results)
  • taking an avocado-soybean unsaponifiables supplement, which is used in Europe as an anti-inflammatory for knee and hip OA, and may also slow down joint damage

By stage 4, the cartilage loss and condition of your bones may drastically curtail your activity and comfort, making pain medication and surgery your main options.

Surgery

In some cases, such as if you have damage to one side of your knee, a surgeon may realign the bone by cutting out a piece or adding more bone. This is called an osteotomy.

Another form of surgery is arthroscopic debridement. For this procedure, the doctor may remove loose pieces of bone and cartilage from the joint. However, with advanced OA, arthroscopy has very little to offer and doesn’t prevent the progression of the disease.

If your joint is severely damaged, the surgeon may replace the joint. This is called arthroplasty, or knee joint replacement surgery, and means the damaged parts of the joint are removed and replaced with plastic or metal parts.

Learn more: The best total knee replacement blogs of the year »

Pain management

If you have persisting pain, talk to your doctor about what painkillers might work best for you. If over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) aren’t effective, your doctor may prescribe something stronger. Other types of drugs include:

  • COX-2 inhibitors
  • tramadol (Ultram)
  • capsaicin topical skin cream

Read more: A guide to the best pain relief creams for arthritis »

Narcotics should be a last resort because of their side effects.

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Outlook

What's the outlook?

OA now affects 27 million Americans. It’s most common in people over age 65. Discomfort and pain can be managed early on in the disease, and therapy can be effective in maintaining good mobility.

Advanced OA can be extremely painful and debilitating. With stage 4 OA, you may not be able to walk, climb stairs, or carry out your daily activities. You may need to have assistance at home and for transportation. You may not be able to work. Painkillers are an option, but can have side effects. Surgery followed with physical and occupational therapy can provide pain relief and allow you to continue functioning.

Ongoing medical research shows promise for finding ways to diagnose OA early on, heal cartilage, and trigger bone growth. New treatments may become available in the future.

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