Severe osteoarthritis (OA) is an advanced stage of the disease. It occurs when most of the cartilage around a joint has worn away. Severe OA may cause constant pain and reduced joint function.

OA is a degenerative joint disease. People with severe OA have extensive joint damage, which may increase the severity of symptoms such as pain and reduced range of motion.

This article looks at the stages of OA progression, symptoms of severe OA, steps that may help prevent OA from worsening, and treatment options.

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Severe OA is the advanced stage of the disease when there is extensive damage to the joint. In severe OA, most of the cartilage protecting the joints has worn away.

This can cause increased severity of symptoms, including persistent pain and stiffness that may make it difficult to carry out everyday activities. People may also experience pain at night.

In the early stages of OA, the articular cartilage, which covers the ends of bones at the joints, becomes thinner and rougher. Over time, the cartilage erodes or disappears completely, affecting more of the bone surface.

Healthcare professionals may classify OA into four stages:

  • Stage 1 (early OA): Minor wear and tear of the joints with little to no pain.
  • Stage 2 (mild OA): People may experience pain and stiffness as the cartilage wears down. Bone spurs may appear on X-rays.
  • Stage 3 (moderate OA): Erosion may occur in the cartilage, and everyday activities may become more difficult or uncomfortable.
  • Stage 4 (severe OA): Almost all cartilage has worn away, resulting in chronic inflammation. People may experience fairly constant pain and stiffness, which affects everyday activities.

People with advanced stage OA may experience pain more constantly and have bouts of unpredictable pain. Severe OA may also cause pain at night, which may affect sleep.

Severe OA may make it more difficult to carry out certain everyday tasks or activities due to pain, stiffness, or reduced range of motion.

Severe OA may cause joint deformity and swelling. People may feel that a joint gives way or buckles, affecting balance and stability.

Other symptoms of OA include:

  • aching joints or pain during or after activity
  • joint stiffness, usually after resting or first thing in the morning
  • swelling around a joint
  • reduced range of motion, which may improve with movement
  • crepitus, a clicking or popping sound when moving a joint
  • muscle weakness around a joint, which may make the joint buckle or feel unstable

Risk factors for OA include:

  • being over the age of 50 years
  • joint injury
  • overuse of a joint
  • obesity
  • misalignment of bones or joints
  • issues with muscle support
  • having family members with OA
  • being female
  • environmental factors, such as occupation, activity levels, diet, and bone density

Factors that may increase the risk of OA progressing rapidly and severely include:

  • obesity
  • older age
  • OA that affects multiple joints
  • varus deformity, which affects the alignment of bones

For most people, OA will not steadily worsen over time. The condition can affect everyone differently, but individuals may find the condition peaks after a few years. After this, symptoms may stay the same or even improve.

Some people may find they have periods of joint pain and periods of improvement.

Treatments and lifestyle changes may help slow the progression of OA and prevent the condition from worsening.

Severe OA may cause complications, such as:

  • deformity from swollen joints
  • difficulty sleeping due to pain
  • difficulty exercising, staying physically active, or carrying out everyday tasks
  • joint instability, which may lead to falls
  • tingling or numbness in the arms or legs due to nerve compression
  • depression, anxiety, or other mental health conditions due to reduced quality of life

Additionally, severe cases of spinal OA may affect bladder and bowel function.

Although treatment cannot reverse joint damage from OA, it may help slow the disease’s progression, reduce pain, and increase joint function.

Treatments for OA include:

For severe OA, people may require surgery. This may include repairing joint damage or replacing a joint.

Certain lifestyle choices may help slow the progression of OA and improve overall health. People may wish to:

  • maintain a moderate weight, which can reduce inflammation and extra stress on the joints
  • eat a nutritious, balanced diet
  • control blood sugar, as high levels can increase the risk of cartilage breaking down
  • maintain range of motion as much as possible by stretching and staying active each day
  • listen to the body and rest as necessary
  • warm up and cool down properly before exercise to protect the joints
  • minimize stress, and take time to relax
  • avoid smoking and limit alcohol
  • get enough quality sleep

People can contact a doctor if they have symptoms of OA. Other conditions may cause similar symptoms, but getting the correct diagnosis and beginning any necessary treatment is important.

If someone finds it difficult to manage severe OA or treatments appear to be ineffective, they can talk with a doctor. A doctor may refer them to a physical therapist, occupational therapist, or orthopedic surgeon to discuss surgical options.

People can also consult a doctor, a mental health professional, or a support group if severe OA affects their mental health and overall well-being. The Arthritis Foundation can connect people with arthritis and their caregivers with peer-led support groups.

Although severe joint damage is not reversible, treatments may help slow disease progression, decrease pain, and improve joint function.

For severe OA, joint replacement surgery may provide the best long-term outlook, with successful outcomes in more than 80% of cases. Joint replacements may last 10–15 years, after which people may need repeat surgery.

Severe OA involves extensive damage in the joint, with most of the cartilage worn away.

This increases the severity of symptoms, and people may experience more constant pain, limited range of motion, and decreased function. Severe OA may affect everyday activities, sleep, and quality of life.

Treatments and lifestyle changes, such as medication, a nutritious diet, and exercise, may help slow the progression of OA and improve symptoms.

Additionally, surgery to repair damage or replace the joint may be necessary if other treatments are ineffective.