Stages of osteoarthritis

Osteoarthritis tends to progress slowly, and many people stay stable for years. Doctors often use the Kellgren-Lawrence (KL) grading on X-rays for the knee, from grade 0 to 4.

Grades on X-ray

• Grade 0: normal joint
• Grade 1: doubtful narrowing, possible tiny bone spur
• Grade 2 (mild): definite bone spurs, possible slight narrowing
• Grade 3 (moderate): clear narrowing of joint space, some bone changes
• Grade 4 (severe): marked narrowing, large spurs, bone-on-bone contact

How symptoms may feel

• Early: occasional stiffness and aching after activity
• Middle: regular pain, swelling, reduced range
• Late: constant pain, night pain, deformity, difficulty walking

X-ray grade and pain do not always match. Some people with grade 3 changes cope well, and others have severe pain with mild changes.

Ayurvedic view

Ayurveda sometimes describes progression from Vata-dominant dryness to deeper tissue (Asthi and Majja Dhatu) depletion. This is an interpretive idea and not a staging system used in medicine.

What changes by stage

Early and mid stages respond well to exercise, weight control and physiotherapy. Injections, bracing or surgery are considered when these are not enough.

See a doctor if pain is worsening over months, walking distance is falling, or the knee is locking or giving way.

When to get help

Book a visit with your doctor or an orthopaedic or rheumatology clinic if joint pain keeps returning, limits walking, stairs or sleep, or if you are unsure which treatments are safe with your other medicines. Early advice often avoids unnecessary scans, tablets and bed rest, and lets you start the right exercise plan sooner.

Remember

A higher grade does not mean you must have surgery. Function and pain guide the decision.