The Four Stages of Osteoarthritis and Natural Pain Solutions!

Recommended Natural Treatments & Remedies for Each Stage

If you have osteoarthritis, you certainly feel the pain, but you may not know its name. Osteoarthritis is a painful and progressive joint disease and people who suffer from it typically seek out medical attention and are then diagnosed with the disease.

Why all the pain?

People with osteoarthritis often have joint pain and reduced motion. Unlike some other forms of arthritis, osteoarthritis affects only joints and not internal organs.

Osteoarthritis is the most common type of arthritis. It results from a number of factors including:

  • Aging
  • Joint injury
  • Being overweight
  • Stresses on the joints from work and/or sports
  • Joints that are not properly formed
  • An abnormal defect in the joint cartilage

Osteoarthritis is a degenerative joint disease affecting both cartilage and bone. Cartilage covers the ends of bones, which allows them to glide over each other. It also helps absorb the shock of movement. In osteoarthritis, the top layer of cartilage breaks down and wears away, and consequently, the bones under the cartilage rub together. The rubbing causes pain, swelling, and loss of motion of the joint. Over time, the joint may lose its normal shape. Also, bone spurs may grow on the edges of the joint. A bone spur is extra bone growth that is not needed. Sometimes, bits of bone or cartilage can break off and float inside the joint space, which causes more pain and damage. Although it usually occurs with aging, it can manifest as early as one’s thirties.

Osteoarthritis does not necessarily cause inflammation, but can result in extreme pain and eventually severe loss of the ability to move your joints. As stated before, osteoarthritis is a progressive disease, meaning it will slowly get worse over time. When pronounced joint pain first sends a patient to seek treatment, the doctor can usually tell what stage of the disease the patient is currently in. The four stages of osteoarthritis are: Acute Subacute Chronic Degenerative

Depending upon the stage of the disease, the doctor will prescribe the appropriate treatment. If a patient is in the early stages—acute or subacute—mild pain killers and lifestyle changes might be the recommendation. However, if the disease has progressed to the chronic or degenerative stages, the treatment options are much more limited and the long-term prognosis can be much worse.

But there is hope … particularly if you have not yet entered the degenerative stage. Even then, there are some things you can do to ease the pain and suffering and return some flexibility of movement. So what can one do if they have osteoarthritis? A lot actually. What follows is a breakdown of each stage of the disease and a list of time proven natural remedies that can be helpful for people in a particular stage. Some of these herbs work well across all four stages of osteoarthritis. Others may only be useful in the acute stage, and still others may bring relief to people who are in the latter stages of the disease. But let’s start at the early stages…

Acute osteoarthritis—people in denial

The word acute in medical jargon means short-term and/or severe. One might have acute pain (severe) for a short period of time. When it comes to osteoarthritis, the acute stage is characterized by occasional joint pain. Short periods of time where joints—knees, hips, elbows, hands, fingers—are stiff and painful to move.

Most people in the acute state of osteoarthritis don’t think of themselves as having arthritis. These people are the exception to the rule that if you have osteoarthritis then you probably know it. Instead, people with acute osteoarthritis are somewhat in denial. They chalk these minor aches and pains up to old sports injuries or to the natural signs of aging. But this is a big mistake. Remember, osteoarthritis is a progressive disease. Without taking some action to arrest it in the acute stage, it is inevitable that the subacute, chronic, and degenerative stages will follow.

Acute osteoarthritis is characterized by minor stiffness and joint pain. Some people think the weather may play a role, and that’s partly true. Cold weather does cause stiffness and loss of flexibility in people with acute osteoarthritis. It can take a while for joints to warm up and allow flexibility to return.

If you suffer from acute osteoarthritis, one of the very best natural treatments you can take is Devil’s Claw extract. We’ll get into more details about Devil’s Claw extract and the other natural remedies later in the article, but for now let’s move on to subacute osteoarthritis.

Subacute osteoarthritis— no denial here

People who are in the subacute stage of osteoarthritis are very much aware they have a problem with their joints. Often times, this stage is characterized by localized joint pain. Some people may feel extreme pain and stiffness in their fingers and hands, but their other joints function properly and painlessly. Still others, depending upon their age and lifestyle, may feel the symptoms in their shoulders or knees, but their fingers and hands feel fine.

The thing to remember about subacute osteoarthritis is that it’s not too late. At this stage, localized pain and stiffness can not only be relieved, but it can also be reversed. Like acute osteoarthritis, Devil’s Claw extract can provide pain relief. Other natural substances like glucosamine, boswellia, and curcumin can be useful in this stage to arrest the progression of the disease and reverse the damage.

Chronic osteoarthritis—constant pain in multiple joints

If your osteoarthritis has progressed to the chronic stage, you are probably in quite a bit of pain. Movement in the chronic stage can be severely limited, and you might very well be taking prescription drugs designed to relieve the symptoms, but do nothing to address the cause of the disease. These drugs, of which NSAIDs (nonsteriodal anti-inflammatory drugs) are the most common, often have unpleasant side effects.

But even if you are suffering from chronic osteoarthritis, there is still hope. Nature’s pharmacy contains some amazing treatments that can bring relief to those who are in the chronic stage. Again, Devil’s Claw extract can treat the pain of chronic osteoarthritis. In fact, Devil’s Claw is so powerful it can even help those in the degenerative stage too. Other natural remedies for chronic osteoarthritis include glucosamine, chondroitin, betaine, and ginger extract.

Degenerative Osteoarthritis—bone on bone and unbearable pain

The degenerative stage of osteoarthritis is truly unfortunate. The degenerative stage is characterized by a complete loss of cartilage surrounding the joint and the terrible pain of bone rubbing on bone. People in the degenerative stage are often immobile, or at the very least extremely feeble and wheelchair bound. They are also prescribed powerful narcotic pain killers to relieve the condition.

To say the degenerative stage of osteoarthritis is hopeless, however, would be wrong. All the natural treatments already mentioned can bring some relief to those suffering from degenerative osteoarthritis. However, the dosage required is almost always much larger. Someone in the acute stage might find relief from one or two capsules of Devil’s Claw extract, while someone in the degenerative stage would take two or three times as much of this natural pain reliever. Additionally, Devil’s Claw extract might be the only remedy the acute sufferer would require, while the person in the degenerative stage might require high doses of all the substances mentioned in this article in order to find relief.

Suffice to say, if you are not yet in the degenerative stage of osteoarthritis, you’ll want to take steps now to arrest the disease in whatever stage you are in and take the appropriate natural nutrients proven to reverse the damage.

A word about inflammation … While it is true that osteoarthritis itself does not cause inflammation, your body’s reaction to the disease does. Inflammation is your body’s response to damage or injury. Thus, many arthritis remedies, both natural and pharmaceutical, contain anti-inflammatory ingredients.

So now the stage is set … The four stages of osteoarthritis have been identified and certain natural remedies have been suggested. Let’s look at each of these remedies individually to understand how they work and the supporting scientific evidence for their efficacy.

Devil’s Claw Extract

Devil’s Claw (Harpagophytum procumbens) has been used for more than half a century in Europe for musculoskeletal pain, and during that time has become an established osteoarthritis treatment option. The European Scientific Cooperative on Phytotherapy (ESCOP) now recommends Devil’s Claw extract for painful osteoarthritis and the relief of low back pain.

Research has shown Devil’s Claw extract to be equal to or better than ibuprofen, acetaminophen, and other NSAIDS for pain relief. Most notably, this natural plant extract is an analgesic, anti-inflammatory, and antidiabetic1 and offers a safer alternative to the now “suspect” COX-2 inhibitors—such as Celebrex® or the now-defunct, Vioxx®—especially since research has found it to be equivalent to them for relieving pain.

The main active ingredient in Devil’s Claw is harpagoside, an iridoid glucoside, which is thought to produce anti-inflammatory, anti-rheumatic, and antioxidant effects. Recent research has focused on the possibility that its antioxidant action may explain the anti-inflammatory and anti-rheumatic actions, but the mechanism is unclear.2

Scientific research on Devil’s Claw: Devil’s Claw works better than placebo and pain relievers for short-term relief of osteoarthritis pain. Two trials examining the effects of Devil’s Claw found strong evidence that daily doses standardized to 50 mg or 100 mg of harpagoside were better than placebo and pain relievers for short-term improvements in pain. Another trial demonstrated the equivalence of taking Devil’s Claw extract to 12.5 mg per day of rofecoxib (Vioxx)—without the side effects.3

In addition to showing that Devil’s Claw may reduce osteoarthritic pain as effectively as some conventional drugs, a double-blind, four-month study of 122 patients in France showed that patients taking the herb experienced significantly fewer adverse side effects than those taking the drug diacerhein. Most notably, the patients preferred the Devil’s Claw extract over the drug.4

Helps relieve pain from acute, subacute, and chronic osteoarthritis of the spine, hip, knee, and low back

Researchers at the University of Toronto, Canada, searched several databases and other sources to identify trials testing Devil’s Claw extract in adults suffering from osteoarthritis or low back pain. They found strong evidence for the use of Devil’s Claw extract in the treatment of acute, subacute, chronic, and non-specific low-back pain.5

In a German study, 75 patients who had arthritic hips or knees took Devil’s Claw extract for 12 weeks. The physicians reported a continuous improvement in typical clinical findings such as 45.5% for pain, 35% for limitation of mobility, and 25.4% for joint crepitus (a peculiar crackling, crinkly, or grating feeling from the wearing out of cartilage). There were only two cases of possible adverse reactions reported—indigestion and a sensation of fullness. Although this was an open clinical study in which there was no other drug or remedy used, the results suggest that Devil’s Claw extract is clinically beneficial in the treatment of arthritis of the hip or knee.6

Devil’s Claw appears to be quite safe, with no evidence of toxicity at doses many times higher than recommended. In fact, a 6-month open study of 630 people with arthritis showed no side effects other than occasional mild gastrointestinal distress7

Although Devil’s Claw has been suggested for many conditions, the best evidence supports its use for the treatment of all four stages of osteoarthritis and low back pain. It provides a safer alternative to traditional pain relief medicines which have numerous long-term side effects. Most importantly, Devil’s Claw extract has been shown to provide pain relief that is equal to or better than traditional over-the-counter and prescription pain relievers. And much to the relief of everyone, it has no serious side effects when used in numerous long-term, human clinical studies.


First used in the United States to treat arthritis-like symptoms in horses and other animals, glucosamine continues to make headlines, as scientific evidence mounts that it is a powerful anti-arthritic. New double-blind medical studies confirm that it not only reduces the symptoms of osteoarthritis, but can also stop the disease dead in its tracks, and may even repair some of the damage that has already occurred.89

Glucosamine is the same substance that is naturally produced by your body and enables you to build new cartilage—the gel-like material that lines your joints and acts as a natural shock absorber. Unfortunately, as you age, you lose the ability to manufacture sufficient amounts of glucosamine, leading to stiffness of the joints and eventually to full-blown arthritis.

Glucosamine combats osteoarthritis by stimulating the manufacture of glucosamino-glycans, a natural lubricant and shock absorber, which enables your joints to move smoothly and painlessly.10 Glucosamine also promotes incorporation of sulfur into cartilage, increasing its strength and durability. In other words, glucosamine has the ability to help rebuild cartilage. This is particularly important for those in the chronic and degenerative stages of osteoarthritis.

Proven to reduce pain and inflammation

A recent study done at King’s College in London, and published in March, 2002, in the British Journal of Community Nursing, compared the effectiveness of glucosamine with ibuprofen for relief of joint pain. The study found that glucosamine can be used as an alternative to anti-inflammatory drugs and analgesics or as a useful adjunct to standard analgesic therapy. The study indicated that glucosamine’s pain-relieving effects might be due to its cartilage-rebuilding properties, which is a significant bonus you certainly don’t get with simple analgesics.11

It’s important to note that ibuprofen and other NSAIDs appear to only treat the symptoms of arthritis, not its cause. Also, NSAIDs carry an increased risk of side effects including gastrointestinal complaints and bleeding. Furthermore, there is an indication that NSAIDs may increase the progression of arthritis. In contrast, glucosamine actually repairs damaged joints, in effect reversing degenerative arthritis.12 The longer glucosamine is used, the more dramatic and long-lasting the improvement.

Glucosamine helps pain associated with sports injuries

Weekend warriors and other aging athletes are finding glucosamine extremely helpful with their acute and subacute osteoarthritis conditions. Because glucosamine acts as both a pain reliever and as a mechanism to repair damaged joints, it is the ideal substance to use to arrest osteoarthritis before it can progress to the chronic and degenerative stages. That’s not to say it can’t help those who are in the latter stages of the disease, it can. But if those old sports injuries are just now starting to revisit, glucosamine supplementation is strongly recommended.


Boswellia is a derivative of the Boswellia serrata tree that grows in India. It’s also known as “Indian frankincense,” and has been used for centuries to combat joint inflammation and pain in India, North Africa, and China. Unlike modern NSAIDs like ibuprofen and aspirin, boswellia doesn’t cause stomach irritation or other harmful side effects. In its cream form, boswellia can be applied directly to the skin to reduce inflammation.

Scientific research on boswellia

A number of scientific studies have confirmed the effectiveness of boswellia. This ayurvedic herb contains a compound known as beta boswellic acid, which is anti-inflammatory and analgesic. It has been shown in animal and test-tube studies to inhibit the production of leukotriens (biologically active compounds formed from arachidonic acid and other polyunsaturated fatty acids that cause inflammation and allergic reactions).

An important recent study of 175 patients with rheumatic and arthritic symptoms showed promising results. Within four weeks of taking boswellia, 122 patients reported reduced stiffness and inflammation. Boswellia also appeared to be particularly effective in alleviating lower back pain.13 Thus, boswellia should be considered by anyone in just about any stage of osteoarthritis, but particularly by those in the chronic and degenerative stages.


Curcumin is an extract of the spice turmeric that provides a huge number of health benefits. In fact, the potential benefits of curcumin are so comprehensive and extensive, that we should all be taking it. A recent search of the Excerpta Medica database found no less than 149 citations referring to the medical benefits of curcumin.

Studies show it inhibits prostaglandin production and stimulates the creation of cortisol, which relieves inflammation.1415 A study conducted in India looked at a combination arthritis formula that included curcumin and boswellia. In a double-blinded, placebo-controlled trial of 42 patients with chronic osteoarthritis, those receiving the test formula showed a significant drop in pain and disability.16 So, boswellin and curcumin work very well together and late stage osteoarthritis sufferers should look for formulas that combine these ingredients, along with other rebuilding compounds like glucosamine and chondroiton.

Chondroitin sulfate

Chondroitin sulfate is a powerful antioxidant and anti-inflammatory derived from cartilage. Chondroitin compounds are naturally manufactured by your body, and are essential for normal joint function. As you age, however, your body produces less and less. You can solve the problem with chondroitin supplements.

Chondroitin sulfate improves joint function in a variety of ways, including increasing your body’s synthesis of cartilage, improving joint lubrication, reducing free radicals which can damage cartilage, and removing blockages in blood vessels that support joints.

Chondroitin and glucosamine combined work well for late stage osteoarthritis

Several new studies recently published in scientific journals confirm the effectiveness of combining glucosamine and chondroitin to battle the later stages of osteoarthritis, particularly the chronic and degenerative stages. Highly effective for osteoarthritis of the knee Members of the faculty of Medicine, at the University of Liege, Liege, Belgium, did exhaustive research of randomized, placebo-controlled clinical trials published or performed between January 1980 and March 2002 that assessed the efficacy of oral glucosamine or chondroitin on knee osteoarthritis. Their results showed that glucosamine and chondroitin were highly effective and safe in ameliorating joint space narrowing, and pain and mobility.17

Counteracts spinal disc degeneration

Although most studies have been done on osteoarthritis of the knee, there has been little investigation into the effects of glucosamine and chondroitin on spinal disc degeneration. A two year study done at the Netherlands Cancer Institute in Amsterdam and recently published in BMC Complementary Alternative Medicine, is particularly important because it suggests that long-term glucosamine and chondroitin sulfate intake may counteract spinal disc degeneration, particularly at an early stage. The researchers found that glucosamine and chondroitin are bioavailable to cartilage chondrocytes (cartilage-building cells), and may stimulate the biosynthesis and inhibit the breakdown of proteoglycans (a building block of cartilage within the joint space).18

Efficacious and safe in animal and human clinical trials

An article written by researchers at the Division of Arthritis Surgery, Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, and published in the Journal of Arthroplasty, April 2003, reported that because of the abundant clinical evidence showing the efficacy and safety of glucosamine and chondroitin in both animal and human clinical trials, they deserve prominent recognition as a nonsurgical treatment of osteoarthritis.19

Betaine (trimethylglycine)

Betaine—also known as trimethylglycine—is essential for rebuilding connective tissue and manufacturing cartilage components. Betaine works with folic acid, vitamins B-6 and B-12, and methionine to form SAMe (S-adenosylmetlonine), and to donate methyl molecules, which are vital for proper liver function and cellular replication. SAMe protects and repairs joints by (1) increasing the number of cartilage cells, (2) stimulating the synthesis of proteoglycans, and (3) decreasing cartilage loss.2021

SAMe is available commercially, but is extremely expensive, and can cost $200-$350 a month. SAMe is also chemically unstable. The preferable alternative for most people is to take betaine and B-supplements, including B-6, B-12, and folic acid.


Used for thousands of years to add zest and excitement to food, ginger (Zingiber officinale) is also one of the oldest natural remedies around. Ginger’s anti-inflammatory properties have been used effectively for thousands of years. Ginger reduces inflammation by inhibiting prostaglandin and leukotriene synthesis. (Prostaglandins and leukotrienes occur naturally in your body. They are major causes of inflammation.)22

Ginger has been proven to be as effective as NSAIDs in reducing inflammation but without their side effects and toxicity that include liver problems, stomach problems, and other debilitating side effects. Ginger reduces inflammation system-wide. This includes reducing inflammation in cases of both rheumatoid arthritis and osteoarthritis.

A 1992 Danish study found that patients with rheumatoid arthritis, osteoarthritis, or musculoskeletal pain who took powdered ginger reported varying degrees of pain relief and no side effects, even among those who took the ginger for more than two years.23

Ginger is also recommended in Ayurvedic medicine for atherosclerosis, bronchitis, diarrhea, hypercholesterolemia, motion sickness, and ulcerative colitis. Because of its strong anti-inflammatory properties, ginger extract may benefit individuals at all stages of osteoarthritis.24

Powerful, natural pain relief

As mentioned earlier, the osteoarthritis sufferers, no matter which stage of the disease they are in, should not give up hope. Of course, it helps to know how far the disease has progressed so you know which formula is going to work best for you. The chart on page 1 may be of benefit. If you are in one of the later stages of osteoarthritis, look for formulas that combine glucosamine with chondroitin, as well as boswellia and curcumin. B vitamins are also important along with betaine. If you are in the early stages like acute and subacute, you should look for formulas that contain glucosamine, boswellia, curcumin, ginger and Devil’s Claw, but you may not need chondroitin.

Getting older does not mean you have to suffer with joint pain. You can arrest the development of osteoarthritis right now, no matter what stage you may be in by taking quality nutritional formulas that contain these key ingredients. And you can do it without the expense of pharmaceutical drugs and their side effects. Don’t suffer through the pain or lose your freedom of movement. Act now to protect your joints and cartilage, so you can enjoy your golden years.



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  3. Chrubasik S, Model A, Black A, Pollak S. A randomized double-blind pilot study comparing Doloteffin and Vioxx in the treatment of low back pain. Rheumatology (Oxford). 2003 Jan;42(1):141-8.
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  7. Shaw D, Leon C, Kolev S, et al. Traditional remedies and food supplements: a 5-year toxicological study (1991–1995). Drug Safety. 1997;17:342–356.

  8. J Y Reginster et al, Long-term effects of glucosamine sulphate on osteoarthritis progression: a randomized, placebo-controlled clinical trial, The Lancet, 357: 9252, 1-27-01.
  9. H Muller-Fassbender et al, Glucosamine sulfate compared to ibuprofen in osteoarthritis of the knee, Osteoarthris Cartilage 2(1994), 61-9.L C Bovati et al, A large, randomized placebo controlled double-blind study of glucosamine sulfate vs. piroxicam and vs. their association on the kinetics of the symptomatic effect in knee osteoarthritis, Osteoarthritis Cartilage 2 (Supp.1) (1994), 56.
  10. K Karzel and R Domenjoz, Effect of hexosamine derivatives and uronic acid derivatives on clycosajminoglycan metabolism of fibroblast cultures, Pharmaceology 5 (1971); 337-45.
  11. Ruane R, Griffiths P. Glucosamine therapy compared to ibuprofen for joint pain. Br J Community Nurs 2002 Mar;7(3):148-52.
  12. A L Vaz, Double-blind clinical evaluation of the relative efficacy of ibuprofen and glucosamine sulfate in the management of osteoarthrosis of the knee in out-patients, Curr Med Res Opin 8(1982) 145-9.
  13. Boswellia,, 1-30-01.
  14. Inhibitory effect of curcumin, an anti-inflammatory agent, on vascular smooth muscle cell proliferation, Eur. J. Pharmacol.(Netherlands), 1992, 221/2-3, 381-384.
  15. Amann HP, et al, Mechanism of anti-inflammatory actions of curcumine and boswellic acids, J Ethnopharmacol (Ireland) 1993 38/2-3, 113-119.
  16. Kulkarni RR, Patki PS, Jog VP, Gandage SG, Patwardhan B. Treatment of osteoarthritis with a herbomineral formulation: a double-blind, placebo-controlled, cross-over study. J Ethnopharmacol 1991 May-Jun;33(1-2):91-5.
  17. Richy F, Bruyere O, Ethgen O, Cucherat M, Henrotin Y, Reginster JY. Structural and symptomatic efficacy of glucosamine and chondroitin in knee osteoarthritis: a comprehensive meta-analysis.Arch Intern Med. 2003 Jul 14;163(13):1514-22.
  18. Van Blitterswijk WJ, Van De Nes JC, Wuisman PI. Glucosamine and chondroitin sulfate supplementation to treat symptomatic disc degeneration: Biochemical rationale and case report. BMCComplement Altern Med. 2003 Jun 10;3(1):2.
  19. Hungerford DS, Jones LC. Glucosamine and chondroitin sulfate are effective in the management of osteoarthritis. J Arthroplasty.2003 Apr;18(3 Suppl 1):5-9.
  20. Cox, M J, McDevitt, C A, et al. Changes in chondroitin sulfate-rich region of articular cartilage proteoglycans in experimental osteoarthritis, Biochlmica et Biophysics Acdts, 6-18-85, 840/2, 228-34.
  21. Brandt K D, Effects of nonsteroidal anti-inflammatory drugs on chondrocyle metabolism in vitro and in vivo. Am J Med 83 (Suppl. GA), 1987, 29-34.
  22. No author given. Ginger – An herbal medicinal with broad anti-inflammatory actions. Journal of Medicinal Food/ Sept 2005.
  23. Judith Horstman. Ayurvedic Herbs. Arthritis Today,

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