WOMAC scores describe pain, stiffness and difficulty with everyday movement in knee or hip osteoarthritis, a joint condition affecting cartilage and nearby tissues. Cartilage is the smooth covering on bone ends. The WOMAC score meaning depends on the scale, but higher numbers usually mean more difficulty. Falling scores mean fewer symptoms on the same scale.
WOMAC stands for Western Ontario and McMaster Universities Osteoarthritis Index. It's a questionnaire, not a scan. It describes daily symptoms, rather than how much cartilage remains.
WOMAC score meaning: pain, stiffness and function
WOMAC has 24 questions divided into three subscales, meaning separate scores for different parts of the experience. The original validation study by Bellamy and colleagues, Journal of Rheumatology, 1988, tested these parts in people with knee or hip osteoarthritis.
Pain describes symptom intensity. Stiffness describes how stiff the joint feels. Physical function describes difficulty with everyday movement. These overlap, but they aren't interchangeable: someone can report less pain while still finding movement difficult.
The five-choice version scores each answer from 0 to 4. Adding those answers gives the following ranges, based on the structure described in Copsey and colleagues' Quality of Life Research paper, published online in 2018.
| Part of WOMAC | Questions | Range when 0–4 answers are added |
|---|---|---|
| Pain | 5 | 0–20 |
| Stiffness | 2 | 0–8 |
| Physical function | 17 | 0–68 |
| Total | 24 | 0–96 |
That total includes many more function questions than pain questions. It isn't simply another name for the pain score.
In STEP 9: what the WOMAC 0 to 100 scale meant
STEP 9 used a different version: numerical rating scale 3.1, which uses numbered responses. Participants reported symptoms over the previous 24 hours. Researchers converted scores to a 0–100 scale, where higher meant worse symptoms.
The 2024 New England Journal of Medicine paper by Bliddal and colleagues enrolled 407 adults with obesity and moderate knee osteoarthritis. The trial tested semaglutide, a weight-management medicine, over 68 weeks. Both groups received diet and activity counseling; placebo was a matching treatment without the drug.
| WOMAC pain measure in STEP 9 | Semaglutide | Placebo |
|---|---|---|
| Average starting score, out of 100 | 72.8 | 67.2 |
| Average change by week 68, in points | −41.7 | −27.5 |
The minus signs mean pain scores fell. These are group results from that trial, not a forecast for a particular person considering semaglutide.
Why the WOMAC pain score range varies
A point belongs to its scale. The five-choice pain range ends at 20, while STEP 9's converted pain range ends at 100. Comparing changes without naming those ranges can make a result look much larger or smaller than it is.
The instrument developer's WOMAC page lists five-choice, visual analogue and numerical versions. A visual analogue scale uses a mark along a line; a numerical version uses numbered choices.
Converting a score to 0–100 changes its units. It doesn't make different questions, recall periods or study populations identical. Pain and total scores also remain different measures after conversion. A useful comparison names the version, the part being scored, the range and which direction means improvement.
WOMAC score change interpretation: points versus percentages
STEP 9's 41.7-point fall wasn't a 41.7% reduction. Points describe distance along the score scale. A percentage change compares that distance with the person's starting score.
The paper also examined people reaching reductions of at least 30% or 50% from their starting pain score. Those were responder thresholds, meaning cutoffs used to count people with a particular amount of change. They weren't promises or universal definitions of successful knee care.
The trial's estimated difference between groups was 14.1 points in semaglutide's favor. Its 95% confidence interval was 8.3–20.0 points in that direction. That interval describes statistical uncertainty around the average comparison, not the range of pain relief an individual can expect.
The estimate came from the study's analysis, which accounted for starting scores and missing follow-up information. It wasn't simply a subtraction of the rounded table entries. Our relative and absolute risk explainer covers the separate question of percentages describing events.
WOMAC pain versus physical function in daily life
Less pain and easier movement are related, but they answer different questions. A pain score describes symptoms. A function score describes reported difficulty doing things. Neither directly measures muscle strength, walking speed or cartilage thickness.
STEP 9 measured function with WOMAC and a separate general-health questionnaire. Their scoring directions differed: higher WOMAC scores meant worse outcomes, while higher scores on the other questionnaire meant better function. A rising number can therefore describe improvement on one report and worsening on another.
A body-composition scan answers another question again: how scanned body mass divides into fat, lean tissue and bone. Its measurements cannot replace a report of symptoms.
For someone discussing semaglutide, a pain number becomes more useful beside a concrete change in everyday movement. An average improvement doesn't tell us whether every participant found the same activities easier.
What a lower score cannot tell us about joint repair
STEP 9 had no follow-up imaging to establish cartilage changes. Its WOMAC results therefore cannot demonstrate cartilage repair. The semaglutide knee-osteoarthritis guide covers the fuller trial findings and that distinction.
As of November 5, 2026, the day this article was written, a review published October 23 in BMC Musculoskeletal Disorders still describes evidence about structural changes as uncertain. Findings about slowing joint damage came from observational studies, which compare people without randomly assigning treatment.
A lower symptom score matters in its own right. It doesn't need to stand in for a scan result. STEP 9 supports a discussion about the studied semaglutide treatment's average symptom changes; it doesn't establish the same results for every preparation containing the molecule.
How the STEP 9 example fits a prescription discussion
As of November 5, 2026, the day this article was written, the American College of Rheumatology's September 14 guidance update conditionally supports considering GLP-1 medicines for appropriate weight goals in knee osteoarthritis. GLP-1 medicines act on a hormone pathway involved in appetite and blood sugar. Conditional means the choice depends on the person's circumstances.
Through Promise, a licensed U.S. compounding pharmacy dispenses semaglutide as a compounded medication, meaning medicine prepared for a prescription. This is different from an FDA-approved product: the formulation offered here is not FDA-approved. The FDA explains that it does not verify the safety, effectiveness or quality of compounded drugs before they are marketed.
A licensed provider may still prescribe — that decision is between you and your doctor. At Promise, a licensed provider reviews every request, and not everyone qualifies.
