Dr. Robert F. Kidd    

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Is it Really Arthritis?

Every occupation and profession develops its own language or jargon, and medicine is no exception. Technical words are supposed to help people within the profession communicate better, but some would say that they are designed to prevent outsiders from knowing too much. In either case, some words take on a life of their own and end up meaning things that were never intended in the first place. This leads to confusion, yet the word is already in common use and cannot be stopped.

"Arthritis" is one of these words. "Arthros" in Greek means "joint" and "-itis" means "inflammation of". Arthritis should therefore mean "joint inflammation". And in a logical world, there should be no problem in using the word this way. The trouble is that it is often used to describe aches and pains where no inflammation exists.

To be fair, there are many types of arthritis and much of the time the word arthritis is used correctly. Inflammation refers to a combination of pain, heat, redness, and loss of function (in the case of a joint, loss of movement). So when these conditions are present in a joint, it can be properly called arthritis. When people develop rheumatoid arthritis (a particularly severe type of arthritis), there is usually no doubt that the joints are inflamed and the word arthritis is the proper term to use.

However, the word often is used in a very loose way, which leads people to think they have a more serious condition than they really have. This happens when on x-ray, signs of "wear and tear" are found in a joint. This may indeed be a sign of arthritis, but it may also be a sign of nothing but, - you guessed it, - wear and tear. In other words, arthritis often leads to wear and tear, but wear and tear does not necessarily lead to arthritis.

The best example of the misleading use of this word is in the spine. As early as in our 20's, signs of wear and tear show up in x-rays of the spine. By our 40's, everybody has signs of wear and tear, and by our 70's, our spines look very worn out indeed. This is often called arthritis, but do old folks have more back trouble than youngsters? On average, no! And can x-rays tell if there is heat or redness? Of course not. So we should stop calling signs of wear and tear in the spine arthritis. And we should be careful how we use the word in any joint simply because there are changes on x-ray.

To make matters even more confusing, worn out joints can become very stiff. The capsule surrounding the joint becomes tight and it does not move well. Sometimes, but not always, the capsule becomes inflamed, and a true arthritis develops. Or, a nearby joint has to move more to compensate for the worn out joint's stiffness, and it in turn becomes irritated and painful. This is not unusual with worn out hips, in which stiffness forces the nearby sacroiliac joint to move more than it is used to. Then it can be hard to tell where the pain is coming from.

The main thing to remember is that the word arthritis is often used carelessly. If there is no sign of inflammation, there may be no arthritis and the pain may be coming from somewhere else.