Dear Panayot :

The proposal you make is absolutely correct, but I think it is a losing battle because the term of osteoarthritis has been generalized in all publications incorrectly

Panayot,

I am in complete agreement with you and with Antonio that the generalized medical community see these two words as the same. It would take a major commitment from all professional societies and major publication journals to agree on one term only.

It could be done the spelling of orthopaedics became standard over orthopedics but took a long time and a commitment by societies.

Regards,

Tim

Dear Antonio,  This is an error that is as old as the English orthopaedic literature exists. However, it is better to try to correct it. Meanwhile, some English surgeons show some desire for change. The majority remain stubborn explaining the wrong term as a bad habit...

 Dear Tim, you are right. It needs time. However, precise terminology is always recommended.   Regards.

I can initiate a policy at our Journal "Reconstructive Review" during the review process to suggest to authors to use the proper term.

Tim, this is a great idea.

Agree with Panayots remark !  In the German orthopedic textbooks ( used in the Netherlands till the seventies, when the Anglo-American medical world took over with many more improper terms, like idiopathic for everything hey did not understand) the joint degenration was called Arthrosis Deformans . This was linked to malalignment in the body. A person with  any unnatural curvature in the spine ( Leibeshaltung, posture) will show alterations and adaptations in the way he/she use and load their lower back and joints of the leg in the first place. ( exo of hips in boys, hyperextension/ varus in girls knees or varus in boys will give overload in only parts of joints and shearstresses that detoriates cartilage. Anglo-American orthopedics is not focused on etiology , so pathways to prevention like posture guidance, proper orthopedic schoolgymnastics will be blurred, and that was and is very beneficial for industries involved in pharma and implants. And surgeons. Who will tell them?

Piet van Loon,

Very informative.

Tim

Medical practice based on treating of symptoms has many drawbacks. Etiology is very important. Unfortunately, we do not know the causes of many pathological conditions. A striking example is the term "low back pain". It is a symptom and not a disease.. The mass use of this term shows our helplessness to understand some conditions. It is a pity, but research goes on. 

Panayot and Antonio,

It might make for an interest paper to draft an article on misuse of medical terminology in the diagnosis and treatment of medical conditions or some similar title.

Tim

Many conditions are just labeled with Latin symptom descriptions, like for "low back pain" you can say "lumbago" and sound very professional. Or "fibromyalgia", a very popular diagnosis nowadays, means nothing at all in regards of etiology, just where the pain is located. So many others.

I had the same difficulties adjusting from "arthrosis" to "arthritis" when I moved from Russia to the U.S. I kept on "educating" my American colleagues and patients for awhile and gave in eventually.  Now I call it arthritis too. Shame on me!

Would be nice to have some of these terms revise and replace.I don't see how though.

International Congress for Medical Terminology?

Mike.

Thank you , Mike, for your sincere post. Some orthopaedic sugeons explain this striking misuse with a sort of habit. I don't think bad habits should be tolerated.

Proper terminology results is more accurate communication. Thank you for pointing this out

Hi Panayot and colleagues

I am a part-time masters student (full time musculosketal physiotherapist) in the UK. My dissertation that I am writing up at the moment is; 'Patients' expectations of physiotherapy treatment with knee osteoarthritis on the Nottingham Hip & knee pathway: A service evaluation'. Thank you, I was not aware of the terminology difference. Should I be changing my title?

Dear Eric, that is a though one, you bring up! It is not your fault, that you are not aware of this semantic discussion opened by Panyot. For many decades biomechanic thinking of the European excersise schools ( heilgymnastik, Schroth, Bugnet, Klapp etc.etc) has disappeared in many anglosaxon influenced health systems and textbooks. If the western orthopaedic world has lost its focus on alignement and posture and accepted terminology, that does not cover the biomechanic etiology, then any intervention or set of interventions will show flaws or unexplainable results in evaluation research. But also for the patients expectations it differs very much in my opinion.If they are not aware that most of their problems with their spines and joints is a lifestyle ( in youth) dependant and posture dependant condition,they expect to much of therapists, medication and docters (surgery) . Critics on many forms of surgery in knee degeneration shows  to be increasingly supported by research. Not "evidence based", what ever this may mean if you miss all clinical and biomechanical aspects of joint degeneration.   The huge increase of varusdeformity in society which will unevitably lead to degeneration of healthy cartilage at young ages sows, that prevention during the growth period has failed. The socio-economic burden of spine and joint degeneration caused by our sedentary lifestyle will influence politics soon.

Wisdom and good luck in trying to incorporate a critical note in your thesis.

It will only change if we all keep repeating it is incorrect. I often state that I am a paediatric physiotherapist/pediatric physical therapist.  Eric you migh consider using a same approach. If we were all to do so in the future (the ones that know the difference that is) we would slowly educate and at least make aware....I can Imagine you gave up after a while Mikhail. It depends on the country and of course English has a English and an American version to make things even easier. :)  

If you find some place for a  critical note on the terminological difference between inflammation and degeneration of the joint, this could provoke at least an interesting discussion. It could be assessed as an important contribution too. Consult your superviser.

Thank you all for shedding valuable light on the use of correct terminology

Best Wishes

Eric

Evidence shows that inflammation does play an important role in osteoarthritis.

Malemud, CJ. "Biologic basis of osteoarthritis: state of the evidence." Curr Opin Rheumatol. 2015 May;27(3):289-94. doi: 10.1097/BOR.0000000000000162.

The above is a good review article on this subjective. It can be said that the use of the term osteoarthritis is technically accurate to describe this condition.

correction: "subject" not "subjective."

Dear Mr. Long,

Thank you for your post and the reference cited.

Unfortunately, I have to disagree with the evidence presented. Osteoarthrosis (in English literature “osteoarthritis”) is a degenerative joint disease but may have different origin (etiology). The most important point here is what is the primum movens for this variety of pathological conditions. The majority of osteoarthrosis types are of secondary nature i.e. DDH, intrarticular fractures or cartilage injuries, static disorders, sports overloading (pure mechanical causes !), state after femoral head osteonecrosis (M. Chandler), metabolic and endocrine disorders, etc. All these are non-inflammatory conditions. The most important factor for degeneration of the joint is the mechanical overloading leading to progressive cartilage wear and damage.

In the paper of CJ Malemud (2015) the accent is placed on the accompanying synovitis which is often encountered in the so-called activated osteoarthrosis. Yes, I agree that in similar cases the inflammation of synovia adds an inflammatory effect and promotes the progression of degeneration. But this is not always the case and it is a secondary pathophysiological moment.

Yes, RA and other rheumatic or bacterial conditions are certainly arthritis types because the primary moment is inflammation or infection. However, when the inflammation subsides or heals, the joint disease goes on the pathophysiolocal pathway of degeneration, and may be accepted as a postarthritic osteoarthrosis.

Unfortunately, this terminological misuse and embarrassment in the English-speaking literature and practice is nourished by some famous medical dictionaries. You may read in Dorland’s Illustrated Medical Dictionary the following terms and explanations:

- osteoarthritis - “noninflammatory degenerative joint disease… characterized by degeneration of the articular cartilage, hypertrophy of the bone at the margins, and changes in the synovial membrane…”

and also:

- osteoarthrosis – “chronic arthritis of noninflammatory character”

What is it ? What is correct ?

In my opinion this awkward situation may be compared for example with the never-happening misuse of “spondylitis” instead of “spondylosis”, and “discitis” instead of “ discosis” which are clearly and correctly differentiated in the medical literature and practice. Such a misuse is unbelievable.

 An excellent and accurate summary of the pathophysiology by Prof. Panayot Tanchev. I agree about the incorrect use of nomenclature in several areas.

Thank you, Dr. D'Netto.

Prof. Tanchev,

I appreciate your bringing this subject up and your answer to my comment. It makes for very interesting discussions.

There has been a similar discussion over the last several years regarding epicondylitis versus epicondylosis. We know from histological studies that there is no inflammation present in the majority of patient who are labeled with epicondylitis; it's more accurate to call it epicondylosis. In the US, physical therapists (which is my profession) have been trying to influence the terminology in this situation but have been met with indifference or resistance, mostly from physicians.

Your arguments are starting to sway me. I think I see the main point here. The inflammation seen in "osteoarthritis" is not the main cause but is secondary hence the argument that the more accurate term would be osteoarthrosis.

 You mentioned the Dorland definition: osteoarthrosis – “chronic arthritis of noninflammatory character.” Even this would seem to self-contradictory. "Arthritis" implies inflammation with it's -itis suffix.

I work with rheumatologists on a regular basis and as a matter of great timing I brought this subject up earlier this morning. They felt the term osteoarthritis is just so ingrained in USA that there is virtually no chance that it would change. If one would switch to osteoarthrosis here in the USA, it would likely cause confusion.

However, I will take up the challenge. I will for the time being switch my use of the phrase and see how it goes.

Thank you for starting this thought provoking discussion.

Thank you, Mr. Long for your prompt post. I appreciate it. Meanwhile, there are some Anglo-saxon authors who start using "osteoarthrosis" for noninflammatory joint diseases. But not many. A salvage exit from the terminological misuse is the abbreviation OA. This makes things more comfortable. Regards

Dear Prof. Tanchev,

I am a physiotherapist and currently doing an MSc in Biomedical Engineering, but most importantly, I am Greek. Since these words are greek and very clear to me, I totally agree with your point. Indeed, whatever ends with '' itis '' indicates inflammation. Unfortunately, it is very common even in Greece to use both words as they are the same. I think this is a result of misunderstanding of the situation. In my opinion, Osteoarthrosis is the proper term for degeneration of the joint. Osteoarthrosis may lead to Osteoarthritis.

Kindest regards.

Dear Ms Farmaki, thank you for your nice post. I am glad to know that more and more researchers understand the meaning of both terms and also the awkward misuse. Kind regards.

Dear Ms Farmaki, I would like to add also the other opportunity, namely Osteoarthritis to turn to Osteoarthrosis. For example, purulent osteoarthritis of the hip in babies and infants is an acute bacterial inflammation.But when the infection is cured the process goes over  to degeneration because of the destroyed joint and it's malfunction. This condition may be defined as postarthritic osteoarthrosis.

Interesting thread...   nomenclature is important

In the Netherlands we are in de middle of that semantic discussion with huge consequenses for the health of patients, for total costs in Healthcare and so on.

All biomechanic thinking healthworkers (orthopedics, therapists,kinesiologists) all use the word "artrose" ( Arthrosis deformans). This word is still in use by all ordinary people, because our Medical science was guided for 2 centuries by the French, and later (1850) the German scientists and orthopedic workers ( doctors, heilgymnastiker , schoolgymnastic teachers) So etiology , prevention, conservative treatment are all biomechanics based issues as it originated in "Orthopedics"centuries ago.  In the eighties, when we defenitively came under influence of the Anglo-american science (by PubMed) osteoarthritis became the prefered word used, even in our biomechanic based research and articles. Rheumatologists, not aware of the biomechanic origin and pathogenesis took over the care for "artrosis" in a biochemical way , by finding indeed characteristics in histology of inflammation, the start of many pharmacological ( and Pharma -industry driven)  therapies and trials. This made the patient with the lifestyle- induced "Arthrosis" a beloved main target of the biochemic trained doctors and Pharmaindustry.

Just by mixing up or misuse of Greek words! And forgetting old mastery in orthopedics.

Dear Piet, 

I am glad to learn that in the Netherlands "arthrosis" is in use. I think this is the case for most countries except for Anglo-saxon literature. Although it is very influential I believe it is time for change, namely a correct use of terms. Regards.