Arthritis

What the label means

'It's just my age. It's arthritis.' I've heard those words more times than I can count in my 25 years as an Osteopath. Sometimes they come from a GP or an X-ray report, and often from the person themselves, before anyone has examined the joint.

Arthritis is one of the most widely used labels in musculoskeletal health, yet it's surprisingly rarely explained. It's worth knowing these x--ray changes are very common in people with no pain at all, so they don't always explain why a joint hurts.

 

So in this post, I'll explain what the word means, what osteoarthritis describes, how it differs from inflammatory arthritis, and how common the label is.

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What does 'arthritis' mean?

The word comes from Greek: 'arthr-' means joint, and '-itis' means inflammation. In everyday use, though, 'arthritis' is an umbrella term for a large family of conditions that involve pain, swelling and stiffness in one or more joints.  There are several common types listed, including osteoarthritis, gout, rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis and juvenile idiopathic arthritis. These are very different conditions that happen to share a name.

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Osteoarthritis: the most common type

Osteoarthritis is the most common type in the UK, and it's the one most people mean when they say 'my arthritis'. It most often involves the knees, hips and small joints of the hands, and it usually starts from the late 40s onwards.

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The label describes changes in and around a joint. The smooth, protective cartilage covering the ends of the bones thins and breaks down, the bone underneath changes, and small bony growths (osteophytes) can form at the edges. Our joints are exposed to a constant low level of deterioration as part of normal life, which the body usually repairs. Osteoarthritis describes the picture when that balance shifts. That's where the familiar phrase 'wear and tear' comes from. In the spine, similar age-related changes in the discs and joints are often called spondylosis, or 'degenerative changes'.

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How the label is usually given

Many people assume an X-ray is needed to diagnose osteoarthritis, but the NICE guideline advises that it can be diagnosed clinically, without imaging, in people who are 45 or over, have joint pain related to activity, and have either no morning stiffness or stiffness lasting no longer than 30 minutes. Imaging is generally kept for situations where something doesn't fit that picture. So if you're in midlife and mention an achy knee or hip, there's a fair chance you'll be told it's arthritis on that basis alone.

If you have had an X-ray or scan, the report may use phrases such as 'degenerative changes', 'joint space narrowing' (the gap between the bones looking smaller, which reflects thinner cartilage) or 'osteophytes'.

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How common is the label?

Research suggests that millions of people in the UK live with arthritis, some in the knee and others in the hip. With numbers like these, it's understandable that 'arthritis' has become a go-to explanation for joint pain as we get older.

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Inflammatory arthritis is different, and needs medical care

Inflammatory arthritis is a different group of conditions, and it's important not to confuse it with osteoarthritis. The current medical protocol states that Rheumatoid arthritis, for example, is an autoimmune disease. This means the immune system, which normally fights infection, attacks the lining of the joints by mistake, making them swollen, stiff and painful. It usually affects the hands, feet and wrists, often on both sides, and can come with tiredness and feeling generally unwell. Morning stiffness that lasts a long time can be a sign of it. Other inflammatory types include psoriatic arthritis, ankylosing spondylitis, which often affects the lower back and usually begins before 40, and gout, a sudden, very painful, hot and swollen joint, often the big toe.

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Arthritis, or a musculoskeletal label?

Many people are convinced they have arthritis in a joint when the diagnosis they've actually been given is something else, such as a tendinopathy, bursitis or a meniscus tear. If that sounds like you, you might find my pages on back pain, neck pain, shoulder pain, hip pain, knee pain and ankle and foot pain helpful.