From Arthritis to Zoster

I want to spend some time talking about arthritis, a condition we’ve all heard about… and one far too familiar to many of us. First, though, I’d like to point out some distinctions and definitions (we in medicine have always been compulsive about little details; it probably dates back to when the only comfort a doctor could offer was to pick the nits from a patient’s pelt).

So, let’s talk about the difference between signs and symptoms, and in the process let’s try to clear up some misconceptions about arthritis.

A sign is something that an observer (not the patient) can detect through the use of his or her senses. Let’s say some poor old fellow limps into my office complaining about pain in his knees. His limp is a sign (I can see it myself). Once I get his pant legs rolled up, I may see redness and swelling around his knees, I may feel warmth over the joints, I may hear crackling when I gently bend and extend his legs; if I get an Xray I may see abnormalities in the joints, and so forth. These are all signs.

The man’s pain, on the other hand, is a symptom. It is not something I can see, hear, feel, smell, or taste.

So. A symptom is something a person complains about, but it is not discernible to someone else. A sign is something that an observer can detect and often quantify.

With me so far? Good. 

Technically speaking, arthritis is a sign, or a collection of signs.

The term arthritis signifies inflammation in a joint. It’s a matter of definition, in fact. The word arthritis is made up of two Greek roots: arthros or arthron– meaning joint– and itis– meaning inflammation. An inflamed joint is a warm, red, swollen joint. An arthritic joint may look abnormal on Xray. Again, these are all signs, detectable by me, the observer.

All that being said, the symptoms that accompany arthritis are certainly important in making a proper diagnosis and in evaluating the effectiveness of treatment.

If the gentleman in the above example complains of pain in his knees– but I detect no abnormalities when I examine him– he is really suffering from arthralgia (arthron, meaning joint; algia, denoting pain). Arthralgia is a symptom. Yeah, it gets a little anal, but your doctor didn’t get into the healing game because he was blind to detail (I hope). And certain distinctions are important– they’re not invented just to make conversation difficult. A physician or healer is going to take a slightly different approach to the individual with bona fide arthritis. Though arthralgia can be a disabling symptom of arthritis, a truly “hot joint” seems to raise our sense of urgency and demands a more aggressive investigation into its cause.

That’s enough nit picking for one day.

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