To the Editor,
Ohliger et al. reviewed surgical options for the treatment of arthritis at the first carpometacarpal joint.1 In their article, they used terms such as “early arthrosis”, “early-stage arthritis”, “moderate to advanced arthritis”, and “advanced arthrosis”. A couple of questions arise. Do the authors propose that arthritis and arthrosis are synonymous? What constitutes “early” vs “moderate to advanced” vs “advanced” arthritis/arthrosis? The authors refer to the Eaton classification without elaboration. Kennedy et al. reported that studies have shown poor correlation between the Eaton-Littler stage and symptom severity.2 They characterized it as having limited clinical utility. Perhaps Ohliger et al. can provide additional comments.
Stuart H. Kuschner, MD
Cedars-Sinai Medical Center, Los Angeles, California
8635 W 3rd St, suite 990W
Stuart.kuschner@cshs.org
In Reply
Dear Dr Kuschner,
Thank you for your letter. As you point out, the distinction between the terms arthritis and arthrosis is often poorly defined and lacks consensus. Personally, I view the terms not necessarily as “synonymous” but more as a Venn diagram where arthritis purely encompasses inflammatory conditions and arthrosis purely encompasses degenerative conditions. I also believe there is some overlap, as would be the case with repetitive abrasive surfaces that have an element of both degeneration and inflammation.
I also agree with you about the utility of the Eaton Classification for Radiographs in that the severity of the class does not necessarily correlate with subjective symptoms. However, for symptomatic patients, I still find it useful for organizing treatment plans.
Richard J. Tosti, M.D.
Hand, Wrist, Elbow, and Microvascular Surgeon
Rothman Orthopaedics
Associate Professor of Orthopaedic Surgery
Associate Hand Surgery Fellowship Director
Richard.Tosti@rothmanortho.com