In 1923, in a symposium of the Royal Society of Medicine, Sir Archibald Edward Garrod (son of Sir Alfred Baring Garrod), “discussed the fact that several diseases were lumped together as rheumatoid arthritis and said that he was ‘fully aware of its shortcomings …. but this in turn has lost its utility and might be superseded by a better name.’”3 There followed a discussion among the participants where many suggestions were made, and Kerr Pringle said that the term was “‘a scrapheap for undiagnosed articular affections’ and suggested four forms, while other speakers divided it into six.” Yet, the British Ministry of Health formally accepted the term “rheumatoid arthritis,” and in 1941, the American Rheumatism Association replaced “atrophic arthritis” with “rheumatoid arthritis.”4 Since then, RA has been used for 90 years unquestioned, even if “arthritis deformans” seems more disease descriptive—or consider “pannus arthritis.” May I submit, most humbly, for a relook by the powers that be, namely, the International Classification of Diseases, Tenth Revision (ICD-10), ACR, EULAR, ILAR, and APLAR?5,6
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Explore This IssueOctober 2012
As another example, the word “podagra” was rechristened “gout.” To this humble rheumatologist, both seem just perfect, short to read, easy to spell, easy to pronounce, and more or less clearly understood by patients the world over. “Gout” sounds cute.
A few other diseases have also been delightfully coined: hypermobility syndrome, tennis elbow or golfer’s elbow, hemophilic arthritis, amyloidosis, reactive arthritis, polymyalgia rheumatica, polymyositis, dermatomyositis, scleroderma, back-pocket sciatica, frozen shoulder, jumper’s knee, carpal tunnel syndrome, traveller’s ankle, erythema nodosum, and psoriatic arthropathy. As against these, we have a few gruesome and complex terms that need to be reviewed: chondrocalcinosis articularis, pseudoxanthoma elasticum, macrodystrophia lipomatosa, and anticardiolipin or antiphospholipid syndrome, with its own confusing and controversial misnomer, “lupus anticoagulant.” And what of “mixed connective tissue disease” (MCTD), which replaced overlap syndrome? The former is supposed to have elements of SLE, RA, dermatomyositis, and scleroderma, all or some of them in varying proportions at different stages. No wonder many young rheumatologists and patients get “mixed up” about MCTD. And what of overlap syndrome?7 The late Professor Eric Bywaters, in one of his erudite presentations, made fun of MCTD and overlap syndrome and, I remember, he said, “If we don’t understand a complex rheumatic disorder or a mixture of disorders, we simply put it in somebody else’s laps as overlap syndrome.” Will ICD please elucidate?
In pediatric rheumatology we have seen different names from time to time, more or less for the same disease: e.g., juvenile rheumatoid arthritis and juvenile chronic arthritis on the left and right side of the Atlantic on the map, finally giving way to juvenile idiopathic arthritis (JIA). Again, to quote Bywaters: “Chronic juvenile polyarthritis is a wide term, Still’s disease is an historical term, juvenile rheumatoid arthritis an exact but misleading term.”8 The current term JIA, rather apologetic, may be in for revision in times to come.