Differences between -itis vs -otis in musculoskeletal conditions

1. “-itis” refers to inflammation, which is the body’s natural immune response to injury, infection, or irritation. Inflammation is typically characterised by the classic signs of pain, heat, redness, swelling, and loss of function. The inflammatory process is a protective mechanism intended to remove harmful stimuli and initiate the healing process.
2. “-osis” refers to degeneration or chronic, non-inflammatory changes in tissue, often associated with wear-and-tear, ageing, or prolonged overuse. Unlike “-itis,” “-osis” does not involve the acute inflammatory markers but is instead characterised by tissue degeneration, thickening, or structural alteration. This degeneration leads to a gradual decline in function and strength over time.

• Injury or trauma: Acute injuries like strains, sprains, or fractures may cause localised inflammation.
• Infection: Bacterial, viral, or fungal infections can result in inflammatory responses, as seen in conditions such as pneumonia or cellulitis.
• Autoimmune diseases: Conditions like rheumatoid arthritis are marked by inappropriate immune responses that attack the body’s own tissues, resulting in inflammation.
• Allergic reactions or irritants: Exposure to allergens or irritants can cause an inflammatory response, as seen in allergic rhinitis or contact dermatitis.

• Ageing: Degenerative changes are common as the body ages, with tissues losing their ability to repair themselves as effectively. Osteoarthritis and tendinosis are classic examples of age-related degeneration.
• Overuse or repetitive strain: Repeated microtrauma to a particular tissue without adequate recovery time can lead to degeneration. Tendinosis is often seen in athletes or workers performing repetitive motions.
• Genetic predisposition: Some degenerative conditions, such as osteoarthritis, may have a genetic component that accelerates the degradation of tissues like cartilage.
• Metabolic or systemic disorders: Conditions like diabetes can affect tissue health and lead to degeneration, as impaired circulation or inflammation may exacerbate structural breakdown.

1. Treating degenerative conditions with anti-inflammatories: In cases of “-osis,” where there is minimal or no active inflammation, prescribing anti-inflammatory medications like NSAIDs or corticosteroids may not address the underlying degeneration. For example, tendinosis, a degenerative condition of the tendons, may be mistakenly treated as tendinitis (inflammation of the tendons), delaying appropriate therapy like loading exercises and rehabilitation.
2. Confusing acute inflammation with chronic degeneration: The signs of acute inflammation (pain, swelling, heat) may sometimes mask the underlying degenerative changes. For instance, a patient with osteoarthritis (a degenerative joint condition) may experience occasional inflammatory flare-ups, leading clinicians to focus solely on inflammation while neglecting long-term management of degeneration.
3. Misidentifying pain patterns: Pain from degenerative conditions like “-osis” tends to be more gradual and dull, often increasing with activity. In contrast, inflammatory pain associated with “-itis” is usually more acute and intense. Failure to correctly identify the type of pain can lead to incorrect diagnoses and treatment approaches.

1. Tendinitis: Tendinitis is the acute inflammation of a tendon, often caused by sudden injury or repetitive strain. The inflammation is typically localised, and symptoms include pain, swelling, and tenderness over the tendon. Common forms include Achilles tendinitis (affecting the Achilles tendon) and rotator cuff tendinitis (inflammation of the tendons in the shoulder).
2. Bursitis: Bursitis is the inflammation of the bursa, a small fluid-filled sac that cushions bones and tendons. Overuse, injury, or infection can cause bursitis. Commonly affected areas include the shoulder, elbow (olecranon bursitis), and hip.
3. Appendicitis: This is the inflammation of the appendix, often caused by obstruction or infection. It is an acute medical condition that requires prompt surgical intervention.

1. Tendinosis: Tendinosis is a chronic degenerative condition of the tendon that occurs due to overuse or ageing. It involves the breakdown of collagen in the tendon without significant inflammation. Unlike tendinitis, tendinosis is a long-term problem characterised by a dull ache, stiffness, and reduced strength. Achilles tendinosis is a common example.
2. Osteoarthritis: Osteoarthritis (OA) is a degenerative joint disease characterised by the gradual breakdown of cartilage, leading to joint pain, stiffness, and reduced mobility. OA is commonly seen in older adults and is considered a classic degenerative condition rather than an inflammatory one.
3. Spondylosis: Spondylosis refers to degenerative changes in the spine, particularly the intervertebral discs and facet joints. It is a common cause of back pain in older adults and is associated with stiffness, reduced flexibility, and changes in the spinal structure.