Osteoarthritis is a well-accepted diagnosis among physicians for a painful and stiff joint, but the other day I spoke with a rheumatologist who has a very different take on how to characterize these symptoms.

Dr. Nortin M. Hadler, a professor of medicine at the University of North Carolina, Chapel Hill, insisted on calling the condition “regional joint pain.” Calling it osteoarthritis reflected the over-medicalization that modern industrialized society imposes on ubiquitous conditions that shouldn’t really qualify as bona fide disorders, he said.

Dr. Hadler’s contention is that having a joint or two grow painful and less functional over the course of more than half a lifetime was inevitable for most people, as unavoidable as “headache and heartache,” he told me. “There is no person after midlife who does not have substantial regional joint pain,” and the older they get the more this colors their life. “It is abnormal [for a middle-aged or elderly person] to go a year without important back pain, or to go 3 years without important knee pain,” he said.

Dr. Hadler added that when people seek out medical care for such routine aches and pains of aging, there is really something else going on in the patient’s life. “The regional disorder can be viewed as a surrogate complaint,” he said. A patient might say “My knee is hurting,” but the reality is that their complaint reflects a broader difficulty they’re having.

He described a study he ran that compared two sets of similar elderly people with the same complaint of knee pain. One group had sought medical care, the other hadn’t. What also distinguished the two groups were their levels of loneliness and depression, which were both higher among those who went to see a physician, he said.

Removing osteoarthritis from the category of pathology and reclassifying it as a more benign and routine part of aging would, no doubt, come as a surprise to many physicians who specialize in studying and treating it.  Last September, I covered the annual meeting of the Osteoarthritis Reasearch Society International (OARSI) and, in counterpoint to Dr. Hadler’s contention, this meeting was attended by hundreds of experts and specialists who would be happy to detail the pathophysiologic processes that appear to define osteoarthritis. Back then, I posted an