Arthritis & musculoskeletal disorders
National Health Priority Areas background paper

Page content: What is Arthritis? | Size of the problem | Historical trends | International comparisons | Projections | Special populations | Evidence-based interventions | Risk factors | Comorbidities | Reference

What is Arthritis?

• "Arthritis" is a term used to refer to the many disorders of one or more joints. Arthritis disorders are part of a broader group of disorders of the muscles and bones called musculoskeletal disorders. Three of the most commonly occurring musculoskeletal conditions are osteoarthritis, rheumatoid arthritis and osteoporosis.

• Osteoarthritis is one of the most common types of arthritis. Osteoarthritis affects the cartilage in the joints. Cartilage cushions the ends of bones, where bones meet to form a joint. In osteoarthritis this cartilage degenerates. Osteoarthritis is most commonly found in the knees, neck, lower back, hip and fingers.

• Rheumatoid arthritis is the most common form of inflammatory arthritis. Inflammatory arthritis is characterised by joint swelling and destruction. In rheumatoid arthritis the immune system attacks the tissues lining the joints. As a result of this attack, inflammation occurs causing pain, heat and swelling. Juvenile rheumatoid arthritis occurs in children. The disease resembles adult rheumatoid arthritis in most respects, but may also have some distinctive patterns, including fever, rash and enlarged spleen, particularly in the systemic form.

• Osteoporosis is not a form of arthritis but is another type of musculoskeletal disorder. Osteoporosis is characterised by bones becoming fragile and breaking easily due to a loss of calcium.

Size of the problem

• Osteoarthritis in Victoria:
  • incidence about 10,000 persons per yea
  • prevalence 150,000 persons
  • burden 15,000 Disability Adjusted Life Years (DALYs)
  • the tenth most frequently managed problem managed by GPs
• Rheumatoid arthritis in Victoria:
  • incidence about 1,000 persons per year
• prevalence 15,000 persons
• burden 3,500 Disability Adjusted Life Years (DALYs)
• Osteoporosis in Victoria:
  • incidence 3,500 per year
• prevalence 40,000 persons
• burden 700 Disability Adjusted Life Years (DALYs) largely due to fractures of the hip, vertebrae and wrist

Historical trends

• Hospital separations for osteoarthritis in Australia have increased by 42% over 7 years, from 39,186 in 1993-94 to 55,758 in 1999-00.

• Hospital separations for rheumatoid arthritis declined over the same 7-year period from 6,179 to 5,135.

International comparisons

• The international experience in relation to arthritis has been similar to the Australian experience.

• In the US, over 43 million people (16.1% of the population) had some form of arthritis in 1997.

• In Canada, approximately 14.2% of those aged 20 years and over have some form of arthritis.

• More than seven million adults (15% of the population) in the UK have some form of arthritis or related condition

• In Australia, the ABS 1995 National Health Survey found that 2.7 million Australians (nearly 15% of the population) suffered from some form of arthritis, with about 60% of these being females.

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Projections

• The age-standardised DALY rates for arthritis and musculoskeletal disorders is projected to remain unchanged from 1996 to 2016

• Due to the ageing population the size of the burden due to arthritis and musculoskeletal disorders is projected to increase relative to other conditions (from the 10th largest to the 8th largest Major Disease and Injury Group from 1996 to 2016 in males, unchanged in females)

Special populations

Arthritis and musculoskeletal conditions prevalence is higher in:

• Older age-groups:
  • The prevalence of osteoarthritis, rheumatoid arthritis and osteoporosis increases sharply with age
• Females:
  • The prevalence of osteoarthritis, rheumatoid arthritis and osteoporosis is greater in females at all ages above 45 years; by age 65, nearly 30% of females and 18% of males report having osteoarthritis

Evidence-based interventions

• Interventions targeted to the avoidance of joint trauma, preventing obesity and modifying occupational joint stress through ergonomic approaches can all help prevent osteoarthritis

• Studies of self-management interventions have found that education programs provide significant improvements in outcomes for arthritis patients in comparison to anti-inflammatory drug treatment alone

• Anti-inflammatory drugs (such as COX-2 inhibitors, available for the first time in the 1990s) have advantages over pure analgesic agents in relieving pain in osteoarthritis

• Glucosamine sulfate has been shown to retard progression of symptomatic knee osteoarthritis

• Weight loss, strength training and exercise to strengthen bones and muscles can provide relief for many osteoarthritis sufferers and delay progression of the disorder

• Early diagnosis and aggressive treatment with anti-rheumatic drugs (particularly the new range of monoclonal antibodies) can significantly improve outcomes for rheumatoid arthritis

• Finally, if all else fails, total joint replacements are now among the most cost-effective interventions in medicine and significantly improve the quality of life in patients with osteoarthritis or rheumatoid arthritis

Risk factors

1. Downstream (biomedical/physiological)
   • Osteoporosis: loss of bone density due to ageing; oestrogen deficiency following menopause
   • Rheumatoid arthritis: aetiology uncertain but probably due to interaction between genetic and environmental factors (possibly involving a virus or bacterium)
2. Midstream (individual/demographic/behavioural)
   • Behavioural:
   • Osteoarthritis: physical inactivity; excess weight; occupational/sports environment;
   • Osteoporosis: poor diet; physical inactivity; tobacco use; alcohol misuse
3. Upstream (physical/social environmental conditions; broader determinants of health)
   • Social capital
   • Civic engagement
   • Income inequality
   • Government policies

Comorbidities

Osteoarthritis:

• prior inflammatory joint disease (e.g. gout, rheumatoid arthritis);
• cardiovascular disease;
• type 2 diabetes (due to common risk factors obesity, physical inactivity);

Rheumatoid arthritis:

• respiratory and infectious disease;
• gastrointestinal disorders;
• non-Hodgkin's lymphoma;
• depression

Osteoporosis:

• chronic liver disease;
• chronic renal disease;
• rheumatoid arthritis;
• hyperparathyroidism and hypogonadism

Reference

National Action Plan 2004-2005 for Arthritis and Musculoskeletal Conditions (National Health Priority Action Council, May 2004)

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