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What are arthritis and musculoskeletal conditions?
Arthritis is a group of musculoskeletal conditions in which there is inflammation of the joints, causing pain, stiffness, disability and deformity. Other joint problems and disorders of the bones, muscles and their attachments to each other are covered under the rubric of musculoskeletal conditions.
There are more than 100 forms of arthritis and musculoskeletal conditions, which include fractures, other injuries due to trauma and various forms of arthritis. The focus of the NHPA initiative is on osteoarthritis, rheumatoid arthritis and osteoporosis.
Osteoarthritis
Osteoarthritis is one of the most common forms of arthritis. It is a degenerative condition that is caused mainly by accumulated wear of the cartilage. Cartilage cushions the ends of bones where they meet to form a joint. As the cartilage degenerates, the normal function of the joint is disrupted causing pain. The disease affects mainly the hands, spine and weight-bearing joints such as the hips, knees and ankles.
- Osteoarthritis affects more than 1.6 million Australians. Osteoarthritis is a major cause of disability, psychological distress and poor quality of life. (Australia's health 2010 pages: 186-190, June 2010)
- Osteoarthritis most commonly develops between the ages of 45 to 90 years. Females are more commonly affected than males. (Australia's health 2010 pages: 186-190, June 2010)
- In 2007-08 there were 86,000 hospitalisations with osteoarthritis as the principle diagnosis, 26% of the hospitalisations involved a total knee replacement. (Australia's health 2010 pages: 190-192, June 2010)
Rheumatoid arthritis
Rheumatoid arthritis is a chronic inflammatory disease that mainly affects the joints and is characterised by joint swelling and destruction. It is an autoimmune disease in which the immune system attacks the tissues lining the joints. The inflamed joints often cause pain, heat and swelling. Rheumatoid arthritis most often affects the hand joints and commonly produces deformities.
- Rheumatoid arthritis is an often serious joint disease that affects around 400,000 Australians and is the second most common type of arthritis, after osteoarthritis. The disease is more common among females and in older age groups. (A picture of rheumatoid arthritis in Australia pages: 1-3, March 2009)
- The disease is more common in females (2.4%) than males (1.5%) and this applies across almost all age groups. Females also tend to develop the disease at an earlier age than males. The disease onset occurs most often in the age groups between 35 to 64 years. (A picture of rheumatoid arthritis in Australia pages: 8-9, March 2009)
Osteoporosis
Osteoporosis meaning "porous bones" is a musculoskeletal disorder where the bone density thins and weakens, resulting in an increased risk of fracture. The most common sites of fracture are the bones of the spine, the hip and the wrist. However other bones are also affected, including the shoulder, ribs and the pelvis.
- Information from the 2007-08 NHS suggests that almost 700,000 Australians (3%) have been diagnosed with osteoporosis. Most of these cases occur after the age of 55, and 82% of those reporting a diagnosis of the condition are females. (Australia's health 2010 pages: 188-190, June 2010)
- Osteoporosis occurs more frequently in older persons as the bone tissue is progressively lost with ageing. Osteoporosis is more common in females as after menopause there is a sharp decline in the female hormone oestrogen, which plays a vital role in maintaining bone mass density. This decrease in the production of oestrogen accelerates calcium loss in bones.
Why do arthritis and musculoskeletal conditions constitute a National Health Priority Area?
Arthritis and musculoskeletal conditions are highly prevalent and large contributors to illness, pain and disability. They place a significant burden on the community, both economic and personal, including the use of hospital and primary care services, disruptions to daily life and lost productivity through disability.
In view of this high burden, arthritis and musculoskeletal conditions were declared a National Health Priority Area in July 2002. The initial focus in this priority area is on osteoarthritis, rheumatoid arthritis and osteoporosis, as these three conditions are the most prevalent forms of musculoskeletal disease within Australia and have been found to place a high burden on the community.
Based on self-reports in the 2007-08 NHS, more than 6.3 million Australians (31%) have arthritis or some other musculoskeletal condition. Arthritis affects over 3.1 million people (15%), with osteoarthritis (1.6 million; 8%) being the most common type. Rheumatoid arthritis, the next most common type, is estimated to affect 429,000 Australians (2%). Both of these conditions are more common among females than males. The prevalence of rheumatoid arthritis is highest among those aged 65-74 years, whereas the prevalence of osteoarthritis increases with age, Back pain, back problems and disc disorders are also very common in Australia, affecting around 2.8 million people (14%). These problems are most prevalent among those aged 55-64 years, and are more commonly reported by males. (Australia's health 2010 pages: 186-190, June 2010)
Arthritis and musculoskeletal conditions were estimated to account for 4% of the disease burden in Australia in 2007-08, in terms of disability-adjusted life years (DALYs). Musculoskeletal conditions were the fourth most commonly managed problem by GPs in 2007-08, accounting for 11.4% of all problems managed. (Australia's health 2010 pages: 190-192, June 2010)
Arthritis and musculoskeletal conditions are estimated to account for only 0.6% of Australia's YLL in 2010. However, they are estimated to be responsible for 7.7% of Australia's YLD. Including both deaths and disability, measured in terms of DALYs, they are expected to account for around 4% of the national disease burden in 2010. (Australia's health 2010 pages: 189-192, June 2010)
Arthritis and musculoskeletal conditions are a major cause of health expenditure. In 2004-05, they accounted for a total of $4.0 billion in direct expenditure in Australia, the third largest set of disease costs. This expenditure includes hospital admitted patient services, out-of-hospital medical services, prescription pharmaceuticals and research. (A snapshot of arthritis in Australia 2010 pages: 12-14, October 2010)
Osteoarthritis accounted for about 30% of this expenditure ($1.2 billion), while $175 million was spent on rheumatoid arthritis. The main component of health expenditure for osteoarthritis was admitted patient services at $898 million, a major portion of which is attributable to joint replacements. In contrast, more than half ($92 million) of the expenditure for rheumatoid arthritis was on medicines. (A snapshot of arthritis in Australia 2010 pages: 12-14, October 2010)