Burden of arthritis in Australia Naila Rahman and Kuldeep Bhatia

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Burden of arthritis in Australia
Naila Rahman and Kuldeep Bhatia
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Why burden?

• Highly prevalent
• Illness and pain
• Associated disability
• Extensive health care needs
• High cost
• National Health Priority Area (NHPA)

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How many people?
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What is arthritis?

• A group of disorders in which there is
  inflammation of the joints, which can become
  stiff, painful, swollen or deformed
• Diverse group of diseases
• Varied causal mechanisms
• Multiple risk factors

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Types of arthritis

• More than 100 types
• Infectious arthropathies
• Inflammatory polyarthropathies (rheumatoid,
  Stills disease, psoriatic, gout)
• Arthrosis (osteoarthritis)
• Other joint disorders

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Common types

• Osteoarthritis
• (Prevalence 1.5 million)
• Rheumatoid arthritis
• (Prevalence 491,000)

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Osteoarthritis

• Painful, degenerative joint disease
• Thins or wears away cartilage
• Hips, knees, lower back involved often
• Inflammation, reduced joint flexibility
• Increasing weight
• 45 and over
• Both sexes

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Cartilage destruction in osteoarthritis
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Osteoarthritis

• Painful, degenerative joint disease
• Thins or wears away cartilage
• Hips, knees, lower back involved often
• Inflammation, reduced joint flexibility
• Increasing weight
• 45 and over
• Both sexes

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Osteoarthritis prevalence, 2004
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Rheumatoid arthritis

• Autoimmune, HLA-DR4 associated
• Systemic, inflammatory disease
• Multiple joints, symmetrically
• Pain, swelling, deformity
• Reduced movement and function
• Onset 25-50 years
• Juvenile rheumatoid arthritis
• Females

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RA deformities
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Rheumatoid arthritis

• Autoimmune, HLA-DR4 associated
• Systemic, inflammatory disease
• Multiple joints, symmetrically
• Pain, swelling, deformity
• Reduced movement and function
• Onset 25-50 years
• Juvenile rheumatoid arthritis
• Females

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Prevalence of RA, 2001
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Impacts

• Psychological impact
• Quality of life
• Self-perception of health
• Co-morbidities

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Associated disability, 2003
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Restrictions

• Core-activity restriction
• self-care
• mobility
• Employment restrictions
• Social participation
• Profound/ severe

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My presentation

• Treatment and management
• GP and specialist consultations
• Surgical interventions
• Non-surgical interventions
• Pharmaceuticals
• Patient education and self-management
• Expenditure

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Treatment and management

• No cure
• Focus
• Controlling pain
• Improving or preserving function
• Delaying, slowing or stopping joint degeneration
• Improving the quality of life

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Use of health services

• GPs
• Specialists
• Hospital care including surgery
• Allied health practitioners
• Help in the home (formal or informal)
• Residential care

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GP consultations

• Almost 4 of GP encounters
• Annual consultations 3.7 million
• 2.5 million for osteoarthritis(Prevalence 1.5
  million)
• 417K for rheumatoid arthritis(Prevalence
  491,000)
• 800K for other arthropathies(Prevalence 1
  million)

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Hospital-based services

• 86,800 separations (200405)
• 81 for osteoarthritis
• 6 for rheumatoid arthritis
• 87 - surgical procedure
• Knee and hip replacements
• Arthroscopy
• 67 - non-surgical intervention
• Allied health
• Non-invasive
• Corticosteroid injections

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Knee and hip replacements

• Cost-effective intervention in cases unresponsive
  to other interventions
• Alleviates pain, improves function and quality of
  life
• Principal diagnosis osteoarthritis
• 90 of total hip replacements
• 95 of total knee replacements
• Number of replacements increasing

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Use of pharmaceuticals

• Analgesics and opioids
• Non-steroidal anti-inflammatory drugs (NSAIDs)
• Disease-modifying anti-rheumatic drugs (DMARDs)
• COX-2 inhibitors
• Topical treatments
• Corticosteroid and hyaluronic acid injections
• Complementary medicines
• glucosamine and chondroitin

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Health expenditure

• AMSC 4.6 billion in 200001
• Third largest contributor
• Osteoarthritis 1.2 billion (25)
• Rheumatoid arthritis 246 million (5)
• Major components
• Hospital services
• residential care, and
• pharmaceuticals

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To summarise

• Arthritis is a common, often debilitating disease
• A major cause of pain and disability
• Significant contributor to health service use and
  direct health expenditure
• No cure, but effective treatment and management
  can reduce its effects and improve quality of life