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Report Measures Impact of Knee Conditions
November 11, 2003
Patients who suffer from osteoarthritis and rheumatoid arthritis understand all too well the affect that those conditions have on their lives. Thanks to the World Health Organization and the Bone and Joint Decade, the rest of the world may soon begin to catch on. The WHO, in collaboration with BJD, recently released a report detailing the personal and economic impact of five musculoskeletal conditions: osteoarthritis, rheumatoid arthritis, osteoporosis, spinal disorders and severe limb trauma. The report describes each condition, details its economic impact, and documents its prevalence by sex, age and world region.
Here are just a few facts about the impact of musculoskeletal disorders:
There are more than 150 musculoskeletal conditions, and they are the most frequent cause of disability worldwide.
These disorders cost the United States $254 billion a year.
In the U.S., bone, joint and muscle conditions lead to 131 million patient/doctor visits every year.
An estimated 40 percent of seniors over age 70 suffer from osteoarthritis of the knee.
More than half of patients with rheumatoid arthritis must completely stop working within a decade of the disease’s onset.
One quarter of patients with osteoarthritis cannont perform major life functions.
The report repeatedly stresses, however, that more research is needed to determine the impact of bone and joint disorders. It’s not always clear how many people have a given condition and how it affects their lives. Studies in different countries may use different methodologies, and therefore comparisons between them are not useful. Health care systems in developing countries are structured differently than those in the developed world, the authors note, which makes measurements even more difficult.
Furthermore, "The economic value of lost productivity differs from country to country in relation to the overall employment rate (especially among women), the wage level and expected social roles," the report states when describing the impact of rheumatoid arthritis, adding: "There is a need for a simple indicator that could be universally used."
What is the Bone and Joint Decade?
This report is one part of a comprehensive campaign to put bone and joint disorders on the world agenda.
On Nov. 30, 1999, when the United Nations endorsed the first decade of the 21st century as the Bone and Joint Decade, UN Secretary General Kofi Annan spoke about the affect of bone and joint disease on individuals and communities around the world:
"There are effective ways to prevent and treat these disabling disorders, but we must act now," Annan said. "Joint diseases, back complaints, osteoporosis and limb trauma resulting from accidents have an enormous impact on individuals and societies, and on healthcare services and economies."
A few months later, the WHO formally launched the BJD, an organization that aims to improve the health-related quality of life for individuals around the world who suffer from musculoskeletal conditions. This report is only one of BJD’s projects; for more information on the organizaton’s activities, visit www.bonejointdecade.org.
The report’s results: Osteoarthritis
What is it and who gets it?
Osteoarthritis is a weakening of cartilage caused by injury or overuse. Cartilage helps the joints move freely, and osteoarthritis can cause stiffening, pain and a loss of range of motion. It most commonly affects the knees, ankles and fingers.
Exactly who has osteoarthritis can be hard to define, however, so estimating the worldwide incidence of the condition is difficult. The WHO Scientific Group that compiled the report estimated that about 10 percent of people over age 60 worldwide have significant problems resulting from osteoarthritic damage, but that number is currently unverifiable. Women are more likely than men to suffer from this condition, and it is more common in older people. Almost 60 percent of women age 85 and over report ostearthritis. While data is mostly available for the developed world, the report says that indirect evidence suggests a worldwide problem.
The fact that osteoarthritis is hard to define means that its costs are hard to define as well. Costs include those related to the health care system—like doctor’s visits—and personal costs related to the disease. Loss of work is less relevant because most people with osteoarthritis are of retirement age.
In Australia, where the best data seem to be available, the Australian Insitute of Health and Welfare estimated that $624 million (in Australian dollars) was spent on the condition in 1993-4; that’s about one-fifth of the total money spent on musculoskeletal disorders.
One study, also in Australia, required participants to list every cost relating to their condition for a 12-month period. The patients spent from $0 to over AUS$2000. Women spent more than men, even at the same level of the disease.
The report’s results: Rheumatoid Arthritis
What is it and who gets it?
Doctors believe that rheumatoid arthritis is triggered by an autoimmune reaction. Certain cells in the body are mistakenly believed to be foreign, and the immune system starts attacking them. RA is a chronic condition, but symptoms—swelling and pain—sometimes come in waves.
No one knows exactly what causes RA, but women between the ages of 20 and 50 are particularly susceptible, as are Native Americans. A family history of arthritis or autoimmune disease is also a risk factor for developing RA.
Rheumatoid arthritis can have a dramatic affect on a patient’s quality of life. Most patients find that their work capacity is diminished within five years of the disease’s onset.
The difficulty of measuring impact
It is hard to come up with a number that shows how much people suffer and how much money is lost because of RA.
The number of hospital visits is sometimes a good indicator of a condition’s impact, but treatment for RA often takes place outside of a hospital. Mortality rates can also be useful, but more than half of the death certificates of RA patients do not even mention the disease.
Rheumatoid arthritis can hasten death, but it does not usually cause it. "Patients with rheumatoid arthritis die of the same causes as the general population, but at an earlier age," the report states. Some studies have found that RA patients have higher death rates from cardiovascular disease, infection and renal disease.
More research is needed to fully determine the impact of rheumatoid arthritis.
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