Arthritis and Musculoskeletal conditions
Arthritis and Musculoskeletal conditions
Reasons for selection
Lead high rates of morbidity (YLD)
Account for 5% of the BOD in Australia
More than 3 million people (15%) have some form of arthritis
700,000 Australians have osteoporosis in 2011
18% females and 12% males have arthritis
Arthritis is a term used to describe a disorder of one or more joints. Arthritis disorders are part of a broader group of disorders of the muscles and bones called musculoskeletal
Osteoarthritis is one of the most common forms of arthritis. It is characterised by the cartilage being
Juvenile arthritis refers to any form of arthritis that occurs in individuals under the age of 16. As juvenile arthritis encompasses a range of conditions, there are no set symptoms but it is often characterised by swelling, stiffness and pain, which can affect any joint.
Rheumatoid arthritis is an autoimmune disease characterised by inflammation of the joints. The
immune system attacks the tissues lining the joints, resulting in inflammation, pain and swelling.
Osteoporosis (meaning ‘porous bones’) is a disease where bone density deteriorates, leaving the bone weak and more prone to fracture
Determinants that act as risk factors
body weight. Being overweight or obese puts more pressure on joints, which can increase the chances of developing arthritis. Current research also indicates that obesity can increase the risk of osteoporosis.
sex. Females are more likely to develop a musculoskeletal condition including juvenile arthritis. Oestrogen assists in the maintenance of bone mass so post-menopausal women are more at risk of osteoporosis. Although the causes of increased risk of osteoarthritis and rheumatoid arthritis in women have not been conclusively identified, it is believed to be related to hormones, particularly the role of oestrogen.
age. More wear and tear on the bones increases the risk of osteoarthritis. Bone mass decreases with age, which increases the risk of osteoporosis.
genetic predisposition. People with a family history of musculoskeletal conditions are at higher risk of developing them, including juvenile arthritis.
low body weight. People with low body weight generally have smaller bones, which can make the effects of osteoporosis more pronounced. They also lack constant weight bearing down through the bones, which increases the risk of osteoporosis.
Tobacco smoking. Chemicals in tobacco smoke, especially nicotine, can directly harm bone cells. Smokers also tend to have a lower body weight and are usually less active than non-smokers. Smoking may reduce the absorption of calcium and vitamin D, which are both required for building bone mass. Tobacco may also interfere with the action of oestrogen, which assists in the maintenance of bone mass. All of these factors increase the risk of developing osteoporosis.
Excessive alcohol intake. The supply of key nutrients such as calcium and vitamin D may be reduced if excessive amounts of alcohol are consumed. Alcohol in large amounts can also be toxic to bone cells, which can reduce bone density, contributing to osteoporosis.
Physical activity. Excessive weight-bearing activity places continual stress on joints and can hasten the effects of arthritis. On the other hand, moderate levels of weight-bearing exercise can assist in the maintenance of bone mass and prevent osteoporosis.
Poor dietary behaviours. A diet lacking in the nutrients required for hard tissue formation (including calcium, vitamin D and phosphorus), particularly during adolescence, may accelerate or even cause the onset of musculoskeletal conditions (especially osteoporosis). Excessive consumption of sodium can contribute to a loss of calcium from hard tissues, increasing the risk of osteoporosis.
Lack of sun exposure. Vitamin D deficiency is a growing area of concern in Australia and can contribute to reduced bone mineral density and osteoporosis. Vitamin D is found in some foods, including fish and milk, but sun exposure is the primary method of obtaining vitamin D. The elderly (especially those living in residential aged care), those with conditions who must limit sun exposure and people whose clothes cover nearly all of their body are most at risk
Food security. Lack of access to a nutritious food supply may mean a person does not receive adequate amounts of the nutrients required for hard tissue formation, which can lead to osteoporosis.
Socioeconomic status. People of lower socioeconomic status may not have knowledge relating to healthy food intake and the value of regular health care. This can increase the risk of musculoskeletal conditions and impact on treatment of these conditions.
Occupations involving heavy lifting can increase the risk of back problems.
access to recreation facilities. Lack of access to facilities such as parks and gardens can decrease physical activity and contribute to obesity and arthritis. Lack of access to facilities that encourage weight-bearing exercise, such as gymnasiums, may contribute to lower bone density and increased risk of osteoporosis.
transport systems. Transport systems that do not promote active transport may contribute to weight gain and arthritis.
Another aspect of the physical environment that can increase the risk of musculoskeletal conditions is the work environment. Back pain is common as a result of injuries sustained at work. For example, if a workplace has a lot of stairs, the risk of falls and associated back and disc problems can increase.
For the individual, direct costs include:
patient co-payments for doctors’ and specialists’ services. Musculoskeletal conditions must continually be monitored and management plans developed and evaluated by doctors and specialists.
patient co-payments for medicines. Medication is a treatment option for many musculoskeletal conditions.
exercise programs. Exercise is a key part of managing arthritis and musculoskeletal conditions. Fees may be required to access a gym or pool and for the services of a physiotherapist.
ambulance transport. Osteoporosis often leads to fractures, which may require emergency care.
Direct costs for the community include:
Medicare contributions for health services. Medicare covers some of the costs associated with doctors and specialists and all of the fees associated with treatment in public hospitals. Joint replacement surgery may be required for some people experiencing osteoarthritis.
medication. The community bears some of this cost through the Pharmaceutical Benefits Scheme.
prevention programs. The federal government has invested in numerous programs that aim to prevent the onset of musculoskeletal conditions, such as the Better Arthritis and Osteoporosis Care initiative.
Specific examples of indirect costs to the individual include:
loss of income. People experiencing reduced mobility may not be able to work for extended periods, which may reduce their income.
carers and other support. Some people with a musculoskeletal condition may require full-time care or need assistance in carrying out their daily activities. They may have to employ people to assist them with these tasks.
transport costs. Those experiencing limited mobility may no longer be able to drive and may rely on taxis.
Indirect costs to the community include:
social security or welfare payments. Those not working can often access disability payments from the government.
lost productivity. Employees with arthritis may not be able to work, which can reduce the productivity of their employer. The employer may have to pay sick leave, which can impact on the employer’s financial position.
Other intangible costs to the individual include:
anxiety over the prospect of falls and fractures. Osteoporosis increases the frequency of falls and probability of fractures.
missing out on social experiences due to reduced mobility. This impacts on social and mental health.
not being able to exercise due to physical limitations. Exercise can be difficult for those with arthritis or osteoporosis. This can further impact on physical, social and mental wellbeing.
loss of self-esteem due to the inability to perform tasks. Those experiencing a musculoskeletal condition may not be able to perform tasks that they previously could such as cleaning the house, playing sport and attending work. Self-esteem can suffer if the individual has to depend on others.
The community includes friends and relatives of those with musculoskeletal conditions, and they may also experience intangible costs. For example:
they may provide care for the sufferer, which can be time consuming and can contribute to missed social experiences.
friends and relatives may worry that elderly sufferers may have falls and experience fractures, especially if they live alone.
Health Promotion Program
Bone Health for Life
What: is an initiative co-ordinated by Jean Hailes for Women’s Health, a non-government and not-for-profit organisation that works to promote health of women in Australia.
Who: Jean Hailes
Where: Australia wide
How: Experts, websites, fact sheets
Why: provide practical advice for women and their health professionals relating to achieving and maintaining healthy bones.