Reducing the Impact of Musculoskeletal Conditions: It’s Time to Act
“Arthritis affects people of all ages and is not just a normal part of aging.”
Musculoskeletal conditions are the leading cause of disability in developed countries worldwide and a serious threat to overall health due to their impact on mobility and physical activity. Arthritis is the most common of these conditions resulting in significant pain, limited mobility, disability, lost play and work productivity, and reduced physical activity and quality of life. One in six adult Canadians has arthritis; this will double by 2016 to more than 7.5 million people. Arthritis costs our economy more than $33 billion a year.
Reducing the burden of arthritis requires a multi-pronged approach.
Prevention
Many of the risk factors are known for some types of arthritis. About 50 percent of people with knee injuries will develop osteoarthritis (OA) within five to ten years, even if they were only a teenager at the time of injury. The FIFA11+ program has been shown to reduce these injuries in youth soccer players. Successfully implemented in Ontario, national implementation is in progress. However, similar programs need to be developed and implemented more broadly in schools and in other sports such as basketball where these injuries are common.
High loads of stress on joints contributes to symptomatic knee OA and other types of arthritis. Weight control throughout the life course will significantly limit loads on the joints.
Awareness and early detection
Arthritis affects people of all ages and is not just a normal part of aging! Painful or swollen joints in childhood, teens, early or even late adulthood isn’t normal. Research has shown that early diagnosis and treatment with disease modifying drugs greatly reduces disease activity, limiting pain and disability for people with inflammatory arthritis (e.g. rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis). While further research is required to understand the cause of inflamma- tory arthritis, critical work is underway to identify people even earlier through genetics so that treatment can be optimized.
Tackling management and improving access to care
Wait times for total joint replacement (TJR) and models of care to improve early diagnosis and treatment for people with inflammatory arthritis have received much attention in the last decade. Much less attention has been paid to people with mild to moderate OA symptoms, where evidence shows that education, targeted exercise and supported self-management are highly effective in reducing symptoms and improving activity.
Several countries have implemented programs for people with OA. The few programs that exist in Canada include only general exercise and are often restricted to people 60 years or older. There is an opportunity to provide programs and increase access through linkages between the wellness and health care sectors. Understanding issues around implementation, how best to ensure people are doing the right exercises in the right way and that they can be incorporated into daily life, in the evaluation of cost effectiveness and evaluation of issues related to and sustainability are key areas for study in the context of delivery in the wellness sector.
While TJR is an effective option for people with moderate to severe OA, we need to understand why 10 to 20 percent of people do not benefit. Additionally, with more people diagnosed with OA, continued attention is required to ensure timely access to TJR and to determine the optimal timing of the surgery to ensure its maximum benefit.
We’re up for the challenge!
We‘ve made significant progress in understanding these musculoskeletal conditions and how to treat them, but increasing awareness for prevention and early management are critical first steps as we work to understand the cause, most beneficial treatments and the best ways to deliver care over the longer term.