Executive summary: Life with arthritis in Canada: a personal and public health challenge

Executive Summary

“Arthritis” is used to describe more than 100 rheumatic diseases and conditions that affect a joint or joints, causing pain, swelling and stiffness which often lead to disability. It is one of the most prevalent chronic health conditions in Canada and is a major cause of disability and health care utilization.

This report, Life with Arthritis in Canada: A personal and public challenge is the second national surveillance report on arthritis. Using the most recent data sources available, it provides an overview of arthritis in the Canadian population and its wide-ranging impact. It also suggests approaches for reducing the risk of developing some types of arthritis (osteoarthritis and gout) in addition to minimizing disability and improving the quality of life of those living with any type of arthritis.

In 2007-2008, over 4.2 million Canadians (16%) aged 15 years and older reported that they had arthritis. With the aging population, this number is expected to increase to approximately 7 million (20%) in 2031. Arthritis was the second and third most common chronic condition reported by women and men, respectively. Overall, nearly two-thirds (64%) of those affected with arthritis were women. Nearly three in five people with arthritis were aged under 65 years.

Arthritis can have a major impact on individuals and families, with many individuals reporting fair or poor general and mental health, needing help with daily activities in addition to limitations in work, community, social and civic life. On average, over a quarter of men and women with arthritis between 25 and 44 years of age were not in the labour force because of their arthritis.

Even though physical activity is very important in the prevention and management of arthritis, in 2007-2008 a higher proportion of individuals with arthritis were physically inactive during their leisure time compared to those without arthritis (59% and 49%, respectively). Furthermore, 63% of Canadians aged 18 years and over with arthritis were overweight or obese compared to 49% of those without arthritis.

While deaths from arthritis are uncommon, in 2005, 777 women and 296 men in Canada died from an arthritis condition: rheumatoid arthritis, systemic lupus erythematosus and other connective tissue diseases accounted for approximately 60% of all arthritis deaths. Two fifths (40%) of people who died from arthritis died prematurely (before the age of 75 years) which is similar to the percentage of Canadians who died prematurely of all causes (39%).

The economic burden of arthritis in Canada was estimated to be 6.4 billion dollars in 2000 — over one quarter (29%) of the total cost of musculoskeletal diseases. Of the total arthritis-related costs, the greatest impact is due to the indirect costs ($4.3 billion) which consists of the lost production attributable to long-term disability and premature death versus direct costs ($2.1 billion) which include hospital, drug, physician and additional health care expenditures. This indirect cost is underestimated as short term disability costs were not available. Nearly two thirds (65%) of the total arthritis-related costs were incurred by individuals aged 35–64 years ($4.1 billion) which emphasizes the important economic burden of arthritis in Canadians of work-force age.

In 2007, over 4 million non-steroidal anti-inflammatory drugs (NSAIDs), over 1 million disease modifying anti-rheumatic drugs (DMARDs), close to a million corticosteroids and approximately 150,000 biologic response modifier prescriptions were written in Canada for individuals with a diagnosis of arthritis. While there has been a decrease in the use of prescription NSAIDs and corticosteroids for arthritis, there has been an increase in the use of the newer DMARDs and biologic response modifiers. Approximately 14% of people over the age of 15 years made at least one visit to a physician in 2005-2006 for any type of arthritis — an estimated total of 8.5 million visits in Canada (excluding the territories). In 2005-2006 most people (80%) who visited a physician for any type of arthritis saw a primary care physician at least once; approximately 19% saw a surgical specialist and fewer (14%) visited a medical specialist. Of all surgical specialists, orthopaedic surgeons were the most commonly consulted surgical specialists (85%).

In 2005-2006, there were 2.2 million hospitalizations in Canada of which 1.5 million were for medical care and 721,000 were for surgery. Arthritis was associated with over 6% (132,000) of the total hospitalizations — 3% of the 1.5 million medical hospitalization (45,000 hospitalizations annually) and 13% of the 721,000 surgical hospitalizations (93,730 hospitalizations annually).

Between 2001/02 and 2005/06, the total number of joint replacements increased by 54%. People aged 65 years and older had the largest number of hip and knee replacements. In 2005-2006, 74% of individuals who underwent hip replacement and 87% of those who received knee replacements were overweight or obese. Given the current prevalence of obesity in the population, it is expected that the number of individuals needing total joint replacements will continue to increase.

Maintaining a healthy body weight and avoiding joint injuries including occupational-related joint stress can help prevent osteoarthritis. Maintaining a healthy body weight, daily exercise and a reduced consumption of purine-rich foods such as red meat, seafood and alcohol will reduce the risk of gout. A balanced diet and maintaining or increasing physical activity are crucial components in the maintenance of a healthy weight.

Interventions exist to prevent disability and improve the quality of life of people living with arthritis (all types). These include: appropriate self-management behaviours such as maintaining a healthy weight, being physically active, avoiding joint injuries, participating in self-management programs, and getting an early diagnosis and treatment, particularly for inflammatory types of arthritis, to help reduce the risk of complications and disability.