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

Introduction

Moving, walking, lifting — all of these activities and more — involve the use of the body's muscles, bones and joints. They are integral to normal functioning of the human body, yet most of us spend very little time thinking about them. For more than 4 million Canadians living with arthritis, these activities cannot be taken for granted. Many have to carry on these activities through pain and fatigue or experience daily restrictions in performing them.

Arthritis makes up a large group of disorders affecting the joints, ligaments, tendons, bones and other components of the musculoskeletal system. It is one of Canada's most common chronic conditions affecting both individuals with the disease and inevitably their families. It is a leading cause of pain, physical disability and use of health care services. Arthritis has an impact on leisure and social activities, and on employment among individuals of all ages and is one of the most costly illnesses.

This is the second comprehensive report to document the impact of arthritis in Canada. Its purpose is to provide an overview of the impact of arthritis in Canada for researchers, health care professionals, policymakers and members of the interested public, particularly individuals with arthritis.

The goals of this report are to:

1. Provide an overview of the magnitude of the impact of arthritis on the Canadian population, including health and social outcomes and the use of health care services;
2. Describe approaches to reduce the risk of developing some forms of arthritis and to reduce adverse consequences of arthritis.

Documenting the impact of arthritis presents a number of challenges. First, the term "arthritis" covers a range of different conditions; the most commonly known are described in Chapter 1. While every effort has been made to be consistent in the types of arthritis included in the analyses, the use of a variety of data sources necessitated some variation in the range of arthritis conditions included. Second, arthritis is not always recorded as the underlying diagnosis in administrative databases such as those related to physician visits, hospital admissions or death, creating a challenge for surveillance.

Third, it is currently not possible to track and provide information for each type of arthritis due to a lack of data. Therefore, the information contained in this report focuses on arthritis as a group of diseases. Finally, while arthritis is more common in older age groups, children are also affected. Unfortunately, data on arthritis in children are currently not available at the national level and not included in this report. New data sources are being developed and this information will be provided as it becomes available.

Throughout the report, vignettes written by people with arthritis illustrate the personal challenge of living with the many different types of arthritis. Members of the Editorial Board, three not-for-profit organizations, Arthritis Consumer Experts (ACE), The Arthritis Society of Canada, and the Canadian Arthritis Patient Alliance (CAPA) were given the opportunity to reach out to their constituents inviting them to share their experiences of living with arthritis.

ACE and CAPA used their on-line and in-print publications, JointHealth™ express and Voices respectively, to send out a request to people living with arthritis to tell their own stories about life with the disease. The Arthritis Society sent an email through various Society channels asking a short list of questions to ensure that the full scope of arthritis' impact would be reflected: types of arthritis, life impact and the geographic diversity of Canada. From the responses, nine people were contacted for comprehensive interviews.

The response to the request for stories was overwhelming. Over 100 stories were received within one week and experiences shared ranged from personal triumph over arthritis to devastating loss — loss of health, mobility, marriage, career and more. Some responses were relatively brief, but the vast majority were detailed experiences of the daily realities of living with arthritis. The end result was a series of personal stories from which vignettes were chosen for the inclusion in this report.

Every person with arthritis has a different and personal story to tell. While the vignettes in this report are only a small reflection of the 4.2 million Canadians with arthritis and may reflect the experience of those with moderate or severe forms of arthritis, having the opportunity to tell and share stories in this forum provides a window on the scope and magnitude of this chronic condition.

Structure of the report

This report is the second in the series of comprehensive surveillance reports that began with Arthritis in Canada: an ongoing challenge, published by Health Canada in 2003.

The current report provides more in-depth information about prevention, treatment and management of these conditions, as well as providing insight into significant issues such as disability and economic burden. The report has been organised into nine chapters with a section on data sources and a glossary.

• Chapter one focuses on the prevalence of arthritis by demographic characteristics, geography and projections over time.
• Chapter two provides information on the modifiable and non-modifiable risk factors for arthritis and the existing prevention interventions.
• Chapter three presents available Canadian data on arthritis-related disability and the impact of the many forms of the disease on quality of life.
• Chapter four focuses on arthritis among Canada's First Nations, Inuit and Métis populations.
• Chapter five presents the most recent mortality data for arthritis.
• Chapter six presents the most recent cost estimates for musculoskeletal diseases and arthritis expenditures from the Economic Burden of Illness in Canada project.
• Chapter seven focuses on arthritis-related medication use.
• Chapter eight examines ambulatory care through an assessment of visits to primary care physicians and relevant specialists.
• Chapter nine presents data on hospital services utilization by people with arthritis — hospitalizations (medical and surgical) and day surgeries.
• The data sources section provides information on all the data sources used in the report.
• The glossary presents the definitions for several technical words used throughout the report.

This report will be useful to a wide range of audiences, including people with arthritis, health care professionals, policy makers and health planners, the general public, as well as community advocates.