Arthritis means more than 100 known types with the most common being OsteoArthritis, Rheumatoid Arthritis, Gout, Systemic Lupus Erythematosus and Ross River Virus. Less prevalent types of Arthritis include juvenile idiopathic arthritis, ankylosing spondylitis (which mainly affects young men), spondyloarthropathies, psoriatic arthritis, scleroderma, bursitis, tendonitis, carpal tunnel syndrome, polymyalgia rheumatica, dermatomyositis, and Reiter’s Syndrome.

The below data is sourced from Painful Realities: The economic impact of arthritis in Australia in 2007 - Access Economics for Arthritis suffers in Australia in 2007

Number afflicted

Nearly one in five Australians has Arthritis; indeed more Australians have Arthritis than any other national health priority condition.
Estimated 3.85m Australians with Arthritis, including 2.4m in the working age population (15-64 years).
More prevalent among females, with over 2m females (19.9% of Australian females) and 1.8m males (17.1% of Australian males) estimated to have Arthritis.
Rates of Arthritis prevalence increase with age to the point where half of all Australians aged over 80 have some form of Arthritis.
By 2050, it is projected there will be 7m Australians with Arthritis - 23.9% of the projected population of 29.4m; forecast to include 3.3m males (22.5% of males) and 3.7m females (25.2% of females).
OsteoArthritis is projected to remain the most prevalent arthritic condition, affecting 3.1m Australians, while the prevalence of Rheumatoid Arthritis is projected to be 0.9m in 2050.

Total cost

Total cost to Australian economy estimated $23.9b, an increase of more than $4b on the cost calculated by Access Economics in 2004.
Almost half of estimated $23.9b due to the non-financial (burden of disease) costs, while Health System Costs account for 20%.
A further 17% of total costs are productivity losses, reflecting the impact on employment and workforce participation.
The main bearers of Arthritis costs are the individuals with the condition themselves who, it is estimated, shoulder 61% of the total cost – due to being the bearer of the burden of disease.
Federal Government is the second biggest cost bearer, a consequence of funding the lion’s share of the large Health System Costs and also bearing the lost taxation revenues associated with the considerable productivity losses.

Health System Costs

$4.2b equates to $1,100 per person with Arthritis:

$2b of this was allocated to OsteoArthritis
$422m of this was allocated to Rheumatoid Arthritis

The larger components of Health System Costs, which exceeded that on coronary heart disease, Depression, stroke, Diabetes and Asthma, was -

(i) hospitals - 44%;

(ii) aged care homes - 23%; and

(iii) pharmaceuticals - 14%.

Other financial costs

Estimated to be $7.6b.
Over half of this was productivity costs, reflecting the reduced employment rates and increased Absenteeism that results from arthritic conditions.
Costs of informal care were estimated to be over $1b, indicative of Arthritis’ degenerative nature, and the need for individuals with the condition to be assisted and supported.
People with Arthritis may also require aids or devices to assist them in carrying out their daily activities, or make additions or modifications to their home to ensure safety and mobility estimated to be $211m.

Burden of disease

The financial costs of Arthritis are only one aspect of the total economic costs of arthritic conditions, the other, the non-financial component, is the burden of disease. The pain and suffering that Arthritis patients endure as a result of their condition can decrease their QOL, and while mortality rates for Arthritis are low, there is also a cost in terms of years of life lost. In 2007 the years of life lost due to disease is an estimated 91,479 while the years of life lost due to premature death is estimated to be 2,376. Consequently, the total disability adjusted life years (DALYs) due to Arthritis is estimated to be 93,855, or in dollar terms, the net cost of loss of wellbeing was $11.7b in 2007.

Jurisdictional costs

While the cost of health care delivery (per case) varies between jurisdictions, the main driver of cost shares is prevalence, which in turn reflects Australia’s demography. As such, New South Wales bears the greatest share of Arthritis costs, 33%. Victoria (25%) and Queensland (19%) are the second and third largest bearers and, naturally, the ACT and NT bear only small fractions of total Arthritis costs (less than 1% each).

Obesity and OsteoArthritis

Obesity is one of the most preventable risk factors for OsteoArthritis; in fact, obese people are 2.4 times more likely to have OsteoArthritis than people of normal weight undertook to model the impact of Obesity on OsteoArthritis under three Obesity scenarios, capturing what may be considered the upper and lower bounds for Obesity prevalence in Australia to 2050. The findings of the analysis revealed that if Obesity remains stable at current levels (around 16% of the population), projected prevalence of OsteoArthritis is 10.7% of the population in 2050 (baseline scenario).

However, if Obesity continues to grow at the rate witnessed over the last decade, such that around 47% of men and 35% of women are obese in 2050, OsteoArthritis is projected to increase in prevalence to 11.2% of males and 14.5% of females, affecting nearly 3.8m Australians. Finally, if Obesity were eliminated by 2050, OsteoArthritis would be reduced by 425,000 persons, relative to the baseline scenario in 2050.

Cost effective interventions

Diverse a range of treatment and management options available for Arthritis and cost effectiveness (measured in dollars spent per Quality-Adjusted Life Year gained) of these varies considerably.

Surgical interventions can offer cost effective treatment for some forms of Arthritis, and in fact there is evidence to suggest that some surgical interventions are even cost-saving (reducing overall financial costs and gains QALYs).

Cost effectiveness of pharmacotherapy and lifestyle interventions varies significantly depending on the intervention and there is a need to evaluate the efficacy of such interventions, to help facilitate the most efficient allocation of resources.

Pharmacotherapy is the usual first line treatment for OsteoArthritis, while newer treatments for Rheumatoid Arthritis such as anti-TNF-alpha agents and other biologic response modifiers may also be cost effective, in particular for some target populations.

TABLE 7.2: COST EFFECTIVENESS OF SELECTED INTERVENTIONS FOR ARTHRITIS

Year of study Lifestyle Interventions Quality score of analysis* $/QALY
in 2002 USD$

2001
Aquatic exercise class at least twice a week vs no exercise/ usual care (less than 1 hour of exercise per week) in patients with OsteoArthritis aged 55-75
4.5 $180,000

2002
Combined spa therapy and exercise therapy (3 weeks) in addition to standard treatment (37 weeks) vs standard treatment of antiinflammatory drugs and weekly group physical therapy (40 weeks) in Dutch outpatients with active ankylosing spondylitis who have had the disease for < 20 years and who follow weekly group physical therapy
4.5 $11,000

Two studies were identified from the CEA registry that evaluated the cost effectiveness of lifestyle interventions (see Table 7.2 above). The first, a 2001 US study (Patrick et al, 2001) calculated the cost effectiveness of aquatic exercise compared to usual care for older patients with Arthritis to be $180,000/QALY in 2002 US dollars. The second, a 2002 European study found the cost effectiveness of combined spa therapy and exercise therapy in addition to standard treatment compared to standard treatment of anti-inflammatory drugs and weekly group physical therapy to be $11,000/QALY in 2002 US dollars, considerably more cost effective than the US aquatic monotherapy.

What is evident from these two evaluations, however, is that the cost effectiveness of lifestyle interventions can, and does, vary considerably between programs, and there is a need to carefully evaluate their efficacy relative to cost in order to increase knowledge about what works best for particular target populations.

In Australia, lifestyle interventions for Arthritis have been widely adopted, with a variety of programs currently conducted across the nation including:

• warm water exercise programs (WAVES);

• chronic disease self-management programs (CDSMP);

• Arthritis Self-Help (ASH) programs;

• Moving towards wellness, self management program in SA;

• Challenging Arthritis, a new self management program initiated in NSW;

• Get the most out of life, a self management program operating in WA; and

• OsteoArthritis of the knee (OAK), a disease specific self management program run in WA.

Lifestyle interventions through exercise

Very important for people with Arthritis, as it helps to decrease pain, keep joints mobile, increase muscle strength, strengthen bones and ligaments, prevent joint deformities, reduce weight and increase fitness and wellbeing in general. Gentle exercises are best, such as walking, Tai Chi and/or hydrotherapy (that is, water exercises – the warmth and buoyancy of the water makes movement much easier).

Although questions remain about how much exercise is too much, regular exercise is known to be very effective for relieving the pain and stiffness of OsteoArthritis and may help slow the progression of the disease. Exercise also helps reach or maintain a healthy weight, which reduces the stress on joints:

Exercise strengthens the muscles that support your joints, which helps protect the joints from further damage and can reduce the pain of Arthritis.

Exercise improves the flexibility of your joints; the more flexible your joints are, the more easily suffers can move them without pain.

Exercise can make lift Self-esteem and emotions by relieving stress and elevating mood.

Exercise can spark energy and generally improve QOL.

The exercise program that will work best is one that fits your lifestyle and physical abilities. GPs generally recommend a combination of stretching exercises, mild strengthening exercises (such as lifting weights), and low-impact aerobic exercises (such as swimming, walking, or bicycling).

It's important for suffers to talk to their GP before they begin any regular exercise program. Their GP can help them determine which exercises are best for them, how often they should exercise, how much exercise they should do, and how to time their medication (if taking medication for your Arthritis) to make their exercise session more comfortable. Their GP may recommend that they work with a physical therapist to design a program that is right for them.

If their exercise routine is comfortable and enjoyable, it will become a habit that will be easy to keep up. It doesn't have to be a formal exercise program. Just fitting more activity into their daily routine, such as taking the stairs instead of the elevator and walking or riding their bike instead of driving, can provide many benefits.

Suffers will get the most out of their exercise program if they plan workouts for those times of the day when their pain is least severe and their joints most flexible. For many people, pain and stiffness are often worse in the morning than at other times. If this is the case, try exercising after have taken a hot shower, which can help loosen joints.

When exercising, doing housework or chores, or engaging in other activities, rest frequently, change positions regularly, and stretch muscles between periods of exertion. Pacing activities throughout the day can help save energy and reduce stress on joints. It is best to exercise several times throughout the day for shorter periods than to do it all in one long session. Begin and end each exercise session with a warm-up and cool-down by walking around slowly for 5 minutes before and after.

Warning A suffer has exercised too much if he/she has sharp pains or more pain than usual while exercising, or if painful 2 hours after exercise. Stop exercising immediately and call your GP if you have chest pain, severe dizziness, difficulty breathing, or an upset stomach.

Stretching exercises, which are also called 'range-of-motion exercises', are good for helping to reduce stiffness in joints and improve flexibility. Stretching exercises include anything that requires regular movement of a joint to its fullest capacity. For example, holding arms out to one's sides and circling them in a windmill fashion stretches shoulder joint. Some forms of water exercise use warm water to loosen joints and help them stretch. Doing stretching exercises for a few minutes every day can significantly improve movement in joints.

Strengthening exercises help maintain or build the muscles around joints, which helps keep the joints stable. Stronger muscles also improve the joint's movement. Lifting light weights, such as 1 to 2 kg dumbbells, every other day is often enough to make a difference. Muscles often need a day off in between to rest and rebuild. But before beginning any type of weight training, talk to your GP. A suffer will need to be carefully instructed in this type of exercise to avoid injury and further damage to your joints. Some forms of water exercise include strengthening exercises.

Fitness exercises, also called aerobic exercises, increase your endurance, strengthen heart and lungs, and increase energy. Try to exercise aerobically for at least 60 to 90 minutes each week. Brisk walking, swimming, and bicycling are good fitness exercises for Arthritis suffers because they allow for smooth rather than jerky movements. Avoid high-impact exercises—such as jogging, tennis, or step aerobics—because they can put too much pressure on your joints and can worsen your symptoms.

Swimming is especially good for Arthritis in knees or hips because the water supports your weight, which reduces stress on those joints. Many communities offer supervised swimming or water exercise programs for people who have Arthritis.

Walking is also a good exercise for relieving the pain and stiffness of Arthritis. Going for regular walks with a friend or family member is a good way to develop the habit of staying active.

See Exercise Therapy for Arthritis

In severe cases, surgical treatments like replacement of hips, knees and (less commonly) shoulders with artificial prostheses, will relieve pain and improve mobility.