Professor Anthony D Woolf

Transcription

1 The Bone and Joint Decade Reducing the impact of arthritis and other musculoskeletal conditions Professor Anthony D Woolf Professor of Rheumatology, Peninsula College of Medicine and Dentistry, UK Consultant Rheumatologist, Royal Cornwall Hospital, Truro, UK Chair Elect, Bone and Joint Decade Co-ordinator, Bone and Joint Monitor Project Co-ordinator EUMUSC.NET Kenya 2010

2 The Burden of Musculoskeletal Conditions Musculoskeletal diseases are the major cause of morbidity throughout the world. These diseases have a substantial influence on health and quality of life and they inflict an enormous cost on health systems Dr Gro Harlem Brundtland Past Director General, WHO January 2000

3 Burden of Musculoskeletal Conditions Commonest chronic conditions 1 in 4 adults in Europe have a longstanding problem with their muscles, bones and joints (arthritis or rheumatism) Eurobarometer 2003 Arthritis and rheumatism are the most common reason for longterm treatment in Europe Eurobarometer 2003 Cause more functional limitations in adults than any other group of disorders 4-5% of the adult population have physical disabilities due to a musculoskeletal condition in surveys carried out in Canada, US, and Western Europe Impact in developing countries not clear but predicted to increase

4 Musculoskeletal pain and disability 20% of adults have musculoskeletal pain Musculoskeletal pain limits every day activities in 25% Musculoskeletal pain is often longstanding and its impact is under-rated Musculoskeletal pain can be severe gout fracture Pain is related to various musculoskeletal conditions and problems

5 Conditions affecting the musculoskeletal system Joint diseases Osteoarthritis Rheumatoid arthritis Gout Infections Back pain Musculoskeletal pain Osteoporosis and low trauma fractures Bone infections Trauma Injuries ARTHRITIS INJURIES & TRAUMA BACK PAIN OSTEOPOROSIS

6 Prevalence of Joint Problems in General Population increases with Aging Knee Shoulder Hand Hip 20 % Badley & Tennant: Postal Survey, Ann Rheum Dis age

7 Osteoarthritis Joint failure Loss of cartilage Pain Loss of function

8 OA : Joints typically involved Can occur in any joint but most common in hip, knee and the joints of the hand, foot and spine

9 Prevalence of Radiographic OA by age Men Women 80 DIP DIP Prevalence of OA (%) Prevalence of OA (%) Knee Knee Hip Hip Age (years) Age (years) Van Saase et al Annals Rheum Dis 1989

10 Knee OA prevalence rates for WHO regions, A Regions A Regions Males AMRO BD EURO BC EURO BC EMRO EMRO WPRO B Prevalence/100,000 Prevalence/100,000 SEARO AFRO Females AMRO BD SEARO WPRO B AFRO Age groups Age groups 80+

11 Rheumatoid Arthritis Prevalence 0.3-1% Disability starts early in course of disease, increasing with duration 10% severely disabled 60% mild moderate 50% unable to work after 10 years Modern agressive therapy dramatically improving outcomes

12 RA prevalence rates for WHO regions, 2000

13 Gout Acute gout Sudden onset Exquisite pain and tenderness Self limiting Chronic arthritis Involved joints persistently uncomfortable, stiff, and swollen Acute flares may still occur Radiographic damage common

14 Back Pain Most prevalent musculoskeletal disorder Second leading cause of sick leave in developed countries Accounts for 50 % of restricted-activity days Specific causes infection traumatic fracture malignancy ankylosing spondylitis Most cases are non-specific

15 Osteoporosis Fragility fractures have doubled in last decade 40% of all women over 50 years in developed countries will suffer an osteoporotic fracture In 2001 there were about 2.1 million hip fractures worldwide Risk to die following a hip fracture equals the risk to die of breast cancer (20 %)

16 Osteoporosis Fragility fractures have doubled in last decade 40% of all women over 50 years in developed countries will suffer an osteoporotic fracture In 2001 there were about 2.1 million hip fractures worldwide Risk to die following a hip fracture equals the risk to die of breast cancer (20 %)

17 Osteoporotic Fractures increase with age

18 Musculoskeletal Infections Septic arthritis Staph aureus Strep pneumoniae Escherichia coli Neisseria gonorrheae Periarticular Septic bursitis Osteomyelitis Staph aureus HIV atypical mycobacteria and fungi Tuberculosis Osteomyelitis Septic arthritis

19 Musculoskeletal Occupational Injuries Major cause of work loss Back pain Shoulder pain Capsulitis Bursitis Elbow pain Medial epicondylitis Lateral epicondylitis Hand pain Tenosynovitis

20 Musculoskeletal Injuries and Trauma

21 Road fatalities per capita Traffic related deaths - Annual number of road fatalities per 100,000 inhabitants. World average was 20.8

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23 What effect do musculoskeletal conditions have? Pain Deformity Physical disability Quality of life

24 Chronic diseases ranked in terms of impact on quality of life: higher scores imply poorer quality of life MAG Spranger et al. Which chronic conditions are associated with a better or poorer quality of life? Journal of Clinical Epidemiology : Summed rank scores for disease clusters

25 Global Burden of Disease: the 10 Leading Causes of YLD, 2001 Low- and middle-income countries YLD Cause (millions of years) % of total YLD High-income countries YLD Cause (millions of years) % of total YLD 1 Unipolar depressive disorders Unipolar depressive disorders Cataracts Alzheimer s and other dementias Hearing loss, adult onset Hearing loss, adult onset Vision disorders, age-related Alcohol use disorders Osteoarthritis Osteoarthritis Perinatal conditions Cerebrovascular disease Cerebrovascular disease Chronic obstructive pulmonary disease Schizophrenia Diabetes mellitus Alcohol use disorders Endocrine disorders Protein-energy malnutrition Vision disorders, age-related Global Burden of Disease and Risk Factors Lopez et al DCPP World Bank 2006

26 Burden of Musculoskeletal Conditions (DALYs) WHO (2004) by gender and by Developed or Developing Regions Connelly, Woolf & Brooks Disease Control Priorities Project 2006

27 Burden of Musculoskeletal Conditions (DALYs) WHO (2004) by Region and Mortality Stratum Connelly, Woolf & Brooks Disease Control Priorities Project 2006

28 The 20 Leading Causes of Global Burden of Disease (DALYs), 2001 Global Burden of Disease and Risk Factors Lopez et al DCPP World Bank 2006

29 Costs of Musculoskeletal Conditions Musculoskeletal conditions represented 22.6% of the total cost of illness in the Swedish Cost of Illness Study The greatest costs are the indirect costs related to morbidity and disability Musculoskeletal conditions are the commonest cause of early retirement or long-term sick-leave between years in Sweden

30 The burden is increasing across the globe Why? Ageing of the population People are living longer in all populations

31 Ageing of the population

32 Ageing of the population EGYPT SOUTH AFRICA KENYA

33 Ageing of the population in Kenya

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36 Population growth , by age Developing countries Percentage change Developed countries Source: Based on the UN 1996 revision Age-group

37 Population growth rate

38 People over 60 yrs in Less and More Developed Regions 1970, 2000 and 2025

39 Distribution of World Population over age 60 by Region, 1995 and 2025

40 Population growth

41 What does the future hold? More than one-third of men over 60 years of age have 2 or more chronic conditions - the number increasing with age and among women

42 The burden of musculoskeletal conditions is increasing Why? Ageing of the population Changes in lifestyle

43 The way we live today consequences for tomorrow?

44 The way we live today Consequences for tomorrow? Physical fitness decreasing Obesity increasing Alcohol - consumption still excessive in many Smoking - increasing Musculoskeletal injuries common - sport, occupational, RTAs, falls A 25-yr old woman today spends 4 times as much time watching TV as exercising!

45 Physical Activity World Health Report % of adults are physically inactive around the world (1124% across regions) 41% of adults take some but insufficient activity (<2.5 hours/week moderate activity) around the world (31-51% across regions) Physical inactivity estimated to cause 1.9 million deaths and 19 million DALYs globally

46 Changes in Transportation

47 Lifestyle Risk Factors Diet Calcium Vitamin D Nutrition (young & elderly) Alcohol & Smoking greatest increases in developing countries

48 Overweight and obesity in school age children

49 Global Prevalence of Obesity in Adult Males % Obese 0-9.9% % % % % 30% Self Reported data

50 Global Prevalence of Obesity in Adult Females % Obese 0-9.9% % % % % 30% Self Reported data

51 Burden of Disease Attributable to Childhood and Maternal Undernutrition (% DALYs in each subregion)

52 Falls, Accidents and Injuries

53 Occupational Injuries

54 The Burden of Musculoskeletal Conditions Musculoskeletal diseases are the major cause of morbidity throughout the world. These diseases have a substantial influence on health and quality of life and they inflict an enormous cost on health systems Dr Gro Harlem Brundtland Past Director General, WHO, January With the increasing number of older people and changes in lifestyle occuring throughout the world, this trend will increase dramatically over the next decade and beyond. we must act on them now Kofi Annan, 1999 Secretary General, UN

55 What can be done to prevent and control musculoskeletal conditions?

56 WHO Strategies for Chronic Diseases Gaining Health The European Strategy for the Prevention and control of Noncommunicable Diseases

57 WHO Strategies for Chronic Diseases Ignored the growing burden of musculoskeletal conditions

58 The European Strategy for the prevention & control of non-communicable diseases Recognises musculoskeletal conditions as major non-communicable diseases Recommendations to Member States: to develop or strengthen national public health strategies for tackling NCD to strengthen health systems towards improved prevention and control of NCD to regard prevention throughout the life-course as an effective investment to ensure universal access to health promotion, disease prevention and health services to set up mechanisms for the implementation and regular monitoring of the public health strategies

59 How do we apply this to prevent and control musculoskeletal conditions? national public health strategies for tackling MSC have a plan strengthened health systems appropriate to prevention and control of MSC appropriate human and physical resources prevention throughout the life-course focus on risk factors and early recognition universal access to health promotion, disease prevention and health services equity of resources + evidence based care mechanisms for regular monitoring of the public health strategies agreed health indicators

60 What public health strategies should we have? Disease Control Priorities in Developing Countries To provide information about cost-effectiveness health interventions European Action Towards Better Musculoskeletal Health A common policy to prevent musculoskeletal conditions and reduce their impact to enable people with musculoskeletal conditions to enjoy their full health potential

61 Disease Control Priorities in Developing Countries Preventive Strategies: deal with risk factors Ideal body weight Balanced diet including calcium & vitamin D Physical activity Avoid smoking & excess alcohol Injury prevention A safe environment

62 A Bone & Joint Healthy Lifestyle

63 Interaction of health determinants and various health conditions

64 The main causes are known - the major determinants of health

65 Burden of Disease Attributable to Leading Global Risk Factors Global Burden of Disease and Risk Factors Lopez et al DCPP World Bank 2006

66 Disease Control Priorities in Developing Countries Treatment aims Pain control Restoring function Disease management Interventions Lifestyle: diet, physical activity Pharmacological symptomatic (analgesics, NSAIDs) disease process (eg MTX for RA, bisphosphonates for osteoporosis) Surgical: fracture, arthroplasty Rehabilitation: multidisciplinary education & self-help physical therapies aids & appliances

67 Interventions are effective Osteoarthritis pain control and self management exercise joint prostheses Rheumatoid arthritis education and self management symptom control & rehabilitation effective disease modifying therapy eg methotrxate Back Pain early rehabilitation Osteoporosis and Fractures fracture prevention strategies for those at highest risk eg previous fragility fracture treat with bisphosphonates

68 Strategies to Control Musculoskeletal Conditions Identify those who are at highest risk Early and appropriate management of those with a musculoskeletal condition Access to appropriate care for those with a musculoskeletal condition

69 Strategies for better bone and joint health? What is needed for their implementation? Case-finding strategies early onset polyarthritis previous fragility fracture Access to appropriate management at the right time disease modifying drugs with monitoring eg methotrexate surgery eg fracture management, arthroplasty Resources trained health professionals / health workers

70 What are the barriers to implementing strategies for better bone and joint health? Lack of: Availability of services and resources Access to services National priorities Lack of awareness about the burden of musculoskeletal conditions and what can be achieved by prevention and treatment in 2010 by policy makers, health care workers and public

71 How to implement strategies for better bone and joint health? Some solutions? Raising awareness and knowledge of public, health professionals and policy makers of importance of bone and joint health how to maintain bone and joint health what can be achieved with treatment for musculoskeletal conditions

72 Raising public awareness and improving attitudes

73 How to implement strategies for better bone and joint health? Some solutions? Raising awareness and knowledge of public, health professionals and policy makers of importance of bone and joint health how to maintain bone and joint health what can be achieved with treatment for musculoskeletal conditions Gaining priority for healthcare provision for musculoskeletal conditions

74 How to implement strategies for better bone and joint health? Some solutions? Raising awareness and knowledge of public, health professionals and policy makers of importance of bone and joint health how to maintain bone and joint health what can be achieved with treatment for musculoskeletal conditions Gaining priority for healthcare provision for musculoskeletal conditions Improving medical education about musculoskeletal conditions

75 Recommendations for a Musculoskeletal Curriculum What every doctor needs to know! Global core recommendations for a musculoskeletal undergraduate curriculum AD Woolf, NE Walsh, K Åkesson and the Bone and Joint Decade Undergraduate Curriculum Development Group Annals of Rheumatic Diseases, 2004

76 How to implement strategies for better bone and joint health? Some solutions? Raising awareness and knowledge of public, health professionals and policy makers of importance of bone and joint health how to maintain bone and joint health what can be achieved with treatment for musculoskeletal conditions Gaining priority for healthcare provision for musculoskeletal conditions Improving medical education about musculoskeletal conditions Developing new models of care using other health workers

77 The Bone and Joint Decade The goal of the Bone and Joint Decade is to improve the healthrelated quality of life for people with musculoskeletal disorders throughout the world by: Raise awareness of the suffering and cost to society associated with musculoskeletal disorders Empower patients to participate in their own care Promote cost-effective prevention and treatment Advance understanding of musculoskeletal disorders and improve prevention and treatment through research Gain priority and resources through advocacy with evidence

78 Joint diseases, back pain, osteoporosis and limb trauma due to accidents and armed conflict have an enormous impact on the individual, on society and on health care and social systems. With the increasing number of older people and changes in lifestyle occuring throughout the world, this trend will increase dramatically over the next decade and beyond. we must act on them now Kofi Annan

79 Beyond the of the Bone and Joint Decade Bringing all stakeholders together in countries throughout the world to work to improve the health-related quality of life for people with or at risk of musculoskeletal disorders