Arthritis and the Public Health Burden
What is arthritis on a biological level?
Osteoarthritis is a disorder involving the degradation of the articular (hyaline) cartilage of synovial joints; it can include changes in the synovial fluid, the subchondral bone and the joint capsule (Lozada C. J., 2017). Though the body initially tries to heal the cartilage, eventually the cartilage becomes soft and begins to flake off, resulting in loss of space in the joint. In turn, this causes more friction of bone on bone and can increase the level of inflammation (Lozada C. J., 2017). The bone itself can experience vascular damage from this friction.
The etiology is either idiopathic or secondary to an event damaging the cartilage. The various events or conditions that can cause it secondarily are trauma, mechanical stress, inflammation, joint instability, neurologic disorders (like diabetic neuropathy), skeletal deformities, hemophilia and certain pharmaceuticals. One of the mechanical stresses is obesity; it contributes most significantly to hips and knees. Obesity is considered a modifiable risk factor, and the symptoms and damage can decrease with weight loss and moderate exercise (Lewis, Dirksen, Heitkemper, Bucher, & Camera, 2011, p. 1642).
Some evidence exists that correlates exacerbation of osteoarthritis and low estrogen levels in women (Roman-Blas, Castaneda, Largo, & Herrero-Beaumont, 2009).
What does arthritis look like?
An early stage of osteoarthritis can last for years and is typified by cartilage swelling. This is an effort by the body to repair the cartilage with proteoglycans (Lozada C. J., 2017). Patients typically complain of pain deep in the joint which is worsened by extensive use. Secondly, there can be reduced range of motion and “snap, crackle, pop”, i.e., crepitus. Some may complain of morning stiffness which lessens within half of an hour (Lozada C. , 2017b).
More women than men suffer with osteoarthritis, and among women who have it, pain is usually more severe than in men (Lewis, Dirksen, Heitkemper, Bucher, & Camera, 2011, p. 1642). As well, rheumatoid arthritis, targets women to a much larger degree than men, 2 to 3 times more (Lewis, Dirksen, Heitkemper, Bucher, & Camera, 2011, p. 1649).
Though the arthritic condition can start in the teens and 20’s, symptoms usually become most patent in the 50s and 60s, with the exception of men’s knees when they occur much earlier. Those participating in football, soccer or jobs that require frequent kneeling and stooping have a higher risk of developing osteoarthritis (Lewis, Dirksen, Heitkemper, Bucher, & Camera, 2011, p. 1642).
A medical provider may aspirate the troublesome joint to remove fluid. That fluid will be analyzed for crystals or joint degradation, which can help rule out non-osteoarthritis. She can also order x-rays and an MRI. Both can show changes in the joint and cartilage that would indicated osteoarthritis (Arthritis Foundation).
How much does arthritis cost Americans annually?
Twenty percent of adults are affected by arthritis in its many forms, i.e. over 100 types of arthritis. Though one may believe that traumatic injuries are the main cause of disability, in fact, per a study published in 2005 and relied upon by the U.S. Office of Disease Prevention and Health Promotion (“ODPHP”), arthritis is the most common cause of all (ODPHP). Therefore it easy to see how, as of 2003, it would create American costs of $128 billion annually (Centers for Disease Control, 2015). That figure includes other rheumatic conditions, as well.
The last study done on these numbers in 2003 broke the expenditures down by state. The costs in Nevada were between 1.0 and 1.4% of gross domestic product. This is on par with the average of 1.2% nationwide. The total Nevada expenditure was over 1 billion (Centers for Disease Control, 2015).
Other statistics show an increase in the use of emergency departments for arthritis and other rheumatic conditions from 2007 to 2012. There were a third more visits to EDs and a more than 20% increase in hospitalizations. Urban metropolitan areas showed the smallest increases, while areas outside of that showed the highest increases in visits, hospitalizations and costs. Small rural areas had the highest mortality rate from conditions related to the arthritis and rheumatic conditions. The form of arthritis that showed the highest increase in visits and hospitalizations was gout (Han, Michaud, Yu, & Watanabe-Galloway, 2016).
Xray of arthritic knee
How can we prevent arthritis?
The U.S. Office of Disease Prevention and Health Promotion, and its stakeholders, group arthritis with two other conditions, osteoporosis and chronic back conditions in terms of developing objectives, interventions and resources (ODPHP).
There are many types of arthritis, each having its own mode of treatment and prevention. Osteoarthritis can be minimized by keeping extra weight off of the joints; i.e., keeping one’s body at a healthy weight (Arthritis Foundation). Therefore, any of the federal, state and local efforts to reduce obesity would dovetail with the prevention of some cases of osteoarthritis (National Center for Chronic Disease Prevention and Health Promotion, 2017).
Aquatic exercise is recommended as an enjoyable way to lose weight while minimizing pressure on joints according to Emilio B. Gonzalez, MD, chief of rheumatology at University of Texas Medical Branch in Galveston (Mann).
In addition, since osteoarthritis sets in frequently on previously injured joints, especially knees, injury prevention is critical. This is why some high schools have begun participating in Knee Injury Prevention Program for Coaches instituted by the Lurie Children’s Hospital of Chicago (Esposito, 2014). This program helps coaches make sure their student athletes have the proper equipment and are using good body mechanics.
Beyond prevention is arthritis management, i.e. to keep the symptoms as minimal as possible. Healthy People 2020 recommends self-management programs developed at Stanford (Office of Disease Prevention and Health Promotion).
Wrapping it Up
Osteoarthritis attacks the cartilage of synovial joints. At first there is swelling but eventually the joint degrades and inflammation results from more friction of bone-on-bone. Pain and dysfunction are the main symptoms though there can be deformity especially in the hands. Typically, this is diagnosed from a history, subjective symptoms and x-ray.
Prevention centers on avoidance of damage to the joints to begin with through proper body mechanics and maintaining ideal body weight. Estimates of the public monetary burden find it to cost in excess of $128 billion. It also increases the use of emergency departments, especially in areas outside of urban metropolises.
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Roman-Blas, J., Castaneda, S., Largo, R., & Herrero-Beaumont, G. (2009). Osteoarthritis associated with estrogen deficiency. Arthritis Research & Therapy, 11, 241. doi:10.1186/ar2791
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