STATE OF MUSCULOSKELETAL HEALTH 2018 - Arthritis and other musculoskeletal conditions in numbers - Arthritis Research UK

 
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STATE OF MUSCULOSKELETAL HEALTH 2018 - Arthritis and other musculoskeletal conditions in numbers - Arthritis Research UK
STATE OF
MUSCULOSKELETAL
HEALTH 2018
Arthritis and other musculoskeletal conditions in numbers
STATE OF MUSCULOSKELETAL HEALTH 2018 - Arthritis and other musculoskeletal conditions in numbers - Arthritis Research UK
Table of contents
03 Introduction
04 Glossary
05 What are musculoskeletal conditions?
06 What is the scale of the problem?
08 Key factors affecting musculoskeletal health
   09 Physical activity
   10 Obesity
   11 Multimorbidity
12 What is the impact?
   13   Years lived with disability
   14   Work
   15   Health and social care services
   16   Economy
17 Economic benefits of musculoskeletal research
18 Condition specific statistics
 19 Axial spondyloarthritis (including ankylosing spondylitis)

 22 Gout

 25 Juvenile idiopathic arthritis

 27 Rheumatoid arthritis

 30 Osteoarthritis

 33 Back pain

 36 Fibromyalgia

 38 Osteoporosis and fragility fractures

41 References
STATE OF MUSCULOSKELETAL HEALTH 2018 - Arthritis and other musculoskeletal conditions in numbers - Arthritis Research UK
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Introduction
Musculoskeletal conditions are extremely           What is the state of                           What methodology was used?
common, however many people whose                  musculoskeletal health?                        Evidence used in this report was gathered
lives affected by them are still not receiving
                                                   This compendium of musculoskeletal health      from the best available qualitative and
recognition they deserve and support they
                                                   data is an important resource providing the    quantitative data. Research articles were
need. Millions of people across the UK are
                                                   best picture of the burden and impact of       selected through systematic literature
limited by the pain, stiffness and fatigue
                                                   eight of the most prevalent musculoskeletal    reviews and where possible restricted to
caused by musculoskeletal conditions,
                                                   conditions in the UK. Where available,         UK population cohorts or comprehensive
such as arthritis or back pain.
                                                   data refers to the whole of the UK, however    meta–analyses. This compendium presents
These conditions affect all aspects of             due to gaps in coverage some findings are      data from sound data sources, including
everyday life, by limiting what people can         restricted to England.                         but not limited to:
do and their ability to be independent. This
                                                   The burden of musculoskeletal illness can      1. national datasets, surveys and audits;
in turn can have a devastating impact on
                                                   be defined by the number of people affected    2. findings from observational, surveillance
a person’s overall quality of life. In fact,
                                                   by a condition and at risk of developing the   and modelling studies;
musculoskeletal conditions remain the
                                                   disease, but also by its wider impact.         3. musculoskeletal sector charity reports.
leading cause of years lived with disability
(YLDs) and the third largest cause of disability   Musculoskeletal conditions can have a          Who is it for?
adjusted life years (DALYs) in the UK today.1      significant impact both on a personal and
                                                   societal level. An individual’s home life,     The State of Musculoskeletal Health 2018
Musculoskeletal conditions are a costly                                                           is a resource for health professionals,
                                                   relationships and work can all be affected,
and growing problem. The prevalence of                                                            policy makers, public health leads and
                                                   causing repercussions for society and the
musculoskeletal conditions is expected to                                                         anyone interested in musculoskeletal health.
                                                   wider economy, for example through the
continue to increase, due to our ageing                                                           We believe that with the best information
                                                   cost of treatment or lost productivity.
population, rising levels of obesity and                                                          you can build awareness, make more
physical inactivity. The latter two are major                                                     informed decisions, feel more confident
modifiable risk factors in the development                                                        and ultimately help more people with
of a musculoskeletal condition.                                                                   musculoskeletal conditions.
STATE OF MUSCULOSKELETAL HEALTH 2018 - Arthritis and other musculoskeletal conditions in numbers - Arthritis Research UK
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Glossary
Arthritis - a general term that most people use         Fit note - issued to patients by doctors following     Musculoskeletal conditions - a broad range
to mean painful joints. Medically, it refers to         an assessment of their fitness for work. People        of health conditions affecting bones, joints and
many different conditions leading to inflamed or        who are off work sick for more than seven days         muscles, pain syndromes and rarer conditions of
damaged joints.                                         will normally need to provide their employer           the immune system.
                                                        with a fit note.
Comorbidity - any additional health conditions                                                                 Prevalence - the percentage of a population
that people may have, beyond the main condition         Inactive - Participating in less than 30 minutes       that is affected with a disease at a given time
being addressed.2                                       of moderate intensity physical activity (any
                                                                                                               Risk Factor - any attribute, characteristic or
                                                        activity where the effort put in is enough to
Disabled - someone with a long-term condition that                                                             exposure of an individual that increases the
                                                        raise your breathing rate) per week.
reports it reduces their ability to carry out day-to-                                                          likelihood of developing a disease or disorder.
day activities, as defined by the Equality Act 2010.3   Incidence - the rate of new (or newly diagnosed)       Some risk factors are modifiable, because you can
                                                        cases of disease, generally reported as the            change them (e.g. smoking, obesity, diet) other
Disability adjusted life-year (DALY) -
                                                        number of new cases occurring within a period          risk factors are non-modifiable, because you can’t
A single metric of overall disease burden
                                                        of time (e.g. per month or year).                      directly change them (e.g. age, sex, family history).
combining years of life lost (YLLs) due to mortality
and years lived with disability (YLDs). One DALY        Literature review - a review of information            Unemployment - unemployment refers to people
can be thought of as one lost healthy life year.4       found in the literature related to a selected          without a job who were able to start work in the
                                                        area or topic of research.                             two weeks following their Annual Population Survey
Employment - People aged 16 or over who did
                                                                                                               (APS) interview and who had either looked for work
some paid work in the reference week (whether           Meta-analysis - a study design that
                                                                                                               in the four weeks prior to interview or were waiting
as an employee or self-employed); those who             systematically combines and assesses previous
                                                                                                               to start a job they had already obtained.5
had a job that they were temporarily away from          qualitative and quantitative studies about a
(e.g. on holiday); those on government-supported        topic or research area in order to develop a           Work days lost - the number of work days lost
training and employment programmes and                  single conclusion.                                     for all people in employment aged over 16 years
those doing unpaid family work (e.g. working in                                                                due to sickness absence.
                                                        Mortality - a term used to describe the number of
a family business).5
                                                        people who died within a population. A mortality       Work related musculoskeletal disorders
Finished Consultant Episodes (FCEs) -                   rate is the number of deaths due to a specific cause   (WRMSDs) - a self-reported musculoskeletal
one episode of care within an inpatient                 divided by the total population over a given period.   condition which a person thinks has been caused
stay under one responsible consultant.                                                                         or made worse by their current or past work.
                                                        Multimorbidity - a person living with
                                                        multimorbidity has two or more long-term               Years lived with disability (YLD) - years of life
                                                        chronic conditions.2                                   lived with any short-term or long-term health loss.4
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What are musculoskeletal conditions?
The term ‘musculoskeletal conditions’ is often used to include a broad range of health conditions affecting the
bones, joints, muscles and spine, as well as rarer autoimmune conditions such as lupus. In fact, musculoskeletal
conditions comprise over 100 different diseases and syndromes that interfere with people’s ability to carry out
their normal daily activities. Common symptoms include pain, stiffness and a loss of mobility and dexterity.
Broadly speaking there are three groups of musculoskeletal conditions:6

                             Age            Progression           Prevalence             Impact            Main treatment        Treatment location        Risk factors

Inflammatory                                                     Common. (e.g.        Can affect and                               Urgent specialist
                                                                  over 400,000       part of the body          Treated by         treatment needed        Genetic factors,
  conditions            Affects any age.   Often rapid onset.   adults in the UK      including skin,        supressing the        usually provided        sex, smoking,
  (e.g rheumatoid                                               have rheumatoid      eye and internal       immune system.            in hospital         obesity and diet.
      arthritis)                                                    arthritis).           organs.                                    outpatients.

                                                                                                              Treated with                                  Age (late 40’s
  Conditions                                                     Very common.
                                                                                                            physical activity                              onwards), sex,
                                                                (e.g. 8.75 million
  of musculo-           More common                               people in the
                                                                                     Affects the joints,        and pain
                                                                                                                                   Treatment based
                                                                                                                                                          genetic factors,
 skeletal pain          with rising age.
                                            Gradual onset.
                                                                 UK have sought
                                                                                      spine and pain         management,
                                                                                                                                    in primary care.
                                                                                                                                                           physical injury,
                                                                                          system.             and in severe                                  obesity and
 (e.g osteoarthritis,                                             treatment for
                                                                                                               cases joint                                  previous joint
     back pain)                                                  osteoarthritis).
                                                                                                             replacements.                                illness or injury.

 Osteoporosis                                Osteoporosis
                                                                                                                                     Prevention is
                                                                                                                                                             Age, genetic
                                              is a gradual                                                                                                factors, smoking,
 and fragility                               weakening of
                                                                  Common. (e.g.        Hip, wrist and         Medication to        based in primary
                                                                                                                                                                alcohol,
  fractures             Affects mainly
                                             bone. Fragility
                                                                 300,000 fragility    spinal bones are      strengthen bones,      and ambulatory
                                                                                                                                                            inflammatory
                         older people.                          fractures occur in     most common           falls prevention       care; fractures
    (e.g. fracture                           fractures are                                                                                                 disorders, poor
                                                                the UK each year).   sites of fractures.   fracture treatment.       may require
   after fall from                          sudden discrete                                                                                               nutrition and low
                                                                                                                                       surgery.
  standing height)                               events.                                                                                                  physical activity.
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What is the scale of the problem?

    An estimated 17.8 million people live with a musculoskeletal condition in the UK.                                                                     Of the total who have musculoskeletal conditions:1
    That’s around 28.9% of the total population.a, 1

                 7.7 million males have                                                       10.1 million females have                                    2.7m               9.1m                6.0m
                 musculoskeletal conditions                                                   musculoskeletal conditions                                    are aged           are aged           are aged 65
                 (male prevalence 25.9%).1                                                    (female prevalence 31.8%).1                                 under 35 years     35 to 64 years        and over
                                                                                                                                                             (15.4%)            (51.1%)             (33.5%)

                                                                                                      Scotland                                            UK estimates by condition:
                                                                                                      1,469,593
                                                                                                                                                          Inflammatory conditions
                Northern                                                                               (28.5%)
                                                                                                                                                          • Over 400,000 people have rheumatoid arthritis.7
                 Ireland
                465,637                                                                                                                                   • 12,000 children have juvenile idiopathic arthritis.8
                 (26.6%)                                                                                                                                  • 200,000 people have ankylosing spondylitis.6
                                                                                                                                                          • 1.5 million people have gout.7
                                                                                                                                                          Conditions of musculoskeletal pain
                                                                                                                                                          • Over 8.75 million people aged 45 and over have
                                                                                                                                                          sought treatment for osteoarthritis.10
                         Wales                                                                                                                            • 10 million people in England and Scotland alone
                                                                                                                        England
                        856,782                                                                                        14,987,194
                                                                                                                                                          have persistent back pain.7
                        (29.2%)                                                                                         (29.0%)                           • Up to 2.8 million people in the UK have
                                                                                                                                                          fibromyalgia.11
                                                                                                                                                          Osteoporosis and fragility fractures
                                                                                                                                                          • Around 3 million people in the
a
 It is difficult to accurately determine how many people have arthritis only or arthritis and other musculoskeletal conditions in the UK. The data        UK have osteoporosis.12
currently available on specific conditions comes from several different sources (e.g. hospital records, national survey’s, statistical models, and
registers) and doesn’t always cover the same time periods. Additionally, when people have more than one condition there is a risk of double counting      • Over 300,000 fragility fractures
or of people being missed from the data if arthritis is not recorded as their primary condition. As a result, you cannot simply add the estimates above
together and have an accurate total of the number with arthritis or musculoskeletal conditions. For these reasons we currently rely on the Global
                                                                                                                                                          occur each year.13
Burden of Disease study to provide us with an estimate of the total number of people with any musculoskeletal condition in the UK today.
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What is the scale of the problem
The relationship between deprivation,                                                                       Among people aged 45–64 the prevalence of arthritisc is more than
age and prevalence.b                                                                                        double in the most deprived areas (21.5%) compared to the least
                                                                                                            deprived areas (10.6%).2
People in the most deprived areas are much more likely to report
arthritis or back pain than people in equivalent age groups who live                                                                        50

                                                                                                              Prevalence of arthritis (%)
in less deprived areas.2
                                                                                                                                            40
Long-term conditions are associated with social class and type of                                                                           30
occupation. People in the poorest communities have a 60% higher
                                                                                                                                                                                       44.4
prevalence of long-term conditions than those in the richest.14                                                                             20                        36.2      33.6
                                                                                                                                            10          21.5   23.1
40% of men and 44% of women in the poorest households report                                                                                     10.6
chronic pain, compared to 24% of men and 30% of women in the                                                                                 0
                                                                                                                                                 45-64         65-74              75+
richest households.15
                                                                                                                                                 Least deprived              Most deprived

       The following tools contain musculoskeletal health metrics to                                        Those people in the most deprived areas experience back painc at a
       help local government and health service professionals plan                                          relatively young age: people of working age (45–64 years) are almost twice
       for musculoskeletal care and services:                                                               as likely to report back pain (17.7%) as those from least deprived areas.2

                                                                                                                                            25

                                                                                                              Prevalence of back pain (%)
                                                                                                                                            20
                                                                                                                                            15
        Arthritis                   Public Health          NHS RightCare                   Local
      Research UK                     England’s             CCG focus                   Government                                          10          17.7          19.3             18.6
                                                                                                                                                                                15.1
     Musculoskeletal               Fingertips Tool           pack tool                  Association’s                                        5   9.1           11.8
       Calculator                                                                        LG Inform
                                                                                                                                             0
                                                                                                                                                 45-64         65-74              75+
b
    Findings based on England data only.                                                                                                         Least deprived              Most deprived
Based on Wave 2 of the England GP Patient Survey (June-September 2014) analysed by Arthritis Research UK.
c
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Key factors affecting musculoskeletal health
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Physical activity
Inactive people are at increased risk of developing
                                                                                                                              Percentage of people (16+) inactive with long-lastinge
a painful musculoskeletal condition in later life.
                                                                                                                              musculoskeletal conditions20, 21
21-32% of adults (19+) in the UK do less than 30 minutes
of physical activity per week.16, 17, 18, 19                                                                                                                          44.6
                                                                                                                                 England

                                                                                                                                                                                                   % inactive
                                                                                                                                                       19.9
Around 16% of people aged 16-64 in England and Scotland
are inactive vs. 40% of people aged over 65.20                                                                                                                       41.2
                                                                                                                                Scotland
                                                                                                                                                10.4
    Physical activity levels of adults (19+ years) in 2016                            d
                                                                                                                                            0          10            20        30       40            50

                                                                                                                                        Musculoskeletal condition                   No condition

          Active                          Some                            Low                          Inactive
       150+ minutes                     60-159 min                     30-59 min                        30 min
                                                                                                                              33.4% of adults (40-60 years)                              % inactive22
                                                                                                                              in England with a limiting
                                                                                                                                                                                 Mobility   41.2%
                                                                                                                              disability or illness are physically
                                           11%                             4%                           23%                                                                     Dexterity   38.8%
                                                                                                                              inactive, compared to 16.7%                 Long term pain    37.9%
      England: 62%
                                                                                                                              of ablebodied adults.22                              None 16.7%

                                           11%                             5%                           21%                   Keeping physically active
      Scotland: 64%                                                                                                           is important for musculoskeletal health.
                                                                                                                              Physical activity reduces the risk of developing joint and back
                                                           14%                                          32%                   pain by 25%.23
        Wales: 54%
                                                                                                                              Exercise generally reduces overall pain for people with a
                                                                                                                              musculoskeletal condition.2 People who are physically active are
         Northern                          13%                             6%                           26%                   less likely to report chronic musculoskeletal pain.23
       Ireland: 55%
                                                                                                                              Low bone density can lead to a higher risk of osteoporosis and
d
 UK physical activity guidelines for adults 19+: Minimum of 150 mins of moderate intensity activity per week in bouts of 10   result in fractures – up to 50% of hip fractures could be avoided
mins or more OR 75 mins of vigorous intensity activity spread across the week, or a combination of moderate and vigorous;
Physical activity levels in Wales include people aged 16+                                                                     with regular physical activity.24
Illnesses lasting or expected to last 12 months or more.
e
STATE OF MUSCULOSKELETAL HEALTH 2018 - Arthritis and other musculoskeletal conditions in numbers - Arthritis Research UK
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Obesity
Musculoskeletal problems constitute one of the greatest
threats to the health of people who are obese.                             Percentage of people (16+) overweight or obese with
                                                                           long-lastingf musculoskeletal conditions20, 21
Over half (62%) of adults (16+) in the UK are classified as being
overweight or obese. 16, 17, 18, 19                                                                                              73.7
                                                                           England
                                                                                                                         58
 Adult (16+ years) BMI (kg/m ) levels in 2016:
                               2

                                                                                                                                 74.6
                      Overweight         Obese        Morbidly obese       Scotland
                       25 to 30         30 to 40         30 to 40
                                                                                                                        60.2
                                                                                          0         10         20         30        40   50     60     70    80

                        35%              23%               3%                                                 % overweight or obese
      England
                                                                                         Musculoskeletal condition                            No condition

                        36%              25%               4%
                                                                       In 2016, the average BMI of hip and knee replacement patients
     Scotland
                                                                       in the UK was 28.8 (overweight) and 31.0 (obese) respectively.30

                        36%                        23%                 Obesity increases the risk of developing other
       Wales                                                           musculoskeletal conditions.
                                                                       People who are obese are four times more likely to develop back pain
                        36%                        27%                 than those with a healthy body weight.31,32
  Northern Ireland
                                                                       Adolescents who are obese are more likely to experience persistent
Obesity increases the risk of developing osteoarthritis and            or recurrent joint pain, including knee pain, and obesity is also
need for joint replacement.                                            associated with more severe pain overall.33

Obesity directly damages weight-bearing joints such as knees and       Obese people are twice as likely to develop gout and tend to develop
hips because of the abnormally high loads they have to carry.25        it at a younger age.34
Obese people are more than twice as likely to develop osteoarthritis   For reasons not well understood, being overweight or obese also
of the knee than those of normal body weight26, with many estimates    significantly increases the risk of developing rheumatoid arthritis.35, 36
putting the risk between four and six times greater.27, 28, 29         Illnesses lasting or expected to last 12 months or more
                                                                       f
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Multimorbidity
The number of people living with multimorbidity is growing.             Musculoskeletal conditions are very common in
By 65 years of age, most people have multimorbidity. Over half          multimorbidity.
(54.0%) of the population aged over 65 in England have two or           Nearly four out of ten people (36%) with multimorbidity are living
more long-term chronic conditions (multimorbidity).37                   with a physical and a mental health condition.2
In Scotland, the prevalence of people with multimorbidityg increases    Among people over 45 years of age who report living with a major
from 64.9% among those aged 65–84 years to 81.5% among those            long-term conditionh, more than three out of 10 also have a
aged 85 years or over.38                                                musculoskeletal condition.2
There is a strong association between multimorbidity and deprivation:   By age 65 years, almost five out of 10 people with heart, lung or
people in the most deprived areas develop multimorbidity 10–15          mental health problemsh also have a musculoskeletal condition.2
years earlier compared to those in the least deprived.39
By the year 2025 the number of people living with one or more                                                                100

                                                                               Percentage of people aged over 45 years (%)
serious long-term conditions in the UK will increase by                                                                       90
nearly one million, rising from 8.2 million to 9.1 million.40                                                                 80
                                                                                                                              70                    55.0         56.9        58.4
                                                                                                                                        63.8                                              67.6
      Multimorbidity increases with age and over time37                                                                       60
      2035 67.8% (65-74)                                                                                                      50
      2025 64.4% (65-74)                                                                                                      40
      2015 45.7% (65-74) to 68.7% (85+)
                                                                                                                              30
                                                                                                                              20                    45.0         43.1        41.6
                                                                                                                                        36.2                                              32.4
Pain and functional limitations of arthritis make it harder to                                                                10
cope with multimorbidity, causing fatigue and depression.                                                                      0
                                                                                                                                       Diabetes     Heart         Lung      Mental    Cancer in the
Four out of five people with osteoarthritis have at least one other                                                                                problem      problem     health     last 5 years
long-term condition such as hypertension, cardiovascular disease
or depression.2                                                                                                                    Musculoskeletal conditions       Neither arthritis nor back pain

Depression is the most common comorbidity among people with             Based on data extracted from 314 medical practice in Scotland in March 2007.
                                                                        g

rheumatoid arthritis, affecting one in six people.41                    h
                                                                            Based on Wave 2 of the England GP Patient Survey (June-September 2014) analysed by Arthritis Research UK.
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What is the impact
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Years lived with disability

The pain and disability                            Many people with musculoskeletal conditions rely on welfare
caused by arthritis and other                      benefits to cover the extra costs resulting from their condition.
musculoskeletal conditions                         42.4% of people (608,168) in ‘receipt of’ or    Of people receiving PIP in GB recorded
result in a substantial loss in                    ‘entitled to’ Attendance Allowance in GB were   with a musculoskeletal condition:46
quality of life.                                   recorded with a musculoskeletal condition as
                                                                                                            20.5%
                                                   their primary disability condition.45
                                                                                                            Other
                                                   One third 33.3% of people (549,614)                 14.2%
                                                   receiving Personal Independence                                         41.8%
                                                                                                    Chronic pain           Arthritis
      78%                      41%                 Payment (PIP) in GB are recorded with
                                                   musculoskeletal disease as their primary
                                                                                                    syndrommes

                                                                                                            23.6%
                                                   disability condition.46                                 Back pain

    of people with      of people with arthritis
 arthritis experience   can’t stand up for long    Musculoskeletal conditions                      People with arthritis and
  pain most days.43        periods of time.43
                                                   such as low back pain are                       related conditions are not
                                                   the top causes of years that                    always aware of the welfare
                                                   people live with disability.                    benefits they are entitled to.
                                                   In 2016, 23.3% of years                         Nearly three out of 10 (27%) people with
      53%                                          lived with disability were                      arthritis are not aware of their entitlements.43
                                                   attributable to musculoskeletal                 Less than two out of 10 (17%) people with
                          Depression is four       conditions in the UK.1                          arthritis believed they were claiming all the
                        times more common
   of people with         among people in          Over half (52.4%) of all working                benefits they were entitled to.43
  arthritis feel they      persistent pain         age (16-64 years) disabled                      Around four out of 10 (42%) people with
  are a nuisance to      compared to those         people in the UK experience                     arthritis believed they did not have welfare
    their family.43        without pain.44         musculoskeletal conditions.42                   entitlements.43
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Work

    Being in good employment is protective of                                                 People with musculoskeletal conditions are less
    health. Conversely unemployment                                                           likely to be in work than people without health
    contributes to poor health.47                                                     22.4%   conditions, and more likely to retire early.
    One in eight of the working age population                                                63% of working age                          100

                                                                                                                      Employment rate %
    reported having a musculoskeletal problem.48                                              adults with a                                80       18% employment gap
                                                                          30.8m               musculoskeletal                              60
    Musculoskeletal conditions are a leading                              working
                                                                                              condition are in work                        40                                  81
    cause of sickness absence. 30.8 million                               days lost                                                               63            51
                                                                                              compared to 81%                              20
    working days were lost in 2016, accounting                                                                                              0
    for 22.4% of total sickness absence.49                                                    of people with no                             Musculoskeletal Mental health   No health
                                                                                              health conditions.52                            conditions     conditions     conditions

    Many people with musculoskeletal conditions
                                                                                              Some musculoskeletal conditions can be caused
    want to work, but they need the right support.
                                                                                              or made worse by work over time.
    One in five fit notesi (466,556) issued to patients by GPs in
    England in 2015-16 were for musculoskeletal conditions,                                   39% (507,000) of all work–related illness cases in GB in 2016-17
    second to mental health and behavioural disorders.50                                      are due to work related musculoskeletal disorders (WRMSDs),
                                                                                              resulting in 8.9 million working days lost (17.5 days/case).53
    41.9% of fit note episodesj for musculoskeletal
    conditions last 5 or more weeks.50
    25.4% (6,360) of people receiving                                                         The prevalence of musculoskeletal conditions
    Access To Work to support them to be                                                      in the workforce is set to increase.
    in work had a musculoskeletal problem,
                                                                                              By 2030, 40% of the working age population will have a
    but many more could benefit.51
                                                                                              long-term condition.48
                                                                                              In the coming years the workforce is projected to get older:48
Not including fit notes with an unknown diagnosis/ICD-10 code
i

j
 the fit note duration does not cover the initial 7 days were employers                       Average age 2016: 39                        Average age 2030: 43
allow staff to self-determine need for sick leave.
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Health and care services
Musculoskeletal conditions are largely managed                              The mean average wait times for hip and knee
in primary and community based care, however                                replacements in 2015 in England:58
services are accessed across all levels of care.                            Hip - 105.2 days (103.2 days in 2014, +1.4% change)
One in five people (20%) consult a GP about a musculoskeletal               Knee - 105.4 days (107.0 days in 2014, –1.5% change)
problem every year.54
Musculoskeletal problems are addressed in one in eight (12%)               In the UK, about 75,000 hip fractures occur annually. The incidence is
GP appointments.55                                                         projected to increase by 34% in 2020, with an associated increase in
                                                                           annual expenditure.59
In primary care, people with multimorbidity are frequent users
of services: six out of 10 (58%) patients have multimorbidity,             Rate of hip fractures in people aged 65 and over in England is
but account for eight out of 10 (78%) GP consultations.56                  575 per 100,000 population in 2016-17.60
1.36 million admissions to consultant care were due to
musculoskeletal conditions in England in 2016-17, resulting in 2.27         Fracture Liaison                     Half (51%) of gross local
million bed days. That’s 8.2% of all admissions to consultant care.57       Services (FLS)                       authority expenditure on
                                                                            reduce the risk of                   adult social care is on people
                                                                            subsequent fractures                 over 65 years, of which a
                  Osteoarthritis is the primary cause                       by up to 50% in                      substantial number will have a
                  of 90% and 99% of primary hip                             people with fragility                musculoskeletal condition.63
                  and knee replacements.27                                  fractures.61
                                                                            Only 42% of
                  101,651 hip replacementsk carried out in 201630           healthcare
                  (+3.5% since 2015)                                        organisations in
                                                                            the UK provide an                                51%
                  108,713 knee replacementsk carried out in 201630          FLS to routinely
                  (+3.8% since 2015)                                        assess people who
                                                                            have broken a bone
                  k
                   England, Wales, Northern Ireland and the Isle of Man.    for osteoporosis.62
Back to index | 16

Economy
Musculoskeletal ill-health results in significant costs that fall on
individuals, employers, the health service and the wider economy.
Musculoskeletal conditions account for     including direct health costs and indirect (lost                    Approximately 33.5 million prescriptions
the third largest area of NHS programme    productivity, sickness absence, informal care)                      (+0.2% in 2015) were dispensed for
spending at £4.7 billion in 2013-14.64     costs was estimated to be £103–129 billion.65                       musculoskeletal and joint diseases in
                                                                                                               England in 2016, costing approximately
In 2007, the total annual cost to the UK   Treating the two most common forms of
                                                                                                               £205.8 million (+8.0% in 2015).69
economy of working-age ill health,         arthritis-osteoarthritis and rheumatoid
                                           arthritis-is estimated to cost the economy                          Conditions such as back pain account for
                                           £10.2 billion in direct costs to the NHS                            around 40% of all sickness absence in the
                                           and wider healthcare systeml this year.                             NHS and costs around £400 million per year.70
         10                                Cumulatively the healthcare cost will reach                         The cost of working days lost due to
          9                                £118.6 billion over the next decade.66                              osteoarthritis and rheumatoid arthritis was
          8                                                                                                    estimated at £2.58 billion in 2017 rising to
                                           Back pain cost the UK economy an estimated
          7                                £1.6 billion direct and £10 billion indirect                        £3.43 billion by 2030.66
          6
  Billions

                                           costsm in 2000.67                                                   Costs of presenteeism (attending work while
          5
                                           The hospital costs of hip fractures alone are                       ill) are estimated to be £30 billion annually.48, 65
          4
                                           estimated at £2 billion per year in the UK.59
          3
          2                                The cost of ankylosing spondylitis in the
                                                                                                                 Public Health England’s
          1                                UK was estimated at roughly £19,016 per
                                                                                                                 Return on Investment
          0                                person per year in direct and indirect costsn
                                                                                                                 (ROI) tool for cost-effective
                                           in 2010. That’s an estimated total cost of
                                                                                                                 interventions for the
                    10.2bn                 £3.8 billion.68
                                                                                                                 prevention and treatment of
              in direct costs to the NHS   l
                                            This includes direct costs (NHS healthcare and other medical         musculoskeletal conditions.
                                           costs (i.e. prescriptions, home care).
                and wider healthcare                                                                             n
                                                                                                                  This includes direct costs (NHS healthcare and other
                                           m
                                            This includes direct costs (NHS healthcare, community care
                   system this year        and private services) and indirect costs (work loss, absenteeism,
                                                                                                                 health costs) and indirect costs (work loss, absenteeism,
                                                                                                                 presenteeism, early retirement, and informal care)
                                           reduced productivity and informal care).
Back to index | 17

Economic benefits of musculoskeletal research
Every £1 invested in medical research delivers a                                                             £1.6 billion of research funding in the UK was invested by medical
return equivalent to around 25p every year, forever.71                                                       research charities in 2016.72
                                                                                                             Government and charity research funding dedicated to musculoskeletal
Investment into musculoskeletal research is money well spent.                                                conditions remains disproportionally small compared to the disease
A new study estimating the returns generated by public and charitable                                        burden attributed by conditions like arthritis and back pain.
investment for musculoskeletal research in the UK has found that                                             Although musculoskeletal conditions account for around 9% of
research into musculoskeletal conditions, such as osteoarthritis,                                            Disability Adjusted Life Years (DALYs) in the UK they received only
rheumatoid arthritis and back pain, not only results in improved                                             2.8% of research funding in 2014.73
health outcomes but also generates economic gain for the UK.
Every £1 invested in musculoskeletal research leads to 7p                                                                            Research spend vs. burden of diseaseo
of direct health benefits with a further 15-18p in benefits
to the wider economy (i.e. spill over) every year, forever.71                                                                             Cancer

                                                                                                                                      Infection
            Yearly return for £1 of public or charity investment.
   30                   Total estimated return of 25p per year                                                                   Neurological
                                                                                                                                                                                                             UK DALY rate
   25                                                                                                                                                                                                             (2012)
                                                                                        Net health gain
                                  10p                 9p                                                                      Cardiovascular
   20            7p                                                     7p              from What’s it
                                                                                        worth studies
   15                                                                                                                          Mental Health
                                                                                                                                                                                                      Proportion of 2014
   10                                                                                                                                                                                                 spend (64 funders)
             15-18p            15-18p            15-18p             15-18p                                                  Musculoskeletal
                                                                                        GDP (or spillover)
     5                                                                                  gain from 2016
     0                                                                                  study                    Metabolic and Endocrine
         Musculoskeletal Cancer                Cardiovascular        Mental
            research     research                 research            health                                                                        0%           5%          10%           15%          20%          25%
                                                                    research*
                                                                                                             o
                                                                                                              This graph represents the top health research spend categories, excluding Inflammatory and Immune System,
*Figure for mental health research subject to greater uncertainty than others, due to methodology.           Generic Health Relevance and other which have no equivalent health categories in the Global Burden of Disease Study
Back to index | 18

Condition specific statistics
Prevalence, risk factors,
comorbidities, and impact
Condition specific data                                                     Back to index | 19

Inflammatory conditions
Axial spondyloarthritis
(including ankylosing spondylitis)
Axial spondyloarthritis (axSpA) is an umbrella term used
to describe a spectrum of long-term (chronic) inflammatory
conditions primarily affecting the spine and/or sacroiliac
joints, resulting in the main symptom of chronic back pain.
It includes both people who have the visible changes or
damage of the sacroiliac joints as seen on x-ray (ankylosing
spondylitis) as well as people who have the symptoms of
chronic back pain without the classic changes or damage seen on
ordinary x-rays of the sacroiliac joints (non-radiographic axSpA).
Inflammation of the spinal joints and surrounding structures causes
pain, stiffness and limitation in the flexibility of the back and causes
new bone to grow at the sides of the vertebrae. Eventually the
individual bones of the spine may link up and fuse. Non-radiographic
axial spondyloarthritis progresses to ankylosing spondylitis at a rate of
about 12% over 2 years.74
To understand more about the causes, diagnosis and treatment of
ankylosing spondylitis download our information booklet. Read more
inflammatory conditions                                                                                                   Back to index | 20

Axial spondyloarthritis (incl. ankylosing spondylitis)

 Who is affected?                            Common risk factors
 Prevalence                                  Age                                              Genetics
 Estimates suggest 0.3-1.2% of the adult     Ankylosing spondylitis usually occurs            Ankylosing spondylitis
 (18–80 years) UK primary care population    between 20–30 years of age, the average          is more common in
 has axial spondyloarthritis, depending on   age of onset is 24 years.78 90–95% of            people with the human
 the classification criteria used.75         people are aged less than 45 years at            leukocyte antigen HLA–
                                             disease onset.75                                 B27 gene. A person who
 Approximately 200,000 people in the UK
                                             Sex                                              is HLA–B27 positive
 have ankylosing spondylitis.76
                                             Approximately 50% of non-radiographic            has a 5–6% chance of
                                             axial spondyloarthritis patients are             developing ankylosing
                                             female,79, 80 however, males are more            spondylitis and this risk
                                             likely to progress to have the structural        is increased if a first
                                             changes of ankylosing spondylitis                degree relative has
                                             compared to females.81                           the disease.82,83
                                                                                              Smoking
                                                  males are more                              Smoking is associated with higher disease
                                                  likely to progress    50%                   activity, increased structural damage
                                                  to have the           of non-               on MRI and as a result lower physical
                                                  structural changes    radiographic axial
                                                  of ankylosing         spondyloarthritis     functioning in people with ankylosing
                                                  spondylitis           patients are female   spondylitis.84, 85

               89%
  of patients with axial spondyloarthritis
 (non-radiographic axial spondyloarthritis
     and ankylosing spondylitis) have
         inflammatory back pain.77
inflammatory conditions                                                                                             Back to index | 21

Axial spondyloarthritis (incl. ankylosing spondylitis)

 Common comorbidities                                                                      Impact on quality of life
 Osteoporosis and fragility fractures          10% of people with ankylosing spondylitis   and work capacity
 People with ankylosing spondylitis are at     have doctor–diagnosed depression            Disability
 increased risk of experiencing loss in bone   compared to 6% of the general population    The most prevalent quality of
 mineral density (BMD) and osteoporosis,       seeking healthcare during a 13–year         life concerns in people with
 which can lead to spinal fractures.           observation period.91                       ankylosing spondylitis include
 1–9% of people with ankylosing                                                            stiffness, pain, fatigue and
 spondylitis experience spinal fractures,                                                  poor sleep.92
 thus increasing the need for surgery.86                                                   Work
 19–62% of people with ankylosing                                                          Withdrawal from work is three
 spondylitis have decreased BMD. High                                                      times more common in people
 rates have even been reported in patients                                                 with ankylosing spondylitis
 with
Inflammatory conditions                                         Back to index | 22

Gout
Gout is a painful inflammatory condition, caused by
the build-up of uric acid in the bloodstream. This is
partly inherited, but lifestyle factors such as alcohol
consumption, diet and obesity are major risk factors.
High uric acid levels lead to crystals forming in the joints.
These crystals can trigger sudden painful episodes of
severe joint inflammation (‘attack’). If untreated these
attacks get more common, spread to involve new joints
and can cause long-term cartilage and bone damage.
To understand more about the causes, diagnosis and treatment
of gout, download our information booklet. Read more
Inflammatory conditions                                                                                                Back to index | 23

Gout

 Who is affected?                            Common risk factors
 Prevalence                                  Age                                       Alcohol
 Around one in 40 people                     3–6% of people with gout experience       Regular consumption of alcohol
 (2.49%) in the UK have gout. That’s         disease onset before 25 years of age.95   (predominantly beer but also spirits) has
 equivalent to around 1.5 million people.9   Men can develop gout as early as their    been associated with a threefold higher risk
 Between 1997–2012, both the prevalence      mid–20s and it becomes more common        of new cases of gout among women and
 and incidence (new cases) of gout           in women after menopause.96               twofold higher risk in men, compared to
 increased significantly in the UK by                                                  those with no alcohol intake or ≤1 ounce/
 64% and 30% increases respectively.9                                                  week.90, 91 Moderate wine consumption has
                                                                                       not been linked to an increased risk.

                                                                                              Risk of gout through regular
                                                                                            alcohol consumption compared
                                                                                                 with no alcohol intake

               30%                                                                        Men

                                             Sex
                                             Gout is generally three to four times     Women
                                             more common in men than women.89

 The prevalence of gout is highest in the    Obesity

                                                                                               l

                                                                                                          k

                                                                                                                     k

                                                                                                                                k
 North East 3.11% and Wales 2.98% and        Obese people are twice as likely to

                                                                                             ho

                                                                                                       ris

                                                                                                                  ris

                                                                                                                             ris
                                                                                           co

                                                                                                       er

                                                                                                                  er

                                                                                                                             er
 lowest in Scotland 2.02% and Northern       develop gout and tend to develop it

                                                                                         al

                                                                                                     gh

                                                                                                                gh

                                                                                                                           gh
                                                                                       No

                                                                                                   hi

                                                                                                              hi

                                                                                                                         hi
 Ireland 2.15%.86                            at a younger age.31

                                                                                                1x

                                                                                                            2x

                                                                                                                       3x
Inflammatory conditions                                                                                              Back to index | 24

Gout

 Impact on quality of life and             Common comorbidities
 work capacity                             54% of people with gout are expected to             22%                         71%
 Work                                      have one or more comorbidities within                Men                        Women
 23% of working–age people with gout       five years of first being diagnosed.100
 say they had to give up work and 18%      Cardiovascular diseases
 had taken early retirement.104
                                           People with gout are 50% more likely to
                                           develop high blood pressure than people                      Men and women
                                23%        without gout putting them at higher risk                      with gout are
                                give up
                                           of stroke.100                                                 more likely to
                                 work
                                                                                                         develop type
                                           The incidence of heart failure and reduced
                                                                                                          2 diabetes
                                           ability of the heart’s ventricles to contract
              working–                     is two to three times higher in people with
             age people                    gout compared to people without gout.101
              with gout
                                           Kidney disease
                                                                                           Liver disease
                                           People with gout are three times more
                                18%                                                        People with gout are almost
                                           likely to develop kidney disease than
                                 early                                                     two times more likely to
                              retirement   people without gout.100
                                                                                           develop liver disease than
                                           Type 2 diabetes                                 people without gout.100
 Quality of life                           There are almost 3.6 million people who         Depression
 Gout is significantly                     have been diagnosed with type 2 diabetes        People with gout are
 associated with poor                      in the UK.102                                   19% more likely to
 overall quality of life,                  Women and men with gout are 71%                 have diagnosed
 even after adjusting                      and 22% more likely to develop type 2           depression than people
 for comorbidities.105                     diabetes.103                                    without gout.100
Inflammatory conditions                                         Back to index | 25

Juvenile idiopathic arthritis
Juvenile idiopathic arthritis affects children under
the age of 16 and is an autoimmune disease that
causes inflammation in the joints. It’s one of the
most common rheumatic diseases of childhood.
There are six different types of juvenile idiopathic
arthritis and symptoms vary between the different types.
To understand more about the causes, diagnosis and
treatment of juvenile idiopathic arthritis visit our website.
Read more
Inflammatory conditions                                                                                                    Back to index | 26

Juvenile idiopathic arthritis

 Who is affected?                               Common risk factors                              Impact on quality of life
 Prevalence                                     Genetics                                         Quality of life
 An estimated 12,000 children (one in           Risk factors for juvenile idiopathic arthritis   Children with juvenile idiopathic arthritis
 1,000) under the age of 16 have juvenile       are not clear, however studies have shown        have significantly lower physical well–
 idiopathic arthritis in the UK.8               strong evidence for genetic susceptibility.      being and psychosocial health (mental,
 Incidence                                      The probability that identical twins will        emotional, social and spiritual well–
 One in 10,000 children are being               both have the same genetic component             being) compared to those without.
 diagnosed with juvenile idiopathic             fundamental to the susceptibility of             Intensity of pain has the greatest
 arthritis in the UK each year. That’s          juvenile idiopathic arthritis ranges between     influence on their psychosocial health.112
 around 1,000–1,500 children.8                  25–40%.106

 Common comorbidities
 Eye inflammation
 10–20% of children with juvenile idiopathic                                                     Adulthood
 arthritis will develop an inflammatory eye                   10-20%                             At least one third of children with
 condition called uveitis, which can cause                    inflammatory                       juvenile idiopathic arthritis will have
 reduced vision and blindness if not treated.                 eye condition                      ongoing active disease in adulthood.113
 107, 108, 109, 110
                                                                                                 Between 30% and 56% of people
 Fragility fractures                                              41%                            with juvenile idiopathic arthritis will
 41% and 34% of children with juvenile                          low bone                         experience severe limitations in dexterity
 idiopathic arthritis have low bone mineral                  mineral content                     and mobility in adulthood because of
 content and low bone mineral density                                                            their arthritis, such as finding it very
 respectively, putting them at increased                                                         difficult or not possible to grasp small
 fracture risk.111                                                                               objects or walk 400 meters.114
Inflammatory conditions                                        Back to index | 27

Rheumatoid arthritis
Rheumatoid arthritis is an autoimmune disease that
causes inflammation in the joints. As a result, the joint
becomes painful, stiff and swollen. This inflammatory
activity can ultimately cause irreversible damage. The
sooner one starts treatment for rheumatoid arthritis,
the more effective it’s likely to be, so early diagnosis and
intensive treatment is important.
To understand more about the causes, diagnosis and treatment
of rheumatoid arthritis, download our information booklet.
Read more
Inflammatory conditions                                                                                                                  Back to index | 28

Rheumatoid arthritis

 Who is affected?                            Common risk factors
 Prevalence                                  Age                                            Studies have shown that:
 There are over 400,000 adults aged 16       Rheumatoid arthritis affects adults of any     BMI ≥25 kg/m2
 and over living with rheumatoid arthritis   age yet prevalence increases with age, with    (overweight/obese) significantly
 in the UK.7                                 peak age of onset between 40–60 years and      increased the risk of developing
                                             is highest at age 70 years and over.116, 117   rheumatoid arthritis by 15%, compared
 The Musculoskeletal Calculator p            Around three quarters of people with           to BMI
Inflammatory conditions                                                                                                        Back to index | 29

Rheumatoid arthritis

 Common comorbidities                                                      Impact on quality of life and work capacity
 Cardiovascular disease                their disease, putting them at      Mortality                           sevenfold increase in depression
 Cardiovascular disease is the         increased risk of death. 127, 128   People with rheumatoid              over the subsequent year.134
 main cause of premature               Osteoporosis & fragility            arthritis have a 47% increased      Work
 mortality and sudden death            fractures                           risk of death compared to the       A third of people with
 in patients with rheumatoid           Rheumatoid arthritis itself,        general population.133              rheumatoid arthritis will have
 arthritis.122                         along with reduced mobility         31% of early death from             stopped working within two
 Around one in 20 people (6%)          and steroids used to treat          rheumatoid arthritis is due to      years of onset and half are
 with rheumatoid arthritis have        rheumatoid arthritis increase       cardiovascular disease, followed    unable to work within 10 years.135
 cardiovascular disease. 123,124       the risk of developing              by pulmonary problems               Physical inactivity
 The risk of heart attack is           osteoporosis and falls.129          (including respiratory infection    Approximately 68% of
 doubled for people with               The rate of osteoporosis can        and lung cancer) responsible        rheumatoid arthritis patients
 rheumatoid arthritis compared         be up to twice as high among        for 29% of all deaths.128           in the UK are physically
 to the general population.125         rheumatoid arthritis patients       Depression                          inactive. Low physical activity
 The risk of stroke is 30% higher      compared to the general             Around one in six people            in patients with rheumatoid
 for people with rheumatoid            population.130                      (16.8%) with rheumatoid             arthritis becomes a vicious
 arthritis than the general            Around 36% of people with           arthritis have major                cycle of disease progression
 population.126                        rheumatoid arthritis aged over      depressive disorder.41              and increased pain, thus
                                       18 report falling at least once     Depression in rheumatoid            affecting both physical and
 Lung disease                                                                                                  mental health.136
 Lung disease is a major               annually.131                        arthritis patients is associated
 contributor to morbidity and          People with rheumatoid arthritis    with increased levels of pain
 mortality in rheumatoid arthritis.    have 2 times the risk of hip        and functional disability.134
 Evidence suggests one in 10           fracture and 2.4 times the risk     A 10% reduction in the ability to               16.8%
 people with rheumatoid arthritis      of vertebral fracture, compared     perform activities important to             1 in 6 people with
                                                                                                                   rheumatoid arthritis have
 will be diagnosed with interstitial   to those without a history of       an individual with rheumatoid
                                                                                                                   major depressive disorder
 lung disease over the lifetime of     rheumatoid arthritis.132            arthritis may be followed by a
Condition specific data                                          Back to index | 30

Musculoskeletal pain
Osteoarthritis
Osteoarthritis is a condition in which the joints of
the body become damaged, stop moving freely and
become painful. Osteoarthritis results from a combination
of the breakdown of the joint and the body’s attempted
repair processes. Pain is the main symptom of osteoarthritis
and can have a devastating impact on people’s lives. The
knee is the most common site in the body for osteoarthritis,
followed by the hip and hands/wrists.
To understand more about the causes, diagnosis and treatment
of osteoarthritis, download our information booklet. Read more
Muskuloskeletal pain                                                                                                 Back to index | 31

Osteoarthritis
 Who is affected?                                                 Common risk factors
 Prevalence                                                       Age
 An estimated 8.75 million people aged 45 years and over          Risk of developing osteoarthritis increases with age. A third of
 (33%) in the UK have sought treatment for osteoarthritis.        women and almost a quarter of men between 45 and 64 have
 60% female, 40% male.10                                          sought treatment for osteoarthritis, this rises to almost half of
                                                                  people aged 75 and over.10
 The Musculoskeletal Calculator estimates:7
                                                                  Sex
                                                                  The prevalence of osteoarthritis is generally higher in women
 England
                                                                  than men. The difference is most apparent for hand and knee
 4.11 million (18.2%) of adults aged over 45
                                                                  osteoarthritis and among people over 50 years of age.137
 years in England have osteoarthritis of the knee.
 6.1% of whom are affected by the severe
 form of the condition.
                                                   18.2%          Women accounted for roughly 60% of hip and knee replacement
                                                                  operations over 90% of whom are due to osteoarthritis.30
 2.46 million (10.9%) of adults aged over 45
 years in England have osteoarthritis of the hip.                         Consultation prevalence of Osteoarthritis (%)10
 3.2% of whom are affected by the severe form of the condition.
                                                                   50
 Scotland
                                                                   40
 420,000 (16.6%) of adults aged over 45 years
 in Scotland have osteoarthritis of the knee.                      30
 4.1% of whom are affected by the severe
 form of the condition.                            16.6%           20
 256,000 (10.1%) of adults aged over 45 years
 in England have osteoarthritis of the hip. 2.5%                   10
 of whom are affected by the severe form of the condition.
                                                                     0
 Do you want to know how many people have osteoarthritis                   45-64         65-74         65-74        Females     Males
 in your area? Visit the MSK Calculator online tool.                       years         years         years
Muskuloskeletal pain                                                                                                          Back to index | 32

Osteoarthritis

 Common risk factors                                                      Common comorbidities
 Obesity                             Joint abnormalities                  Cardiovascular disease              to 23% of people without
 The risk of developing              People with abnormal hip shape       Women and men over 65 years         osteoarthritis, putting them
 osteoarthritis throughout life      caused by developmental              of age who have osteoarthritis      at increased risk of developing
 increases with rising BMI.138       problems, have greatly increased     are at 17% and 15% increased        cardiovascular disease and
 People who are overweight or        risk of developing osteoarthritis.   risk of hospitalisation for         diabetes.145
 obese are approximately 2.5         Abnormal hip shape accounts          cardiovascular disease.144          Depression
 and 4.6 times more likely to        for nearly one in 10 primary         Metabolic syndrome                  Around 20% of people with
 develop knee osteoarthritis         hip replacements in adults,          Metabolic syndrome is               osteoarthritis experience
 than those of normal body           rising to nearly one in three hip    prevalent in 59% of people          symptoms of depression
 weight.139,140                      replacements in people under         with osteoarthritis compared        and anxiety.146
                                     the age of 60 years.142
 The average BMI of hip and
 knee replacement patients in
 2016 was 28.8 (overweight)
                                      Genetic factors                     Impact on quality of life and work capacity
                                      Genetic factors account
 and 31.0 (obese) respectively.30                                         Pain                                After joint replacement
                                      for 60% of hand and hip
 Occupation                                                               Nearly three quarters of people     surgery only 21.4% of knee
                                      osteoarthritis and 40% of
 Knee osteoarthritis is more                                              with osteoarthritis report some     replacement and 17.5% of hip
                                      knee osteoarthritis.143
 frequently observed in people                                            form of constant pain, with one     replacement patients reported
 with occupations that require            60%                             in eight describing their pain as   moderate or severe pain in the
 squatting and kneeling, hip           hand and hip                       often unbearable.147                past four weeks, compared to
 osteoarthritis is associated with                                        Joint replacements                  93.9% and 93.0% of patients
 prolonged lifting and standing.                                          Osteoarthritis was recorded as      before they received surgery.148
 Hand osteoarthritis is more                                              the main indication for surgery     Work
 frequent in people with                                                  in 90% of primary hip and 99%       A third of people with
 occupations requiring                    40%                             of primary knee replacement         osteoarthritis retire early, give
                                            knee
 increased manual dexterity.141                                           patients in 2016.30                 up work or reduce hours.10
Muskuloskeletal pain                                          Back to index | 33

Back pain
Back pain is a common condition often caused by a
simple muscle, tendon or ligament strain and not
usually by a serious problem. Back pain can be acute,
where the pain starts quickly but then reduces after a
few days or weeks, or chronic (severe), where pain might
last on and off for several weeks or even months and years.
To understand more about the causes, diagnosis and
treatment of back pain, download our information booklet.
Read more
Muskuloskeletal pain                                                                                                                            Back to index | 34

Back pain

 Who is affected?                                                 Common risk factors
 Prevalence                                                                                                             Deprivation
 Back pain affects around
 one third of the UK adult
                                          20%                                                                           People aged 45–64 years of age
                                                                                                                        (working age) in the most
                                   of all musculoskeletal
 population at some point                                                                                               deprived areas are almost twice
                                  consultations are related
 each year.149, 150                                                                                                     as likely to report back pain
                                     to the back (14%
 Between one in four and                                          Obesity                                               (17.7%) as those from the least
                                     for the lower back
 one in seven young people                                        People who are obese are four                         deprived areas (9.1%).2
                                       specifically).150
 have long–term low                                               times more likely to develop
 back pain.151, 152                                               back pain than those with a
                                                                  healthy body weight.31, 32

                                                                                                                                     17.7%
                                                                  Depression
 The Musculoskeletal calculatorr estimates:7                      The odds of back pain in people
                                                                  with symptoms of depression                                  of people aged 45-64 in
                                                                  have been shown to be 50%                                    the most deprived areas
 9.11 million (16.9%) people in England
                                                                  higher than in those without                                   are twice as likely to
 have back pain, 5.5 million of whom               16.9%          symptoms of depression.153                                       report back pain.
 have severe back pain.
                                                                  Smoking
                                                                  The prevalence of low back pain
 910,000 (19.1%) of adults aged over                              is approximately 50% higher
 18 years in Scotland have back pain,              19.1%          in daily smokers compared to
 564,000 of whom have severe back pain.                           non–smokers.154, 155

                                                              The MSK Calculator is a local estimates prevalence model developed by Imperial College London in partnership
                                                              r

 Do you want to know how many people have back pain in your   with Arthritis Research UK. Prevalence estimates for Wales and Northern Ireland are currently not available.

 area? Visit the MSK Calculator online tool.
Muskuloskeletal pain                                                                                         Back to index | 35

Back pain

 Impact on quality of life and work capacity                                         Common comorbidities
 Disability                        Work limitation                                   Musculoskeletal and mental health
 Low back pain                     Back pain is the second most common               conditions
 was the top cause                 cause of short–term absences after minor          People with chronic low back pain have
 of years lived with               illnesses (such as colds, flu and sickness).159   been shown to have a significantly
 disability (YLDs)                 68.3% of people return to work one                higher frequency of musculoskeletal
 in the UK in both                 month after an episode of back pain,              and neuropathic pain conditions and
 1990 and 2016.1                   rising to 85.6% at one to six                     common sequelae
 Low back pain patients            months and 93.3%                                  of pain such as
 generally stop seeking            at more than                                      depression (13.0%
 medical attention within          six months.160                                    vs. 6.1%), anxiety

                                                          68.3%
 three months, however                                                               (8.0% vs. 3.4%)
 60% to 80% of people                                                                and sleep disorders
 still report pain or disability                        of people return to          (10.0% vs. 3.4%),
 a year later and up to                                  work one month              compared to people
 40% of those who have                                   after an episode            without low back
 taken time off work will                                   of back pain             pain.156
 have future episodes of
 work absence.157, 158
Muskuloskeletal pain                                               Back to index | 36

Fibromyalgia
Fibromyalgia is a long-term (chronic) condition
causing many symptoms including widespread body
pain and fatigue. It’s quite common – up to one person
in every 25 people may be affected. The exact causes
of fibromyalgia are still not known, but research suggests
that there’s an interaction between physical, neurological
and psychological factors. Fibromyalgia in itself doesn’t
cause any lasting damage to the body’s tissues. However,
it’s important to build up and maintain physical activity levels
to avoid and address weakening of the muscles (deconditioning)
which could lead to worsening pain and fatigue.
To understand more about the causes, diagnosis and treatment
of fibromyalgia, download our information booklet. Read more
Muskuloskeletal pain                                                                                                   Back to index | 37

Fibromyalgia

 Who is affected?                            Common risk factors                          Comorbidities
 Prevalence                                  Age and Gender                               Depression and anxiety
 It’s not entirely clear how many people     Fibromyalgia prevalence increases with       Depression and anxiety are more
 are affected by fibromyalgia alone, as it   age, reaching a peak around 75 years,        prevalent in people with fibromyalgia
 can be a difficult condition to diagnose.   and is more common in women than in          than individuals without.163, 164, 165, 166
 Estimates suggests around 1.2-5.4%          men at every age.11                          Lifetime prevalence of depression and
 of adults in the UK are affected by         Genetics                                     anxiety in people with fibromyalgia
 fibromyalgia depending on the               Fibromyalgia develops because of a           go up to 70%
 classification criteria used. That’s        combination of biological, psychological     and 60%,
 equivalent to up to 2.8 million people.11   and social factors. Family studies have      respectively.163, 167
                                             identified a link between genetic markers,   High levels of
              2.8m people                    supporting the genetic background of the     depression and
                                             disease, however key hereditary factors      anxiety in people
                                             have not yet been identified.161             with fibromyalgia are associated with
                                             Other musculoskeletal conditions             more physical symptoms and poorer
                                             Fibromyalgia commonly co-occurs with a       functioning than lower levels.168
                                             number of physical conditions, including     Post-traumatic stress disorder
                                             rheumatoid arthritis and systemic lupus      People with Fibromyalgia are six times
              UK adults                      erythematosus.162                            more likely to report post-traumatic
             affected by                                                                  stress disorder compared to people
                                                                                          with two stomach conditions
            fibromyalgia                     Impact on quality of life                    (achalasia and dyspepsia).169
                                             and work capacity                            Irritable Bowel Syndrome (IBS)
                                             People with fibromyalgia often experience    Studies have shown fibromyalgia and
                                             mental and physical disabilities and a       irritable bowel syndrome coexist in
                                             significantly impaired quality of life.172   many patients.170, 171
Condition specific data                                     Back to index | 38

Osteoporosis & fragility fractures
Osteoporosis means spongy (porous) bone. Everyone
has some degree of bone loss as we get older, but the
term osteoporosis is used only when the bones become
quite fragile. When bone is affected by osteoporosis, the
holes in the honeycomb structure become larger and the
overall density is lower, which is why the bone is more
likely to fracture.
To understand more about the causes, diagnosis and
treatment of osteoporosis & fragility fractures, download
our information booklet. Read more
Condition specific data                                                                                                   Back to index | 39

Osteoporosis & fragility fractures

  Who is affected?                              Common risk factors
  More than 3 million people in the UK          Age                                          mineral density osteoporotic fractures.180
  are estimated to have osteoporosis.12         After the third decade of life, bone         People who smoke are at 25% increased
  More than 300,000 fragility fractures         naturally begins to decline at the rate      fracture risk compared to those who
  occur each year in the UK.13 In England       of 0.3% of bone per year.175                 had never smoked.181
  and Wales, around 180,000 of the              Prevalence of osteoporosis increases         Low vitamin D and calcium levels
  fractures presenting each year are the        markedly with age, from 5% at 50             Elderly patients who consume adequate
  result of osteoporosis.173                    years to over 30% at 80 years.176            vitamin D and Calcium supplements are
  In 2016, over 65,000 people aged 60 or        Sex                                          at decreased fracture risk.182
  older presented to hospital with a hip        One in two women and one in five men         Previous fracture
  fracture in England, Wales and Northern       over the age of 50 are expected to           People who have had one fracture
  Ireland.174                                   break a bone during their lifetime.177       remain at greater risk of sustaining a
                                                Genetics                                     secondary fracture. After a first fracture
   3 million               300,000              Parental history of fracture is associated   the risk of fracturing again is increased
    in UK have         fragility fractures in   with an increased risk of fracture,          by two to threefold.183, 184
   osteoporosis          the UK each year.      independent of bone mineral density.178      Alcohol
                                                Menopause                                    People who consume more than two
                                                After the onset of menopause, women          alcoholic drinks per day are associated
                                                can lose an average of 2.5% of their         with higher risk of hip fracture compared
                                                bone per year for the first five years,      with those who don’t drink.185
                                                due to the decrease in oestrogen             Low BMI
                                                production, putting them at increased        People with a BMI of less
                                                risk of developing osteoporosis.179          than 18.5 kg/m2 are at
                                                Smoking                                      increased fracture risk.
                                                Smoking is associated with low bone          186, 187
Condition specific data                                                                                                     Back to index | 40

Osteoporosis & fragility fractures

  Common comorbidities                                                                             Impact on quality of life
  Diabetes                                       compared to the general population.130            and work capacity
  People with type 1 diabetes have a six         Around 36% of people with rheumatoid              Mortality
  times greater risk of hip fracture compared    arthritis aged over 18 report falling at least    A month after suffering a hip fracture,
  to those without.188, 189                      once annually.131                                 one in 15 people (6.7%) died in 2016
  Chronic inflammatory bowel disease                                                               (7.1% in 2015) and over half (66.1%)
                                                 People with rheumatoid arthritis are at 2
  Chronic inflammatory bowel disease                                                               returned home by 120 days.174
                                                 times the risk of hip fracture and 2.4 times
  (IBD) has been shown to be associated          the risk of vertebral fracture, compared to
  with an increased risk of fractures.190        people without rheumatoid arthritis.132
  The incidence of fractures among
  patients with chronic inflammatory
  bowel disease is approximately 40%                People with                                    One in four people (28.7%) die within a
  higher than in the general population.191       type 1 diabetes               IBD has been       year of suffering a hip fracture.194
                                                  have a six times             associated with
  Coeliac disease                                  greater risk of             an increased risk
  Patients with coeliac disease are at a            hip fracture                 of fractures
  higher risk of fractures compared to the
  general population.192
                                                                                                   Pain
  Hyperthyroidism
                                                                                                   One in three people who have long–term
  Mild (subclinical) hyperthyroidism is
                                                                                                   pain from fractures describe it as severe
  associated with an increased risk of hip
                                                   36% of people                                   or unbearable.195
  and other fractures, especially among           with rheumatoid
  those with thyroid–stimulating hormone           arthritis report              People with       Disability
                                                                                 rheumatoid
  (TSH) levels of less than 0.10 mIU/L.190.193     falling at least                                Research has found that 43% of people
                                                   once annually                arthritis are at
                                                                               2 times the risk    who were previously independent are
  Rheumatoid arthritis
                                                                                of hip fracture    unable to walk independently in the year
  The rate of osteoporosis can be up to twice
                                                                                                   after a hip fracture.196
  as high among rheumatoid arthritis patients
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