National Health Priority Area: Arthritis and other musculoskeletal conditions By Jason and Nikita

What are NHPAs and how are they chosen? National Health Priority Areas are diseases or conditions selected by the Commonwealth Government as key focus targets for improvement in Australian health. Involves many key stakeholders, such as all levels of government, non-government organisations and the private sector. Aim is to work collaboratively to reduce the burden of disease associated with these areas. There are nine total areas identified by the National Health Priority Action Council. The NHPAs are chosen as a result of one or more of the following: - Significant contribution to burden of disease - Significant potential for improvement in health - Potential to reduce inequality between population groups - Associated costs for the disease or condition are substantial - Potential for practical strategies to be implemented

Clarification of NHPA: Arthritis and other musculoskeletal conditions While there are over 100 musculoskeletal conditions, the focus of this National Health Priority Area consists of four: - Osteoarthritis - Rheumatoid arthritis - Osteoporosis - Juvenile arthritis Do not prominently contribute to mortality figures, but lead to high rates of morbidity, accounting for approximately five per cent of the burden of disease in Australia.

Osteoarthritis One of the most common forms of arthritis. Characterised by the wearing down of cartilage that cushions the joints where bones meet, causing bone to rub on bone. Bone rubbing causes pain and limits mobility. Most common sites are: knees, neck, lower back, hips and fingers. Degenerative disease often leading to reduced functioning; inability to write, walk or stand. More common among females than males, while also rising in prevalence with age and increasing body weight.

Rheumatoid arthritis An autoimmune disease, meaning the immune system is mistakenly attacking body tissues. Characterised by the inflammation of the joints. Immune system attacks tissue lining the joints, resulting in inflammation, pain and swelling. Commonly present in symmetrical fashion. Disease quickly disables area, seriously compromising the quality of life. Chronic inflammation can eventually wear bone and muscle away, resulting in deformities in the joints. Often affects small joint areas such as hands and feet, although that doesn’t prevent it from affecting larger joint areas like knees and hips.

Osteoporosis Deterioration of bone density, leaving fragile and easily fractured bones. Most common sites of fracture are the spine, hip and wrist. The process of replacing old bone tissue with new bone tissue to maintain bone mass, and any malfunction within, can be a contributing factor to the development of osteoporosis.

Juvenile arthritis Refers to any form of arthritis that occurs in individuals under 16 years of age. Encompasses a range of musculoskeletal conditions. Often characterised by swelling, stiffness and pain as with all types of arthritis. Can affect development and growth of skeletal tissue and thus reduce mobility.

Risk Factors Biological Obesity; increases the pressure on joints, increasing chances of developing arthritis, but also decreasing the risk of osteoporosis. Gender; females are more likely to develop musculoskeletal conditions, “probably” related to hormones, particularly the role of oestrogen. Age; wear and tear on bones increases the risk of osteoarthritis, while decreasing bone mass leads to development of osteoporosis. Genetics; family history of musculoskeletal conditions. Low body weight; smaller bones can equate to a more pronounced effect of osteoarthritis and osteoporosis.

Risk Factors Behavioural Tobacco smoking; chemicals can directly harm bone cells, and behaviour related to smoking usually leads to a lower body weight and less physical activity. Excessive alcohol intake; can be toxic to bone cells, reducing bone density and alcohol may reduce consumption of key nutrients. Physical activity; excessive or insufficient weight-bearing activity that adds stress to, or doesn’t maintain strength of, joints. Diet; lack of nutrients required for hard tissue formation, particularly during adolescence resulting in acceleration or even cause the onset of musculoskeletal conditions. Lack of sun exposure; vitamin D deficiency can contribute to reduced bone mineral density and osteoporosis.

Risk Factors Social Food security; lack of access to nutritional food and thus the nutrients that promote healthy bones. Socioeconomic status; lack of access to health care information, treatment and medication.

Contribution to Burden of Disease Arthritis and other musculoskeletal conditions contribute approximately five per cent to the burden of disease in Australia. - More than three million people (15% of population) had some form of arthritis and over 500,000 (3% of population) had osteoporosis in 2008. - Overall prevalence of arthritis was 18 per cent for females and 13 per cent for males in 2008. - Prevalence of osteoporosis was 5% for females and 1% for males in 2008. - In 2008, osteoarthritis affected over 1.6 million Australians. - In 2008, rheumatoid arthritis affected around 430,000 Australians. - In 2008, osteoporosis affected almost 700,000 Australians.

Costs of Disease Direct cost; Surgery an hospital fees. Joint replacement surgery may be required for some people experiencing osteoarthritis. The cost of medication. Medication is a treatment option for many musculoskeletal conditions. Indirect cost; Lost productivity. Parents may have to take time off work to care for a child with their academic progress. loss of income. Reduced mobility may not be able to work, which reduces their income. Intangible; Anxiety over the prospect of falls and fractures. Osteoporosis increases the frequency of falls and probability of fractures. Lack of exercise due to physical limitations. Exercise can be difficult for those with arthritis or osteoporosis. This can impact on social, mental and physical wellbeing.

Better Arthritis and Osteoporosis Care (BAOC) An initiative aimed at: - improving prevention of arthritis and osteoporosis - facilitating early detection - improving management and quality of life of sufferers 2006-2010 initiative has an emphasis on: - juvenile idiopathic arthritis - improved primary care - improved self-management - improved secondary and tertiary preventions. Five program areas funded by the BAOC: 1. Awareness-raising, consumer education and self-management  2. Health service improvement  3. Health professional education  4. Data monitoring  5. Evaluation http://www.health.gov.au: Home > For Consumers > Conditions and Diseases > Chronic disease > Musculoskeletal conditions - arthritis and osteoporosis

Waves Warm Water Exercise Programs Involves gentle exercises that give you a general workout for the whole body. Hydrotherapy pools across Melbourne. Comfortable and effective way for sufferers to exercise. 32-34 degree temperature to aid in relieving stiffness and pain. Buoyancy reduces weight on joints, giving support and protection. Classes led by instructors on the slow-paced exercise program. http://www.arthritisvic.org.au/Useful-Information/Our- Services/Waves-Warm-Water-Exercise-Programustralia.com.au

Bibliography Http://www.aihw.gov.au/national-health-priority-areas/ http://www.arthritis.org/ Key concepts in VCE Health & Human Development, 2nd edition http://www.health.gov.au/internet/main/publishing.nsf/content/pq- arthritis-baoc http://www.arthritisaustralia.com.au http://www.youtube.com/watch?v=cdUUNfDSfMg