Why is osteoarthritis a problem in Australia?

Arthritis and musculoskeletal conditions are a National Health Priority Area (NHPA) in Australia. This is because they are more prevalent than any other conditions – this includes cancer, diabetes and obesity. 1 2 Here, we take a closer look at why evidence-based care of osteoarthritis (OA) is so important.

Comparative pain and functionality

As you can see in this chart, knee OA is extremely pain dominant. Furthermore, the pain becomes persistent and more limiting as OA progresses. Physical function becomes increasingly impaired, impacting substantially on quality of life and ability to participate in social, leisure and occupational activities.

There is no cure for OA, so treatments to reduce symptoms and delay joint replacement are critical. Clinical guidelines emphasise non-drug non-surgical strategies^{3 4 5 6 7} focussing on self-help and patient-driven options rather than clinician-delivered passive therapies. In particular, advice and information for self-management, exercise and weight control (if required) are core management. Drugs, injections and manual therapy are considered adjunctive to core treatments.^{3 4 5}

The importance of primary care

Knee OA is mostly managed in primary care, yet in Australia management of OA is inadequate: Australian Care Track data shows 57% of people with OA do not receive appropriate healthcare.⁸ Analysis of 489,000 Australian general practitioner encounters where OA was managed found that use of non-pharmacologic treatments as first-line management for knee OA was low (20.7 per 100 contacts), compared with pharmacologic management (78.7 per 100).⁹

Data from community-dwelling people with knee OA in Melbourne show 54% have never undertaken muscle strengthening.¹⁰ Data from people with hip and knee OA referred for orthopaedic management at an Australian public hospital show only 30% consulted a physiotherapist prior to referral, with even fewer having tried supervised exercise.¹¹ The National Health Survey shows only 2% of people with OA visited a physiotherapist in the 12 months leading up to their first hospital appointment.¹²

This data is alarming, as arthroplasty is only advocated when non-surgical measures are no longer effective. International data¹³ shows under-utilisation of exercise for knee OA is a global problem.