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The individual and socioeconomic impact of osteoarthritis


Osteoarthritis (OA) is a highly prevalent, disabling disease, with a commensurate tremendous individual and socioeconomic burden. This Perspectives article focuses on the burden of OA for the individual, the health-care system and society, to draw attention to the magnitude of the current problem with some reference to projected figures. We have an urgent opportunity to make fundamental changes to the way we care for individuals with OA that will have an effect upon the direct and indirect costs of this disease. By focusing on the burden of this prevalent, disabling, and costly disease, we hope to highlight the opportunity for shifts in health-care policy towards prevention and chronic-disease management.

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Figure 1: The disease burden of OA.
Figure 2: Ranking of burden of disease by YLDs in 1990 and 2010.
Figure 3: Distribution of direct costs of OA by type.
Figure 4: Distribution of indirect costs for OA by type.


  1. Centers for Disease Control and Prevention (CDC). Prevalence and impact of chronic joint symptoms—seven states, 1996. MMWR Morb. Mortal. Wkly Rep. 47, 345–351 (1998).

  2. Dunlop, D. D., Manheim, L. M., Song, J. & Chang, R. W. Arthritis prevalence and activity limitations in older adults. Arthritis Rheum. 44, 212–221 (2001).

    Article  CAS  Google Scholar 

  3. Hunter, D. J. Lower extremity osteoarthritis management needs a paradigm shift. Br. J. Sports Med. 45, 283–288 (2011).

    Article  Google Scholar 

  4. Hootman, J. M. & Helmick, C. G. Projections of US prevalence of arthritis and associated activity limitations. Arthritis Rheum. 54, 226–229 (2006).

    Article  Google Scholar 

  5. Perruccio, A. V., Power, J. D. & Badley, E. M. Revisiting arthritis prevalence projections—it's more than just the aging of the population. J. Rheumatol. 33, 1856–1862 (2006).

    PubMed  Google Scholar 

  6. Centers for Disease Control and Prevention (CDC). Prevalence of disabilities and associated health conditions among adults—United States, 1999. MMWR Morb. Mortal. Wkly Rep. 50, 120–125 (2001).

  7. Guccione, A. A. et al. The effects of specific medical conditions on the functional limitations of elders in the Framingham Study. Am. J. Pub. Health 84, 351–358 (1994).

    Article  CAS  Google Scholar 

  8. Vos, T. et al. Years lived with disability (YLDs) for 1,160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380, 2163–2196 (2012).

    Article  Google Scholar 

  9. Murray, C. J. et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380, 2197–2223 (2013).

    Article  Google Scholar 

  10. Hawker, G. A. et al. Understanding the pain experience in hip and knee osteoarthritis—an OARSI/OMERACT initiative. Osteoarthritis Cartilage 16, 415–422 (2008).

    Article  CAS  Google Scholar 

  11. Dieppe, P. A. & Lohmander, L. S. Pathogenesis and management of pain in osteoarthritis. Lancet 365, 965–973 (2005).

    Article  CAS  Google Scholar 

  12. Hunter, D. J., McDougall, J. J. & Keefe, F. J. The symptoms of osteoarthritis and the genesis of pain. Rheum. Dis. Clin. N. Am. 34, 623–643 (2008).

    Article  Google Scholar 

  13. Wilkie, R., Peat, G., Thomas, E. & Croft, P. Factors associated with restricted mobility outside the home in community-dwelling adults ages fifty years and older with knee pain: an example of use of the International Classification of Functioning to investigate participation restriction. Arthritis Rheum. 57, 1381–1389 (2007).

    Article  Google Scholar 

  14. Hawker, G. A. Experiencing painful osteoarthritis: what have we learned from listening? Curr. Opin. Rheumatol. 21, 507–512 (2009).

    Article  Google Scholar 

  15. Hawker, G. A. et al. The multidimensionality of sleep quality and its relationship to fatigue in older adults with painful osteoarthritis. Osteoarthritis Cartilage 18, 1365–1371 (2010).

    Article  CAS  Google Scholar 

  16. Centers for Disease Control and Prevention (CDC). National and state medical expenditures and lost earnings attributable to arthritis and other rheumatic conditions—United States, 2003. MMWR Morb. Mortal. Wkly Rep. 56, 4–7 (2007).

  17. Nuesch, E. et al. All cause and disease specific mortality in patients with knee or hip osteoarthritis: population based cohort study. BMJ 342, d1165 (2011).

    Article  Google Scholar 

  18. Losina, E. et al. Impact of obesity and knee osteoarthritis on morbidity and mortality in older americans. Ann. Intern. Med. 154, 217–226 (2011).

    Article  Google Scholar 

  19. Lawrence, R. C. et al. Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States. Arthritis Rheum. 41, 778–799 (1998).

    Article  CAS  Google Scholar 

  20. Zhang, Y. et al. Prevalence of symptomatic hand osteoarthritis and its impact on functional status among the elderly: The Framingham Study. Am. J. Epidemiol. 156, 1021–1027 (2002).

    Article  Google Scholar 

  21. Lawrence, R. C. et al. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II. Arthritis Rheum. 58, 26–35 (2008).

    Article  Google Scholar 

  22. March, L. M. & Bachmeier, C. J. Economics of osteoarthritis: a global perspective. Baillieres Clin. Rheum. 11, 817–834 (1997).

    Article  CAS  Google Scholar 

  23. Gupta, S., Hawker, G. A., Laporte, A., Croxford, R. & Coyte, P. C. The economic burden of disabling hip and knee osteoarthritis (OA) from the perspective of individuals living with this condition. Rheumatology (Oxford) 44, 1531–1537 (2005).

    Article  CAS  Google Scholar 

  24. Kotlarz, H., Gunnarsson, C. L., Fang, H. & Rizzo, J. A. Insurer and out-of-pocket costs of osteoarthritis in the US: evidence from national survey data. Arthritis Rheum. 60, 3546–3553 (2009).

    Article  Google Scholar 

  25. Wright, E. A. et al. Impact of knee osteoarthritis on health care resource utilization in a US population-based national sample. Med. Care 48, 785–791 (2010).

    Article  Google Scholar 

  26. Hiligsmann, M. et al. Health economics in the field of osteoarthritis: an expert's consensus paper from the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). Semin. Arthritis Rheum. 43, 303–313 (2013).

    Article  Google Scholar 

  27. Matthews, G. L. & Hunter, D. J. Emerging drugs for osteoarthritis. Expert Opin. Emerg. Drugs 16, 479–491 (2011).

    Article  Google Scholar 

  28. Losina, E. et al. Disease-modifying drugs for knee osteoarthritis: can they be cost-effective? Osteoarthritis Cartilage 21, 655–667 (2013).

    Article  CAS  Google Scholar 

  29. Le, P. C., Reygrobellet, C. & Gerentes, I. Financial cost of osteoarthritis in France. The “COART” France study. Joint Bone Spine 72, 567–570 (2005).

    Article  Google Scholar 

  30. Leardini, G. et al. Direct and indirect costs of osteoarthritis of the knee. Clin. Exp. Rheumatol. 22, 699–706 (2004).

    CAS  PubMed  Google Scholar 

  31. Loza, E. et al. Economic burden of knee and hip osteoarthritis in Spain. Arthritis Rheum. 61, 158–165 (2009).

    Article  Google Scholar 

  32. Mongan, J. J., Ferris, T. G. & Lee, T. H. Options for slowing the growth of health care costs. N. Engl. J. Med. 358, 1509–1514 (2008).

    Article  CAS  Google Scholar 

  33. Lungren, M. P. et al. Physician self-referral: frequency of negative findings at MR imaging of the knee as a marker of appropriate utilization. Radiology 269, 810–815 (2013).

    Article  Google Scholar 

  34. Agency for Healthcare Research and Quality. Healthcare Cost and Utilization Project: Nationwide Inpatient Sample (NIS), 1999–2008 [online], (2012).

  35. Kurtz, S., Ong, K., Lau, E., Mowat, F. & Halpern, M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J. Bone Joint Surg. Am. 89, 780–785 (2007).

    PubMed  Google Scholar 

  36. Li, X., Gignac, M. A. & Anis, A. H. The indirect costs of arthritis resulting from unemployment, reduced performance, and occupational changes while at work. Med. Care 44, 304–310 (2006).

    Article  Google Scholar 

  37. Dunlop, D. D., Manheim, L. M., Yelin, E. H., Song, J. & Chang, R. W. The costs of arthritis. Arthritis Rheum. 49, 101–113 (2003).

    Article  Google Scholar 

  38. Schofield, D. et al. Modelling the cost of ill health in Health&WealthMOD (Version II): lost labour force participation, income and taxation, and the impact of disease prevention. Int. J. Microsimulation 4, 32–36 (2011).

    Google Scholar 

  39. Kotlarz, H., Gunnarsson, C. L., Fang, H. & Rizzo, J. A. Osteoarthritis and absenteeism costs: evidence from US National Survey Data. J. Occup. Environ. Med. 52, 263–268 (2010).

    Article  Google Scholar 

  40. Centers for Disease Control and Prevention Public Health Service US Department of Health and Human Services. Osteoarthritis and you: patient information from the CDC. J. Pain Palliat. Care Pharmacother. 24, 430–431 (2010).

  41. Hubertsson, J., Petersson, I. F., Thorstensson, C. A. & Englund, M. Risk of sick leave and disability pension in working-age women and men with knee osteoarthritis. Ann. Rheum. Dis. 72, 401–405 (2013).

    Article  Google Scholar 

  42. Zhang, W., Gignac, M. A., Beaton, D., Tang, K. & Anis, A. H. Productivity loss due to presenteeism among patients with arthritis: estimates from 4 instruments. J. Rheumatol. 37, 1805–1814 (2010).

    Article  Google Scholar 

  43. Schofield, D. J., Shrestha, R. N., Passey, M. E., Earnest, A. & Fletcher, S. L. Chronic disease and labour force participation among older Australians. Med. J. Aust. 189, 447–450 (2008).

    Article  Google Scholar 

  44. Schofield, D. J. et al. The personal and national costs of lost labour force participation due to arthritis: an economic study. BMC Public Health 13, 188 (2013).

    Article  Google Scholar 

  45. Schofield, D. J. et al. Economic impacts of illness in older workers: quantifying the impact of illness on income, tax revenue and government spending. BMC Public Health 11, 418 (2011).

    Article  Google Scholar 

  46. Arthritis Australia. Painful realities: the economic impact of arthritis in Australia in 2007 (Access Economics, Sydney, 2007).

  47. Felson, D. T. & Zhang, Y. An update on the epidemiology of knee and hip osteoarthritis with a view to prevention. Arthritis Rheum. 41, 1343–1355 (1998).

    Article  CAS  Google Scholar 

  48. Brand, C. et al. Improving care for people with osteoarthritis of the hip and knee: how has national policy for osteoarthritis been translated into service models in Australia? Int. J. Rheum. Dis. 14, 181–190 (2011).

    Article  Google Scholar 

  49. Institute for Health Metrics and Evaluation (IHME). GBD 2010 change in leading causes and risks between 1990 and 2010. Seattle, WA: IHME, University of Washington, 2012 [online], (2014).

  50. Arthritis and Osteoporosis Victoria. A problem worth solving: the rising cost of musculoskeletal conditions in Australia (Arthritis and Osteoporosis Victoria, Elsternwick, 2013).

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D.J.H.'s work is funded by an Australian Research Council Future Fellowship (FT0991246). The comments and editorial expressed in this article represent those of the authors and do not reflect those of any official scientific role or institution that the authors may hold or be affiliated with.

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D.J.H. and E.C. researched data for the article, and D.J.H., D.S. and E.C. made substantial contributions to discussion of the content, writing, and review/editing of the manuscript before submission.

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Correspondence to David J. Hunter.

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Hunter, D., Schofield, D. & Callander, E. The individual and socioeconomic impact of osteoarthritis. Nat Rev Rheumatol 10, 437–441 (2014).

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