Epidemiologi og sykdomspåvirkning Till Uhlig, Seksjonsoverlege/professor Nasjonalt kompetansetjeneste for revmatologisk rehabilitering Revmatologisk avd., Diakonhjemmet Sykehus, Oslo
Burden of disease Individual perspective Societal perspective Health economy perspective
Therapy 2010;7:605-17
Polyartrose og revmatoid artritt Primær sykdomsprosess Generalisert artrose Bruskdegenerasjon, evt. sekundær synovial inflammasjon RA Synovial inflammasjon med sekundær skade på brusk og ben Alder Oftest gamle Unge og gamle Distribusjon av leddforandringer DIP, PIP, CMC-1, kne, hofte, rygg, MTP-1 PIP, MCP, MTP 2-4, håndledd, (albue, kne m.fl.) Røntgenforandringer Redusert bruskhøyde, subkondral sklerose, osteofytter Redusert bruskhøyde, erosjoner, usurer, periarticulær osteoporose Leddvæske Viskøs, klar, celletall 0-5 x 10 9 /l mononucleære celler Tynn, blakket, celletall 5-20 x 10 9 /l, polynucleære celler Labprøver Normale Akutt fase (SR, CRP ), Revmatoid faktor positiv hos ca. 60-80%
synovial fluid viscosity inflammatory cells OSTEOARTHRITIS RHEUMATOID ARTHRITIS
Societal pespective Osteoarthritis (OA) is perceived as a growing problem Number of individuals with OA has in USA increased by approximately 6 million to 26.9 million during the period of 1995 2005 Aging population, increasing obesity or more sensitive methods for detection of OA
Societal pespective In 1990 OA was already estimated to be the eighth-leading nonfatal burden of disease in the world, accounting for 2.8% of total years of living with disability In 2000 the sixth-leading cause of years of living with disability at a global level, accounting for 3% of the total global years of living with a disability
Societal pespective By 2030 in high-income countries projected that OA will be ninth on a list of causes of disability-adjusted life years
Helseøkonomi: cost of illness Canada: US$4900 per OA patient per year (2000) USA: Average annual costs per OA patient : direct medical US$ 8601 drugs US$ 2941 indirect work-loss US$ 4603 Spain: 1500 annually per patient with hip or knee OA
Osteoarthritis epidemiology Prevalent diagnosed cases (in millions) Country 2002 2007 2012 United States 13.2 14.4 15.5 Europe 14.5 15.2 15.8 Japan 6.6 6.9 7.2 OA total prevalent cases 34.3 36.5 38.6 RA total prevalent cases 2.8 3.1 3.4
Prevalence of knee osteoarthritis 2000 Woolf AD & Pfleger B. Bull WHO 2003;81:646-56
Radiografisk artrose Knesmerter Kneartrose selvrapportert
Forekomst artrose 80% av alle over 55 har røntgenologisk tegn til artrose ved røntgen. Ca. 10-30% av disse har signifikant smerte og funksjonssvikt. Det estimeres at 12% i aldersgruppen 25-74 år har klinisk diagnostisert artrose.
Prevalence of radiological features of knee OA Population Age (years) Female % Male % USA 65-74 18 8 USA 63-69 25 30 Pima Indians 65-74 4 7 Sweden 70 55 52 The Netherlands 70 46 46 Bulgaria >65 10 10 The Netherlands >55 29 16
Prevalence of radiographic hand OA (Framingham) Haugen et al. Ann Rheum Dis 2011;70:1581-6
Hvem har risiko for å få artrose? Uhlig et al. Therapy 2010;7:605-17
Konsekvenser for individet: Livskvalitet Subjektive plager smerter stivhet Redusert bevegelighet Funksjonsreduksjon
Preferences for improvement in health: A comparison between age, sex and education-matched patients with osteoarthritis and rheumatoid arthritis ** ** ** * *<0.05 **<0.01 Heiberg, Slatkowsky-Christensen, Kvien.. Ann Rheum Dis 2001;60(suppl 1):291.
Konsekvenser Medikamentbruk Bruk av smertestillende legemidler (2% daglig) Bivirkninger Kirurgi Hofteproteser 4000-5000/år Kneproteser 1000/år
Utfallsvariabler for forløp Smerte (visuell analog skala) Funksjonsindex (WOMAC, AUSCAN, FIHOA) Leddbevegelighet Røntgen, ultralyd, MR Walking time Hovne ledd Oppbluss Medikamentbruk Kirurgi
Outcome measures in OA studies Inflammation OMERACT Qol - Utility Stiffness Other Performance Surgery Pain Physical function Patient global Imaging Doctor global Biologic markers Core measures Recommended Optional
Moe RH et al. Rheumatology 2013;52:189-96
(Numeric rating scale 0-10) OA localisation and disease impact Moe RH et al. Rheumatology 2013;52:189-96
Disease impact of OA in disease specific questionnaires AN hand OA WOMAC knee OA p<0.001 (0-30) P=0.01
Number of comorbitidies and OA localisation
tional Register of Joint Prostheses 00 primary hip joints and 3500 in other joints
Disability pension in knee OA OA n=15345 Population n=789366 t twofold increased risk of sick leave and % increased risk of disability pension
omparison of disease burden in rheumatic disease and in the population
-36 in OA patients vs general population
Pain in OA and RA d poor
Comparison of disease burden: 6 in OA, RA, controls and population norms
EUMUSC.net project ntify the burden on individuals and society of across EU Member States t standards of care both for individuals and for lthcare providers for osteoarthritis and umatoid arthritis sess whether these are being achieved lp overcome the barriers to achieving these ndards to enable the effective and equitable vention and management of these condition in
Konklusjon se påvirker individet og er en økende utfordring i unnet kelig å kartlegge sykdomsbyrde på grunn av store sjoner i sykdommens alvorlighet de interesse for artrose - forskning og behandling: peisk prosjekt for å øke bevisstheten.eumusc.net)