THE ILLUSION
The myths associated with an arthritis diagnosis
Arthritis.
Contrary to popular belief, this is not just a “coming of age” condition that everybody “eventually gets.”
This lack of urgency can lead to serious and irreversible joint pain without diagnosis and treatment. Failure to recognize that arthritis can strike at any age contributes to many Canadians being left undiagnosed, as stigmas seem to be hindering awareness and therefore treatment.
The consequences of these misconceptions are outlined in a news release published by The Arthritis Society, as the document says, “almost half of Canadians still believe that arthritis affects primarily older Canadians.”
Aging or not, experts say joint stiffness or pain that occurs daily or prominently at any age should not continue without further inquiry.
Morning stiffness is one of the early signs of any form of arthritis and should be considered with much care. Currently, a study conducted by The Arthritis Society shows that more than a quarter of Canadians report that if they had joint pain, they would “not view it as a health priority.”
1/4
Canadians would not view
joint stiffness as a cause
for health concern.
In fact, Dr. Dianne Mosher, professor of medicine and chief of rheumatology for Alberta Health Services, presses that this morning stiffness, if lasting longer than 30 minutes, is one of the most common symptoms early onset, along with swelling in the small joints of the hands.
Mosher adds that it is important to see a family doctor “right away,” to either rule out or properly diagnose the presence of arthritis.
Although, living with or without the disease, arthritis has gone on to become a disease everybody knows exists, but few understand or discuss the details of.
Liz Kehler, manager of education and services for The Arthritis Society Alberta and Northwest Territories division, explains that arthritis just “doesn’t seem to be one of those conditions people talk about. It is a silent disease people deal with.”
Not "Just Arthritis"
Perhaps those suffering with arthritis avoid discussing the details of their conditions because of the reported “lack of awareness” among Canadians surrounding arthritis.
If few understand that arthritis can be a serious, life-altering and chronic rheumatic disease that can leave anyone at any age seriously disabled, those living with it wouldn’t have to minimize the impact something that most think just “come with age” actually has.
Arthritis may be primarily defined, according to Medical News Today, as “stiffness and swelling in the tissues and joints,” but it is a term used to describe over 100 rheumatic diseases and systemic conditions that affect more than the joints—including tissues that surround the joints, organs and other connective tissues.
Although forms of arthritis can be localized—meaning the symptoms and stiffness are limited to one specific area, it is the systemic versions of this condition that are misunderstood. When a disease is systemic, according to Merriam-Webster dictionary, it is “affecting the entire body.”
Few realize the disease runs in many forms and that there are plenty of early symptoms to look out for, aside from stiffness. According to the Public Health Agency of Canada, there are “plenty of other risk factors that everyone needs to be aware of.”
Studies by the agency show the lack of awareness surrounding the risk factors are “causing stigmas, a lack of support to the arthritis foundation and ultimately slowing the possibility of finding a cure.”
Regardless of the common misunderstandings, according to the Public Health Agency of Canada, arthritis is actually “the most common chronic condition” in Canada and is currently costing the country more than $33-billion each year in health care costs.
If this is the most common chronic condition, why does it seem that so few—with the exception of those living with the disease—know anything about it?
Not a "Hot Topic"
High mortality rates are a common factor of the diseases that are commonly known among the general public—people approach death with urgency.
Kehler notes that although arthritis isn't portrayed as one of the most "deathly" diseases, there are plenty of things to consider.
“People with arthritis can experience chronic pain, physical disability, mental instability and an overall poor quality of life,” she says.
Aside from the realities of arthritis being “commonly misunderstood,” the connection of associated diseases and conditions is a crucial fact in realizing the needed increase in urgency.
According to studies collected by The Arthritis Society, it is common for those with any type of arthritis to have other chronic conditions. These can stem from minor to serious back problems, high blood pressure, migraines, asthma, diabetes, heart disease, bowel disorders, urinary incontinence, ulcers, cancer and strokes. Although some of these associated risk factors are known by the general public, it isn’t commonly understood that a person’s likelihood to develop these complications can stem from an arthritis diagnosis.
However, it isn’t just the patients or those susceptible to developing the disease that should be further educated. Experts say the lack of diagnosis can be at the fault of general practitioners and missing the connection between associated conditions.
Mosher, who is currently working on a research project to implement systems and educations for those with arthritis in the working world, says that it is “important to educate primary practitioners on the symptoms, specifically for rheumatoid arthritis.”
There are two families of arthritic diseases. Osteoarthritis is a degenerative disease resulting from the breakdown of joints and tissues over time, which is common in coming of age. Inflammatory arthritis is a group of autoimmune conditions where the body’s own defence system begins to attack the joints and tissues. Forms of inflammatory are more difficult to diagnose.
$33 billion
Is what arthritis treatment is costing healthcare systems across canada.
rheumatoid arthritis vs. osteoarthritis
There are distinct differences between rheumatoid arthritis and osteoarthritis. RA is the most commonly diagnosed among women across Canada, while osteoarthritis is the most widely known and referenced form of arthritis across Canada.
According to The Arthritis Society, rheumatoid arthritis (RA) is the most common form of inflammatory arthritis and the diagnosis process can be difficult for both patients and practitioners, due to symptoms appearing in different forms and varying in severity with each case.
“You can still have rheumatoid arthritis without the positive blood test, 25 per cent of people with RA didn’t have it show up in their blood work,” says Mosher.
Kehler adds that upon diagnosis, ability to understand the nature of the condition and what to associate with an autoimmune disease is common, as “72 per cent of people that are diagnosed with arthritis leave their doctor without a lot of information or sure of what to do next.”
“This is why we’re reaching out to allied healthcare professionals,” says Kehler.
One Unfortunate Connection
Aside from the common belief of arthritis not being “that serious,” and mostly acting as an “eventual” and “expected” condition that comes with old age, it is commonly known that rheumatoid arthritis specifically affects more women than men.
Without an exact or factually confirmed reason as to why, the reality is that two out of three Canadians affected are women and 20 per cent of women over the age of 15 are living with arthritis, according to The Arthritis Society.
In regards to the nature of an autoimmune disease such as rheumatoid arthritis, the additional complications of both treatment and associated conditions for women can be more severe in the cases of hormones and pregnancy.
With an overwhelming amount of “mostly women” attending the arthritis education programs Kehler holds, she's seen the proof to support the fact that women are indeed more susceptible to RA than men.
Mosher, who has worked in rheumatology for over 20 years, says that “one wonders about the role of hormonal changes” but adds that science has not yet confirmed exactly why women are more susceptible. She says that multiple stages of a women’s life can create different situations for the disease to fluctuate.
“Sometimes we see with hormonal changes during pregnancy the disease commonly goes into remission, and post-partum it can flare, we even see fluctuations near menopause. It is likely multifactorial,” Mosher says.
September is Arthritis Awareness Month. Read more about the campaign from The Arthritis Society.
According to the Arthritis Alliance of Canada, an alliance with 36 member organizations, working collectively with health care professionals, researchers, funding agencies, governments, voluntary sector agencies, industry and representatives from arthritis consumer organizations from across Canada, suggest that RA is rising. One statistic from the AAC studies predict that the 1 in 136 workers in the employed labour force currently suffering from RA will increase to 1 in 68 workers “within a generation,” by the year 2040.
On this note, increased awareness of arthritis in general, furthermore rheumatoid arthritis and the increased susceptibility of women, is crucial to slowing the severity and increase of cases. However, as mentioned, there are many complications when it comes to understanding the nature of RA. Difficult for both doctor and patient, Kehler notes that the disease impacts each person differently and “symptoms and limitations of one person can be completely different and more or less severe than someone with the exact same diagnosis.”
Early diagnosis is key in the treatment of RA and many who receive an early diagnosis can lead mostly normal lives with manageable conditions and limited pain if treatment begins in the earlier stages.
In every age group, the case of women with arthritis is noticably higher.
Photo courtesy of Statistics Canada.
Although there is no cure, Mosher says that all of the tools are there to significantly help and treat conditions associated with RA.
“I think we’ve come a huge way in understanding the disease (RA) and the disease process. We have more medications that are more targeted to the alterations that happen within the immune system, which is why we’ve seen such improvement. We are more clear on the mechanisms of the disease,” Mosher says.
“We may not know the cause of RA but we are familiar with how the immune system is altered and we’ve targeted medications and treatments towards that.”
Mosher says that at the present day it is known that the prescription of Disease-Modifying Anti-Rheumatic Drugs (DMARDs) is important. DMARDs are used to reduce inflammation and slow disease progression. If a patient doesn’t respond to initial treatment, additional strategies are available and the patient may be a candidate for other newer biologic response modifier (biologic) therapies. According to Mosher, all of these treatments “attack different points of the immune system and inhibit different things.”
According to the Arthritis Alliance of Canada, early treatment with successful response can even put the RA into remission.
However, studies by the AAC also note that “the failure to recognize RA in its early stages and the lack of understanding of the need for treatment among patients and health care professionals continues to persist.”
If arthritis is no longer a “shoulder shrugging topic,” that many perceive as something that “eventually happens with old age,” experts say the urgency could increase and impact could decrease.
If forms of this condition should become generally understood in their nature and prevalence, specifically RA in women, chances of early diagnosis can increase. This can prevent the lifelong physical limitations and costly national impacts of this disease.
It’s time to understand how arthritis is already affecting Canadians and how it can continue to. It’s time to face the reality.
By Veronica Pocza
-The Arthritis Society
-The Arthritis Society
The complications of RA are not limited to just the small joints. RA can have an impact on many parts of the body, as well as a person's overall health.
Photo courtesy of Health Line
Understanding what those living with arthritis are facing will help ease the difficulties for those diagnosed.
Photo courtesy of Driod Gingerbread, Flickr
Graph courtesy of ra.com