ARCHIVED - Your Health Research Dollars at Work 2005-2006

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Arthritis

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The Canadian Institutes of Health Research (CIHR) is the Government of Canada's agency for health research. Through CIHR, the Government of Canada invested approximately $19 million in 2005-06 in research on arthritis across Canada.

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The Facts

• Arthritis comprises more than 100 conditions including lupus, fibromyalgia, gout, temporo-mandibular joint pain and scleroderma.
• The most common type of arthritis in Canada is osteoarthritis, affecting three million Canadians, or 1 in 10. Long-term disability accounted for almost 80% of the economic costs of arthritis in 1998, at nearly $3.5 billion. The 35-64 year age group incurred 70% of these costs.
• Rheumatoid arthritis is the second most common type of arthritis, affecting 300,000 Canadians, or 1 in 100. It is an autoimmune disorder, in which the immune system attacks healthy joints, resulting in damage to cartilage, bone, tendons and ligaments. Twice as many women as men get rheumatoid arthritis. It most commonly appears between the ages of 25 and 50.
• Two thirds of those with arthritis are women and nearly 60% are under the age of 65.
• For all age groups, arthritis disables two to three times more workers than all other chronic conditions.
• Epidemiologists predict there will be about 100,000 new cases of arthritis each year for the next 30 years. It is estimated that by 2026, more than six million Canadians over the age of 15 will have arthritis.
• Over 4 million Canadians are afflicted by musculoskeletal (MSK) diseases and conditions - 90% in the form of osteoarthritis.
• MSK diseases cost Canadians $16.4 billion every year, the second highest cost of disease after heart disease. Of this total, $2.6 billion is in direct costs such as physician and hospital care and drugs, and $13.7 billion is in indirect costs including premature disability and death.

Research Finding Solutions to Arthritis Problems

• Cost-sharing for prescription drugs is common in Canada; while arrangements differ, users usually pay a portion of all the costs up to a maximum beyond which there is no or a minimal charge for the drug. According to a study of elderly patients suffering from rheumatoid arthritis, patients were much more likely to visit the doctor or hospital during periods when they had to pay drug fees. The study, conducted by CIHR-supported researcher Dr. Aslam Anis and other team members from St. Paul's Hospital in Vancouver, suggests that, in a predominantly publicly-funded healthcare system, cost-containment strategies may be backfiring because users are treating healthcare services as alternatives to prescription drugs.

• No one, it seems, likes to admit they're in pain. According to studies by CIHR-supported researcher Dr. Gillian Hawker of the University of Toronto, this is clearly the case with elderly persons suffering from osteoarthritis (OA). In interviews with persons with OA, respondents expressed reluctance to take painkillers even if they had been prescribed, putting pressure on their families and the healthcare system. The research highlights the need to rethink how painkillers are prescribed and how pain is managed for older patients with OA.

• CIHR-supported researcher Dr. Jason McDougall of the University of Calgary has taken the first steps towards better understanding pain in persons with arthritis and finding new, non-addictive drugs to control this pain. In testing with rats, a new type of pain reliever called endomorphin 1 worked well in cases where knee joints had one-time, acute inflammation. But the same drug had no effect on joints with chronic inflammation. The research provides valuable information needed to help find ways of making the medication work for persons with chronic arthritis.

• Managing a chronic illness while keeping a job is a major issue for people with such illnesses. CIHR-supported researcher Dr. Monique Gignac of the Toronto Western Research Institute, University Health Network, is studying how people with arthritis cope with such a situation. She has found that such people have several different ways of coping, such as asking for help, modifying one's activities, changing one's behaviour and simply planning ahead to avoid anticipated problems. Arthritis sufferers reported using far fewer of these coping behaviours at work, using them mainly in their personal life. So-called "anticipatory coping" was most common in the workplace. The research provides important information for policy-makers in understanding the burdens of chronic illness and how best to address these needs.

• Many bone and joint conditions are chronic diseases, creating lifelong challenges for patients in managing their health. CIHR-funded researcher Dr. Peter Tugwell of the University of Ottawa, in partnership with an organization called the Cochrane Collaboration, is documenting the kinds of skills healthcare consumers need to effectively manage their conditions. Skills fall under categories such as how to use health information to make decisions, communicating with others, clarifying values and priorities and negotiating their role as a patient. The list will be used to develop a tool for helping ensure that healthcare consumers get what they need from the healthcare system at all points during the course of their disease.

In the Pipeline...
Increasing Mobility for Persons with Osteoarthritis

Current research supports the view that a healthy musculoskeletal system is central to an individual's ability to be mobile and physically active. In one CIHR-funded project currently underway, Dr. Catherine Arnold of the University of Saskatchewan is undertaking a two-year clinical trial to study the effect of aquatic exercise and aquatic exercise combined with education on reducing the risk of falls in older adults with hip osteoarthritis. Among older adults, hip fractures from falls are particularly devastating, often resulting in death or admission to long-term care. Because seniors with hip osteoarthritis often suffer from pain, they find it difficult to participate in exercise programs designed to improve balance, strength and mobility - and reduce falls. If Dr. Arnold is able to demonstrate which fall prevention programs would be most effective, it may be possible to avert death resulting from hip fractures and loss of quality of life for these older adults.

The Researchers...
Dr. Steven Boyd - Seeing is Believing

The small South Okanagan town of Oliver, B.C., (pop. 4,500) now has two famous sons: Canada's first Parliamentary Poet Laureate George Bowering and, perhaps somewhat less known but no less deserving, Dr. Steven Boyd.

Dr. Boyd, a mechanical engineer and associate professor at the University of Calgary (U of C), is one of a growing number of researchers with roots in mechanical engineering who are applying their expertise and generating results in the field of health research.

"I have to be careful that, every once in a while, I publish in an engineering journal, just to remind people I'm still an engineer," Dr. Boyd jokes.

Dr. Boyd is a key player on several CIHR-supported projects and counts a number of different faculty members at the university as collaborators. Projects involve research into conditions such as osteoporosis and osteoarthritis and make use of a powerful imaging technique known as CT scanning to detect and track changes in bone structure. CT scanning provides highly detailed 3-D images of bones.

"I love to be able to look inside a structure and see what's going on with a really high degree of accuracy. With this approach we are able to focus on and answer important clinical questions," he says.

One question involves the impact of injuries on osteoarthritis. As an example, a single knee injury as a teenager or young adult can triple the risk of osteoarthritis in that knee by middle age.

According to Dr. Boyd, one of the reasons for this statistic is that the initial injury actually creates significant bone loss, affecting bone strength which, in turn, affects the cartilage. As the saying goes, a house is only as strong as its foundation and, in this case, when the joint or foundation becomes compromised, weaker tissues such as cartilage, as Dr. Boyd puts it, "simply go along for the ride".

In studies with mice, Dr. Boyd, in collaboration with Dr. Ronald Zernicke, also with the U of C, used CT scans to demonstrate that 40% of bone loss occurs within three months of the injury. The team has also been experimenting with osteoporosis drugs as a way to prevent this bone loss and, consequently, the onset of osteoarthritis.

"Patients never present themselves until they are in pain. By this time, the initial injury has created changes in the bone and things have stabilized in a bad way. The bone is no longer providing the optimal foundation for the cartilage. We're trying to prevent these changes so that the patient never reaches the clinic in the first place," Dr. Boyd comments.

The CIHR Institute

CIHR's Institute of Musculoskeletal Health and Arthritis' work is literally out of this world - among other important projects, the Institute is working with the Canadian Space Agency to fund research on long-term bed rest and bone loss in space flight. An active member of the Canadian National Action Network, the Institute is also an avid supporter of the Bone and Joint Decade launched by the World Health Organization and endorsed by the United Nations in 2000.

About CIHR

The Canadian Institutes of Health Research (CIHR) is the Government of Canada's agency for health research. CIHR's mission is to create new scientific knowledge and to catalyze its translation into improved health, more effective health services and products, and a strengthened Canadian healthcare system. Composed of 13 Institutes, CIHR provides leadership and support to more than 10,000 health researchers and trainees across Canada.

Canadian Institutes of Health Research
160 Elgin St., 9th Floor, Ottawa, ON K1A 0W9
http://www.cihr-irsc.gc.ca/