What’s new?

C The prevalence and cost of musculoskeletal conditions will

continue to rise as the population ages

C The increasing prevalence of obesity will contribute to a rise in

the incidence of osteoarthritis, gout and rheumatoid arthritis

INTRODUCTION

The burden ofmusculoskeletal conditionsSarah Parsons

Deborah PM Symmons

AbstractMusculoskeletal conditions (MsC) are a major burden to the individual,

society and the health service. Approximately 10% of GP consultations are

for MsC. Most new consultations are for self-limiting conditions such as soft

tissue rheumatism, chronic widespread pain and arthralgia. Incident cases

of osteoarthritis are ten times more common than rheumatoid arthritis

(RA). The prevalence of MsC is higher in women and rises with age. It is likely

that MsC prevalence will continue to rise as life expectancy increases. Costs

for MsC include those to healthcare services, to society and indirect costs.

One-fifth of all incapacity claims in Great Britain are for MsC. Combined

costs for RA patients amount to £7000 per person affected per year. Major

hipprocedures costonaverage£7800andmajorkneeproceduresonaverage

£4471. Risk factors for MsC include age andgender. The prevalence of certain

MsC varies depending on ethnicity, lifestyle factors and genetic predisposi-

tion. The main consequences of MsC are chronic pain and disability. The

burdenofMsC is high and the impactof these conditionson the health service

and society will continue to rise alongside increasing life expectancy.

Keywords cost; disability; epidemiology; incidence; morbidity; mortality;

musculoskeletal; prevalence; rheumatic; risk factors

Introduction

There are over 200 types of musculoskeletal conditions, which

together are a major burden to the individual, society and health

services. Musculoskeletal conditions include all types of arthritis and

conditions affecting the muscles, bones, soft tissue, joints and spine.

The burden of these conditions is evaluated by assessing their

prevalence and incidence. Accurate morbidity estimates of these

conditions are useful in healthcare planning, although these esti-

mates will differ depending on which level of care is assessed. At the

community level, there will be more cases of non-specific musculo-

skeletal pain compared to cases ascertained from general practice or

a hospital environment. Furthermore, differences in the wording and

case-definition may result in differences in prevalence estimates.

Incidence

The most recent data available for the incidence of musculoskeletal

disease come from the General Practice Research Database. Based

on attendance in general practice, the number of new onsets of

Sarah Parsons BSc is a Research Assistant at the ARC Epidemiology

Unit, University of Manchester, UK. Competing interests: none declared.

Deborah PM Symmons MD FFPH FRCP is Director of the ARC Epidemiology

Unit, University of Manchester and Honorary Consultant Rheumatolo-

gist, East Cheshire NHS Trust, UK. Competing interests: none declared.

MEDICINE 38:3 126

musculoskeletal disease in 2001 was 947 per 10,000 persons: 832

for males, 1057 for females.1 Most new musculoskeletal consul-

tations in the UK were for self-limiting conditions (soft tissue

rheumatism, chronic widespread pain, arthralgia). In persistent

conditions, new onsets of osteoarthritis were ten times more

common than those for rheumatoid arthritis (RA) (Figure 1).

Prevalence

Annual prevalence figures are released by the Royal College of

General Practitioners’ Weekly Returns Service on a yearly basis.

The prevalence of musculoskeletal conditions generally increases

with age (Figure 2). The ratio of men to women amongst those

who consult their GPs for a musculoskeletal condition is 1:1.3.

In 2007, 16% of the UK population was 65 years and older.2

This is expected to increase to 22.5% by 20323; and in turn, the

proportion of people of working age will decrease. With

increasing life expectancy, the prevalence of musculoskeletal

conditions can be expected to increase, leading to a rise in

consultation rates and GP workloads, and an increase in demand

for services, especially from elderly patients.

Four per cent of children (aged <15 years) (equivalent to

427,000 children in the UK) attended their GPs in 2007 for

a musculoskeletal condition.2,4

Prevalence in adults

� Twenty-nine per cent of responders to a community health

survey (2001) reported having had arthritis in the previous year;

this reduced to 19% when asked if they had seen a doctor about

it (source: unpublished data from the Wigan and Bolton Health

Survey, 2001).

� Results from the General Household Survey suggest that 7.3

million UK adults (14.3%) reported having a long-standing

condition relating to the musculoskeletal system in 2007: 3

million men, 4.3 million women.2,5

� A total of 12.1% of GP consultations in 2007 in England and

Wales related to diseases of the musculoskeletal system and

connective tissue.4

Mortality

In England and Wales, there were 4304 (1284 male, 3020 female)

deaths attributed to diseases of the musculoskeletal system and

connective tissue in 2007; 38% of these were attributed to

arthropathies.

In 2007, there were 89 fewer deaths in England and Wales

attributed to diseases of the musculoskeletal system and connec-

tive tissue than in 2004. However, there were 29 more male deaths.

Cost

The costs to the healthcare service for musculoskeletal condi-

tions include drugs, physiotherapy, GP attendance, hospital

� 2009 Elsevier Ltd. All rights reserved.

New musculoskeletal consultations, UK 2001

30% Soft tissue rheumatism and chronic widespread pain

25% Arthralgia

22% Back pain

10% Osteoarthritis

1% Rheumatoid arthritis

1% Osteoporosis

11% Other

Figure 1 From the General Practice Research Database. Available at: www.

gprd.com

INTRODUCTION

referrals/admissions, and surgery. Costs to society include

disability pensions and incapacity benefits.

Musculoskeletal conditions are the second most common

cause of loss of time from work in Great Britain after mental

disorders.6 Over 20% of all incapacity claims in 2007 were for

diseases of the musculoskeletal system.7 Average hospital,

Male

Female

Age group

Pre

vale

nce

pe

r 1

0,0

00

pe

rso

ns

<1 1–4 5–14 15–24 25–44 45–64 75+

0

3,000

2,500

1,000

1,500

500

2,000

3,500

4,000

65–74

Annual prevalence of musculoskeletal conditions presenting to UK primary care, 2007

Figure 2 From the Weekly Returns Service Annual Prevalence Report 2007.

Available at: http://www.rcgp.org.uk/clinical_and_research/rsc/annual_

prevalence.aspx

MEDICINE 38:3 127

medication and indirect costs for RA patients are considerable,8

amounting to £7000 per person affected per year; it is estimated

that RA costs the UK health service £4 billion per year.9

In 2007, just under 35 million prescriptions (single items on

a prescription form) were dispensed in England for musculo-

skeletal and joint diseases and drugs affecting bone metabolism.

The number of prescriptions dispensed in England for

musculoskeletal and joint diseases and drugs affecting bone

metabolism has increased by almost 2 million since 2004.

In the 2006 financial year, the NHS funded over 90,000 major

hip and knee procedures, costing over £400 million. A large

proportion of these were joint replacements.10 In 2007, there were

approximately 1.4 million outpatient attendances for rheuma-

tology and over 6 million for trauma and orthopaedics.10,11

Predictors of musculoskeletal disease

The occurrence of musculoskeletal conditions is affected by

certain risk factors; for example, they are more common in

women and increase with age.

The prevalence of certain musculoskeletal conditions varies with

ethnicity. RA prevalence is lower in people of Pakistani and Afro-

Caribbean origin compared to Caucasians12; osteoarthritis of the hip

has a lower prevalence in Indians and Afro-Caribbeans compared to

Caucasians12; systemic lupus erythematosus is more common in

Asian and Afro-Caribbean women compared to Caucasian women.13

Obesity is a major risk factor for some musculoskeletal

conditions. The rise in obesity is contributing to the increase in

prevalence of osteoarthritis.12

Those in deprived areas (determined by postcode of resi-

dence) are more likely than those in more affluent areas to report

back pain. Some conditions such as RA and gout tend to run in

families, which could be a result of genetic predisposition and/or

shared environmental factors.

Disability associated with musculoskeletal disease

The main consequences of having a musculoskeletal disease are

chronic pain anddisability. The Disability LivingAllowance (DLA) is

available to all individuals under 65 who suffer from a severe

disability. In2007, those suffering from‘arthritis’ and ‘muscle/bone/

joint disease’ combined accounted for a quarter of those receiving

DLA payments, equating to over half a million individuals.7

Conclusion

The burden of musculoskeletal conditions is high. The impact of

these conditions on the health service and society will continue

to rise alongside increasing life expectancy. A

REFERENCES

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research/rsc/annual_prevalence.aspx; 2006.

� 2009 Elsevier Ltd. All rights reserved.

INTRODUCTION

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reporting longstanding condition groups, by sex; General Household

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gov.uk/statistics/overall/hssh0708.pdf; 2008.

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at: http://83.244.183.180/100pc/tabtool.html; 2009.

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MEDICINE 38:3 128

11 NHS Information Centre for health and social care. Hospital episode

statistics: main specialty, 2007e08. Available at: http://www.ic.nhs.uk/

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12 Silman AJ, Hochberg MC, Cooper C, eds. Epidemiology of the rheu-

matic diseases. 2nd edn. Oxford: Oxford University Press, 2001.

13 Johnson AE, Gordon C, Palmer RG, Bacon PA. The prevalence and

incidence of systemic lupus erythematosus in Birmingham, England.

Relationship to ethnicity and country of birth. Arthritis Rheum 1995;

38: 551e8.

FURTHER READING

Hochberg MC, Silman AJ, Smolen JS, et al., eds. Practical rheumatology.

3rd edn. Philadelphia: Mosby, 2004.

Silman AJ, Hochberg MC, Cooper C, eds. Epidemiology of the rheumatic

diseases. 2nd edn. Oxford: Oxford University Press, 2001.

� 2009 Elsevier Ltd. All rights reserved.