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arthritis in canada: stats, risk and research
8 minute read
arthritis prevalence increases with age, affecting nearly half of those over 65
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when most people think of arthritis, they envision an older person, possibly hunched over, probably using a walker, maybe even wearing a knee brace. but it might surprise those same people to learn that more than half of the six million canadians with arthritis are younger than 65, according to arthritis society canada, and about a third of them were diagnosed before the age of 45.
other perhaps surprising facts are that arthritis isn’t just one condition, it comprises 100 types; that it’s more common in women (one in four women and one in six men), and that it’s the most prevalent chronic health condition in the country, above diabetes, heart disease, cancer and stroke. even more startling, about 25,000 canadian children live with arthritis.
what is arthritis?
arthritis is a broad term referring to inflammation of the joints. it can affect one joint or multiple joints. there are more than 100 different types of arthritis, with different causes and treatment methods.
the most common types of arthritis are:
- osteoarthritis (oa): often the most commonly mentioned type, oa involves the gradual wearing down of cartilage at the ends of bones, predominantly affecting the hands, knees, hips, and spine.
- rheumatoid arthritis (ra): this is an autoimmune condition where the body’s immune system erroneously targets its own joint linings. it leads to swelling, and over time, can cause joint deformation.
- psoriatic arthritis: typically associated with psoriasis, a skin condition marked by red, scaly patches, this form of arthritis usually develops after the onset of skin symptoms. however, joint issues can sometimes precede the skin manifestations.
- gout: characterized by acute and intense pain, gout occurs in joints, often the big toe, due to the accumulation of uric acid crystals.
- ankylosing spondylitis: primarily impacting the spine, this type of arthritis causes inflammation of the spinal joints, leading to chronic pain. other joints can also be involved in some cases.
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“by far the most predominant type is osteoarthritis, which impacts five million canadians,” says dr. sian bevan, researcher and chief science officer for arthritis society canada. “the other broad category is called inflammatory arthritis, which impacts about one million. a lot of those are autoimmune conditions, which are very different in nature from osteoarthritis.”
in fact, inflammatory arthritis, which includes rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis, occurs when the body’s defense system mistakenly attacks the joints’ tissues instead of germs and viruses. the joints become damaged and deformed and without treatment can affect the whole body, including the organs.
arthritis stats in canada: aging population, young women and mental health
six million canadians are living with arthritis, according to arthritis society canada.
- about 1 in 5 people aged 15 and up have arthritis.
- around 25,000 canadian youth seek treatment for arthritis.
- women are disproportionately affected, with nearly 60 per cent of arthritis cases
- 1 in 4 canadian women and 1 in 6 canadian men have arthritis.
- arthritis prevalence increases with age, affecting nearly half of those over 65
- it also affects working-age adults, with over half of sufferers under 65
as the baby boom population ages and life expectancy increases, so too will arthritis cases rise — up to 50 per cent by 2040, affecting about nine million canadians. this will put enormous pressure on an already strained healthcare system.
but more than that, it will put added pressure — and stress — on those living with arthritis, who are four times more likely to say they are not in good health overall. in fact, nearly four out of five canadians with arthritis have one other chronic health condition, such as high blood pressure, high cholesterol, heart disease, diabetes, and migraine headaches.
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“pain is the most significant reported challenge for people living with arthritis,” says bevan. “about 40 per cent say their pain limits daily activities.”
canadians with arthritis are five times more likely than those without it to have problems with mobility, such as walking, climbing stairs, washing and dressing. working people, especially those as young as 35, with arthritis are twice as likely to miss work, emphasizing the need for more employer supports.
younger adults with osteoarthritis, especially young women, report having poorer sleep quality and are more apt to struggle with fatigue than their older counterparts. they’re also more likely to perceive life as stressful.
from a mental health standpoint, they are twice as likely to grapple with anxiety or depression and other mood disorders than the average population.
“it’s important to take advantage of the available supports in your community and those online,” advises bevan. “being aware and acknowledging your mental health and the things that help you, whether it’s your supportive network, mindfulness or medication” can ease stress.
bevan also highlights the impact on indigienous populations in canada, which data shows are disproportionately affected with arthritis but how and why is not yet fully understood due to the limited number of first nations people who enroll in the studies.
according to a 2018 report by the public health agency of canada – percentage of population impacted by arthritis:
- first nations people living off reserve – 26 per cent,
- first nations people living on reserve – 25.2 per cent
- métis people – 25.8 per cent
- inuit – 21.1 per cent
- non-indigenous people living in canada – 16.6 per cent
risk factors for arthritis
while age doesn’t cause osteoarthritis, a majority of canadians will be affected with it by the age of 70, according to health canada. other risk factors include excess weight that puts a strain on weight-bearing joints, especially the knees; high-impact sports; injury; or other diseases that affect the joints, such as diabetes.
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bevan says that researchers have found some genetic factors that can contribute to certain types of arthritis, but they don’t fully understand how. “just because your family member has arthritis does not mean that you will necessarily develop it, but there are certainly a number of genetic marks or changes that researchers are identifying in people living with arthritis that seem to be influencing the disease.”
there’s also evidence that people with gum disease tend to have more severe rheumatoid arthritis, and develop infected gums at 20 times the rate. some researchers have found that oral bacteria can seep from damaged gum tissue, enter the bloodstream and travel throughout the body to affect the joints.
also, young people with juvenile idiopathic arthritis have been shown to have inflammatory mouth bacteria, some of which is associated with more affected joints as well as cavities that don’t respond to fluoride treatment.
bevan says that, while some risk factors — such as our sex, age and genetics — are beyond our control, we can control a healthy lifestyle. a healthy body weight, healthy diet, being physically active all can improve quality of life for those with arthritis. smoking raises significant risk for rheumatoid arthritis in particular, she says.
“there’s a myth that just because your joints hurt you shouldn’t move them,” says bevan. “physiotherapists often use the phrase ‘motion is lotion’ [to describe how movement lubricates joints]: stay mobile, stay active, keep your muscular system flexible and strong, all of which will help you live [better] with arthritis. some physical activity that doesn’t put as much strain or pressure on your joints include swimming, stretching, and yoga.”
one of the more unusual contributors to flare-ups is weather. some people swear they can predict that the weather is about to change based on increased pain in their joints. “some say a sharp drop in temperature or barometric pressure can cause their pain to flare up, others say it’s the humidity,” says bevan. “we don’t know exactly why. it’s possible that some of these changes in the atmosphere could be affecting the fluid in their joints.”
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the complexity of arthritis, research and treatment
bevan says research is revealing much more about arthritis’ molecular profile, specifically that it’s not a generic disease. “just because you have the same type of arthritis as somebody else doesn’t mean that your specific disease will be caused by the exact same challenges in your body. researchers are finding particular genetic profiles, or genetic markers or proteins, that are different in people with certain types of arthritis.”
as for treatment, she says there has been great progress in the use of a class of drugs called biologics, which target cell systems. “these drugs can basically target those specific signals that are going wrong. so, in inflammatory arthritis, which is autoimmune, your body is incorrectly attacking its own tissues, and these new drugs can turn off those signals.”
however, the news isn’t so good for osteoarthritis. “unfortunately, we have no drugs that change or target osteoarthritis.” she does say, however, there is ongoing research into disease-modifying osteoarthritis drugs. and scientists are understanding more about this type of arthritis, that it is not a “wear-and-tear disease” but something else going on inside the body. “understanding that better is helping us look for new drugs that can either prevent the cartilage from degrading or help it regenerate.”
like just about every other area of medicine, arthritis researchers believe artificial intelligence could play a role. “it’s being used more and more to look at different models that can help either predict people’s likely trajectory with arthritis, how we can learn from these models, and what predictors will help how somebody will likely fare, or respond to a particular drug or treatment approach. we’re currently investing in a pediatric arthritis study, essentially categorizing kids based on their genetic profile and using ai to help map out how these kids’ respond to certain medications, which will therefore inform future treatment decisions.”
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she says the society is also looking at using ai to assist people in recording their pain, symptoms, and flare-ups with their smartphone. it’s also interested in having them engage in activities, then do a finger prick to allow researchers to see if there’s any association between the symptoms and the activities.
bevan says there’s also a researcher in manitoba who is using ai to assess patterns in health care data to predict who is accessing health care and whether that can help identify and diagnose people earlier so they can be prescribed the right treatments earlier.
“the future is here, we’ll see where it goes next,” she says. “the exciting thing is that we’re starting to unravel what’s going on in these diseases much better, which is opening up different opportunities to treat it in different individuals in different ways. too many people say it’s ‘just arthritis’, but when you look at the people affected, the impact it’s having on their quality of life at work, at home. my optimism is that more organizations like ours are trying to increase awareness and understand the impact it will have.”
“we need to invest more to take advantage of all these technologies to really change how people are being treated in the future. there have been some great breakthroughs — in particular in inflammatory arthritis — so the time is now to look at osteoarthritis and get beyond pain management approaches to really change the disease.”
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