Arthritis and musculoskeletal conditions are a leading cause of disability in the UK. Despite this, the conditions receive just 3.4 per cent of UK research funding. It is often left to charities like Versus Arthritis – the UK’s largest arthritis charity – to provide dedicated support to those living with the condition. Deborah Alsina, chief executive of the charity, offers her thoughts on Britain’s treatment of the disease.
How prevalent is arthritis in the UK?
It’s a hugely prevalent condition. One in six people in the UK are affected by arthritis. And it’s part of a group of musculoskeletal conditions that affect over 20 million people in total.
How does the condition manifest?
Arthritis is an umbrella term that accounts for painful, stiff and restricted joints. There are three main forms: one is osteoarthritis, which affects about ten million people. It’s a condition where the cartilage at the end of the joint is unable to repair and maintain itself, so it becomes thin and uneven. Then there are autoimmune inflammatory conditions, such as rheumatoid arthritis, which affects about 450,000 people. This is where the immune system attacks the joints. The final grouping is crystalline forms of arthritis. The most common is gout, which affects about 1.6 million people and is very painful.
What is treatment provision like?
Different types of arthritis need different treatments. Autoimmune arthritis requires medicines that control and rebalance the immune system – such as anti-TNF therapies, the development of which Versus Arthritis has helped fund. Gout attacks can be agony yet are completely preventable with medicines that lower uric acid in the blood, but not enough people can access them. There has been less progress on osteoarthritis. Physical activity or maintaining a “healthy” body weight can play a huge role, but people don’t get support to achieve and sustain this. Often, people find that medicines to manage pain cause side effects, or aren’t helpful enough. And although many people with osteoarthritis won’t go on to have joint replacement surgery, those who do find it life-changing.
How do long NHS waiting lists affect people with arthritis?
Trauma and orthopaedics, which include hip and knee replacements, have the longest waiting times of any treatment category – there are around one million active cases across the UK. I want to debunk the idea that “elective” surgery implies that people have choice. People’s conditions often deteriorate while they’re waiting for treatment. I’ve seen surgical presentations where people were put onto a waiting list needing a hip or knee replacement, then when they have arrived for an operation there’s been a huge deterioration in the joints. This results in more costly, complicated operations, and potentially worse outcomes.
How painful are these conditions?
Hugely. People waiting for a hip replacement, for example, describe an everyday activity such as walking as like walking on jagged glass. People talk about feeling like being stabbed. That’s the level of pain people are dealing with.
What impact does this have on people’s livelihoods?
The current status quo is taking away people’s ability – if they’re of working age – to work. We already know that people with arthritis are 20 per cent less likely to be in work than the general population. With people stuck in these NHS backlogs, that figure has surely increased. It’s doubling down on people, so not only are they living with pain and fatigue, they’re also at risk of greater poverty as well. Some are having to retire early, and that in turn is leading to greater levels of poverty in later life.
Are there any examples that exemplify the issues at hand?
We have a free phone helpline, and lots of people get in touch to share their experiences as we support them to self-manage their condition. One person who stands out to me is a woman called Roberta, who is in her seventies. She told us that she felt that her life had been put on hold. She was barely able to walk more than a few steps while she was waiting for her hip
surgery. It meant that her partner had to do everything for her. It takes away people’s independence, and those basics of dignity. Others tell us that they are feeling suicidal because of their high levels of pain. When you don’t know where you are on a waiting list, or how long you have to wait, it becomes very difficult for people to keep going.
Do you think this issue is being taken seriously enough?
About 50 per cent of people living with heart, lung, or mental health conditions will also be living with arthritis or another musculoskeletal condition. So it’s really important that we think about arthritis and musculoskeletal conditions in their own right, but also as a co-morbidity to other conditions as well. That’s why the next government has to take arthritis seriously.
What can the UK do to improve its treatment of the condition?
We need a greater prioritisation of arthritis and musculoskeletal conditions in the UK. We’re pleased that the government has recognised arthritis and musculoskeletal conditions in the Major Conditions Strategy in England. Data collection on the condition is poor – especially relative to a disease area such as cancer, which tracks how treatment relates to outcomes. Most importantly, with one million cases waiting for orthopaedic treatment, we need to see long-term protected plans to bring down orthopaedic waiting lists. This would ensure people get treatment in a timely manner so that they avoid further deterioration in their health.
This article first appeared in a Spotlight print report on Healthcare, published on 17 May 2024. Read it in full here.
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