Osteoarthritis affects 18.5% of the population in Belgium. This joint disease is characterized by destruction of cartilage that extends to all structures of the joint. And if we are interested today, it is because the Stop-Arthrose II survey, an initiative of AFLAR (Association Française de Lutte Anti-rhumatismale) and the Belgian Osteoarthritis Foundation (which initiated “World Osteoarthritis Day”) was presented earlier this week.
This study is a first in Belgium, but as the title of the report suggests, a second part in France, where the first edition took place in 2013. Nearly 3,500 French and Belgian patients, with a reported diagnosis of osteoarthritis, have participated in the survey between September 12, 2019 and January 1, 2021. It should be noted that it took place during the pandemic and this made it possible to collect additional information on the disease. People were able to deliver the main repercussions of osteoarthritis on their quality of life, but also explain the needs and expectations in terms of care.
Osteoarthritis in a nutshell
Osteoarthritis is an extremely common degenerative disease where the destruction of cartilage spreads to all structures of the joint. There are now 4 main origins of the disease: aging, metabolic, post-traumatic (after an accident, for example) and genetic origin.
In France, it is the second cause of disability. We often think that it only affects the elderly, but this is not always the case, according to the Stop-Arthrosis II survey, more than a third of the patients questioned had pain before the age of 40. . According to forecasts, 23% of the French population could suffer from osteoarthritis in 2030 against 17% currently. At issue: the aging of the population, but also “the obesity epidemic that is taking hold in France“, explains Doctor Laurent Grange, rheumatologist at Grenoble University Hospital and president of AFLAR.
In Belgium, a 2008 survey shows that just over 13% of the population suffered from osteoarthritis. There were twice as many women as men affected by the disease.
Another observation made at the time, the declarations of suffering linked to this pathology depend on social class and above all on the level of education. Professor Yves Henrotin, doctor in physiotherapy and functional rehabilitation, manual therapist, founder and president of the Arthrose Foundation evokes some mechanisms to explain these links: “care, self-management which requires a certain amount of instruction, there is also access to physical education provided by schools […] We already have a way to improve things, it is also to improve the level of education and schooling of people.”
The management of
Physical activity and muscle building exercises
Non-drug management is fundamental. Professor Yves Henrotin recalls that the first thing to do when you have osteoarthritis and you are overweight is to lose weight. By specifying that it is important to combine this weight loss with physical activity and especially muscle strengthening exercises to be performed every day, at a certain intensity and supervised, if possible, by a health professional.
Solutions also exist to make daily activities less painful, such as shoes or adapted soles, but also to raise chairs and toilets. Thermal cures can also help (they are reimbursed in France, not in Belgium) as well as acupuncture.
According to this doctor in physiotherapy and functional rehabilitation, pharmacological solutions should only be used to facilitate physical activity, muscle building, etc. and in no case to replace them.
Osteoarthritis hurts, which is why analgesics or nonsteroidal anti-inflammatory drugs are prescribed. Opioids can help too, but with the risks involved. Other solutions exist such as, for example, cortisone infiltrations or food supplements based on turmeric extracts, etc.
Solutions therefore exist, pharmacological and non-pharmacological, to treat osteoarthritis. Treatments: “which have a low to moderate effectiveness, it is true. But it’s by associating a lot of things […] that we will improve the quality of life of patients“, summarizes Doctor Laurent Grange.
The Stop-Osteoarthritis II investigation and the pandemic
The coronavirus pandemic was declared a few months after the start of the investigation. This made it possible to study three periods: before – confinement – during – the coronavirus crisis. And what has been observed is a deterioration in the morale and general state of health of the patients during the first strict confinement, but also an increase in the intensity of the pain.
These transient degradations, Professor Yves Henrotin explains by a probable decrease in physical activity, weight gain and dietary modification, isolation of patients and finally more professional and family stress. For Dr Laurent Grange, the analysis of these data shows the importance of the first treatment for osteoarthritis which is “move appropriately“.
What have we learned in 8 years?
The first survey of this type was carried out in 2013 in France. Eight years later, the finding is practically similar. Little or no improvement was observed on all the points of this report, note the experts.
- A large majority of patients questioned still hope for a reduction in pain, or even disappearance and regain mobility in the joints.
- 3/4 of people lack clear information about the disease. They are looking for practical ways to improve their daily lives.
- 65% want better medical monitoring.
Data analysis also sheds light on the impact of osteoarthritis on family and professional life, but also for one in four people, on married life with consequences on sexual life.
The quality of sleep deteriorates for 68% of patients. This last point obviously influences the state of physical and moral fatigue.
The impact on morale
The impact on the morale of people with osteoarthritis is still as important (81%) with a degradation of self-image, explains the study. Note that rare are those who consult a psychologist. Céline Mathy, psychologist and managing director of the Arthrose Foundation, asks herself the question: “If the patient’s current path takes him to the doctor, physiotherapist, rheumatologist, why would these health professionals not suggest that their patient also go to the psychologist?“
Self-image is also taking a hit with more than 3 in 10 patients saying they are frustrated with the changes caused by the disease.
Pain is certainly one of the elements that characterizes osteoarthritis since the first consultations with patients. It concerns 9 out of 10 patients. This pain is present during movements of parts of the body, but also during crises due to inflammation of the joint and the tissues around it. What is dramatic, explains Françoise Alliot-Launois, Vice-President of AFLAR, is “that there is not an ounce of change, not progress on pain in almost 10 years (Reference to the first study: editor’s note) “This pain is disabling.
To improve pain management, we must work on 3 points, specifies the Vice-President of AFLAR:
- Work on information on analgesics (painkillers) and in particular with pharmacists
- Learn self-care (massage, application of ointment, etc.)
- Physical activity, in other words: moving.
If, as this study says, the management of osteoarthritis has not changed enormously in 8 years and is even lagging behind in relation to other pathologies, the experts have in their conclusions some avenues for improving this situation.
It has already been mentioned: Moving appropriately, physical activity is the best treatment for osteoarthritis pain, specifies Professor Yves Henrotin.
For Dr. Laurent Grange, we must improve medical care, put more resources and accelerate research on promising molecules. Better inform patients about the disease as well and finally put in place a real prevention policy: physical activity, the fight against overweight and early management of the disease.