Treatment

Arthritis and Hospital Services

Canadians with arthritis are significantly more likely to report that they required but did not receive health care in 1999, compared to Canadians with another or no chronic condition.

The number of arthritis-related orthopaedic procedures per capita in Canada has remained remarkably static since 1994.iii
The only procedures for which rates increased significantly in Canada from 1994-2000 were hip and knee replacements.iv
The number of outpatient procedures increased from 1994-2000 in Canada, likely as a result of the increased use of arthroscopic (keyhole) surgery.v
The higher prevalence of arthritis among women is only partially reflected in the rates of orthopaedic procedures; the slightly higher rate of hip and knee replacement procedures among women does not wholly reflect their greater need.vi
The rate of orthopaedic procedures reached a plateau from 1994-2000 in older age groups in Canada, but the rate of medical admissions continued to climb.vii
Considerable provincial variation in both orthopaedic procedures and medical admissions is apparent, even after adjustment for differences in the age and sex composition of the provincial populationsviii

The percentage of Canadians with prescriptions for disease-modifying anti-rheumatic drugs (DMARDs), which are effective in treating rheumatoid arthritis, has increased steadily over time. Nevertheless, the overall rate of provision of these drugs falls short of the estimated prevalence of the disease.ix
The prescription of conventional non-steroidal anti-inflammatory drugs (NSAIDs) in Canada has shown a notable decline since 1998 for individuals over the age of 65. The release of COX-2 inhibitors onto the Canadian market in 1999 has likely contributed to this trend.x
Some of the increases and decreases in prescription rates over time may be a result of changes in the provincial drug plan formularies over time.xi
The total cost of drugs, including management of the effects of drug toxicity, constituted only 15% to 20% of the direct costs of arthritisxii

Approximately 163 of every 1,000 Canadians 15 years of age and older made a visit to a physician in 1998/1999 for arthritis and related conditions – an estimated total of 8.8 million visits in Canada. More women than men made arthritis-related visits. The rate of consultation was highest among older people of both sexes. xiii
Eighty-two percent of Canadians who made visits for arthritis and related conditions made at least one of these to a primary care physician. Overall 18.5% of people with arthritis-related visits saw a surgical specialist such as an orthopaedic surgeon at least once. 13.7% saw a medical specialist such as rheumatologist or internist at least once.xiv
Visit rates for arthritis and related conditions varied by province, ranging from 146 to 207 per 1,000 people aged 15 years and older. Differences in the provincial physician billing databases may account for some of this variation. Differences in the availability of physicians, especially specialists, may also be a contributing factor.xv

In Canada, over 15.5 million physician visits were made for musculoskeletal disorders during 1998-1999.xvii
Approximately 24% of Canadians made at least one physician visit for musculoskeletal disorders in 1998-1999.
- 16% for arthritis and related conditions
- 2% for bone disorders
- 7% for back disorders
- 6% for ill-defined symptomsxviii

Arthritis in Canada. September 2003. Chapter 2, p. 23, Figure 2-25
Ibid., Chapter 6, p. 79
Ibid., p. 80
Ibid., p. 82
Ibid., p. 90
Ibid., p. 91
Ibid.
Ibid.
Arthritis in Canada. September 2003. Chapter 5, p. 70, Figure 5-6
Ibid., p. 68, Figure 5-2
Ibid., Chapter 5, p. 72
Ibid.
Arthritis in Canada. September 2003. Chapter 4, p. 52, Table 4-1
Ibid., p. 55, Table 4-3
Ibid., p. 58
Ibid., Chapter 2, p. 23, Figure 2-25
Power JD, Perruccio AV, Desmeules M, Lagacé C, Badley EM. Ambulatory physician care for musculoskeletal disorders in Canada. J Rheumatol. 2006 Jan;33(1):133-9. [Pub Med ID 16395761] Abstract & Supplementary Information
Ibid.