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New projections for the future burden of arthritis in Australia provide an important impetus for greater investment in arthritis to ensure Australia’s health system can capably meet future health care demand and deliver high value care.
Arthritis is an umbrella term that comprises over 100 different diseases that can affect people of all ages. While all arthritis conditions affect the joints, some types of arthritis also affect other parts of the body such as the skin, eyes and other organs. Importantly, arthritis is not just a condition of older age — it can affect babies, children, adolescents and younger as well as older adults. Arthritis is incredibly common — National Health Survey data indicate that around 15% of Australians are currently living with a form of arthritis — and most of us will know a friend, family member or colleague who has the condition, even if the symptoms are not always visible.
Arthritis is most often associated with pain, stiffness and reduced function, all of which can profoundly impact a person’s quality of life and ability to participate in work, family and social activities. Importantly, effective prevention strategies for arthritis are currently lacking and there is no cure. It’s in this context that understanding the likely future burden of arthritis is critical. Forecasting the future burden allows us to plan for health care needs in the years ahead including the medical, surgical, nursing, and allied health workforce that will be needed to deliver care for the growing number of people with arthritis. We also see our projections as a valuable opportunity for raising community awareness about arthritis and its impacts, and to advocate for much needed research investment into prevention, identifying and evaluating new therapies and ensuring patients receive high value, cost-effective care that optimises outcomes.
How many Australians are expected to be living with arthritis?
Based purely on expected population growth and ageing, our new modelling suggests that 5.39 million Australians will be living with arthritis by 2040. That’s an additional 1.28 million people with arthritis (or a 31% increase) relative to 2025 numbers. A high population growth scenario would put even greater strain on our health care system, with 5.56 million Australians forecast to have arthritis under this scenario.
In all projection scenarios that we examined, the highest burden of arthritis is expected to be borne by women. For osteoarthritis, the most common form of arthritis and the most common indication for hip, knee and shoulder replacement surgery, we have forecast that 3.11 million Australians will have the condition in 2040.
Looking at the age groups most affected, older adults will continue to form a major part of the osteoarthritis population but notably as our population grows, people of working age (the current millennials) will also be greatly impacted. Over 1.03 million people between the ages of 45 and 64 years are forecast to have osteoarthritis in 2040, with implications for work productivity and workforce participation. Notably, our modelling is conservative and does not incorporate any changes in rates of obesity or joint injury, both known contributors to the development of knee osteoarthritis.
For rheumatoid arthritis, the most common form of inflammatory arthritis, we have forecast that by 2040, there will be an increase of over 186 000 people who will require specialist rheumatology care, relative to 2025 numbers. By contrast, the number of children and adolescents with juvenile idiopathic arthritis is anticipated to remain relatively stable over time given little expected population growth for these younger age groups.
Arthritis burden relative to arthritis research investment
Health system expenditure for osteoarthritis and rheumatoid arthritis totalled $5.26 billion in 2020–21 and is projected to exceed $11.92 billion by 2040 based on our forecast numbers. Yet there is a clear mismatch between the high burden of arthritis (when considered both in terms of the number of people affected and associated health system expenditure) and the magnitude of research funding that is allocated. The most recent data indicate that in 2022–23, only $42.8 million was invested by the National Health and Medical Research Council (NHMRC) into research for all musculoskeletal diseases (including arthritis) and there is still no dedicated Medical Research Future Fund (MRFF) mission for musculoskeletal health.
To put this into context, 2022–23 NHMRC research expenditure for other common health conditions was far higher at $102.8 million for mental health, $94.1 million for cardiovascular disease and $161.1 million for cancer. In relative terms, research investment for musculoskeletal diseases represented only 0.27% of the $15.9 billion of health system expenditure for these conditions in 2022–23, compared with markedly higher research investment for mental health, cardiovascular disease and cancer at 0.87%, 0.58% and 0.86% of health system expenditure, respectively. Australia has a well established and successful national clinical trials network focused on arthritis and other musculoskeletal conditions but moving forward, a targeted MRFF mission in musculoskeletal health will be essential for building a sustainable research workforce and conducting innovative translational research from basic science through to implementation trials.
Ensuring timely access to care
While prevention opportunities are currently limited, it is critical that people have access to the care they need for their arthritis, particularly for those who live outside the major cities. The forecast burden means we need to be planning for appropriately resourced health services that can provide timely care to growing arthritis populations, without lengthy delays and long waiting lists. For people with inflammatory arthritis, a key priority should be ensuring timely access to specialist rheumatology care for diagnosis and treatment to prevent or minimise joint damage. Addressing existing health workforce shortages is also imperative. The current shortfall of 302 adult rheumatologists is projected to worsen, particularly in regional and rural areas, and there are only 20 practising paediatric rheumatologists (13 full-time equivalent) in Australia to provide care for children and young people with juvenile idiopathic arthritis. Increasing the number of advanced training positions for both adult and paediatric rheumatologists is urgently needed. New approaches to how we deliver arthritis care will also be needed to meet the growing population demand. We’ve already seen that the uptake of remote access health care was fast-tracked in many clinical areas during the COVID-19 pandemic. Continued innovation and investment in telehealth and virtual hospital approaches may also go some way to improving timely access to care for more Australians with arthritis, particularly for people living in non-metropolitan areas and those who are experiencing significant functional disability.
Professor Ilana Ackerman is a musculoskeletal epidemiologist and physiotherapist. She is Deputy Director of the Musculoskeletal Health Unit in the School of Public Health and Preventive Medicine at Monash University.
Professor Rachelle Buchbinder is a rheumatologist and clinical epidemiologist. She heads the Musculoskeletal Health and Wiser Health Care Units in the School of Public Health and Preventive Medicine at Monash University and is the current Chair of the Australia and New Zealand Musculoskeletal (ANZMUSC) Clinical Trial Network Centre of Research Excellence Executive Committee.
The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.
The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated.
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