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Osteoarthritis: It’s time to talk about mental health

Hannah Stevenson
Medical Lead for Chronic Pain, Pfizer UK

14th June 2021

From the isolation and uncertainty of lockdowns, to the stress of living side-by-side with a virus that has caused widespread devastation, there is no doubt that COVID-19 has placed our physical and mental health under considerable pressure.

 

This has made the recent Mental Health Awareness Week (10-16 May) more important than ever and further demonstrates the need for integrated healthcare and support that meets the physical and mental health needs of patients. And this also applies to people living with musculoskeletal conditions like osteoarthritis – the most common form of arthritis in the UK.

Osteoarthritis occurs when cartilage breaks down in one or more joints and physical symptoms can include joint pain and stiffness, and mobility problems.1 Even when compared to people with a similar burden of health conditions, people suffering from moderate to severe pain associated with osteoarthritis are more likely to have anxiety or depression, as well as other conditions such as cardiovascular disease.2 Digging a little deeper into the experiences of people with osteoarthritis may help us to understand what it’s like to live with this condition.

Firstly, there’s the pain: nearly three quarters of people with osteoarthritis report some form of constant pain, with one in eight describing their pain as often unbearable.3 Studies have shown that people with the highest pain levels are the most likely to be anxious or depressed. And, this works both ways – while pain can incite anxiety and depression, these can in turn worsen pain and quality of life.3,4,5,6,7

Secondly, osteoarthritis can significantly impact how people live their lives, due to loss of mobility, social connections, and overall independence. In the Global Osteoarthritis Patient Perception Study that ran in 2018, 91% of people living with osteoarthritis reported limitations in their everyday physical activities, 49% reported an impact on their work, and 37% reported an effect on their social lives.8 A third of people with osteoarthritis retire early, give up work or reduce the hours they work because of their condition.9 All of these disruptions may also impact mental health. 

Osteoarthritis isn't a problem that affects 'other people' – it affects our families, friends and our neighbours.”

There are treatment pathways to help manage the physical symptoms of osteoarthritis, as well as for anxiety and depression. These include physical activity programmes, medications, surgery, and talking therapies.1,10,11 A multi-disciplinary health team is important to ensure patient-centered care, and health policies and services should focus on treating the whole patient, recognising that physical and mental wellbeing are inextricably linked. Employers have a role to play to make workplaces inclusive and supportive towards individuals’ specific needs as well.

Health is multi-faceted and no single organisation can meet the entire needs of patients alone. In April this year, NHS England launched new integrated care systems (ICS); this represents a significant move towards better joined up care to improve services for patients. These systems are bringing together hospital, community and mental health trusts, GPs and other primary care services with local authorities and other care providers in each region.12,13

Equally important is a healthcare system that treats not only those with health conditions, but also focuses on prevention and keeping people well. Osteoarthritis is not a condition that affects only those in late adulthood – around 8.75 million people aged 45 years and over in the UK have sought treatment for osteoarthritis. This is equivalent to 33% of adults in the 45+ age group.14 As we live longer, it is important we stay as healthy as possible.

The NHS, healthcare professionals, policy makers, local authorities and employers all have a collective responsibility and play an important role in supporting people both physically and mentally – including those living with osteoarthritis. The key is to ensure high-quality holistic care, as supported by the integrated care systems, the rewards from which we will all benefit. Osteoarthritis isn’t a problem that affects ‘other people’ – it affects our families, friends and our neighbours. It can impact mental as well as physical well-being. As individuals, we can all try to have a better understanding of what osteoarthritis can mean for those affected, and offer our support.

 

 

 
References

  1. NHS UK. Osteoarthritis. August 2019.
  2. Stevenson, H. et al. Characterising the morbidity and mental health profile of patients with moderate-to-severe chronic pain in osteoarthritis: a retrospective analysis of linked primary and secondary care data in England. Abstract presented at the British Pain Society Annual Scientific Meeting; 27-29 April 2021. Abstract number: [AS001154].
  3. Versus Arthritis. The state of musculoskeletal health. 2019.
  4. Sharma A, Kudesia P, Shi Q, Gandhi R. Anxiety and depression in patients with osteoarthritis: impact and management challenges. Open Access Rheumatol. 2016;8:103-13.
  5. Rathbun AM, Stuart EA, Shardell M, Yau MS, Baumgarten M, Hochberg MC. Dynamic Effects of Depressive Symptoms on Osteoarthritis Knee Pain. Arthritis Care Res (Hoboken). 2018;70(1):80-8.
  6. Stubbs B, Aluko Y, Myint PK, Smith TO. Prevalence of depressive symptoms and anxiety in osteoarthritis: a systematic review and meta-analysis. Age Ageing. 2016;45(2):228-35.
  7. Arthritis Foundation. Arthritis and Mental Health. Accessed 19/05/2021.
  8. Vitaloni, M., Botto-van Bemden, A., Sciortino, R. et al. A patients' view of OA: the Global Osteoarthritis Patient Perception Survey (GOAPPS), a pilot study. BMC Musculoskelet Disord 21, 727 (2020). https://doi.org/10.1186/s12891-020-03741-0.
  9. Arthritis Care. OA Nation 2012 Report. May 2012.
  10. NHS UK. Overview - Generalised anxiety disorder in adults. December 2018.
  11. NHS UK. Overview – Clinical Depression. June 2018.
  12. NHS England. What are Integrated Care Systems? Accessed 10/05/2021.
  13. NHS England. NHS achieves key Long Term Plan commitment to roll out integrated care systems across England. March 2021.
  14. Arthritis Research UK. Osteoarthritis in general practice July 2013.
PP-PFE-GBR-3688 / June 2021