hello and welcome to this edition of joint action [Music] this podcast is dedicated to all those out there who have osteoarthritis on the show we unpack the truth and demystify the myths about the disease and its management if you have joint pain and want to know more about how to manage it from the world's best experts you've come to the right place without further ado it is time to welcome your host david hunter hello and welcome to this week's edition of the joint action podcast where we have the privilege of discussing about the burden of osteoarthritis now the impact of osteoarthritis remains a major challenge for healthcare systems worldwide with approximately 528 million people affected around the world the global prevalence of hip and knee osteoarthritis is approaching 5 and is expected to increase further with the aging population the increasing rates of obesity in adults combined with the lack of physical activity and joint injuries are also contributing to the rise in osteoarthritis incidents osteoarthritis is a serious condition which has substantial implications on one's day-to-day functioning it is associated with other diseases such as high blood pressure high cholesterol and back pain all of which lead to an increase in mortality now for those of you out there who have osteoarthritis none of this will come as a complete surprise to you but i think it's really important that we reflect on the impact this disease has so that we better understand it but also use that for advocacy and policy work when thinking about new innovations and strategies that our governments and people in healthcare can adopt on this week's episode of joint action we have joined by gillian hawker to discuss this really important topic of the burden of osteoarthritis dr jillian hawker is a professor of medicine in the department of medicine at the division of rheumatology at the university of toronto in canada she's an active staff in rheumatology at women's college hospital where she's a clinician scientist at the women's college research institute she is a senior scientist at the institute for health policy management and evaluation and adjunct senior scientist at the institute for clinical evaluative sciences in july 2014 she was appointed the sir john young and lady eaton professor and chair of department of medicine at the university of toronto she's an active osteoarthritis researcher with a great interest in this particular topic and as a world expert in that area and it's a privilege to have her join us on this show jillian welcome to the show it's great to have you here i'm delighted to be here fantastic it's good to see that you decided as well now as part of the initial get to know you point of the show what i usually try to do is give you a little few probing questions so that the listeners can get to know you a little bit better it also helps for me to get to know you a little bit better but in the first instance can you share with the listeners a little bit more about your background and what a typical day looks like so i'm a rheumatologist in toronto at the university of toronto but i spend most of my time doing two things doing clinical research in the area of osteoarthritis and a large administrative role at the university where i'm the chair of the department of medicine so i'm responsible for all the clinical training of people in various medical specialties and research wonderful now probably of greater interest to you but when you're not doing your day job what is it that you like to do albeit there's probably only three hours a year that that happens i was going to say it's true there's not a lot travel i love to travel which is not great during the pandemic um i've got one kid in stockholm and one child in england london so uh but i like to i like to travel love to hike with that family have a great garden love to garden so i like being outdoors and physically active sounds like wonderful activities and hopefully at some point in the not too distant future you'll be able to get back and start traveling and see your kids as well now if you had to describe yourself in five words what would they be i'd say passionate i would say disruptive i would say high standards i would say a good listener and caring is that five that's probably six or seven but good enough no yeah no that's definitely five and i thought you were going to throw in excited but uh i'm very happy that you're passionate because i'm sure that the excitement gets captured in the passion there somewhere as it does absolutely yeah now just being a little bit more probing and feel free to say david this is none of your business but tell us something interesting about you that you don't think most people would know i don't think there's very much that's terribly interesting about me but i'll tell you something that people don't know probably is i'm a total bird fanatic i'm sitting here actually with my binoculars that sit on my desk at all times because i have a bird feeder outside of my office window and i'm constantly watching and feed them year round and i'm pretty encyclopedic in those birds i love them i absolutely love them wonderful do you get out on weekends and go bird watching not really they come to our backyard i know i live in the middle of toronto but there's tons of great birds you just have to have your eyes open and the baseball teams named after a bird do you ever see those blue jays all the time good good yep yep they're gorgeous they're beautiful blue and they're big bit noisy yeah all right all right anyway we digress i do love birds myself but don't get a lot of time to do the bird watching and i wouldn't call myself an expert by any stretch of the imagination but let's get into the topic of the day which is really talking about this big burdensome disease and getting your perspectives on that i guess in the first instance can you just give us a little bit of information about how prevalent osteoarthritis is and what type of osteoarthritis is most prevalent yeah osteoarthritis is unfortunately way too common any estimate would say probably one in every three adults over the age of 65 has oa and you know now we're starting to see younger and younger people with osteoarthritis and probably the most disabling type of osteoarthritis is knee osteoarthritis and the overall rates are increasing pretty quickly so that osteoarthritis right now is the third most rapidly rising disabling condition worldwide which is pretty horrible you touched upon some really important topics there but i guess one is that i'd like to dig into a little bit further as i guess a why are we seeing more young people with osteoarthritis and what are the major risk factors that are driving the increased prevalence that we're seeing moving forward yeah a great question i mean the number one i think is body weight we're seeing children and and adolescents with obesity at much higher rates than we ever did before and obesity is a strong risk factor for knee osteoarthritis so we're seeing consequently a much higher frequency of really advanced knee osteoarthritis in people in their 30s and 40s that we didn't used to see other contributing factors are things like knee injury and ligament tear acl tear meniscal tear and then people who are just not using their muscles doing enough physical activity and get weak and so that they're not supporting their joints as well as they might but really obesity is a big problem now for listeners out there most of whom have osteoarthritis what is the typical impact this disease has on an individual that's affected by osteoarthritis yeah i have it too osteoarthritis causes joint pain the pain it hurts you to use your joints whatever joint it is that's affected and obviously if it's a lower extremity a knee or a hip or a foot it's difficult to walk so it affects your mobility when you have pain in your joints it can affect your sleep you can have interrupted sleep you can have fatigue as a result of both being in pain and having interrupted sleep you can't do the kinds of activities that you want to do initially the things that are sort of more vigorous activities and then eventually even things that are just basic daily activities like going upstairs or walking to the store and that can cause mood change so you can become anxious or depressed because you're living now not able to do the kinds of things that you want to do tired and in pain so it's pretty it's a pretty devastating condition yeah and i mean most of the impacts you've spoken about there are obviously a hugely burdensome to the individuals themselves what impact does this have for the individual and their opportunity to participate their work disability and the society i guess as well yeah excellent point huge so we know painful osteoarthritis is associated with inability to work at all so early retirement and time off work it's also associated with something called presenteeism so people are at work but they're not able to do really they're not able to work at their full capacity there's a lot of because of limited mobility and often changes in residence they can't continue to live independently and then there's a whole set of associations with healthcare use and joint replacement that can come later on oh wonderful thanks for sharing that with us now the impacts are massive and broad but do they differ by the different joints that are affected in a person who has osteoarthritis yes they do differ by the joints affected but unfortunately more and more we're seeing people with multiple joints affected at any one time so you know we used to sort of think somebody has base of the thumb hand away and that would affect their grip and their ability to write and important activities obviously with your dominant hand or knee or hip or if you if you're a lumper like i am the low back but often we see people with three four five joints involved often bilateral so both knees or both hips and the hands and the low back and the neck so um yes the impact varies it seems to be greater with with impact on the lower extremities the hips the knees the feet but honestly i don't see a lot of people anymore that have a single joint that's the problem it's multi-joint that's much more common i think yeah so on that note and just thinking about ways that we potentially can address this epidemic if i want to use that word moving forward in the future um there's been a lot of people that have spoken about the importance of single joint therapies you know whether that be injections whether that be a joint replacement but when we think about the fact that you know a large proportion of people here have multiple joint osteoarthritis oftentimes it's symmetric across you know both knees both hips and both hands are public health approaches here going to become more important and or should we just continue to focus on reacting to the single joint that's presenting to us in the clinic i'm so glad you asked that question because that's exactly where i think we need to go i think really at the end of the day the two most important things that we have to do for this osteoarthritis epidemic is to address obesity and physical inactivity and probably joint injury too and that is not what we're doing currently we need to really be starting in childhood with lifestyle behaviors and that's really hard because it's not just about people it's about the whole built environment and the social health determinants income access to good food it's a it's complex and complicated but to me i don't think we're going to get out of this if we keep just reacting with joint replacements we need to really get at the very beginning and that's that's the same thing that's true for diabetes or heart disease or anything because they all have these common risk factors and obesity in particular at the at the core yeah it's one wonderful to hear you say that and uh i don't think we can emphasize that point enough is that you know whilst we're obviously talking about burden and the impact on individuals today it's great to think futuristically and visionary about how we might change that moving forward and i think we're really going to need to reevaluate the way we deliver health at the moment and focus much more on health than it is on uh reacting to disease but that's probably a nice segue into thinking about osteoarthritis per se and the impact this has on both the presence of other illnesses and the concomitant comorbidities that occur with it can you just tell us a little bit about some of the common comorbidities how common they are and the impact that that in addition to osteoarthritis has yeah osteoarthritis is very very very commonly associated with other conditions that are also age-related obesity related so diabetes high blood pressure heart disease abnormally high lipid levels in particular so things that we call cardio metabolic that relate to that the increased body mass and i actually know quite a bit about how these conditions interrelate in the sense that we know that people that are living with osteoarthritis but also have one of these other conditions which maybe up to 90 percent do are less likely to get their osteoarthritis diagnosed less likely to get their diet their osteoarthritis treated and we think that that's because the other condition is seen as or conditions are seen as more important more life-threatening you know and people still have this crazy belief that osteoarthritis is just normal aches and pains of aging but what we're focused on now is that i talked a few minutes ago about the mobility issue and the fact that knee osteoarthritis is going up at leaps and bounds and when you can't walk you can't do your physical activity which is a core management approach for all these other conditions your heart disease your high blood pressure your diabetes etc so you know we've got some evidence and it's a growing body of evidence that if we don't treat the osteoarthritis we're actually making the other conditions worse we're increasing risk of developing diabetes complications having a heart attack or a stroke or actually even dying so i think it's starting to become a more coherent story about listen this is all one person and we've got to pay attention to the osteoarthritis in the midst of these other conditions it's so so important and i guess the unfortunate and frustrating element of most medical care at the moment is we oftentimes tend to be very siloed uh very much focused on diseases that kill you as as opposed to those that name or disable you but again moving forward how would you envisage this would occur and how would you frame this should this be about just managing chronic non-communicable diseases as a whole or should we continue in the siloed frustrating approach that often occurs at the moment actually we're working right now on a project to identify and treat osteoarthritis and osteoarthritis in people with diabetes to prove hopefully that if we can improve their ability to be mobile that we can actually improve their diabetes management so i do think that there's a holistic need to look at those core management of all these conditions it's kind of back to what we were talking about physical activity and maintaining a healthy weight are critical to everything everything so problem is i don't know about in australia but in canada i didn't get taught how to prescribe exercise i wasn't really taught about how to talk about diet i mean i can figure things out but it really wasn't part of our core medical curriculum i think it should be i think we should all know how to talk to people about physical activity and about weight management there's actually more been done on weight management that there has been on physical activity we've just finished doing interviews of family physicians and endocrinologists who treat diabetes and even though physical activity is a is in every guideline for the management of diabetes and most of them have you know diabetes educators and you know these complex diabetes programs nobody is trained to talk about physical activity and nobody's asking about joint complaints and when the joint complaints come up they say oh well there's nothing we can do about that i guess we shouldn't be pushing you to do exercise so i you know i totally think we need to shift the way we think about it's kind of the same conversation we just had is we physicians need to get with the program and really need to to be learning how to do motivational interviewing talk about physical activity healthy lifestyle and and in a pragmatic and simple way that resonates with the rank and file population that we're we're taking care of yeah such important issues and hopefully we can address some of those gaps particularly educational gaps moving forward as we've alluded to some of these diseases get higher priority such as cancer and heart disease because the perception is that they kill you um and rightfully so historically i think most people have thought osteoarthritis is not associated with any increase in mortality but rather just disability or i shouldn't say just but disability yep what's the truth i don't think we know quite yet but i would say i think there is a increased risk of death associated specifically with osteoarthritis we know a lot of that is due to other risk factors that we've already talked about obesity probably physical activity etc i guess the the big question is whether there's some level of inflammation um in the body associated with osteoarthritis that might be contributing to risk over and above the other conditions being heavy being physically inactive pain but i i think there is and we have shown that there is a meaningful increased risk of of death associated with osteoarthritis yeah such important messages and i hope some of those messages get through to both the listeners but also ultimately in time to to policy makers and government so that they can influence the care that people receive now is there anything on the topic of burden and impact of this disease that you think we haven't emphasized enough that you haven't spoken about that you'd like to cover off well there is one thing given that we're in the middle of the covet pandemic and surgery has been cancelled i've spent a lot of my career looking at appropriate access to joint replacement and while i think we've already stated that joint replacement is is a treatment for the end it's a pretty effective treatment for the end when other things have not been successful at keeping somebody active and pain-free i've seen through the pandemic so many people toss musculoskeletal surgery joint surgery like joint replacement off as you know it's it's optional it's elective it's not important and i guess i guess well it's not the same as taking a cancer out of somebody's belly or it isn't i get that but i think it just minimizes how incredibly important it is to relieve people of their pain and their disability for all the reasons we already said and a cancer in a belly is less common than people walking around with advanced osteoarthritis which could be significantly benefited by surgery so i guess i'm not pushing surgery i'm a rheumatologist not an orthopedic surgeon but it's a very good procedure and it bothers me that we're at least here in canada we have long wait lists that have just doubled because of the pandemic and because of the sort of belief that it's it's part of the whole oa thing it's just not that important so i guess i want to emphasize that and the rates of joint replacement continue to climb we've just finished a study that shows well everybody is showing that the rates of knee replacement are going up fastest in people under the age of 60. and in the group that we just studied there were about 15 of the people under the age of 50 who had a body mass index over 40 so huge impact of obesity again on early development of oa and the need for joint replacement so again i just think it's it's part of the story and part of the it's the burden of this disease yeah yeah and some of those messages are so important for our policy makers out there in terms of prioritizing the importance of this particular disease and not treating it as a second-rate citizen which is often the case and be prioritizing it according to the management of other diseases this is a serious disease um and for those people out there who are struggling in the pandemic accessing healthcare there's some wonderful resources that are remotely deliverable and available through the cure university website through the joint action website that provides some remote resources that hopefully can help people as they're struggling through what is a very challenging time globally now julian you're a visionary if you could do anything to improve health and health care what would you do well you already asked me that question because we already talked about it and that is i would pay a heck of a lot more attention to the social health determinants i think we have to be much more focused on public health i think that we've got to really fundamentally get to the root of what determines health education clean water good food physical activity safe environments i think frankly we've got to a point where if we don't start paying more attention to those things we're going to be bankrupt as a health care system probably all health care systems so i think we need to pivot agreed now how do you continue to learn in order to stay on top of things in your own well having graduate students or trainees are probably the best source of asking you tough questions that you can't answer that then you have to go and figure out so i would say having lots of young people around me asking those questions is very helpful and constantly reading constantly i mean i think that's one of the beauties of research actually too because you're you need to read in order to write a paper or write a grant or you know develop a protocol so you're constantly reading and it's the pleasure of this whole academic effort now my favorite question i think that i ever get to ask people because it provides me more insight than i think it probably provides more listen my mother the listeners that are out there but why do you do what you do what motivates you i really really really care about osteoarthritis i really want to crack this nut and i kind of realize that i probably am not going to see it cracked in my lifetime but i do feel that what you're doing what i'm doing in terms of advocacy and and providing new knowledge that helps to influence policy makers is uh it's just so meaningful it's really gratifying and taking care of patients is the most wonderful thing in the world so you know it's a good job well keep doing what you're doing and maintain the passion now if you could have a billboard with anything on it what would it be and why yeah yeah i i struggle with this question i think it would be something related to yes you can walk on a sore joint it will make it better but i think that's too convoluted so i have to figure out a cool way to say it but i think a lot of people are flummoxed by well it hurts my joint to walk on it so why would they be telling me to exercise so it's busting that myth that i think i would use the billboard to do yeah so something like stay active don't fear it or something yeah that's good okay i'll think about that i'm sure you'll come up with something brighter and more creative than i did but is there any one piece of advice knowledge wisdom that you'd like to give to people out there who have osteoarthritis i would say that people need to demand care i think people with osteoarthritis have become complacent or maybe always work complacent because everybody tells them that their disease is not important and you can't do anything about it and it's not serious so really the best thing that could happen would be that people don't take no for an answer i i have to tell you a little anecdote one of my research patients actually said to me her family doc told her that she was just getting too old you know and it was just aging and wearing of her knee and she said well with all due respect doctor so and so my left knee's the same age as my right knee and it's not bothering me at all so i think we need more patients questioning their clinicians their physicians and demanding the care that they deserve yeah definitely don't take this lying down get as proactive as we can and demand better care completely agree angeline what have you read or listened to recently that inspired you maybe something to wacko out there i i've been spending a lot of time really on equity diversity inclusive inclusivity and in canada we're having quite a horrible time with anti-indigenous racism so i've been reading a lot of work from indigenous canadians to try to really get my head around and understand how a country like yours and mine which were colonies have got to where they've got not taking care of people and i've read some incredible indigenous canadian authors tanya talaga is the most recent one and i've found her work very inspirational we'll continue that really important work i think there's a lot of parallels that probably we can learn from one another with the treatment of our indigenous people it's been horrific and hopefully we can learn from one another in that now where can listeners connect with you online well they can email me if they wish i'm also on twitter but i'm not on my personal twitter i'm on my department of medicine university of toronto twitter but they can get me there if they so choose and my email i'm happy for people to email me anytime sirian thank you so much for coming along today your words your passion i hope you continue to do the really important work that you're doing in this space it's a wonderful privilege to have a chance to chat to you about it thank you david i've enjoyed myself also thank you very much i hope you've enjoyed this week's topic as we've discussed an important topic that i think is of relevance to all of you particularly when thinking about making a difference to those who create policy and govern us as described in the show over 528 million people worldwide are affected with osteoarthritis and this number is continuing to rise due to the aging population and increase in risk factors major risk factors for osteoarthritis include injury occupation and obesity there's a number of different comorbidities associated with osteoarthritis including high blood pressure cholesterol and back pain and importantly those with osteoarthritis have a 55 increase in all-cause mortality take this information away go and talk to your policy makers your politicians and see what they can do about making a difference for you and for those other people out there with osteoarthritis do take care and we'll be with you soon thanks for listening to joint action with david hunter if you like our show and want to know more check out www. jointaction.
info if you have any questions you can email us at hello at jointaction. info and follow us on twitter at jointaction.
