World Arthritis Day falls on 12 October. On this day, people suffering from arthritis from all over the world come together to make their voices heard and raise awareness on arthritis. The words “arthritis” and “rheumatism” include about 200 different disorders that affect bones and joints. As a group of diseases, arthritis is the commonest condition to affect mankind: about one in four people suffer from some form of arthritis. It is estimated that in Europe more than one hundred million people are affected by arthritis, making it a much more prevalent condition than other common diseases such as diabetes, hypertension and heart disease. A survey carried out in Malta some years ago estimated that between one in three and one in four people suffer from joint problems including back pain. Anybody can be affected by arthritis, males, and females, young and old – although the elderly are much more likely to fall victim to arthritis. With the so-called “baby boomers” (those who were born in the mid to late 40s) now reaching their 60s, it is expected that the prevalence of arthritis will increase significantly within the next five to 10 years.

There are many different forms of arthritis – some are temporary and improve with simple measures such as rest or medication with pain relieving drugs. Unfortunately, most forms of arthritis are chronic and will trouble the patient for the rest of his/her life. The commonest form of arthritis is osteoarthritis, where the cartilage covering the joint surfaces gets eaten away and the bones rub against one another, interfering with proper function of the joint. Rheumatoid arthritis is another form of arthritis, which, though not as common as osteoarthritis, can cause severe pain and disability: the thin membrane covering the joints (called the synovial membrane) becomes inflamed and eventually destroys the joint. Osteoporosis is a form of bone disease which makes bones weaker and brittle, and results in an increased risk of breaking of bones with minimal trauma or even spontaneously. Osteoporosis is much more common in females, but males are not spared: it is estimated that one out of every five patients with osteoporosis is male. Other forms of arthritis include lupus and scleroderma: these diseases are not as common as osteoarthritis or osteoporosis, but can be very serious since they may involve many different parts of the body (such as the skin, kidneys and heart) apart from the joints. They may be a cause of chronic ill health and, if severe enough, actually cause death.

All forms of arthritis have two common characteristics: they cause pain and they interfere with the function of the joint affected. Because of the chronic nature of the disease, most patients with arthritis are in continuous pain. Interference with function of the affected joint or body part renders the patient incapable of carrying out certain functions – including things we do not even think about when doing them, such as getting out of bed, dressing, bathing, eating, drinking – the so-called activities of daily living. Interference with these activities limits the patient’s ability to lead a normal life with possible limitation in the ability to work. As a group, the arthritic disorders are the commonest cause of sick leave and early retirement, and thereby a considerable burden on any country’s economy. Between the direct costs (doctor, hospital visits, medications, physiotherapy and so on) and indirect costs (loss of productivity at work, premature retirement, social benefits and so on), arthritis is the single most expensive health care factor in our society. Arthritis in the elderly makes it more difficult for patients to leave their house and go out, resulting in social isolation and subsequent depression. Osteoporosis is often complicated by bone fractures: any bone may be involved but the most serious one is the hip bone. Hip fractures require admission to hospital and it is calculated that only about half the patients will eventually have the same quality of life they enjoyed before the fracture. A significant number of patients with hip fracture will die, while many others will lose their independence and be unable to continue living on their own. Long-term problems with arthritis, including certain deformities, will make walking and access to public places difficult – if not impossible.

Although arthritis is so common and can have such a devastating effect on the lives of patients, and on any country’s economy, it was not given its due importance until relatively recently. It is likely that this may have been due to misconceptions such as arthritis being a “normal” consequence of ageing and therefore not a disease. The expectations, both of patients and the medical profession, of the treatment that could be offered were not high, so a general negative attitude prevailed. The World Health Organisation recognised the problem of arthritis and the expected increase of arthritis and its problems in the next few years. After several years of study it decided to dedicate the years 2000 to 2010 to arthritis and launched the so-called “Bone and Joint Decade”. The aims of this ambitious project are to increase worldwide awareness of arthritis among all individuals, including patients, the medical profession and the general public. The last few years have seen a real explosion in the knowledge of arthritis, which, in certain instances, has resulted in the development of “wonder drugs”. These have proved almost miraculous in patients with certain forms of arthritis, especially rheumatoid arthritis and ankylosing spondylitis. Significant advances have been registered in other forms of arthritis as well. There has been a drive to improve teaching of the rheumatic disorder both to the medical profession as well as to nursing and other paramedical staff. Patients with arthritis are made increasingly aware of what is happening in their field and what services are available locally for them. The establishment of associations for arthritis and rheumatism has been actively encouraged. Here in Malta three such associations exist – The Maltese Society for Rheumatology, where membership is open to doctors, not necessarily specialists, who are interested in arthritis; the Association of Health Professionals in Rheumatology, open to paramedical staff such as nurses and physiotherapists, and the Association of Arthritis and Rheumatism of Malta (ARAM), which is a patient founded association that is open to any patient suffering from arthritis and any person interested in learning more and contributing towards the well being of patients with arthritis. Seeing that the chances of any of us developing arthritis are so high, we can all consider ourselves as potential patients – so all would be welcome to join ARAM! The Maltese Society of Rheumatology and ARAM are full members of EULAR (the European League against Rheumatism) which embraces national European Rheumatology associations) and PARE (Patients with Arthritis and Rheumatism in Europe).

World Arthritis Day has been one of many results of the Bone and Joint Decade. The theme for this year’s World Arthritis Day is “Think Positive”. This theme acknowledges the fact that challenges associated with arthritis and rheumatism can affect patients not only physically but also emotionally and psychologically; but that there are several positive things they can do to help them feel better in themselves. Besides, this theme also emphasises that we should all be more positive about arthritis: a lot can be offered to help arthritis patients and the attitude that arthritis patients should “grin and bear it” or “suffer in silence” should be dumped in the wastebasket of history!

Various countries around the world organise activities to mark this day. In Malta we have been observing World Arthritis Day since 2006: over the past two years we have held symposia for patients, doctors and health care professionals that addressed various aspects of arthritis. This year three events are taking place. A walk is being held around Mater Dei Hospital on Friday 10th October at 9.30am preceded by a press conference at which Parliamentary Secretary for Health Dr J. Cassar will be present. Anybody who would like to join this walk can join at the main entrance of Mater Dei Hospital. On Saturday, a symposium is being held at Mater Dei Hospital (Auditorium 1, Administration Block) by the Maltese Society for Rheumatology for doctors and senior medical students and. Doctors and medical students who wish to attend are kindly requested to send an e-mail to Prof. C. Mallia at [email protected] On Sunday 12 October, the Association of Arthritis and Rheumatism – Malta, is organising a symposium at Corinthia San Gorg Hotel, St Julian’s at 9am. Individuals who wish to attend, or who wish to know more about ARAM, are to e-mail Mrs Mary Vella at [email protected]

Dr Mallia is Professor of Medicine at the University of Malta and a Consultant Physician and Rheumatologist