2.5. Rheumatic and osteoarticular diseases

Rheumatic and osteoarticular diseases are still the most diffuse chronic condition affecting the Italian population and according to the findings of the 2010 Multi-Purpose Survey conducted by ISTAT, arthritis and osteoarthritis affect 17.3% of the population and 7.3% have osteoporosis. The ISTAT data confirms the increase in prevalence of the main rheumatic diseases (arthritis/osteoarthritis and osteoporosis) in relation to age, regardless of sex, whereas analysis by gender shows that the prevalence of these disorders is higher amongst women than men (22.1% of arthritis/osteoarthritis in women vs. 12.1% amongst men). This difference is even more marked when we consider osteoporosis (12.0% vs. 1.7%). Regional distribution shows a higher prevalence in Umbria, Basilicata, Sardinia and Abruzzo (>20%), with the lowest values recorded in the Autonomous Provinces of Trent and Bolzano. The geographical differences observed suggest that certain areas of the country require initiatives based on the simple correction of lifestyles in the different ages.

Gout affects between 0.5 and 1% of the general population (at least 300,000 patients in Italy).

During 2009, in Italy there were over 159,000 joint replacement operations, of which: approximately 58% were hip replacement procedures, 39% were knee replacements, 2% were shoulder replacements and the remaining 1% were operations on the minor joints. During the period 2001-2009, there was an increase in the number of orthopaedic joint replacement procedures with a mean annual increase of approximately 4% for hip replacements and 11% for knee replacement surgery, although this growth rate slowed in 2009. The number of women undergoing all types of joint replacement surgery is still far higher than the number of men (67% women, 33% men) and they also have a higher mean age (73 years for females, 69 for males). In 2009, the economic impact of joint replacement surgery in Italy was estimated at approximately 1.5% of national health expenditure.

Musculoskeletal diseases are systemic conditions with a significant impact on the individual’s working abilities and autonomy, as well as a reduction in life expectancy. To stem the spread of this type of disease, suitable primary prevention schemes are required involving the diffusion of projects aimed at reducing sedentariness and promoting active life styles. It is also necessary: to improve the instruments for early diagnosis, both by informing general practitioners better and by sensitising the population and patients, who must play an active role in treatment; guaranteeing access to therapy, by investing in reducing territorial differences in the availability of appropriate diagnostic and therapeutic pathways which, in the early phases of the disease, efficaciously reduces impairment, maintains function and improves the life expectancy of rheumatic patients. The therapy available for rheumatic diseases is largely pharmacological and is based, for certain conditions, on the use of “biologics”, biotechnological products that selectively target pathogenic mechanisms. The high costs of therapy with these medicines and the need for long-term clinical monitoring, call for the keeping of fully-blown registers aimed at monitoring the long-term risk/benefit profile, thus responding to the need to build lasting surveillance systems.