Woolf Anthony D, Pfleger Bruce
Peninsula Medical School, Duke of Cornwall Department of Rheumatology, Royal Cornwall Hospital, Truro TR1 3LJ, England.
Bull World Health Organ. 2003;81(9):646-56. Epub 2003 Nov 14.
Musculoskeletal conditions are a major burden on individuals, health systems, and social care systems, with indirect costs being predominant. This burden has been recognized by the United Nations and WHO, by endorsing the Bone and Joint Decade 2000-2010. This paper describes the burden of four major musculoskeletal conditions: osteoarthritis, rheumatoid arthritis, osteoporosis, and low back pain. Osteoarthritis, which is characterized by loss of joint cartilage that leads to pain and loss of function primarily in the knees and hips, affects 9.6% of men and 18% of women aged > 60 years. Increases in life expectancy and ageing populations are expected to make osteoarthritis the fourth leading cause of disability by the year 2020. Joint replacement surgery, where available, provides effective relief. Rheumatoid arthritis is an inflammatory condition that usually affects multiple joints. It affects 0.3-1.0% of the general population and is more prevalent among women and in developed countries. Persistent inflammation leads to joint destruction, but the disease can be controlled with drugs. The incidence may be on the decline, but the increase in the number of older people in some regions makes it difficult to estimate future prevalence. Osteoporosis, which is characterized by low bone mass and microarchitectural deterioration, is a major risk factor for fractures of the hip, vertebrae, and distal forearm. Hip fracture is the most detrimental fracture, being associated with 20% mortality and 50% permanent loss in function. Low back pain is the most prevalent of musculoskeletal conditions; it affects nearly everyone at some point in time and about 4-33% of the population at any given point. Cultural factors greatly influence the prevalence and prognosis of low back pain.
肌肉骨骼疾病给个人、卫生系统和社会护理系统带来了沉重负担，其中间接成本占主导地位。联合国和世界卫生组织通过认可2000 - 2010年骨与关节十年，已经认识到了这一负担。本文描述了四种主要肌肉骨骼疾病的负担：骨关节炎、类风湿关节炎、骨质疏松症和腰痛。骨关节炎的特征是关节软骨丧失，主要导致膝盖和臀部疼痛及功能丧失，在60岁以上的男性中发病率为9.6%，女性中为18%。预期寿命的增加和人口老龄化预计将使骨关节炎在2020年成为第四大致残原因。在可行的情况下，关节置换手术可提供有效的缓解。类风湿关节炎是一种炎症性疾病，通常会影响多个关节。它在普通人群中的发病率为0.3 - 1.0%，在女性和发达国家更为普遍。持续的炎症会导致关节破坏，但这种疾病可以通过药物控制。发病率可能在下降，但一些地区老年人数量的增加使得难以估计未来的患病率。骨质疏松症的特征是骨量低和微结构恶化，是髋部、脊椎和前臂远端骨折的主要危险因素。髋部骨折是最具危害性的骨折，死亡率为20%，功能永久性丧失率为50%。腰痛是最常见的肌肉骨骼疾病；几乎每个人在某个时候都会受到影响，在任何给定时间约有4 - 33%的人口受其影响。文化因素对腰痛的患病率和预后有很大影响。
