debate on the inquiry of the Honourable Senator Comeau,
calling the attention of the Senate to the debilitating
nature of arthritis and its effect on all Canadians.—(Honourable
Hon. Lillian Eva Dyck:
Honourable senators, it is my pleasure to join the debate on
the inquiry of the Honourable Senator Comeau calling the
attention of the Senate to the debilitating effects of
arthritis and its effects on all Canadians.
Honourable senators who have
participated in this debate so far have done an excellent
job in outlining the various forms of arthritis, the
incidence of arthritis, its differential impact on women and
Aboriginals and the lack of equitable funding to arthritis
research compared to other diseases such as cancer, diabetes
and so on.
I have been contacted by people from
Saskatchewan who have asked me to speak to this inquiry and
to lobby for more funds to support arthritis research. I met
with Anne Dooley, the President of the Canadian Arthritis
Patient Alliance, and she provided me with lots of
information on arthritis.
Today, I will focus my comments on the
greater impact of arthritis on the Aboriginal population. I
will also discuss the need for improved information about
arthritis on the web, particularly with respect to the
Health Canada website.
First, I will review two major forms
of arthritis, using information from the Arthritis Society
of Canada website. The most common kind of arthritis is
osteoarthritis. It affects 1 in 10 Canadians, about 3
million of us; and it affects men and women in equal
Most people develop osteoarthritis
after the age of 45, but it can occur at any age. According
to the Public Health Agency of Canada, 85 per cent of
Canadians will be affected by osteoarthritis by age 70.
Osteoarthritis is caused by the
breakdown of cartilage. Pieces of cartilage may break off
and cause pain and swelling in the joint. Osteoarthritis
usually affects the hips, knees, hands and spine. Being
overweight can increase the risk of osteoarthritis. As well,
joint injury or repeated overuse of a joint can damage its
cartilage and lead to osteoarthritis.
The warning signs of osteoarthritis
are pain, stiffness and swelling around a joint that lasts
longer than two weeks. As mentioned above, the joints that
are usually affected are the hips, knees, feet and spine,
though the finger and thumb joints may be affected also.
The second type of arthritis I will
talk about is rheumatoid arthritis, which is an autoimmune
disease characterized by redness, pain, swelling or a
feeling of warmth or heat in the affected joint. The hands
or feet are the most commonly affected.
Rheumatoid arthritis affects 1 in 100
Canadians, about 300,000 people, and women are three times
more likely than men to be affected. Most people develop
rheumatoid arthritis between the ages of 25 and 50. The
warning signs of this type of arthritis are morning
stiffness that last more than 30 minutes, pain in three or
more joints simultaneously, joint pain lasting all night
long and pain in the same joints on both sides of the body.
In general, the key risk factors for
the development of arthritis are age, excess weight, injury
and complications from other conditions, heredity and lack
of physical activity. Preventive measures include exercise
such as walking, cycling and swimming, and maintaining a
healthy body weight.
As was mentioned previously by other
honourable senators, the incidence of arthritis is two and a
half times higher in the off-reserve Aboriginal population
than in the rest of the Canadian population. Yet, this fact
seems to go unnoticed. However, this situation may not be
surprising, given the general lack of awareness concerning
the incidence and seriousness of arthritis compared to other
chronic diseases such as cancer and diabetes.
So far, only limited data on the
prevalence of arthritis in the off-reserve Aboriginal
population has been collected. The age-standardized
prevalence of arthritis was 27 per cent in the Aboriginal
population, and 16 per cent in the non-Aboriginal
population. The standardized prevalence of diabetes was
above 9 per cent in the Aboriginal population, and 5 per
cent in the non-Aboriginal population. In other words,
arthritis was a far more common chronic medical condition
than diabetes in the Aboriginal population.
Though it is well known that diabetes
is more prevalent in the Aboriginal population, it is not
common knowledge that arthritis is also more prevalent in
the Aboriginal population — and that it is more prevalent
than diabetes. In addition, it is noteworthy that the most
common chronic medical condition for Aboriginals is
arthritis, and for non-Aboriginals it is allergies.
According to a news report last month,
the severe forms of arthritis are five times more common in
Aboriginals than in non-Aboriginals. This situation can be
attributed to the inheritance of the gene associated with
rheumatoid arthritis, which is present in as many as 70 per
cent of the Aboriginal population.
There are also clear gender
differences in the self-reported prevalence of arthritis in
Canadians 15 years of age and over. In women, the incidence
is nearly 20 per cent; while in men, it is only about 12 per
Most people who have hip or knee
replacement surgery — 90 per cent — have arthritis. Studies
show that women are more likely to be recommended for
surgery when their arthritis is at a more advanced stage
than it is for a man. In other words, men are recommended
for surgery at an earlier stage of disease progression than
is the case for women. Similarly, a recent study shows that
a man with moderate arthritis is twice as likely to be
recommended for knee surgery than a woman with moderate
arthritis. This gender discrimination may be due to
subconscious bias on the part of physicians and, in my
opinion, it may also reflect gender differences in
assertiveness. Perhaps men are more vocal than women in
articulating their pain or in asking for surgery.
Honourable senators, after reviewing
the information sent to me and the comments of other
honourable senators, I decided to search the web using
PubMed, a search engine for biomedical research
publications. In the last year there were 775 reviews of
arthritis in humans but, of those, only nine papers were
listed on Aboriginals and arthritis. Only two of these were
published by Canadians. When I checked for First Nations and
arthritis, eight other publications were identified.
However, I found something interesting: There were 77,932
publications on women and arthritis. My interpretation of
these numbers is that there is a crying need for more
research on arthritis in Aboriginals.
I then checked the website for the
First Nations and Inuit Health Branch, known as FNIHB, to
see what information was posted on arthritis. I was
surprised by what I found. On the main page there is a list
of diseases of interest, but arthritis is not on the list.
Diabetes, HIV/AIDS, influenza, tuberculosis and West Nile
Virus were listed but not arthritis.
Given the greater incidence of
arthritis in the Aboriginal population and the greater
prevalence of arthritis compared to diabetes in the
Aboriginal population, one would expect to find information
about arthritis on the FNIHB website. Perhaps if and when
this inquiry is the subject of a Senate committee report, it
should be recommended that the FNIHB website be revised to
include prominent information on arthritis.
I next checked the Health Canada
website for information about arthritis. Once again,
arthritis was not in the main list of diseases but was
included under other diseases. Diabetes was, however,
included in the main list of diseases. As above, I would
argue that given that the incidence of arthritis in the
Canadian population is 16 per cent and the incidence of
diabetes is less, at 5 per cent, Health Canada's website
ought to include arthritis as a separate listing on the main
page and not relegate it to a sub-listing under other
Honourable senators, it is quite clear
that the incidence of arthritis and its cost to the
physical, emotional and psychological health of Canadians is
under-recognized. As has been stated previously, in 2000,
nearly 4 million Canadians reported arthritis as a chronic
health condition. As stated previously, 85 per cent of
Canadians will be affected by osteoarthritis by age 70. The
Canadian population is aging. We cannot afford to be
The Alliance for the Canadian
Arthritis Program has outlined three priorities for
immediate action. I commend the alliance for the work they
have done and the excellent information they have provided.
Their three immediate priorities are: First, every Canadian
must be aware of arthritis; second, all relevant health
professionals must be able to perform a valid, standardized,
age-appropriate musculoskeletal screening assessment; and
third, every Canadian with arthritis must have timely and
equal access to appropriate medications.
I emphasize that the phrase "every
Canadian" includes all of us: men, women, Aboriginals and
non-Aboriginals. I am in favour of this inquiry being sent
to a Senate committee for further investigation, and that a
report with recommendations for action be undertaken by such