Lancet: A Public Health Policy Call Out for Osteoarthritis Save

Know-it-now

• Osteoarthritis' (OA) identity problem drives neglect. Framing OA as “wear and tear” that is inevitable and untreatable fuels policy neglect, therapeutic nihilism, and low-value care.
• Surveillance comes first: “no data, no disease.” OA should be built into national NCD surveys such as WHO STEPS, with data broken down by age, sex, and social determinants.
• OA belongs in integrated NCD and primary care. 67% of people with OA have another chronic condition, compared with 56% of those without OA, and 24% have three or more.
• Language matters. Clinicians should drop “bone on bone” and “wear and tear” in favor of strengths-based messaging. They should also stop low-value care: opioids, arthroscopy, hyaluronic acid, and PRP.
• Prevention centers on two modifiable targets: excess weight and joint injury. Females deserve particular attention because they carry a higher symptom burden and a 2–3-fold higher risk of sports-related knee injury.

In honor of World Arthritis Day (Oct. 12th), The Lancet has published a public Health Policy report is to "outline a globally relevant roadmap to address the osteoarthritis identity problem, focusing on health policy responses. The intended audience includes health policy makers, health services and programmes managers, clinicians, and civil society."

Osteoarthritis (OA) affects roughly 600 million people worldwide, and that number is projected to approach 1 billion by 2050. Even so, a Health Policy report from Briggs and an international group that included people with lived experience argues that OA remains nearly invisible in national and global health agendas. The report was published online October 11, 2026. It sets out a co-created roadmap with three strategic priorities, six actions, and a set of “accelerators.”

This paper suggests progress has stalled for three reasons: 1) OA is treated as an inevitable part of ageing, 2) it is kept separate from chronic disease care, and 3) it lacks surveillance and financed research. The burden itself is well documented:

• Years lived with disability from OA rose 65% between 1990 and 2023.
• Direct costs consume 1–2.5% of GDP in established market economies. US direct costs were $47.5 billion in 2019.
• Potentially preventable OA is projected to rise by up to 200% over 30 years in sub-Saharan Africa, North Africa and the Middle East, South Asia, and Andean Latin America.

The gap between evidence and practice is large. Appropriate care was delivered in only 43% of encounters in Australia, 57% in the US, and 62% in Singapore. In 11 years of Australian GP data covering 9,196 encounters, only 23% of patients received lifestyle management. By contrast, 74% received medications (15% opioids), 25% had imaging, and 13% were referred for surgery.

Global policy reinforces this neglect. SDG 3.4 targets premature mortality from only four WHO non-communicable disease (NCDs): cancer, cardiovascular disease, diabetes, and chronic lung disease. The fourth UN High-level Meeting Political Declaration did not mention musculoskeletal health or chronic pain. In an earlier policy review, only four countries or regions had a dedicated OA strategy, and none were low- and middle-income countries (LMICs).

Definition. For surveillance and first-contact care, the authors propose a clinical definition aligned with NICE criteria, applied without routine imaging:

• Age over 45.
• Movement-related joint pain that limits activity on most days of the past month.
• No morning stiffness, or stiffness of 30 minutes or less.

They note that the age threshold is a practical aid, not a biological boundary, because post-traumatic OA often begins earlier.

Prevention Targets:

• Combined risk: Overweight/obesity and joint injury together account for 14% of the population attributable risk for incident radiographic knee OA.
• Body weight: Each 1-unit rise in BMI increases knee OA risk by 17%. High BMI accounted for 73 million OA cases and $34.9 billion in costs in 2019.
• GLP-1 therapies: GLP-1 and GIP/GLP-1 agonists improve symptoms, function, and joint loading in established knee OA. No completed trial has yet tested weight control for primary prevention.
• Injury prevention: Neuromuscular training reduces sports-related knee injuries by 40–50%. An Australian model projected an 8.1% reduction in ACL ruptures, knee OA, and knee replacements over 35 years, a 3.5-fold return on investment.

This roadmap recasts OA as a systemic, multimorbid, modifiable disease rather than an orthopedic endpoint. For rheumatologists, the message is to lead the change in how OA is described, champion first-line non-surgical care, and push for post-2030 NCD targets that measure morbidity, not just mortality.

Priority Recommendations

Guiding principles across all three priorities: a life-course approach, health equity, and affordability and sustainability through Universal Health Coverage (UHC).

Priority 1: Recognise and respond to OA

• Action A: Build national surveillance capacity to track OA burden, cost, and modifiable risk factors, with reporting broken down by social determinants.
• Action B: Explicitly include musculoskeletal health in national and subnational health policy and strategy.

Priority 2: Scale up high-value, person-centred, equitable care

• Action C: Reframe societal attitudes and adopt an accurate, globally accepted OA narrative.
• Action D: Reconfigure primary care into integrated NCD models that include OA and address its social, environmental, and commercial determinants.

Priority 3: Slow the OA trajectory

• Action E: Unite disease groups, including OA, behind established obesity prevention and control actions.
• Action F: Implement joint injury prevention programmes in workplaces, community sport, and schools.

Panel Recommendations (Accelerators)

Panel 1, for Action A (Surveillance)

• Adopt a standardised clinical case definition for surveys, surveillance, and first-contact care.
• Update national NCD policies to fund surveillance, including musculoskeletal survey modules and care-quality indicators.
• Add minimum musculoskeletal targets and indicators to the WHO NCD Country Capacity Survey and the Decade of Healthy Ageing monitoring framework.

Panel 2, for Action B (Policy inclusion)

• Raise awareness across sectors of the musculoskeletal burden, especially among women and older people.
• Share national policy successes, using the Global Alliance for Musculoskeletal Health as a knowledge hub, and add musculoskeletal items to the WHO NCD Country Capacity Survey.
• Promote WHO musculoskeletal technical products and the Joint Effort Initiative’s OA Management Programme guidance.
• Unite behind post-2030 NCD targets that go beyond premature mortality.

Panel 3, for Action C (Narrative)

• Co-create and spread accurate public messaging that does three things:
  • avoids impairment language;
  • adopts strengths-based framing;
  • identifies ineffective or unsafe interventions.
• Feature joint health explicitly in strategies for healthy ageing, women’s health, and First Nations health.

Panel 4, for Action D (Service models)

• Co-create service models with people who have lived experience of OA, including underserved communities.
• Scale up integrated models within UHC essential packages. Examples include WHO ICOPE, OA Management Programmes, and digital or AI-enabled care.
• Finance integrated care sustainably, for example through WHO Best Buys. Current NCD spending covers only 5–10% of need in LMICs and 10–30% in high-income settings.
• Build the determinants of musculoskeletal health into public policy, including built environments and green and social prescribing.

Action E accelerators (stated in the text)

• Unify disease groups around shared obesity actions, for example through World Obesity.
• Pursue trials, long-term safety monitoring, and cost-effectiveness studies of GLP-1 and GIP/GLP-1 therapies, with attention to equitable access.
• Recognise obesity as an OA risk factor in obesity policy, with sex-specific strategies.