SUMMARY: a look at the CDC’s plans to prevent and control arthritis, the nation’s leading cause of disability.
ABSTRACT: “Arthritis and other rheumatic conditions have an annual economic impact on the nation roughly equivalent to a moderate recession, with an aggregate cost of about 1.1% of the gross national product.” – Edward H. Yelin, PhD Professor (Adjunct) of Medicine and Health Policy University of California, San Francisco
Arthritis affects more than 42 million Americans, or almost one out of every six people, making it one of the most prevalent diseases in the United States.
Arthritis is the leading cause of disability in the United States, limiting everyday activities for more than 7 million Americans. In many cases, arthritis deprives people of their freedom and independence and disrupts the lives of family members and other caregivers. In addition, disabilities from arthritis create enormous health care costs for individuals, their families, and the nation. Each year, arthritis results in 39 million physician visits and more than half a million hospitalizations. Estimated medical care costs for people with arthritis total $15 billion annually, and total costs (medical care and lost productivity) are estimated at almost $65 billion annually.
The impact of arthritis is expected to increase dramatically as the “baby boomers” age. By 2020, an estimated 60 million Americans, or almost 20% of the population, will be affected by arthritis, and more than 11 million will be disabled.
Arthritis comprises a variety of diseases and conditions, including osteoarthritis, rheumatoid arthritis, lupus, childhood arthritis, gout, bursitis, rheumatic fever, Lyme arthritis, and carpal tunnel syndrome. These diseases and conditions can result in debilitating and at times life-threatening complications. Osteoarthritis and rheumatoid arthritis, the two most common forms of arthritis, have the greatest public health implications.
Osteoarthritis, also known as “degenerative joint disease,” results from physical changes in joints and surrounding tissues, leading to pain, tenderness, swelling, and decreased function. The joints most often affected are the hip, knee, and hand. Osteoarthritis affects more than 20 million people. The risk of having osteoarthritis increases as people get older. In addition to advancing age, risk factors for osteoarthritis include joint
Rheumatoid arthritis is a painful, potentially disabling disease characterized by chronic inflammation of the joint lining. In severe cases, this inflammation extends to other joint tissues and surrounding cartilage, where it may erode bone and cartilage and lead to joint deformities. Symptoms include stiffness, pain, and swelling of multiple joints. Rheumatoid arthritis affects more than 2 million people in the United States. Two to three times more women are affected than men
Making a Difference for People with Arthritis:
Arthritis is not just an “old person’s disease”: nearly three of every five people with arthritis are
younger than 65 years.
Prevailing myths have portrayed arthritis as an old person’s disease, an inevitable part of aging that must be endured. However, effective interventions are available to prevent much of the burden of arthritis and its complications. Some forms of arthritis, such as osteoarthritis, can be prevented with weight control and precautions to avoid certain occupational and sports injuries. Similarly, the pain and disability accompanying all types of arthritis can be minimized through early diagnosis and appropriate management, including weight control, physical activity, self-management, physical and occupational therapy, and joint replacement therapy when indicated.
Effective help is available now for people with arthritis. In addition to medications and physical therapy, knowing how to manage their arthritis can greatly benefit people with this disease. A course developed at Stanford University, the Arthritis Self-Help Course, teaches people about arthritis and how to minimize its symptoms. This 6-week course, taught in a group setting, has been shown to reduce arthritis pain by 20% and physician visits by 40%. However, in 1997, it still reached fewer than 1% of people with arthritis. More widespread use of this course nationwide would save money as well as reduce the impact of arthritis.
CDC Framework for Arthritis Prevention and Control
With fiscal year 1999 funding of more than $9 million, CDC will implement programs in up to 10 states to reduce the onset and consequences of arthritis.
To support state-based programs, CDC will continue to build the foundation for arthritis prevention and control at the national level. A cornerstone for this foundation is the National Arthritis Action Plan: A Public Health Strategy. Released in November 1998, this Plan was developed under the leadership of CDC, the Arthritis Foundation, and the Association of State and Territorial Health Officials. The plan delineates for the first time the action necessary to better understand the arthritis burden in the United States and to more fully apply known, effective interventions. The document, which will serve as a blueprint for public health efforts targeting arthritis, represents the combined effort of nearly 90 organizations, academic institutions, governmental agencies, community interest groups, and others with an interest in arthritis prevention and control.
Implementing the National Arthritis Action Plan
The National Arthritis Action Plan proposes a national coordinated effort for reducing the occurence of arthritis and its accompanying disability by focusing on these three areas:
1) Surveillance, epidemiology, and prevention research to strengthen the science base.
2) Communications and education to increase awareness and provide accurate information about arthritis.
3) Programs, policies, and systems that promote increased quality of life for people with arthritis and facilitate prevention measures.
Strengthening the Science Base
To enhance the science base, CDC will expand on the following innovative activities already under way:
Limiting Disability From Arthritis: Hip and knee osteoarthritis, the leading causes of arthritis disability and the primary reasons for expensive joint replacement surgery, are becoming more prevalent as the population ages. CDC, in collaboration with the University of North Carolina at Chapel Hill and the National Institutes of Health, is assessing risk factors for the incidence and progression of these conditions among residents of Johnston County, a rural area of North Carolina. About 3,200 participants have been enrolled in this study, the first ever to look at a biracial population over time with the goal of learning more about how to prevent and limit the occurrence and progression of arthritis and associated disabilities.
Clarifying the Important Role of Good Nutrition and Physical Activity: CDC continues to accumulate scientific knowledge on the benefits of physical activity. Certain forms of arthritis, particularly osteoarthritis of the knee, are more common among people who are overweight or obese. Because healthy eating reduces a person’s risk of The Plan also calls for going beyond research and communications to promote policy and environmental changes that are conducive to prevention efforts. Effecting such changes will require active partnerships between CDC and state and local health agencies, health care providers, voluntary and professional organizations, and others. Examples of such changes include developing standards of care for arthritis, broadening dissemination of the Arthritis Self-Help Course, building effective self-management education programs such as the Arthritis Self-Help Course into routine arthritis care, and encouraging the development and implementation of appropriate physical activity programs for people with arthritis.
“The Arthritis Self-Help Course helped me learn how to manage the pain, find out that there really are lots of things I CAN do, keep a positive attitude, and better meet the challenges of the workplace.”
Joyce Gallagher, age 48
Source: Center for Disease