 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
|||||||||||
|
 |
|||||||||||
CDC NEW BACKGROUNDER: ARTHRITIS AND ELDERSMay 6, 2004 CDC ENCOURAGES OLDER ADULTS TO USE PHYSICAL ACTIVITY AND SELF-MANAGEMENT TO REDUCE SYMPTOMS OF ARTHRITIS Older adults looking for arthritis pain relief should take a regular dose of physical activity — swimming, brisk walking, bicycling, gardening or raking leaves. That’s because the problems that plague the health of many Americans — lack of exercise and being overweight — also contribute to the pain and disability of arthritis. Arthritis affects 21.4 million older adults and is the leading cause of disability among all U.S. adults. Physical activity, weight loss and other self-management techniques, along with good medical care, are the keys to coping with arthritis and improving the quality of life for people with arthritis, conclude experts from the U.S. Centers for Disease Control and Prevention (CDC) in Atlanta. “The most important message is that there is a lot that people who have arthritis can do to help themselves,” said CDC senior behavioral scientist Teresa J. Brady, Ph.D., O.T. The slogan for CDC’s arthritis communications campaign is “Physical Activity … The Arthritis Pain Reliever.” CDC’s educational effort aims to increase awareness about the importance of physical activity and to urge adults with arthritis to become more active. “People underestimate the arthritis burden and tend to minimize its effects, assume it is a normal part of aging, and don’t go to their doctor,” said Chad Helmick, M.D., a CDC medical officer and senior epidemiologist. They self-diagnose and don’t understand that there are self- management techniques that can help. “Arthritis isn’t just a normal part of aging that must be endured. It is a disease,” Dr. Helmick said. He noted that 60 percent of people with arthritis are under age 65. Approximately 16 percent of the people over age 65 who have chronic joint symptoms (CJS) have not seen their doctor, said Joe Sniezek, M.D., M.P.H., chief of CDC’s Arthritis Program. “Part of CDC’s role is to increase awareness that people should see their doctor about their chronic joint condition, but in addition, there are things that they can do for themselves,” Dr. Sniezek said. In addition to physical activity, self-management techniques include weight control and pain management, as well as learning coping skills and how to navigate the health care system. The U.S. Surgeon General’s 1996 report, Physical Activity and Health, found that regular moderate aerobic or resistance-training exercise programs reduce symptoms and improve functioning among people with rheumatoid arthritis and osteoarthritis. A review of community-based arthritis patient education interventions showed that participants had 16 percent less pain than people in control groups, as well as 22 percent greater improvement in depression ratings and an 8 percent greater improvement in disability ratings (Patricia D. Mullen, University of Texas Health Science Center-Houston, et al., 1987). Research by Marian A. Minor, P.T., Ph.D., a principal investigator with the Missouri Arthritis Rehabilitation Research and Training Center, shows that physical activity is effective in osteoarthritis treatment, leading to a decrease in pain and disability and an increase in mobility and flexibility. Physical activity reduces joint pain and stiffness and increases flexibility, muscle strength, cardiac fitness and endurance. Stronger muscles help support and protect joints affected by arthritis. Activity also helps with weight reduction, contributes to an improved sense of well-being and delays disability. Weight control is also essential for people who have arthritis because extra pounds put pressure on many joints. Weight loss reduces joint stress and helps prevent further damage. Some research indicates that weight management and physical activity can actually help prevent knee osteoarthritis (Framingham Osteoarthritis Cohort Study). Similar studies have shown that weight loss slows the progression of some forms of arthritis. “So losing weight actually does help once you’ve got arthritis,” Dr. Helmick said. Other treatments include medications, physical/occupational therapy and surgery. Treatment plans may also recommend balancing rest and activity, proper diet, and instruction on the correct way to use joints and conserve energy by not wasting motion. Some patients are advised to apply heat or cold to sore joints, sometimes in conjunction with exercise. WHAT IS ARTHRITIS AND WHO GETS IT? Arthritis literally means joint inflammation — swelling, redness, heat and pain caused by tissue injury or disease in the joint. There are more than a 100 types of arthritis and rheumatic conditions, including osteoarthritis, rheumatoid arthritis, gout, fibromyalgia, systemic lupus erythematosus, bursitis, tendonitis and carpal tunnel syndrome. These diseases can cause pain, stiffness and swelling in joints, as well as in muscles, tendons, ligaments and bones. Some forms, such as rheumatoid arthritis, can also affect other parts of the body, including internal organs. Causes vary by type of arthritis and include autoimmunity factors (rheumatoid arthritis and lupus), tissue degeneration (osteoarthritis), repetitive motion (carpal tunnel syndrome), inflammation (bursitis or tendonitis), metabolic problems (gout) and trauma. In addition, the causes of many types are unknown. According to CDC, risk factors for arthritis may include one’s genetic make-up and hormone levels, as well as lifestyle-related factors, such as weight. People who are overweight are more likely to get osteoarthritis. Women are also at higher risk. The prevalence of arthritis among minority groups is not significantly greater, but minority groups generally have a higher rate of disability associated with arthritis. “So they don’t necessarily have more disease, but they experience more limitations from their disease,” Brady explained. HOW MANY PEOPLE HAVE ARTHRITIS? CDC estimates that in 2001, 49 million adults — including 21.4 million older adults — had doctor-diagnosed arthritis. However, the number of U.S. adults with arthritis could be as high as 70 million if those reporting chronic joint symptoms but not reporting doctor-diagnosed arthritis are included. “The real story, though, is how much this number will increase,” Dr. Helmick noted. By 2030 approximately 41.1 million older adults will have some form of arthritis, compared with 21.4 million today. (Note to journalists: for a look at the projections for each state, go to: www.cdc.gov/mmwr/preview/mmwrhtml/mm5221a1.htm.) Almost 60 percent of people over the age of 65 report arthritis or chronic joint symptoms. About 20 percent of people with arthritis report limitations in activity, including 3 million to 4 million older adults, CDC data show. WHAT IS THE COST OF ARTHRITIS? As the leading cause of disability among U.S. adults, arthritis and other rheumatic conditions also carry the highest cost for any disability, Dr. Helmick said. The latest data from the 1997 Medical Expenditure Panel Survey show that arthritis costs the nation $86.2 billion a year. The figure includes direct costs ($51.1 billion in medical expenditures) and indirect costs ($35.1 billion in lost wages among the working-age population), Dr. Helmick said. Costs by state ranged from a low of $121 million in Wyoming to a high of $8.4 billion in California. While there is not a lot of data on whether arthritis treatment can reduce these costs, “it makes sense that if you slow the progression of the disease, you are going to save resources along the way,” Dr. Sniezek said. Effective management of arthritis may produce other cost savings as well. For example, if people with arthritis start to limit their activities, then they may gain weight and develop high blood pressure or diabetes. “The arthritis self-management techniques address risk factors shared by many other diseases,” Dr. Sniezek noted. WHAT ARE SELF-MANAGEMENT COURSES? Arthritis self-management education and physical activity classes, such as those offered by the Arthritis Foundation, can teach people the importance of staying active and how to go about it, Dr. Helmick said. The Arthritis Self-Help Course is a six-week-long series of classes held for about 2 hours a week. The program was developed by Dr. Kate Lorig, R.N., Dr.PH, Stanford University, and licensed to the Arthritis Foundation in 1981. Trained lay leaders involve participants in group discussion and interaction. Classes cover generic skills like problem-solving, decision-making, and communicating with one’s physician, as well as arthritis-specific content on exercise and relaxation techniques. “This course has very robust science behind it. Even four years after the intervention, there continues to be a 20 percent reduction in pain and a 40 percent reduction in physician visits for people who take the Arthritis Self- Help Course,” Brady noted. “However, the bad news is that less than 1 percent of people with arthritis have taken the course.” Aquatics Programs. The Arthritis Foundation (AF) Aquatics Program, also known as the AF/YMCA Aquatics Program, primarily teaches range-of-motion exercises with some conditioning and endurance activities, Brady said. The course is usually delivered as a six- to eight-week series, but in some places it is ongoing. “The key thing that makes it arthritis-specific is that it is done in water that is warmer than you find in most pools.” Preliminary evidence indicates this exercise is beneficial for people with arthritis. “The program is generally very well received,” Brady said. “One of the challenges of the program is that once people get into it, they don’t like to leave. It becomes both a good exercise program and a social activity,” she explained. The course is taught by trained fitness instructors. PACE, which stands for People with Arthritis Can Exercise, is similar to the aquatics program, but is land-based. The course consists of range-of-motion and simple conditioning exercises done in a group for six to eight weeks, or on an ongoing basis. It also is taught by trained fitness instructors. “The advantage of the arthritis-specific classes is that they are designed to be safe for people with arthritis, and the people teaching them have at least a working knowledge of what is important with arthritis,” Brady said. For information on these activities, go to www.arthritis.org and type in your zip code to find local chapters and activities. HOW DOES SOMEONE WITH ARTHRITIS START EXERCISING? In addition to their day-to-day activities, people with arthritis should get at least 30 minutes of conditioning activity at least three days a week. If necessary, this exercise can be done in 10-minute increments three times a day. The National Institute of Arthritis and Musculoskeletal and Skin Diseases, in its publication Questions and Answers about Arthritis and Exercise, recommends that people with arthritis should first check with their doctor, and then slowly begin physical activity. Physical activity should involve stretching and warm up, range-of-motion exercises, strengthening exercises with small weights (1 or 2 pounds), and the gradual addition of aerobic exercise, the institute says. The American College of Sports Medicine recommends avoiding rapid or repetitive movements of affected joints and adapting physical activity to the needs of the individual. Walking, biking and swimming are good activities for people with arthritis. The important point is that they find a form a physical activity that works for them, CDC scientists emphasize. WHAT ABOUT ALTERNATIVE MEDICINE? According to CDC, people with arthritis often have pain that is not entirely relieved by medication, they are some of the biggest consumers of complementary and alternative medicine (CAM). However, there is not a lot of research on whether CAM works and whether it is safe. And there is also a concern that people may use CAM instead of doing something that is more effective, Dr. Sniezek cautioned. The National Institutes of Health advises that research does not support the claims of some popular remedies, such as snake venom, copper bracelets and DMSO (the solvent dimethylsulfoxide used for pain relief). It is conducting research on whether glucosamine-chrondroitin helps osteoarthritis. Preliminary results from European studies indicate that supplements like glucosamine-chrondroitin sulfate may help arthritis. These compounds occur naturally in the body and may be involved in the repair and maintenance of normal cartilage. But Dr. Sniezek cautioned that “The final word is not in yet.” HOW DOES CDC PROMOTE ARTHRITIS AWARENESS? CDC is focusing on reducing the impact of arthritis and improving the quality of life for people with the disease. Its public health communications campaign is designed to increase awareness about the importance of physical activity for people with arthritis and “to get folks moving,” Dr. Sniezek said. The arthritis communications campaign includes radio spots, print ads, posters and brochures, Brady stated. Another key role played by CDC is helping to bring awareness of the “cost burden” and quality of life problems stemming from arthritis to the attention of the public health community. Because of the high prevalence of arthritis, its cost, its capacity to cause disability, and the existence of good interventions, arthritis self- management can make a difference, CDC experts say. Until a few years ago, arthritis was not on the public health radar screen, probably because it is not a leading cause of death. “It is really a quality of life issue,” Dr. Sniezek said. Most chronic disease efforts in the past were primarily concerned with averting death, and thus focused on diabetes prevention, heart disease prevention, and smoking cessation. Three events that occurred in the late 1990s finally put arthritis onto the public health agenda. In 1998, CDC, the Arthritis Foundation and the Association of State and Territorial Health Officials, with input from more than 90 organizations, spearheaded the National Arthritis Action Plan, which “rallied the public health community around the issue of arthritis,” said Dr. Sniezek. “It is a strategic document that offers ways that we can achieve the arthritis quality-of-life goals,” Brady added. “The action plan brought all the right people together,” leading to public health activities, research, programs and monitoring, Dr. Sniezek said. The second event was the addition of arthritis to Healthy People 2010, the nation’s decennial health objectives. “That provides the marching orders of where, as a public health system and as a nation, we want to go in terms of improving the quality of life for people with arthritis,” Brady said. The third event occurred in 1999, when Congress appropriated the first funds to CDC to develop arthritis activities through the public health system at the national and state levels. CDC currently provides funds to 36 state public health departments for their arthritis programs. All of these programs have produced innovations such as delivering the Arthritis Self-Help Course to low-income, minority or rural communities; reaching Spanish-speaking individuals with a Spanish version of the program; and reaching out to women. CDC cited exemplary projects in several states, including Alabama, California, Florida, Georgia, Illinois, Minnesota, Missouri and Utah. While other states can follow these models, state health departments need to overcome their unique challenges in delivering their programs, Dr. Helmick noted. CDC also helps fund the Johnston County Osteoarthritis Project in rural North Carolina to examine the incidence and progression of hip and knee osteoarthritis among white and black county residents. “This is an important study that will help us examine some of the risk factors for osteoarthritis and why it gets worse,” Dr. Helmick said. In 2003, six workgroups, including representatives from CDC, formulated recommendations regarding physical activity and arthritis. The workgroups, part of the Exercise and Physical Activity Conference held in St. Louis, Mo., called for better awareness and prevention programs for people with arthritis, exercise recommendations for those with specific types of arthritis, consistent measurement and analysis to assess physical activity among people with arthritis, and more research on the effectiveness of weight control and exercise in preventing the development and progression of osteoarthritis. (The workgroup’s recommendations are published in the February, April and June 2003 issues of the journal Arthritis Care and Research.) CDC also regularly publishes articles on arthritis in the Morbidity and Mortality Weekly Report (www.cdc.gov/mmwr/) and other professional journals. WHAT IS THE FUTURE FOR PEOPLE WITH ARTHRITIS? “There is hope,” the CDC scientists concluded. “We need to get the word out about what people can do improve their quality of life. People can learn how to better manage their pain and talk with their physicians. This is the benefit of self-management education. We need to get more people to take classes, such as the Arthritis Self-Help Course.” In addition, there have been exciting advances in medications. “Hopefully this will continue,” Dr. Helmick added. This media background paper is available online at www.asaging.org/media. It was written by Nancy Aldrich. STORY IDEAS FOR JOURNALISTS 1) Are older adults in your community aware of treatment and self-management for their arthritis? Do they understand the role of physical activity? 2) Does your community offer the Arthritis Self-Help Course, AF/YMCA Aquatic Program or other intervention programs? If so, how do these programs reach people with arthritis? 3) Talk to your local Arthritis Foundation chapter for ideas on a local story. Talk to local public health officials to see if they understand the importance of arthritis management. 4) Watch for future research on arthritis diagnosis, treatment and prevention. # # # RESOURCES FOR REPORTERS CENTERS FOR DISEASE CONTROL AND PREVENTION: Arthritis Program National Center for Chronic Disease Prevention and Health Promotion Mail Stop K-40, 4770 Buford Highway NE, Atlanta, GA 30341- 3717 (770) 488-5131 Email: cdcinfo@cdc.gov arthritis information: www.cdc.gov/nccdphp/arthritis/index.htm state-based programs: www.cdc.gov/nccdphp/arthritis/states.htm state program contacts lists: www.cdc.gov/nccdphp/arthritis/contacts.htm exemplary state programs: www.cdc.gov/nccdphp/exemplary/arthritis.htm Johnston County (N.C.) Osteoarthritis Project: www.cdc.gov/nccdphp/arthritis/funded_research.htm#Johnston Arthritis Prevalence and Activity Limitations -- United States, 1990: www.cdc.gov/mmwr/preview/mmwrhtml/00031480.htm Health-Related Quality of Life Among Adults With Arthritis - - Behavioral Risk Factor Surveillance System, 11 states, 1996-1998: www.cdc.gov/mmwr/preview/mmwrhtml/mm4917a2.htm Impact of arthritis and other rheumatic conditions on the health-care system--United States, 1997: www.cdc.gov/mmwr/preview/mmwrhtml/mm4817a2.htm National Arthritis Action Plan: www.cdc.gov/nccdphp/pdf/naap.pdf Prevalence of Arthritis--United States, 1997: www.cdc.gov/mmwr/preview/mmwrhtml/mm5017a2.htm Prevalence of Disabilities and Associated Health Conditions among Adults -- United States, 1999: www.cdc.gov/mmwr/preview/mmwrhtml/mm5007a3.htm Prevalence and Impact of Arthritis by Race and Ethnicity -- United States, 1989-1991: www.cdc.gov/mmwr/preview/mmwrhtml/00041424.htm Prevalence of Leisure-Time Physical Activity among Persons with Arthritis and Other Rheumatic Conditions -- United States, 1990-1991: www.cdc.gov/mmwr/preview/mmwrhtml/00047588.htm Prevalence of Self-Reported Arthritis or Chronic Joint Symptoms among Adults — United States, 2001: www.cdc.gov/mmwr/preview/mmwrhtml/mm5142a2.htm Public Health and Aging: Projected Prevalence of Self- Reported Arthritis or Chronic Joint Symptoms among Persons Aged >65 Years -- United States, 2005—2030 [May 30, 2003 Morbidity and Mortality Weekly Report, 52(21):489-491]: www.cdc.gov/mmwr/preview/mmwrhtml/mm5221a1.htm Targeting Arthritis: The Nation’s Leading Cause of Disability: www.cdc.gov/nccdphp/aag/aag_arthritis.htm OTHER GOVERNMENT PUBLICATIONS AND WEBSITES: Handout on Health: Osteoarthritis: www.niams.nih.gov/hi/topics/arthritis/oahandout.htm Handout on Health: Rheumatoid Arthritis: www.niams.nih.gov/hi/topics/arthritis/rahandout.htm Healthy People 2010: www.healthypeople.gov/document/HTML/Volume1/02Arthritis.htm La Osteoartritis Resumen (Osteoarthritis Summary) (Spanish): www.niams.nih.gov/hi/topics/arthritis/osteoartritis_resumen. htm Managing Osteoarthritis: Helping the Elderly Maintain Function and Mobility: www.ahrq.gov/research/osteoria/osteoria.htm National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS): www.niams.nih.gov/, (877) 226-4267 NIAMS Osteoarthritis Initiative: www.niams.nih.gov/ne/oi/ (Appendix A includes contacts for longitudinal studies of osteoarthritis) National Institute on Aging (NIA): www.nia.nih.gov, (800) 222-2225 NIA Arthritis Advice, www.niapublications.org/engagepages/arthritis.asp Osteoartritis (Osteoarthritis) (Spanish only): www.niams.nih.gov/hi/topics/arthritis/osteoartritis_spanish. htm Questions and Answers about Arthritis and Exercise: www.niams.nih.gov/hi/topics/arthritis/arthexfs.htm Questions and Answers about Arthritis and Rheumatic Diseases: www.niams.nih.gov/hi/topics/arthritis/artrheu.htm Questions and Answers about Arthritis Pain: www.niams.nih.gov/hi/topics/arthritis/arthpain.htm Seniors.Gov: www.seniors.gov/health/conditions/arthritis.html ¿Tengo Artritis?/Do I Have Arthritis? (Spanish/English): www.niams.nih.gov/hi/topics/arthritis/tengo/index.htm OTHER WEBSITES: American Academy of Orthopaedic Surgeons: www.aaos.org, (800) 346-AAOS American College of Rheumatology/Association of Rheumatology Health Professionals: www.rheumatology.org, (404) 633-3777 American Physical Therapy Association: www.apta.org, (703) 684-2782 or (800) 999-2782 Arthritis Foundation: www.arthritis.org, (800) 283-7800; Arthritis Self-Help Course, www.arthritis.org/events/getinvolved/ProgramsServices/Arthri tisSelfHelp.asp Johns Hopkins Arthritis web site: www.hopkins- arthritis.som.jhmi.edu/rheumatoid/rheum.html Lupus Foundation of America Inc.: www.lupus.org, (202) 349- 1155 National Fibromyalgia Partnership Inc.: www.fmpartnership.org SLE (Lupus) Foundation: www.lupusny.org, (212) 685-4118 or (800) 74-LUPUS Spondylitis Association of America: www.spondylitis.org, (800) 777-8189 JOURNAL CITES:
Chang R, Roubenoff R, Mayer J, Brandt KD, Schanberg
LE. “Work group recommendations: 2002 Exercise and
Physical Activity Conference, St. Louis, Missouri: Exercise
in the Presence of Rheumatic Disease,” Arthritis Care and
Research 2003; 49(2): 280
Felson DT, Zhang Y, Anthony JB, Naimark A, Anderson
JJ. “Weight loss reduces the risk for symptomatic knee
osteoarthritis in women.” Annals of Internal Medicine 1992;
116:535-9. Also see:
www.niams.nih.gov/ne/oi/oaepipappen_a.htm#Framingham%
20Osteoarthritis%20Cohort%20Study%20(FOS)
Krebs D, Herzog W, McGibbon CA, Sharma L. “Work group
recommendations: 2002 Exercise and Physical Activity
Conference, St. Louis, Missouri: Biomechanical
Considerations for Exercise,” Arthritis Care and Research
2003; 49(2): 261-262
Meenan R, Sharpe P, Boutaugh M, Brady T. “Work group
recommendations: 2002 Exercise and Physical Activity
Conference, St. Louis, Missouri: Population Approaches to
Health Promotion and Disability Prevention through Physical
Activity,” Arthritis Care and Research 2003; 49(3): 477
Minor Marian A. “Exercise in the treatment of
osteoarthritis.” Rheumatic Disease Clinics of North America
1999; 25(2):397-415
Minor M, Stenstrom CH, Klepper SE, Hurley M, Ettinger
WH. “Work group recommendations: 2002 Exercise and
Physical Activity Conference, St. Louis, Missouri: Evidence
of Benefit of Exercise and Physical Activity in Arthritis,”
Arthritis Care and Research 2003; 49(3): 453-454
Mullen PD, Laville E, Biddle A, Lorig K. “Efficacy of
psychoeducational interventions on pain, depression and
disability in people with arthritis: a meta-analysis.”
Journal of Rheumatology 1987; 15(15):33-39
Sniezek J, Macera CA, Hootman JM, Eyler AA. “Work group
recommendations: 2002 Exercise and Physical Activity
Conference, St. Louis, Missouri: The Problems and
Challenges of Inactivity,” Arthritis Care and Research
2003; 49(1): 141
Yelin EH, Dunlop D, Jette AM. “Work group recommendations:
2002 Exercise and Physical Activity Conference, St. Louis,
Missouri: Arthritis and Disability: Impact and
Consequences,” Arthritis Care and Research 2003; 49(1): 121
###
|
||||||||||||