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Arthritis and Indiana:
Our State's Burden
There are more than 100 related diseases and conditions collectively known as “arthritis.” The most common forms include osteoarthritis, rheumatoid arthritis, juvenile rheumatoid arthritis, fibromyalgia, bursitis, lupus, and gout. Though their causes may vary, these diseases often occur in or around one or more joints. Sometimes the problem is actually in the joint (as in osteoarthritis). Other times it is in the surrounding ligaments, tendons, or muscles (as in fibromyalgia). Some forms of arthritis are systemic and can affect the internal organs (as in rheumatoid arthritis).
OA is the most common form of arthritis, estimated to affect at least 21 million Americans.9 OA is sometimes called “everyday” or “wear and tear” arthritis. A slippery material called cartilage covers the end of each bone and acts as a shock-absorbing cushion. In OA, cartilage starts to break down. Loss of that rubbery cushion in a joint--where bone meets bone-- leads to symptoms of pain, stiffness, and swelling in the knee, hip, spine, feet, thumb, or fingers.
Current research contradicts accepted wisdom that OA “is a natural part of aging.” There is evidence that obesity is a significant risk factor in the development and progression of OA. Even modest weight loss can reduce the risk of developing OA.10 Once OA symptoms have begun, weight-bearing activities can help improve function. Physical activity and specific strengthening exercises strengthen the muscles around joints, stabilize them and enhance proprioception, the sense of joint position that the body uses to maintain balance. Moving joints through their full range of motion can reduce stiffness and pain. In addition, losing excess weight may retard the damage caused to weight-bearing joints (knees and hips) by obesity and may reduce symptoms.
Fibromyalgia affects muscles and is characterized by diffuse pain, fatigue, memory difficulties, disturbed sleep, and specific tender points. It occurs more often in women and is estimated to affect about two percent of the population. Exercise is a key component of fibromyalgia management. Aerobic exercise has been shown to improve muscle fitness, reduce pain, and improve sleep. Low impact activities, like walking, bicycling, or swimming, are recommended. Even for people who have been completely inactive and can only exercise a few minutes initially, the goal is to work slowly towards aerobic fitness. Other treatments include medications to reduce pain and improve sleep, stretches to improve muscle tone, relaxation techniques, and pain management strategies.
RA is estimated to affect 3 million people nation wide.11 This disease occurs more often in women, and is frequently first diagnosed during a woman’s childbearing years. RA is a systemic, autoimmune disease, the cause of which is unclear. It is characterized by inflammation of the fluid lining the joints called synovium. The inflammation causes pain, stiffness, fatigue, redness, swelling, and warmth in the area around the joint. Over time, the inflamed joint lining can damage or deform the joint.
A relatively new class of medications called disease-modifying drugs can stop or slow joint damage, and biologic response modifiers can block the inflammatory processes and reduce pain. These medications have greatly improved the quality of life for people with RA and make early diagnosis and treatment more critical than ever.
New research gives hope that early diagnosis, proper medical treatment, and self-management strategies can help optimize function, reduce pain, and improve quality of life for people with arthritis. Individuals should consult with a health care provider for advice appropriate to their medical needs.
9 American College of Rheumatology Web site: http://www.rheumatology.org/patients/factsheet/oa.html.
10 Dixon JB and O’Brien PE. Quality of life after lap-band placement: influence of time, weight loss and comorbidities. Obes Res 2001; 9: 713-21.
11 Klippel JH, Crofford LJ, Stone JH, Weyand CM, editors. “Rheumatoid arthritis: Epidemiology, pathology, and pathogenesis,” In Primer on the Rheumatic Diseases, 12th Edition. Atlanta, GA: Arthritis Foundation, 2001, p. 289.
In 1998, the Centers for Disease Control and Prevention, the Arthritis Foundation, and the Association of State and Territorial Health Officials jointly released the National Arthritis Action Plan: A Public Health Strategy (NAAP), which outlined a national charter for addressing arthritis. In 2000, the CDC began funding states to develop arthritis programs. CDC-funded programs emphasized improving life for people with arthritis by encouraging early diagnosis, proper treatment, and self-management strategies to optimize functional status. For more information about the CDC program, see http://www.in.gov/isdh/dataandstats/arthritis/www.cdc.gov/arthritis.
The Indiana State Department of Health (ISDH) received funding in 2001, and the Indiana Arthritis Initiative (IAI) began work. IAI is facilitated by the ISDH Chronic Disease Division; a steering committee directs the initiative’s efforts (see Appendix A for steering committee member list). Since their inaugural meeting in November 2002, the IAI steering committee has authored the Indiana Arthritis Strategic Action Plan, initiated exercise and self-management programs across the state, developed an easy to read exercise booklet entitled Movement is Medicine, and implemented annual health communication campaigns that promote physical activity for people with arthritis.
IAI produced this burden report to aid planning, implementing, and evaluating efforts to improve the lives of state residents affected by arthritis. The burden of arthritis includes functional limitations, reduced quality of life, work disability, lost wages, and associated medical costs.
The results in this report are based on Indiana’s 2005 Behavioral Risk Factor Surveillance System (BRFSS) survey. The BRFSS is administered annually by all 50 states with funding from and in cooperation with the CDC. Developed to collect data on major behavioral risk factors contributing to premature death and disability, the BRFSS is a random digit-dial telephone survey of adults aged 18 years and older. Results are based on respondents’ answers to BRFSS questions.12
Respondents were considered to have physician-diagnosed arthritis if they answered yes to the following question:
Have you ever been told by a doctor or other health professional that you have some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia?”
12 Indiana's sample size for 2005 was 5,635 randomly selected Indiana residents aged 18 years or older. The data are adjusted so that weighted sample data produces demographic distribution corresponding closely to the state’s population. Indiana's CASRO (Council of American Survey Research Organizations) response rate in 2005 was 48.6 percent. States’ response rate varied from 34.6 percent to 67.4 percent.