Testimony
June 8, 2004Thank you, Mr. Chairman, Members of the Committee, for the opportunity to address an important health problem in our society - that of preventing, controlling and curing arthritis. The National Arthritis Act of 1974 (Public Law 93-640) as enacted in 1975 has largely been successful in promoting basic and clinical arthritis research and establishing Multidisciplinary Clinical Research Centers. Arthritis is a large problem that is getting larger as our population ages. The public health efforts called for in the 1974 Act have only recently been initiated. The National Arthritis Action Plan: A Public Health Strategy was published in 1999. Our health priorities for the nation, Healthy People 2010, include arthritis objectives for the very first time. In my remarks today, I would like to focus on the impact of arthritis in the United States and the opportunities public health has to make a difference in reducing the pain and the disability associated with arthritis. I would also like to highlight a few of our activities: an example from one of our state-funded arthritis programs; a research program examining the incidence and progression of arthritis; and, a health communications campaign designed to increase physical activity among persons with arthritis. Impact of Arthritis: Today and in the Future Arthritis comprises over 100 different diseases and conditions. The most common are osteoarthritis, gout, fibromyalgia, and rheumatoid arthritis. Common symptoms of arthritis include pain, aching, stiffness and swelling. Some forms of arthritis, such as rheumatoid arthritis and lupus, affect multiple organs, and associated with premature death. In 2001, 49 million adults reported a doctor had told them they had arthritis; nearly one of every four adults--making it among the most common health problems in the United States. An additional 21 million Americans reported chronic joint symptoms that may be arthritis, but have yet to be told by a physician they have arthritis. In the next 25 years as the population ages, CDC estimates that 71 million adults will have arthritis, including a doubling of the rate among adults over age 65. This is likely a conservative number, since it does not take into account the ongoing obesity epidemic in America, which may significantly contribute to the future prevalence of arthritis. Although rarely discussed, arthritis causes over nine thousand deaths each year. Most notable, is the fact that arthritis-related mortality disproportionately affects women and minorities. For example, systemic lupus deaths show marked age, sex, and race-specific disparities with the highest death rates occurring among working-age, black women. Arthritis and its related disability cause an enormous burden for the people who have arthritis, their families and society. Arthritis is the most frequent cause of activity limitation in America; more than eight million citizens are limited in some way because of arthritis. Arthritis is also a significant cause of work disability, especially for persons with inflammatory arthritis, such as rheumatoid arthritis, of which, as many as 30 percent may be work disabled. Each year, 750,000 hospitalizations and 36 million outpatient medical care visits occur because of arthritis. Arthritis is costly to society and individuals. In 1997, arthritis cost more than $51 billion in direct medical costs and another $35 billion in indirect costs. No doubt, these numbers will increase dramatically as our population ages and the number of people with arthritis increases. We know other things about people with arthritis. People with arthritis
The Role of Public Health in Arthritis CDC has identified the following critical priorities to address arthritis:
Reducing arthritis-related disability will benefit our aging population in America. In seven years, the leading edge of the baby-boomers will reach age 65. Many older Americans, those most likely to have arthritis and to be limited by arthritis, may need to or wish to work longer. We will need to better understand how we can reduce arthritis-related disability and how older Americans can be accommodated in the workplace so that they can remain active and, if they choose to be, employed. This aging trend will have enormous implications for our society. CDC and the public health community in our states and communities have a continued role to play in bringing the benefits of prevention to persons with arthritis. Public health brings the focus on population-based approaches to health, the knowledge of what works, and links to the clinical community. What CDC brings to the table is its well-recognized scientific expertise, long-standing experience in prevention research, the ability to evaluate health promotion programs and identify those that work, knowledge of the public health network and the ability to work with states and communities to implement disease prevention and health promotion programs, and unique surveillance capacity to better guide programmatic efforts. Priority areas to address:
CDC works closely with the Arthritis Foundation, the voice for people with arthritis and their families for more than 50 years. The Arthritis Foundation recognizes the need for health promotion strategies for people with arthritis that are tested and proven effective. CDC's strength is its ability to demonstrate the effectiveness of an intervention strategy or program and help states and communities put it into practice. The growing evidence for the benefits of healthy behaviors (physical activity and weight control) and disease management strategies for people with arthritis must be shared and implemented widely in public health practice. CDC can, through its leadership role in the public health community, make sure that the growing body of evidence that we can improve the quality of life among people with arthritis is applied through public health practice and supported by clinical medical practice. Current CDC Efforts Despite the enormous burden of arthritis, public health efforts for arthritis are fairly new. Prior to 1998, we are aware of only two states that had organized activities addressing arthritis: Missouri and Ohio. There was no national public health plan for arthritis and arthritis had never been made a priority in our national health objectives. CDC, too, had limited efforts. The National Arthritis Action Plan: A Public Health Strategy was developed by CDC, the Association of State and Territorial Health Officials, and the Arthritis Foundation with the help and input of 90 other organizations to address this large and growing problem. This landmark plan recommends national, coordinated efforts to reduce pain and disability and improve the quality of life for people with arthritis. This plan forms the foundation for CDC's arthritis efforts. The primary goal of the CDC Arthritis Program is to improve the quality of life for people affected by arthritis-decreasing the pain and disability that often accompany arthritis. Since 1999 when CDC received its first ever appropriation for arthritis, CDC has made progress.
Improve how we measure the burden of arthritis.
In conclusion, I would like to thank the Committee for its leadership and commitment to the health of our nation and the interest in people affected by arthritis. Great progress has been made in addressing arthritis, one of our most common chronic conditions. The nation has a national plan, catalyzing activities in both the public and private sectors. State programs, almost unheard of just six years ago exist in 36 states. The pain and disability of arthritis can be improved. We need to continue our work to identify promising approaches, develop new approaches, and put this science into action-getting programs that work out to the people who need them. I would be happy to answer any questions from the Committee. References 1a. Arthritis Foundation, Association of State and Territorial Health Officials, CDC. National Arthritis Action Plan: A Public Health Strategy. Atlanta, Georgia: Arthritis Foundation, 1999. 1b. HP2010 Health Objectives for the Nation. 2. Bolen J, Helmick CG, Sacks J, Langmaid G. Prevalence of self-reported arthritis or chronic joint symptoms among adults - United States, 2001, MMWR, 2002; 51(42):948-50. 3. Hootman JM, Helmick CG, Langmaid G. Public Health and Aging: Projected Prevalence of Self-Reported Arthritis or Chronic Joint Symptoms Among Persons Aged >65 Years --- United States, 2005-2030. MMWR, 2003; 52(21):489-91. 4. Sacks JJ, Helmick CG, Langmaid G. Deaths from Arthritis and Other Rheumatic Conditions, United States, 1979 - 1998. In Press: J Rheumatol, 2004. 5. Sacks JJ, Helmick CG, Langmaid G, Sniezek JE. Trends in Deaths from Systemic Lupus Erythematosus --- United States, 1979-1998. MMWR, 2002; 51(17):371-4. 6. Centers for Disease Control and Prevention. Prevalence of Arthritis --- United States, 1997. MMWR, 2001; 50(17):334-6. 7. Sokka, T. Work disability in early rheumatoid arthritis. Clin Exp Rheumatol, 2003; 21(5 suppl):S71-4. 8. Lethbridge-Cejku M, Helmick CG, Popovic JR. Hospitalizations for arthritis and other rheumatic conditions: data from the 1997 National Hospital Discharge Survey. Med Care, 2003; 41(12):1367-73. 9. Hootman JM, Helmick CG, Schappert SM. Magnitude and characteristics of arthritis and other rheumatic conditions on ambulatory medical care visits, United States, 1997. Arthritis Care Res, 2002; 47(6):571-81. 10. Murphy L, Cisternas M, Yelin E, et al. Update: Direct and Indirect Costs of Arthritis and Other Rheumatic Conditions --- United States, 1997. MMWR, 2004; 53(18):388-9. 11. Mili FD, Helmick CG, Zack MM, Moriarty D. Health-related quality of life among adults reporting arthritis: Behavioral Risk Factor Surveillance System, 15 states and Puerto Rico, 1996-1999. Journal of Rheumatology 2003; 30:160-6. 12. Mehrotra C, Naimi T, Seruda M, Bolen J, Pearson K. Arthritis, body mass index, and professional advice to lose weight: Implications for clinical medicine and public health. In press: Am J Prev Med. 13. Hootman JM, Macera CA, Ham S, Helmick CG, Sniezek JE. Physical activity levels among the general US adult population and in adults with and without arthritis. Arthritis and Rheumatism (Arthritis Care and Research) 2003; 49(1):129-135. 13a. Fontaine K, Heo M, Bathon J. Are U.S. adults with arthritis meeting public health recommendation for physical activity? Arthritis and Rheumatism 2004;50(2):624-28. 14. Wang G, Helmick CG, Macera A, Zhang P, Pratt M. Inactivity-associated medical costs among U.S. adults with arthritis. Arthritis Care and Research 2001;45:439-445. 15. RAO JK, CALLAHAN LF, HELMICK CG. Characteristics of persons with self-reported arthritis and other rheumatic conditions who do not see a doctor. J Rheumatol 1997;24:169-73. 16. Bolen JC, Helmick CG, Sacks JJ, Langmaid G. Adults who have never seen a health-care provider for chronic joint symptoms --- United States, 2001. Morbidity and Mortality Weekly Report 2003;52:416-419. 17. Boutaugh ML. Arthritis Foundation community-based physical activity programs: effectiveness and implementation Issues. Arthritis & Rheumatism (Arthritis Care & Research) 49(3): 463-470, 2003 18. Breedveld F, Kalden J. Appropriate and effective management of rheumatoid arthritis. Ann Rheum Dis 2004;63:627-633. 19. Minor M. 2002 Exercise and Physical Activity Conference, St. Louis, Missouri: Exercise and Arthritis "We know a little bit about a lot of things�" Arthritis and Rheumatism (Arthritis Care and Research) 2003;49(1):1-2. 20. American College of Rheumatology/Association of Rheumatology Health Professionals. Proceedings from the International Conference on Health Promotion and Disability Prevention for Individuals and Populations with Rheumatic Disease: The evidence for Exercise and Physical Activity. 2003. Atlanta, Georgia. 21. Lorig K, Mazonson P, Holman HR: Evidence suggesting that health education for self-management in patients with chronic arthritis has sustained health benefits while reducing health care costs. Arthritis and Rheumatism, 36(4):439-446, 1993. 22. Lorig KR, Ritter P, Stewart AL, Sobel DS, Brown BW, Bandura A, Gonzales VM, Laurent DD, Holman HR . Chronic Disease self-management program-2-year health status and health care utilization outcomes. Medical Care 39(11): 1217-1223, 2001. 23. ORC Macro. Market Research for the Arthritis Foundation. A focus group study. May 2003. 24. Toal S. Assessment of Arthritis Program Capacity . Unpublished report prepared for the Arthritis Council, Chronic Disease Directors, March 2004. 25. JORDAN JM, RENNER JB, LUTA G, DRAGOMIR A, FRYER JG, HELMICK CG, HOCHBERG MC. Hip osteoarthritis (OA) is not rare in African -Americans and is different than in Caucasians. Arthritis Rheum 1997;40(9)suppl: S236 (#1232). 26. JORDAN JM, LUTA G, RENNER JB, DRAGOMIR A, FRYER JG,HELMICK CG, HOCHBERG MC. African-Americans face an increased risk of bilateral knee osteoarthritis (OA) from obesity. Arthritis Rheum 1997;40(9)suppl:S331 (#1796). 27. Jordan JM, Luta G, Renner JB, Linder GF, Dragomir A, Helmick CG, Fryer JG. Self-reported functional status in osteoarthritis of the knee in a rural, Southern community: the role of sociodemographic factors, obesity, and knee pain. Arthritis Care Res 1996; 9:273-278. 28. Jordan JM, Luta G, Renner JB, Dragomir A, Hochberg MC, Fryer JG. Knee pain and knee osteoarthritis severity in self-reported task-specific disability: the Johnston County Osteoarthritis Project. J Rheumatol 1997 ; 24:1344-1349. 29. Felson DT, Lawrence R, Dieppe PA, Hirsch R, Helmick CG, Jordan JM et al. Osteoarthritis: new insights. Ann Intern Med 2000; 133:635-646. 30. Dunn AL, Marcus BH, Kampert JB, et al. Comparison of lifestyle and structured interventions to increase physical activity and cardiorespiratory fitness: A randomized controlled trial. JAMA, 1999;281(4):321-34.) 31. Geppert J. Physical Activity. The Arthritis Pain Reliever. Pilot test results-unpublished report. 2003. |
Last Revised: June 8, 2004