Turning the Tide on the Arthritis Tsunami
Turning the Tide on the Arthritis Tsunami | Arthritis, Arthritis Foundation, Osteoarthritis, Rheumatoid Arthritis, Juvenile Arthritis, OA, RA, JA, Dr. Patience White, Chronic Disease Management, National Arthritis Action Plan, NAAP, Institute of Medicine, IOM

Dr. Patience White.

Myth: Arthritis is an inevitable part of aging, and there is nothing you can do about it.

Fact: While aging and genetics play a role in developing osteoarthritis (OA), the most common form of arthritis, behavioral choices are a much larger factor in the development and progression to disability of this chronic condition. In addition, 300,000 children have arthritis and more people under 65 years of age have arthritis than those over 65.

Myth: For most, arthritis might mean joint pain, but it’s not like arthritis is a life-threatening disease.

Fact: Rheumatoid arthritis (RA) affects 3.1 million Americans and is a major risk factor for heart disease that causes heart attacks and death. While OA doesn’t typically take center stage when it comes to ‘cause of death,’ a major byproduct of the disease is a reluctance to engage in physical activity… and that can result in ballooning weight, which does play a starring role in a host of killer conditions ranging from cardiovascular disease to diabetes to certain types of cancer.

 

Patience H. White, MD, MA, has spent her career focused on arthritis.

“Arthritis is the most common cause of disability,” said the Harvard-educated physician, who is board certified in internal medicine and rheumatology.

White is a professor of medicine and pediatrics at George Washington University School of Medicine and also has taken care of adults and children with arthritis for more than 25 years. As vice president of Public Health for the Arthritis Foundation, however, much of White’s day is spent raising awareness of arthritis as a major public health problem and reducing the impact of the disease.

According to the most current statistics, 50 million Americans have been diagnosed with some form of arthritis. By 2030, that number is expected to be 67 million unless the trend is reversed. Osteoarthritis is by far the most common form of the disease, impacting 27 million people in the United States. White was quick to add all of these figures are very conservative because so many people remain undiagnosed.

“For every person who has been told they have osteoarthritis, there are two or three more that probably haven’t gone to their physicians about it,” she said.

Furthermore, it is increasingly a ‘younger’ disease. In fact, White said there are more people under 65 living with OA than those over 65. One reason, she noted, is that injury and OA share a close relationship. For most people, White said, “If you have a significant injury to your knee, whether you are 15 or 40, you are likely to get osteoarthritis within 10 years.”

After injury a second major contributor to OA is weight. “For every pound you gain, it adds four pounds of load to each knee … so gaining five pounds adds 20 pounds to each knee,” she explained.

Furthermore, White continued, the lifetime risk of getting OA correlates to weight. An individual who is obese increases the risk of developing OA by two-thirds and an overweight person by half. Considering the 2009-2010 National Health and Nutrition Examination Survey (NHANES) found 78 million U.S. adults and 12.5 million children and adolescents were clinically obese … and about twice that number were defined as overweight … White called the number of Americans at heightened risk for developing arthritis “mindboggling.”

She said education regarding the actions that can be taken to decrease the risk of pain from arthritis – for both patients and healthcare providers – is critical in turning the tide of the approaching arthritis tsunami. “There is lots of data that if you lose weight, 10-15 pounds, you decrease your osteoarthritis knee joint pain by 50 percent,” White said. “If you add physical activity (strengthening and stretching) to weight management, you can decrease the progression of osteoarthritis and the trajectory toward loss of independence and disability.”

Considering the average length of a medical appointment and the pressing need to address other common chronic conditions including diabetes, hypertension and cardiovascular disease, White said it was easy for both patients and providers to put talking about arthritis on the back burner. Adults with arthritis are less likely to be physically active than those without the disease, which is unfortunate for two reasons – physical activity is the cornerstone in the management of comorbid conditions such as diabetes and heart disease and there are proven benefits in the management of arthritis from engaging in such activity. White noted approximately 50 percent of people with heart disease and diabetes have arthritis and tend not to follow advice to do physical activity unless the arthritis is also addressed.

“I think the message physicians need to get out is ‘you can do something about arthritis, and if you do something about your arthritis, you do something about a lot of other conditions, as well,’” she said.

However, White was quick to add, “People with arthritis will not listen to generic physical activity messages.” She said when a patient with arthritis hears ‘you need to exercise,’ the unspoken reply is often, ‘I can’t, it hurts and must be bad for my joints.’

Therefore, White noted, providers really need to articulate to patients the importance of engaging in physical activity and explain how it can relieve joint pain. They should also provide specific low impact physical activity ideas such as aquatic exercise, yoga, cycling, stretching and strengthening, and other safe options to get patients moving (see arthritis.org for a list of evidence-based physical activity and self-management programs for people with arthritis and information on the local AF chapter as a resource).

While genetics play a major role in the development of RA, White noted smoking is a risk factor for the disease. RA is one of the most serious forms of arthritis and accounts for 22 percent of all deaths from arthritis or other rheumatic conditions. In fact, a person with RA is 2.3 times more likely to die than persons of the same age without RA in the general population.

Happily, the science has come a long way in treating RA. “We now have excellent drugs that can put this disease into remission. We have biologics and chemotherapeutic agents that can decrease and stop the inflammatory autoimmune disease.”

Like RA, juvenile arthritis is an autoimmune disorder with a growing arsenal of treatment options that relieve pain and alter the course of the disease. However, also like RA, juvenile arthritis can cause joint damage, which along with extra weight and lack of physical activity could result in OA when they are older.

Despite the prevalence of arthritis and its impact on comorbid conditions, it’s really only been in the last 14 years that the disease has received broad national attention. In 1999, the Arthritis Foundation, the Association of State and Territorial Health Officials, and the Centers for Disease Control and Prevention (CDC), joined forces to create the National Arthritis Action Plan (NAAP) that set a course for recognizing arthritis as a major public health issue and disseminate evidence-based programs for people with arthritis.

In the past few years, activity has focused on OA. In 2010, more than 30 organizations came together and developed the National Public Health Agenda for Osteoarthritis  (www.arthritis.org/osteoarthritis-agenda) and in 2011 formed the Osteoarthritis Action Alliance in (www.oaaction.org) to move forward the key principles outlined in the National Public Health Agenda. This year, the Institute of Medicine released “Living Well with Chronic Disease,” which White called “visionary blueprint” for the public health system, the healthcare delivery system and community organizations to integrate services to better assist Americans in living well with chronic diseases.

To help underscore the message, the Arthritis Foundation has launched a resource site — www.fightarthritispain.org — with two of their key media campaigns: “Moving is the Best Medicine” and “What’s Your Weapon in the Fight against arthritis?” Spokesperson Billie Jean King likes to battle her arthritis with a tennis racquet. The site, along with the website www.arthritis.org, offers useful tools for both patients and healthcare providers.

“Much progress has been made in recognizing arthritis as a major public health issue,” White concluded. “Today it is important to think of prevention as not just about preventing death but also about living well with chronic disease.”