The time to register for the Arthritis State of the Science Meeting...
Arthritis is a term that describes over 100 rheumatic conditions that are typically characterized by inflammation, tissue destruction, pain and stiffness of joint tissues (e.g., bone, cartilage, synovial fluid, ligaments, tendons, muscles and connective tissue).
Arthritis is the most prevalent musculoskeletal condition of adults.
Approximately 43 million adults in the United States—22% of the adult population—self-report physician-diagnosed arthritis. By 2030, 25% of the adult U.S. population is expected to have arthritis. Knee osteoarthritis (OA) is the most prevalent type of arthritis and affects approximately 37% of the adult population.
- Symptomatic knee OA—radiographic knee OA with frequent knee joint pain—is present in approximately 6% of adults over the age of 45 and 12% of adults over the age of 60.
- Gout, rheumatoid arthritis (RA), and systemic lupus erythematosus (SLE) are less prevalent affecting an estimated 3 million, 1.3 million, and 161,000-322,000 adults in the United States, respectively.
- Adults are not the only ones to get arthritis—294,000 children have juvenile arthritis.
Disability Due To Arthritis
Longitudinal studies among persons with inflammatory arthritis show significant risks of progressive disability in task performance and home and work roles. In a sample of adults ages 65 and over who reported frequent knee pain, Miller et al. found that 45% experienced progression of disability over 15-months and 53% experienced progression over 30-months. Others show a decline in balance, strength, and function over time among older adults with symptomatic knee OA showed persons at risk for symptomatic knee OA have high rates of disease progression over 30-months—if disease progression were related to disability, this would suggest a high rate of disability progression.
Work loss, a type of participation restriction, specifically tied to work performance and employment, can be substantial among persons with arthritis and can have enormous impact on those affected.
- In clinical samples of persons with rheumatoid arthritis, 40-50% of persons are unemployed after one decade of disease.
- In the 2001-2002 National Health Interview Survey (NHIS) data, 31% of persons with arthritis—or 8.3 million people—with arthritis reported a work limitation that was at least partially related to their musculoskeletal condition.
In recognition of the critical importance of work outcomes among people with arthritis and the limited evidence-based intervention approaches, the Centers for Disease Control Health People 2020 objectives and the current National Institute on Disability and Rehabilitation Research agenda specifically address work outcomes.
To date, there are no “cures” for arthritis.
Current treatment for most rheumatological conditions focuses on disease management with the goal of preventing joint destruction, minimizing pain, and optimizing function.
- Significant advances have been made with current medications for RA and gout, but few medications exist for OA.
- Total joint replacement is typically the intervention choice for end-stage joint disease with the goal of improving pain and function and decreasing disability. Long-term outcomes, however, of joint replacements show mixed outcomes 2 years after surgery especially for knee replacement.
Non-invasive strategies are increasingly promoted for disease management and functional outcomes. Physical activity and strength training are now well recognized as critical components of disease management. However, despite the strong evidence supporting beneficial effects at decreasing pain and improving function, the vast majority of persons with arthritis are not meeting recommended levels of activity and exercise and adherence to programs is poor.
Recent research has drawn increased attention to the role factors outside of the biomedical model—e.g., the environment, social support, and empowerment—have on disability. Factors outside the biomedical model are clear targets of interventions aimed at work disability. Studies of the effectiveness of vocational rehabilitation work retention programs show that programs aimed at changing the work environment are more effective than those with a primarily medical approach.
Most of today’s intervention approaches treat disease processes or disease impairments (e.g., pain, strength). While critical, these interventions may not fully address the challenges people with arthritis face in the context of engaging in broader life roles such as work, volunteering, and engaging in social and community activities. Interventions aimed at these outcomes most likely need to incorporate elements beyond biomedical disease processes such as environmental and behavioral factors. These interventions, however, are sparse. ENACT was established to identify effective interventions aimed at optimizing activity and participation outcomes, foster exercise adherence, measure functional outcomes , and develop rheumatological rehabilitation scholars; in order to improve the lives of persons with arthritis.
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