1. Arthritis: The Disease, The Program & Interventions Debbie Campbell MBA, CHES Arthritis Health Section Chief Department of Health & Human Services - Division of Health and Appathurai Balamurugan MD, MPH Senior Epidemiologist, Department of Health & Human Services - Division of Health Assistant Professor, Dept. of Epidemiology, UAMS College of Public Health Debbie Campbell MBA, CHES Arthritis Health Section Chief Department of Health & Human Services - Division of Health and Appathurai Balamurugan MD, MPH Senior Epidemiologist, Department of Health & Human Services - Division of Health Assistant Professor, Dept. of Epidemiology, UAMS College of Public Health

2. The “Arthritis” Story 70 million Americans 70 million Americans Leading cause of disability among Americans over age 15 Leading cause of disability among Americans over age 15 Affects nearly 300,000 children Affects nearly 300,000 children Baby boomers are now at prime risk, as more than half those affected are under age 65 Baby boomers are now at prime risk, as more than half those affected are under age 65 70 million Americans 70 million Americans Leading cause of disability among Americans over age 15 Leading cause of disability among Americans over age 15 Affects nearly 300,000 children Affects nearly 300,000 children Baby boomers are now at prime risk, as more than half those affected are under age 65 Baby boomers are now at prime risk, as more than half those affected are under age 65

3. The “Arthritis” Story Cont. Second only to heart disease as a cause of work disability Second only to heart disease as a cause of work disability 39 million physician visits every year 39 million physician visits every year More than a half million hospitalizations per year More than a half million hospitalizations per year $86.2 billion annually $86.2 billion annually Second only to heart disease as a cause of work disability Second only to heart disease as a cause of work disability 39 million physician visits every year 39 million physician visits every year More than a half million hospitalizations per year More than a half million hospitalizations per year $86.2 billion annually $86.2 billion annually

4. Outline Arthritis – Economic & Disease Burden Arthritis – Economic & Disease Burden Arthritis Health Program Arthritis Health Program Arthritis Management Arthritis Management Arthritis – Economic & Disease Burden Arthritis – Economic & Disease Burden Arthritis Health Program Arthritis Health Program Arthritis Management Arthritis Management

5. Arthritis is an umbrella term Rheumatoid Arthritis Fibromyalgia Gout Lyme Disease Bursitis Lupus Juvenile Arthritis Ankylosing Spondylitis Osteoarthritis

7. * Source: BRFSS, 2004

9. Percentage of Population

10. Figure 4. Percentage of Adults with Arthritis,* 2003 * People 18 or older with self-reported, doctor-diagnosed arthritis. Source: CDC, Behavioral Risk Factor Surveillance System, 2003

11. Figure 5. Arthritis Prevalence In Arkansas By Age Categories, 2004 * Source: BRFSS, 2004 Percentage with Arthritis

12. Figure 6. Arthritis Prevalence in Arkansas by gender, 2004 * Source: BRFSS, 2004 Percentage with Arthritis

13. Figure 7. Arthritis Prevalence in Arkansas by race, 2004 Percentage with Arthritis

14. Arthritis Prevalence in Arkansas, 2002 Prevalence of Doctor- Diagnosed Arthritis*  24.6 – 29.9% █ 30.0 – 34.9% █ 35.0 – 39.9% █ 40.0 – 48.6% * BRFSS 2002

15. Cost Due to Arthritis and Related Conditions

16. Figure 8. Total* Cost Attributable to Arthritis and Other Rheumatic Conditions, Using Selected Categories, 50 States and D.C., U.S., 1997 * Total = direct (costs attributable to medical expenditures) + indirect (costs attributable to work loss) Source: CDC Arthritis Program $2.2 – $8.4 billion $1.5 - $2.2 billion $750 million - $1.3 billion $121 million - $578 million

17. Direct Healthcare Expenses Due to Arthritis Site of Service Costs Rank Site of Service Costs Rank Home Healthcare $ 2.49 B 1 Ambulatory care $ 7.93 B 2 In-patient $ 5.70 B 4 Prescription Meds $ 5.15 B 5 Site of Service Costs Rank Site of Service Costs Rank Home Healthcare $ 2.49 B 1 Ambulatory care $ 7.93 B 2 In-patient $ 5.70 B 4 Prescription Meds $ 5.15 B 5 Source: Healthcare Spending and Use Among United State Community-Dwelling Adults for the 20 most costly conditions

18. Direct Healthcare Expenses Due to Arthritis by Source of Payment Source: Healthcare Spending and Use Among United State Community-Dwelling Adults for the 20 most costly conditions $ Billions of dollars

19. Number of Hospital Discharges

20. Millions of Dollars ($) Year

21. Thousands of Dollars

22. Osteoarthritis (OA) Clinical presentation Clinical presentation Epidemiology Epidemiology Diagnosis Diagnosis Treatment Treatment Clinical presentation Clinical presentation Epidemiology Epidemiology Diagnosis Diagnosis Treatment Treatment

23. Number of Hospital Discharges

24. Millions of Dollars ($) Year

25. Rheumatoid Arthritis (RA) Clinical presentation Clinical presentation Epidemiology Epidemiology Diagnosis Diagnosis Treatment Treatment Clinical presentation Clinical presentation Epidemiology Epidemiology Diagnosis Diagnosis Treatment Treatment

26. Number of Hospital Discharges Year

27. Millions of Dollars ($) Year

28. Systemic Lupus Erythematosus (SLE) Clinical presentation Clinical presentation Epidemiology Epidemiology Diagnosis Diagnosis Treatment Treatment

29. Number of Hospital Discharges Year

30. Millions of Dollars ($) Year

31. Gout Clinical presentation Clinical presentation Epidemiology Epidemiology Diagnosis Diagnosis Treatment Treatment

32. Number of Hospital Discharges Year

33. Millions of Dollars ($) Year

34. Fibromyalgia Clinical presentation Clinical presentation Epidemiology Epidemiology Diagnosis Diagnosis Treatment Treatment

35. Back Pain Clinical presentation Clinical presentation Epidemiology Epidemiology Diagnosis Diagnosis Treatment Treatment

36. Infectious Arthritis Clinical presentation Epidemiology Diagnosis Treatment Clinical presentation Epidemiology Diagnosis Treatment

37. Occupational & Sports Related Injuries Causing Arthritis Clinical presentation Clinical presentation Occupational – CTS Occupational – CTS Sports – Tennis Elbow Sports – Tennis Elbow Epidemiology Epidemiology Diagnosis Diagnosis Treatment Treatment Clinical presentation Clinical presentation Occupational – CTS Occupational – CTS Sports – Tennis Elbow Sports – Tennis Elbow Epidemiology Epidemiology Diagnosis Diagnosis Treatment Treatment

38. Juvenile Arthritis Clinical presentation Epidemiology Diagnosis Treatment Clinical presentation Epidemiology Diagnosis Treatment

39. Health Status Among People With Arthritis

40. Arthritis is the No. 1 cause of disability in the US and in AR

41. Figure 21. Health status* among people with arthritis * Source: BRFSS, 2004

42. Percentage

43. Risk Factors & Preventive Care Services

44. Figure 23. Role of Body weight in Arthritis * Source: BRFSS, 2004

45. Figure 24. Role of Physical Activity in Arthritis * Source: BRFSS, 2003

46. * Source: BRFSS, 2004

47. ARthritis Health Program

49. MissionMission “Reduce the Impact of Arthritis and other Rheumatic Conditions” among Arkansans

50. Goals Increase Awareness and Knowledge Increase Awareness and Knowledge Expand Evidence-based Interventions Expand Evidence-based Interventions Establish and Maintain Partnerships Establish and Maintain Partnerships Expand and Maintain Surveillance Expand and Maintain Surveillance

51. Interventions (No Longer Sitting Still for the Pain) Health Communication Campaign Health Communication Campaign Evidence-Based Programs Evidence-Based Programs

52. “Physical Activity. The Arthritis Pain Reliever”

53. Physical Activity and Arthritis Pain Relief Improved Joint Function Improved Well-being Overall Health Benefits Reduced Disability Weight Loss Physical Activity

55. Benefits of Exercising With Arthritis Joint flexibility & mobility Joint flexibility & mobility Nourishes cartilage Nourishes cartilage Muscle strength Muscle strength Cardiovascular fitness, circulation Cardiovascular fitness, circulation Weight control, better appearance Weight control, better appearance Sense of well-being, less stress & depression Sense of well-being, less stress & depression Joint flexibility & mobility Joint flexibility & mobility Nourishes cartilage Nourishes cartilage Muscle strength Muscle strength Cardiovascular fitness, circulation Cardiovascular fitness, circulation Weight control, better appearance Weight control, better appearance Sense of well-being, less stress & depression Sense of well-being, less stress & depression

56. Benefits of Exercising With Arthritis Cont. Bone strength Bone strength Endurance, stamina, more energy Endurance, stamina, more energy Function, ability to perform daily activities Function, ability to perform daily activities Posture, balance & coordination Posture, balance & coordination Regular bowel habits Regular bowel habits Quality of sleep Quality of sleep Bone strength Bone strength Endurance, stamina, more energy Endurance, stamina, more energy Function, ability to perform daily activities Function, ability to perform daily activities Posture, balance & coordination Posture, balance & coordination Regular bowel habits Regular bowel habits Quality of sleep Quality of sleep

58. 1. Arthritis Foundation Aquatic Program

59. Aquatics Classes In Arkansas Counties * Aquatics classes Source: Arthritis Foundation, 6/8/2005

60. 2. Arthritis Foundation Exercise Program

61. PACE Classes In Arkansas Counties @ PACE classes Source: Arthritis Foundation, 6/8/2005

62. 3. Arthritis Foundation Self–Help Program: Take Control With Knowledge ASHC WORKSHOP OVERVIEW TOPICS Week One Week Two Week Three Week Four Week Five Week Six 1. Self-Management Principles √ 2. Pain-Management Principles √ 3. Cognitive Pain Management √√√√ 4. Goal-Setting/Action Plans √√√√√√ 5. Problem-Solving Steps √ 6. Exercise/Fitness √√√ 7. Feedback/Problem-Solving √√√√√

63. 3. Arthritis Foundation Self–Help Program: Take Control With Knowledge ASHC WORKSHOP OVERVIEW TOPICS Week One Week Two Week Three Week Four Week Five Week Six 8. Difficult Emotions √ 9. Healthy Eating √ 10. Osteoporosis √ 11. Fatigue and Energy Conservation Conservation√ 12. Medication Usage √ 13. Depression √ 14. Working with Health Care Providers Providers√ 15. Evaluating Treatments √ 16. Sleep √

64. Support Groups Arthritis Support Group Arthritis Support Group Lupus Support Group Lupus Support Group Fibromyalgia Support Group Fibromyalgia Support Group Arthritis Support Group Arthritis Support Group Lupus Support Group Lupus Support Group Fibromyalgia Support Group Fibromyalgia Support Group

65. Support Groups In Arkansas Counties * Arthritis support group # Fibromyalgia support group @ Lupus support group Source: Arthritis Foundation, 6/8/2005

66. Arthritis Management

67. 10 Signs Of An Unproven Arthritis Remedy 10. The "Conspiracy Theory" 9. It's a "Special Diet " 8. It's "Untested “ 7. Drugs and Surgery are "Condemned" "Condemned" 6. The Body is "Cleansed" 10. The "Conspiracy Theory" 9. It's a "Special Diet " 8. It's "Untested “ 7. Drugs and Surgery are "Condemned" "Condemned" 6. The Body is "Cleansed"

68. 10 Signs Of An Unproven Arthritis Remedy Cont. 5. It's "Quick or Simple" 4. Advertising is "Sensationalized" 3. The "Testimonial" 2. It's a "Secret" 1. It's a "Cure" 5. It's "Quick or Simple" 4. Advertising is "Sensationalized" 3. The "Testimonial" 2. It's a "Secret" 1. It's a "Cure"

69. Arthritis Treatment Medical management – Analgesics, NSAIDs, DMARDs, Biologic response modifiers, Corticosteriod Medical management – Analgesics, NSAIDs, DMARDs, Biologic response modifiers, Corticosteriod Surgery – Traction, Joint or Disc replacement, Laser, endoscopy Surgery – Traction, Joint or Disc replacement, Laser, endoscopy Medical management – Analgesics, NSAIDs, DMARDs, Biologic response modifiers, Corticosteriod Medical management – Analgesics, NSAIDs, DMARDs, Biologic response modifiers, Corticosteriod Surgery – Traction, Joint or Disc replacement, Laser, endoscopy Surgery – Traction, Joint or Disc replacement, Laser, endoscopy

70. Alternative Treatment for Arthritis Hot Springs, Arkansas

71. Alternative Treatment for Arthritis Cont. Acupuncture Acupuncture Ayurveda Ayurveda Biofeedback Biofeedback Chiropractic Chiropractic Chondroitin sulfate Chondroitin sulfate Copper bracelet Copper bracelet Chinese Herbs Chinese Herbs Diet & Supplements Diet & Supplements Fish oil Fish oil Acupuncture Acupuncture Ayurveda Ayurveda Biofeedback Biofeedback Chiropractic Chiropractic Chondroitin sulfate Chondroitin sulfate Copper bracelet Copper bracelet Chinese Herbs Chinese Herbs Diet & Supplements Diet & Supplements Fish oil Fish oil Green tea Green tea Homeopathy Homeopathy Hydrotherapy Hydrotherapy Massage Massage Meditation Meditation Tai Chi Tai Chi Yoga Yoga Green tea Green tea Homeopathy Homeopathy Hydrotherapy Hydrotherapy Massage Massage Meditation Meditation Tai Chi Tai Chi Yoga Yoga

72. Recent Advances in Arthritis Management Newer Drugs – abatacept, Rituximab, Febuxostat Newer Drugs – abatacept, Rituximab, Febuxostat Medicare Part D prescription drug plan Medicare Part D prescription drug plan Research findings – Weight loss and Exercise Research findings – Weight loss and Exercise FDA decision on COX-2 selective inhibitor drugs FDA decision on COX-2 selective inhibitor drugs Genetic research Genetic research Newer Drugs – abatacept, Rituximab, Febuxostat Newer Drugs – abatacept, Rituximab, Febuxostat Medicare Part D prescription drug plan Medicare Part D prescription drug plan Research findings – Weight loss and Exercise Research findings – Weight loss and Exercise FDA decision on COX-2 selective inhibitor drugs FDA decision on COX-2 selective inhibitor drugs Genetic research Genetic research

73. CDC Recommendations See Your Doctor See Your Doctor Learn What You Can Do Learn What You Can Do Be Active Be Active Watch Your Weight Watch Your Weight Protect Your Joints Protect Your Joints