A Public Health Approach to Addressing Arthritis in Older Adults: The Most Common Cause of Disability

Arthritis Program, Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
American Journal of Public Health (Impact Factor: 4.55). 03/2012; 102(3):426-33. DOI: 10.2105/AJPH.2011.300423
Source: PubMed


Arthritis is highly prevalent and is the leading cause of disability among older adults in the United States owing to the aging of the population and increases in the prevalence of risk factors (e.g., obesity). Arthritis will play a large role in the health-related quality of life, functional independence, and disability of older adults in the upcoming decades. We have emphasized the role of the public health system in reducing the impact of this large and growing public health problem, and we have presented priority public health actions.

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Available from: Teresa Brady, Jul 21, 2014
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    • "Arthritis is one of a 100 musculoskeletal conditions of varying etiologies and most prevalent disease involving middle age and elderly i.e., 50-65yrs and go on increasing in prevalence with age i.e. >65 yrs, the incident rate of arthritis is three times higher in females compared to males.1112 In this study also there were 22 men with 46 women with mean age 50.7 yrs, suggestive of high incidence rate in middle age women. "
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    ABSTRACT: Background: Cyclooxygenase-2 inhibitors (COX-2-Is) have recently been concerned in the occurrence of adverse cardiovascular (CV) events. Rofecoxib and valdecoxib has been withdrawn from the market, but celecoxib, etoricoxib and parecoxib continues to be used. Other nonsteroidal anti-inflammatory drugs (NSAIDs) may also increase the risk of CV events. However, clinical trial databases for COX-2-Is had created lots of controversies regarding cardiovascular safety of selective and nonselective cyclooxygenase inhibitors (COX-Is). This study was, conducted to assess and compare the CV risk of COX-Is in arthritic patients over a period of time. Materials and Methods: In this prospective cohort study adult arthritics of either sex those were freshly diagnosed or taking COX-Is for < 3 months; were included. Patients were grouped into nonselective and selective COX-2-I groups with reference to treatment they received. The CV risk factors like blood pressure (BP), blood sugar level (BSL), lipid profile, body mass index (BMI) were assessed and compared; demography of CV risk factors was also studied. Data obtained was analysed using Student's ‘t’-test of OpenEpi statistical software. Results: Study clearly revealed that all NSAIDs exhibit variable CV risk; however, selective COX-2-Is found to exhibit more CV risk. BMI, BP and lipid profile; the potential CV risk factors, showed significant impairment in selective COX-2-Is group; P < 0.01, P < 0.001 and P < 0.05, respectively, compared to baseline and P < 0.05 vs. nonselective COX-Is for BMI. Conclusions: This study portrays the potential CV risk of selective COX-2-Is; confirms and re-evaluate the results of earlier studies in this regard.
    Journal of the Nigeria Medical Association 09/2014; 55(5):417-22. DOI:10.4103/0300-1652.140386
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    • "Nearly 20% of the U.S. population will be 65 years of age or older by the year 2030 and about 34% of them will suffer from some type of osteoarthritis [1]. Lumbar Spinal Stenosis (LSS) is a chronic condition that is caused by degenerative changes in the lumbar spine, which is highly prevalent in the older adult population. "
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    ABSTRACT: Background Lumbar spinal stenosis is the most common reason for spinal surgery in older adults. Previous studies have shown that surgery is effective for severe cases of stenosis, but many patients with mild to moderate symptoms are not surgical candidates. These patients and their providers are seeking effective non-surgical treatment methods to manage their symptoms; yet there is a paucity of comparative effectiveness research in this area. This knowledge gap has hindered the development of clinical practice guidelines for non-surgical treatment approaches for lumbar spinal stenosis. Methods/design This study is a prospective randomized controlled clinical trial that will be conducted from November 2013 through October 2016. The sample will consist of 180 older adults (>60 years) who have both an anatomic diagnosis of stenosis confirmed by diagnostic imaging, and signs/symptoms consistent with a clinical diagnosis of lumbar spinal stenosis confirmed by clinical examination. Eligible subjects will be randomized into one of three pragmatic treatment groups: 1) usual medical care; 2) individualized manual therapy and rehabilitative exercise; or 3) community-based group exercise. All subjects will be treated for a 6-week course of care. The primary subjective outcome is the Swiss Spinal Stenosis Questionnaire, a self-reported measure of pain/function. The primary objective outcome is the Self-Paced Walking Test, a measure of walking capacity. The secondary objective outcome will be a measurement of physical activity during activities of daily living, using the SenseWear Armband, a portable device to be worn on the upper arm for one week. The primary analysis will use linear mixed models to compare the main effects of each treatment group on the changes in each outcome measure. Secondary analyses will include a responder analysis by group and an exploratory analysis of potential baseline predictors of treatment outcome. Discussion Our study should provide evidence that helps to inform patients and providers about the clinical benefits of three non-surgical approaches to the management of lumbar spinal stenosis symptoms. Trial registration ClinicalTrials.gov identifier: NCT01943435
    Chiropractic and Manual Therapies 05/2014; 22(1):19. DOI:10.1186/2045-709X-22-19
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    • "Participants were eligible to take part in the study if (1) they answered " yes " to the question: " Have you EVER been told by a doctor or other health care professional that you have some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia? " (this question uses the CDC definition of arthritis and is used in the BRFSS) [17]; (2) they reported at least one symptom of arthritis (joint pain, stiffness, tenderness, decreased range of motion, redness and warmth, deformity, crackling or grating, and fatigue); (3) they were 18 years of age or older; (4) they are not diabetic and taking insulin; (5) they did not have uncontrolled hypertension; (6) they were able to participate in PA (as measured by the Physical Activity Readiness Questionnaire (PAR-Q)) [18]; (7) they were sufficiently inactive at the time of enrollment (defined as engaging in <3 days per week of at least 30 minutes of aerobic activity and <2 days per week of at least 20 minutes of strength training). Participants were ineligible if (1) they had a fall in the past year that required medical assistance; (2) they were pregnant, breastfeeding, or planning to become pregnant in the next year (women); (3) they were a diabetic and taking insulin; (4) they could not walk longer than 3 minutes without taking a rest; (5) they could not stand without assistance for more than 2 minutes; (6) they could not sit in chair without arms for more than 5 minutes; (7) they were already physically active (aerobic activities ≥3 days/week for ≥30 minutes/day or strength training ≥3 days/week for ≥20 minutes/day). "
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    ABSTRACT: Arthritis and obesity, both highly prevalent, contribute greatly to the burden of disability in US adults. We examined whether body mass index (BMI) was associated with physical function and health-related quality of life (HRQOL) measures among adults with arthritis and other rheumatic conditions. We assessed objectively measured BMI and physical functioning (six-minute walk, chair stand, seated reach, walking velocity, hand grip) and self-reported HRQOL (depression, stiffness, pain, fatigue, disability, quality of life-mental, and quality of life, physical) were assessed. Self-reported age, gender, race, physical activity, and arthritis medication use (covariates) were also assessed. Unadjusted and adjusted linear regression models examined the association between BMI and objective measures of functioning and self-reported measures of HRQOL. BMI was significantly associated with all functional (Ps ≤ 0.007) and HRQOL measures (Ps ≤ 0.03) in the unadjusted models. Associations between BMI and all functional measures (Ps ≤ 0.001) and most HRQOL measures remained significant in the adjusted models (Ps ≤ 0.05); depression and quality of life, physical, were not significant. The present analysis of a range of HRQOL and objective measures of physical function demonstrates the debilitating effects of the combination of overweight and arthritis and other rheumatic conditions. Future research should focus on developing effective group and self-management programs for weight loss for people with arthritis and other rheumatic conditions (registered on clinicaltrials.gov: NCT01172327).
    12/2013; 2013(60):190868. DOI:10.1155/2013/190868
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