The prevalence and impact of arthritis in older persons

Association between combined exposure to dioxins and arthritis among US adults: a cross-sectional study

Dioxins and dioxin-like compounds (DLCs) are common pollutants hazardous to human health. We applied 12 dioxins and DLCs data of 1851 participants (including 484 arthritis patients) from National Health Examination Survey (NHANES) 2001-2004 and quadrupled them into rank variables. Multivariate logistic regression, weighted quantile sum (WQS) regression, and Bayesian kernel machine regression (BKMR) models were used to explore the relationship between individual or mixed exposure to the pollutants and arthritis after adjusting for multiple covariates. In multivariable logistic regression with an individual dioxin or DLC, almost every chemical was significantly positively associated with arthritis, except PCB66 (polychlorinated biphenyl 66) and 1,2,3,4,6,7,8-heptachlorodibenzofuran (hpcdf). The WQS model indicated that the combined exposure to the 12 dioxins and DLCs was positively linked to arthritis (OR: 1.884, 95% CI: 1.514-2.346), with PCB156 (weighted 0.281) making the greatest contribution. A positive trend between combined exposure and arthritis was observed in the BKMR model, with a posterior inclusion probability (PIP) of 0.987 for PCB156, which was also higher than the other contaminants.

Disability Among Older Adults in South-Eastern Nigeria

Disability is a common reason for the loss of independence. There is a dearth of data on older adults with disability in south-eastern Nigeria. Using a multistage sampling technique and disability indexes, we assessed 816 persons aged 65 years and above living with a disability. While respondents' experiences of abuse and property inheritance differ by gender, they have poor health status. Elevated risks of disability were associated with gender, increased age, education, smoking, alcohol use, and engagement in physical exercise. Findings suggest urgency in formulating and implementing ageing welfare policy in this African community undergoing demographic and social changes. While this is underway, we recommend a massive health promotion among older adults in this community. We also suggest the integration of courses on ageing in schools' curriculum since ageing is a life course phenomenon. This in the long run would provide ageing-friendly education that averts old age's deleterious effects.

Changes in Health, Functional and Psychosocial Status and Coping Strategies of Home-Based Older Persons with Arthritis over Three Years

The population of persons over 65 years of age, both in simple headcount and in proportion of the total population of the United States, has been increasing dramatically since 1900. This trend is projected to continue at least until the middle of the next century. Approximately half of persons over 65 years of age experience pain and/or activity limitation as a result of arthritis. There has been little study of the changes over time in health, functional, and psychosocial status of elders with arthritis, nor of the coping strategies they employ. Using participants from the University at Buffalo Consumer Assessments Study, we retrospectively selected 61 cognitively intact Mini Mental Status Exam (MMSE>23) elders with arthritis that impacted on activities, who were living at home at an initial interview and at a three-year follow-up interview. Using paired ṯ-tests we found significant changes at the three-year follow-up in four measures of health status: number of medications, number of chronic illnesses, pain, and vision. Functional status declined significantly as measured by the FIM (using MANOVA for six sections of the FIM), the Sickness Impact Profile, and the IADL section of the OARS (using paired ṯ-tests). No significant changes were found for psychosocial status. Using MANOVA, we found a significant increase in numbers of assistive devices owned (from an initial mean of 14.7 to a three-year follow-up mean of 20.1), and number of devices used. Satisfaction with devices was high. Environmental problems in the home showed a significant increase over the three years. While our selection of study participants did not include individuals who went to nursing homes or hospitals, or who had died, we still found significant decline in health and functional status, and clear evidence of successful coping strategies. Results suggest a strong role for occupational therapy services for elders with arthritis. There is also a need for change in policy toward home modification and occupational therapy services.

Pharmacist-initiated intervention trial in osteoarthritis: a multidisciplinary intervention for knee osteoarthritis

OBJECTIVE

Knee osteoarthritis (OA) is a commonly undiagnosed condition and care is often not provided. Pharmacists are uniquely placed for launching a multidisciplinary intervention for knee OA.

METHODS

We performed a cluster randomized controlled trial with pharmacies providing either intervention care or usual care (14 and 18 pharmacies, respectively). The intervention included a validated knee OA screening questionnaire, education, pain medication management, physiotherapy-guided exercise, and communication with the primary care physician. Usual care consisted of an educational pamphlet. The primary outcome was the pass rate on the Arthritis Foundation's quality indicators for OA. Secondary outcomes included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Lower Extremity Function Scale (LEFS), the Paper Adaptive Test-5D (PAT-5D), and the Health Utilities Index Mark 3 (HUI3).

RESULTS

One hundred thirty-nine patients were assigned to the control (n = 66) and intervention (n = 73) groups. There were no differences between the groups in baseline measures. The overall quality indicator pass rate was significantly higher in the intervention arm compared to the control arm (difference of 45.2%; 95% confidence interval 34.5, 55.9). Significant improvements were observed for the intervention care group as compared to the usual care group in the WOMAC global, pain, and function scores at 3 and 6 months (all P < 0.01); the PAT-5D daily activity scores at 3 and 6 months (both P < 0.05); the PAT-5D pain scores at 6 months (P = 0.05); the HUI3 single-attribute pain scores at 3 and 6 months (all P < 0.05); and the LEFS scores at 6 months (P < 0.05).

CONCLUSION

Pharmacists can launch a multidisciplinary intervention to identify knee OA cases, improve the utilization of treatments, and improve function, pain, and quality of life.

Time-varying nature of risk factors for the longitudinal development of disability in older adults with arthritis

Background

To investigate changes over time in risk factors for the development of Activities of Daily Living (ADL) disabilities in older adults with arthritis.

Methods

The data were obtained from the Longitudinal Survey of Health and Living Status of the Elderly in Taiwan (1989–1999). The major analytic cohort comprised 977 older adults (458 men and 519 women) with arthritis and without ADL limitation at study baseline. A generalized estimating equations (GEE) model was used to analyze all temporally correlated errors, population-averaged estimates, and longitudinal relationships.

Results

Overall, the cumulative incidence of ADL disability in the analytic cohort was 17.4% during an observation period of 11 years. With respect to baseline risk, ADL disability was associated with older age, presence of comorbid chronic conditions, and poor self-rated health. However, the findings changed after accounting for the time-varying nature of risk factors and the temporal sequence of possible cause-and-effect relationships. In addition to the baseline predictors, a high score on the Center for Epidemiologic Studies Depression Scale, lack of regular exercise, and becoming widowed were associated with an increased risk of ADL disability and a decreased chance of recovery.

Conclusions

An understanding of the time-varying nature of risk factors for the disabling process is essential for the development of effective interventions that aim to maintain functional ability and prevent limitations among older adults with arthritis.

After patients are diagnosed with knee osteoarthritis, what do they do?

OBJECTIVE

To learn more about the health services and products that patients use after receiving a diagnosis of knee osteoarthritis (OA), as well as the trajectory of their health-related quality of life (HRQOL).

METHODS

Using a simple screening survey, community pharmacists identified 194 participants with previously undiagnosed knee OA. Of these participants, 190 were confirmed to have OA on further investigation. At baseline and 1, 3, and 6 months after diagnosis, a survey was administered to assess health services, product use, and HRQOL, including the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Medical Outcomes Study Short Form 36 (SF-36) health survey, the Paper Adaptive Test (PAT-5D-QOL), and the Health Utilities Index Mark 3.

RESULTS

With a mean age of 63 years, participants were mostly women, white, and overweight. By 6 months, more than 90% of the participants had visited their family physician to discuss their OA, and more than 50% of participants took either prescription or nonprescription analgesics. In addition, three-quarters of the participants started exercising, one-third initiated activity aids, and one-third had started natural medicine products. At 6 months compared with baseline, significant improvements were seen in the SF-36 physical component summary (P = 0.001) and bodily pain domain scores (P = 0.02), the PAT-5D-QOL overall, pain, and usual daily activities scores (P < 0.001 for all), and the WOMAC total, pain, and function scores (P < 0.001 for all).

CONCLUSION

Within 6 months of receiving a diagnosis of knee OA, participants made several lifestyle interventions, often without the advice of a health professional, and saw improvements in their pain and function.

Improving osteoarthritis detection in the community: pharmacist identification of new, diagnostically confirmed osteoarthritis

OBJECTIVE

Osteoarthritis (OA) is the most common arthritis and a leading cause of disability. Many persons with knee OA are not diagnosed and not referred for treatment. Therefore, identification of patients with knee pain who have undiagnosed OA needs to be improved. Our objective was to determine if pharmacists, using a simple screening questionnaire, can identify individuals with previously undiagnosed knee OA.

METHODS

Patients with knee pain and no previous diagnosis of knee OA were recruited by community pharmacists who used a simple questionnaire (<10 minutes to complete) to determine likelihood of knee OA. Patients who were likely to have knee OA were referred for a standardized knee examination and radiograph.

RESULTS

Of the 411 patients screened by pharmacists, 274 were eligible. Of these, 44 declined, 35 were ineligible (18 had a previous OA diagnosis,16 had other inflammatory conditions, and 1 was excluded for other reasons), and 1 died. The remaining 194 were mostly female (62%) with a mean age of 62 years and were mostly white (86%). Body mass index (BMI) was classified as normal (18.5-24.9 kg/m(2)) in 29%, overweight (25.0-29.9 kg/m(2)) in 45%, and obese (>30.0 kg/m(2)) in 26%. Of those examined, 190 (98%) of 194 met the American College of Rheumatology clinical criteria for knee OA. The radiographic results revealed that most participants likely had mild OA.

CONCLUSION

Pharmacists administering a simple screening questionnaire can identify >80% of patients with knee pain who have undiagnosed knee OA. Based on radiographs and BMI, much of this OA is early and may be amenable to intervention.

Molecular basis for skeletal variation: insights from developmental genetic studies in mice

Skeletal variations are common in humans, and potentially are caused by genetic as well as environmental factors. We here review molecular principles in skeletal development to develop a knowledge base of possible alterations that could explain variations in skeletal element number, shape or size. Environmental agents that induce variations, such as teratogens, likely interact with the molecular pathways that regulate skeletal development.

Relationship of limb length inequality with radiographic knee and hip osteoarthritis

OBJECTIVE

This study examined the relationship of limb length inequality (LLI) with radiographic hip and knee osteoarthritis (OA) in a large, community-based sample.

METHODS

The total study group comprised 926 participants with radiographic knee OA, 796 with radiographic hip OA, and 210 (6.6%) with LLI >or=2cm. The presence of radiographic OA was defined as Kellgren/Lawrence (K/L) grade >or=2. Multiple logistic regression models were used to examine the relationship of LLI with hip and knee OA, while controlling for age, gender, race, body mass index, and history of hip or knee problems (joint injury, fracture, surgery, or congenital anomalies).

RESULTS

In unadjusted analyses, participants with LLI were more likely than those without LLI to have radiographic knee OA (45.1% vs 28.3%, P<0.001) and radiographic hip OA (35.2% vs 28.7%, P=0.063). In multiple logistic regression models, knee OA was significantly associated with presence of LLI (adjusted Odds Ratio [aOR]=1.80, 95% Confidence Interval [95% CI] 1.29-2.52), but there was no significant relationship between hip OA and LLI (aOR=1.20, 95% CI 0.86-1.67). Among participants with LLI, right hip OA was more common when the contralateral limb was longer than when the ipsilateral limb was longer (30.3% vs 17.5%, P=0.070).

CONCLUSION

LLI was associated with radiographic knee OA, controlling for other important variables. Future research should examine the relationship of LLI with hip or knee OA incidence, progression, and symptom severity, as well as the efficacy for LLI corrective treatments in OA.

Profile of arthritis disability: II

OBJECTIVE

Arthritis is the most common chronic condition and the most common cause of disability among older US adults. We studied social participation, disabilities in many life domains, accommodations used (buffers), and accommodations needed (barriers) for US adults with arthritis disability compared with adults with disability from other conditions.

METHODS

The data source is the National Health Interview Survey Disability Supplement Phase Two. Arthritis-disabled individuals named arthritis as the main cause of > or =1 disabilities. Other-disabled individuals named only other conditions as causes of their disabilities. We compared outcomes for the groups, taking sample weights and complex variances into account.

RESULTS

Arthritis-disabled individuals get out and about less often than other-disabled individuals, but they manage to maintain active social ties. They have more disabilities of all types (personal care, household management, physical tasks, transportation, home, work), and the disabilities often cause fatigue, long task time, and pain. Despite this, arthritis-disabled individuals use less personal assistance than other-disabled individuals; they do use more equipment assistance. Arthritis-disabled individuals report more barriers in getting around outside their home and at their workplace.

CONCLUSION

The distinctive profile of arthritis disability includes extensive and uncomfortable disabilities, yet there are active management strategies to handle these disabilities. Problems away from home and at work should inspire engineers and planners to improve public access and equipment for persons with this high-prevalence disability.

Measuring quality in arthritis care: methods for developing the Arthritis Foundation's quality indicator set

OBJECTIVE

To develop a comprehensive set of explicit process measures to assess the quality of health care for osteoarthritis, rheumatoid arthritis, and analgesics use.

METHODS

Potential quality measures and a summary of existing data to support or refute the relationship between the processes of care proposed in the indicators and relevant clinical outcomes were developed through a comprehensive literature review. The proposed measures and literature summary were presented to a multidisciplinary panel of experts in arthritis and pain. Using a modification of the RAND/UCLA Appropriateness Method, the panel rated each proposed measure for its validity as a measure of health care quality.

RESULTS

Among 66 proposed indicators, the expert panel rated 51 as valid measures of health care including 14 for osteoarthritis, 27 for rheumatoid arthritis, and 10 for analgesics use.

CONCLUSIONS

Sufficient scientific evidence and expert consensus exist to support a comprehensive set of measures to assess the quality of heath care for osteoarthritis, rheumatoid arthritis, and analgesics use. These measures can be used to gain an understanding of the quality of care for patients with arthritis.

Positive affect and disability among older Mexican Americans with arthritis

OBJECTIVE

To examine the relationship between positive affect and subsequent functional disability in older Mexican Americans with self-reported physician-diagnosed arthritis.

METHODS

We conducted a 2-year prospective cohort study using a population-based sample of 1,084 noninstitutionalized Mexican American subjects aged > or =65 years residing in 5 southwestern states. Measures included self-reported diagnoses of various medical conditions, functional ability, body mass index, and ratings of positive and negative affect.

RESULTS

For 937 subjects with arthritis who reported no limitations in activities of daily living (ADLs) at baseline, 697 remained ADL independent, 84 became ADL dependent, 41 died, and 115 were lost to followup 2 years later. There was a significant association between high positive affect (score = 12) and reduced risk of ADL disability 2 years later, controlling for baseline sociodemographic variables, medical conditions, and negative affect (odds ratio 0.46, 95% confidence interval 0.22-0.94). There was an interaction effect between positive affect and sex, with positive affect having a larger effect in reducing risk of ADL dependence in men than in women.

CONCLUSION

High positive affect was associated with lower incidence of ADL disability in older Mexican Americans with self-reported physician-diagnosed arthritis. The strength of the positive affect is stronger in men than in women.

The Impact Of Drug Coverage On COX-2 Inhibitor Use In Medicare

Passage of the Medicare drug benefit legislation has renewed attention to the relationship between drug coverage and medication use. This study assesses the impact of drug coverage on COX-2 inhibitor use among elderly people with osteoarthritis, taking into account risk for adverse gastrointestinal events. COX-2 use among aged beneficiaries with the most generous coverage was twice that of those with no third-party coverage. COX-2 use also increased with increasing gastrointestinal risk. However, this risk differential in COX-2 use disappears among those with the most generous coverage. Potential overuse of costly medications should be addressed as the Medicare drug benefit is being phased in.

Racial disparities in joint replacement use among older adults

BACKGROUND

Although joint replacement can restore function for arthritis patients with severe joint disease, this procedure has not been used equally across racial groups. Differences in joint replacement use are assessed from a national sample.

OBJECTIVE

This study evaluates the role of health conditions and economic access to explain differences in joint replacement among older black and Hispanic minorities relative to white persons.

DESIGN

Longitudinal (1993-1995) Asset and Health Dynamics Among the Oldest Old (AHEAD) study.

SETTING

National probability sample of US community-dwelling older adults.

PATIENT POPULATION

AHEAD participants (n = 6159) aged 69 to 103 years.

MEASUREMENTS

The outcome is subject-reported 2-year use of any arthritis-related joint-replacement. Independent variables are demographics, health needs (arthritis, other medical conditions, functional health), and economic access (income, assets, education, and health insurance).

RESULTS

Older minorities reported arthritis-related joint replacements (black: 0.98%; Hispanic: 0.97%, annually) less frequently compared with white persons (1.48% annually). Older minorities were significantly less likely to use joint replacement compared with white persons (OR, 0.37; 95% CI, 0.20, 0.71) controlling for demographics, and arthritis and other health needs. Disparities remained significant (OR, 0.46; 95% CI, 0.22, 0.98) after additionally controlling for economic medical access. Use was lower among people who depended solely on Medicare compared with those with supplemental health insurance (OR, 0.46; 95% CI, 0.22, 0.95).

CONCLUSIONS

These national data document low rates of arthritis-related joint replacement among older Hispanic persons comparable to black persons. Less use among older minorities compared with white persons is not explained by differences in health needs or economic access. Other cultural and attitudinal factors merit investigation to explain disparities.

Why do older adults decide they are having difficulty with a task?

OBJECTIVE

Previous studies have identified risk factors for decline in physical function, but they have not examined specific reasons older adults report difficulty with mobility tasks.

DESIGN

Community-dwelling people ( n = 160) aged 59 yr and older in an observational cohort study were questioned to determine the most common cited reasons for self-reported difficulty in task performance.

RESULTS

Mobility tasks were most often reported to be difficult (66%). The reasons cited for difficulty in low exercise tolerance tasks were task modification by method (33%) and rate (33%). For high exercise tolerance tasks, reasons cited included having to modify the rate of performing the task (20%) or the method (13%). Among those who reported difficulty with low exercise tolerance mobility tasks, >80% reported modification (odds ratio, 46.4 [95% confidence limits: 9.75, 220.51]) and 32% also report frequency change (odds ratio, 5.9 [95% confidence limits: 2.72, 12.85]) as the reason for perceiving difficulty. For those who reported difficulty performing high exercise tolerance-demanding tasks, >90% reported modification (odds ratio, 5.5 [95% confidence limits: 2.05, 14.88]) and 61% also report frequency changes (odds ratio, 3.9 [95% confidence limits: 1.93, 8.04]).

CONCLUSION

The findings suggest that people are able to cite specific reasons for difficulty with mobility task performance, most commonly related to task modification.

Efficacy and safety of a once-daily morphine formulation in chronic, moderate-to-severe osteoarthritis pain: results from a randomized, placebo-controlled, double-blind trial and an open-label extension trial

A randomized, 4-week, double-blind trial followed by an open-label extension trial assessed the efficacy and safety of a once-daily, extended-release morphine formulation (Avinza (previously referred to as Morphelan)) in 295 patients with chronic, moderate-to-severe osteoarthritis pain who had failed to obtain adequate pain relief with NSAIDs and acetaminophen. Participants received one of four treatments: Avinza 30 mg once daily (QAM or QPM), MS Contin(R) 15 mg twice daily, or placebo twice daily. Patients (n =181) received Avinza QAM or QPM during the 26-week open-label extension trial and could increase their dose to optimize pain control. Avinza and MS Contin reduced pain and improved several sleep measures versus placebo. Analgesic efficacy was comparable between Avinza and MS Contin; however, Avinza QAM demonstrated greater improvements in overall quality of sleep. The most common adverse events were constipation and nausea. The majority of AEs occurred at a similar incidence among the active treatment groups.

Compliance among pharmacies in California with a prescription-drug discount program for Medicare beneficiaries

BACKGROUND

Several states have developed prescription-drug discount programs for Medicare beneficiaries. In California, Senate Bill 393, enacted in 1999, requires pharmacies participating in the state Medicaid program (Medi-Cal) to charge customers who present a Medicare card amounts based on Medi-Cal rates. Because Medicare beneficiaries may not be accustomed to presenting their Medicare cards at pharmacies, we assessed the compliance of pharmacies with Senate Bill 393.

METHODS

Fifteen Medicare beneficiaries who received special training and acted as "standardized patients" visited a random sample of pharmacies in the San Francisco Bay area and Los Angeles County in April and May 2001. According to a script, they asked for the prices of three commonly prescribed drugs: rofecoxib, sertraline, and atorvastatin. The script enabled us to determine whether and when, during their interactions with pharmacists or salespeople, the discounts specified in Senate Bill 393 were offered. Pharmacies at which the appropriate discounts were offered were considered compliant.

RESULTS

The patients completed visits to 494 pharmacies. Seventy-five percent of the pharmacies complied with the prescription-drug discount program; at only 45 percent, however, was the discount offered before it was specifically requested. The discount was offered at 91 percent of pharmacies that were part of a chain, as compared with 58 percent of independent pharmacies (P<0.001). Compliance was higher in the San Francisco Bay area than in Los Angeles County (84 percent vs. 72 percent, P=0.004) and was higher in high-income than low-income neighborhoods (81 percent vs. 69 percent, P=0.002). A Medicare beneficiary taking all three drugs would have saved an average of $55.70 per month as compared with retail prices (a savings of 20 percent).

CONCLUSIONS

Discounts required under California's prescription-drug discount program for Medicare beneficiaries offer substantial savings. Many patients, however, especially those who use independent pharmacies or who live in low-income neighborhoods, may not receive the discounts.

Swing phase mechanics of healthy young and elderly men

This study examined the effect of ageing on the swing phase mechanics of young and elderly gait. Sagittal plane marker trajectories and force plate data were collected while 10 young (24.9+/-0.9 years) and eight elderly (68.9+/-0.4 years) subjects walked at their preferred walking speeds. Comparison between young and elderly gait was made for a range of spatial-temporal, kinematic and kinetic variables with emphasis given to identifying possible differences at toe-off, minimum metatarsal-phalangeal joint clearance and heel contact. In order to control for the confounding effect of gait velocity on the dependent variables, a multivariate analysis of covariance was used to identify differences between the young and elderly subjects due to age. In contrast to studies that have reported lower preferred walking speeds in the elderly compared to the young [J.O. Judge, R.B. Davis III, S. Ounpuu, Step length reductions in advanced age: the role of ankle and hip kinetics, Journal of Gerontology: Medical Sciences 51 (1996) M303-312; D.C. Kerrigan, M.K. Todd, U. Della Croce, L.A. Lipsitz, J.J. Collins, Biomechanical gait alterations independent of speed in the healthy elderly: evidence for specific limiting impairments, Archives of Physical and Medical Rehabilitation 79 (1998) 317-322], no differences in walking speed nor in the spatial-temporal variables that determine walking speed were detected. The elderly were however, found to have a greater hip extension moment at the time of minimum metatarsal-phalangeal joint clearance, and a significantly higher anterior-posterior velocity heel contact velocity that was linked to a significantly higher shank and foot angular velocity at heel contact. Since many gait variables are highly correlated with walking speed [C. Kirtley, M.W. Whittle, R.J. Jefferson, Influence of walking speed on gait parameters, Journal of Biomechanical Engineering 7 (1985) 282-288; D.A. Winter, Biomechanical motor patterns in normal walking, Journal of Motor Behaviour 15 (1983) 302-330], differences between young and elderly gait found in the present study may therefore be attributed to ageing, rather than a secondary effect of differences in gait velocity.

Have we oversold the benefit of late-life exercise?

BACKGROUND

Increasing exercise among older adults to improve function and prevent or decrease disability is widely promoted in developed countries. This review seeks to critically evaluate the degree to which existing scientific evidence supports these claims.

METHODS

A literature review was performed in Medline and Best Evidence databases for the years 1985 to 2000. Experimental and quasi-experimental aerobic and resistance exercise interventions were reviewed for impairment, function, and disability outcomes. The impact of exercise on specific impairments, functions, and disabilities was examined by summarizing the findings reported across all studies.

RESULTS

Thirty-one studies were identified. Impairment and functional outcomes were reported in 97% and 81% of the studies, respectively; half of the studies examined disability outcomes. The most consistent positive effects of late-life exercise were observed in strength, aerobic capacity, flexibility, walking, and standing balance, with over half of the studies that examined these outcomes finding positive effects. Of the studies that examined physical, social, emotional, or overall disability outcomes, most found no improvements. In the five studies that reported reduced physical disability, the effect sizes ranged from .23 to .88.

CONCLUSIONS

Late-life exercise clearly improves strength, aerobic capacity, flexibility, and physical function. Existing scientific evidence, however, does not support a strong argument for late-life exercise as an effective means of reducing disability. This may be due, in part, to methodological limitations in studies that have examined disability outcomes. On the other hand, the theoretical basis of interventions aimed at reducing disability may need to extend beyond exercise and address behavioral and social factors.

The burden of arthritis and nonsteroidal anti-inflammatory treatment. A European literature review

The purpose of this literature review is to summarise data available from publications describing the burden of osteoarthritis and rheumatoid arthritis in Europe, and to highlight gaps in the literature. On the basis of extensive literature research, the epidemiology of arthritis, its treatment costs, and iatrogenic costs related to nonsteroidal anti-inflammatory drug (NSAID) treatments are described, differentiating results by country. The review shows that, as well as having a significant impact on healthcare budgets, arthritis also affects patients and caregivers. For those countries where data were available, indirect costs were found to be of comparable magnitude to direct costs. Additionally, it was found that the iatrogenic costs related to the treatment of NSAID-induced adverse events are a significant component of the total costs of arthritis. The number of publications on the burden of arthritis in Europe is rather small in comparison with what is available for the US. Comparison of national results shows wide variations between countries, which may be partly due to discrepancies in the methodology applied to estimate the burden of arthritis, the cost items included in the analysis, and the data sources used to gather cost information. Additionally, comparing the burden of arthritis by country across Europe is difficult because of the variety of ways in which results are presented, e.g. on a per-patient basis, or for the whole population. To better understand the burden of illness of arthritis in Europe, not only is more research required, but the methodology to be applied in burden-of-illness analyses must also be standardised.

Gender differences in the risk of developing disability among older adults with arthritis

OBJECTIVES

Although older women are disabled from arthritis at higher rates than men, there is an inadequate understanding of the factors that place women at higher risks. The purpose of this research is to improve understanding of gender differences in the process of becoming disabled among older adults with arthritis.

METHODS

Gender differences in risk factors associated with developing a disability during a 30-month period are examined among a sample of noninstitutionalized elders with arthritis (N = 749).

RESULTS

Results from discrete time-hazard models indicate that sociodemographic factors account for gender differences in disability with activities of daily living (ADLs). However, for difficulties performing instrumental activities of daily living (IADLs), gender differences remain unexplained by variations in demographic and health factors.

DISCUSSION

More descriptive and explanatory work needs to focus on gender differences in IADL disability; however, these findings suggest that the gendered nature of the IADL tasks influences gender differences in IADL disability.

Estrogen replacement therapy and incidence of self-reported physician-diagnosed arthritis

BACKGROUND

This longitudinal study examined the association between use of estrogen replacement therapy and incidence of self-reported, physician-diagnosed arthritis.

METHODS

Data of 2,416 postmenopausal women who participated in the National Health and Nutrition Examination Survey Epidemiological Follow-Up Study were used in this study. Women, free of self-reported arthritis at entry into study and for 3 years thereafter, were questioned about use of estrogen and physician-diagnosed arthritis at each of the follow-up waves of study. Proportional hazard regression models were used for the analysis.

RESULTS

Use of ERT was found to be associated with higher risk of incident arthritis, after adjusting for potential confounders (RR = 1.61, CI 1.37-1.89). Whenever use of ERT was replaced by duration of use in the regression model, ERT users for a year or less significantly increased their risk of incident arthritis (RR = 1.37, CI 1.07-1.74). The risk increased by 30 and 96% with hormone use for 1 to 4 and 4 to 10 years, respectively, and by 104% with hormone use for 10 or more years.

CONCLUSION

Results suggest that users of ERT were at higher risk of developing arthritis and the longer the use of the hormone, the higher the risk.

Recruiting adults with osteoarthritis into an aquatic exercise class: strategies for a statewide intervention

OBJECTIVE

Although research suggests that regular exercise can be helpful in reducing the dysfunction and discomfort of osteoarthritis, promoting exercise among older adults within this population is neither straightforward nor easily accomplished. This article describes the various methods, and their relative success rates, that were employed to recruit older adults throughout the state of Washington into an aquatic exercise program.

METHODS

Strategies included a recruitment letter distributed to Arthritis Foundation (AF) members in Washington state, local media news coverage, physician referrals, and advertisements in local papers and newsletters.

RESULTS

The most successful methods for enrolling participants were through the AF recruitment letters and local television coverage. The AF recruitment letter was the most expensive method of generating responses, while the television coverage was the least expensive.

CONCLUSIONS

Collaborating with a well-reputed community-based organization and capitalizing on available publicity resources are important strategies researchers can use to gain access to a difficult and geographically dispersed population.