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NIH Record

Arthritis Briefing Examines Growing Costs of Disability

By Barbara Weldon

"An explosion of science is having an impact on arthritis research, and these new findings will ultimately benefit the patient," said NIAMS director Dr. Stephen I. Katz, at the opening of a recent science writers briefing at NIH. Cosponsored by NIAMS, NIAID, the American College of Rheumatology and the Arthritis Foundation, the briefing was part of the first biennial Arthritis Research Conference that brought together established researchers and young investigators to discuss their findings.

"New information from the research bench will ultimately be translated into better diagnosis and better treatment for patients with rheumatic disease," said Dr. William Koopman, president of the American College of Rheumatology. Rheumatic diseases affect more than 40 million Americans, and by the year 2020 it is estimated that 60 million Americans will have some form of arthritis, he said.

Participants in the arthritis briefing are (from l) Drs. John McGowan, Stephen Katz, William Koopman and Doyt Conn.

Debra Lappin of the Arthritis Foundation said arthritis is not just minor aches and pains, but a major public health issue. "It affects people of all ages and is the leading cause of disability in the nation today," she said. "The estimated cost of arthritis in medical expenses and lost wages is about $64 billion each year." Noting that people with arthritis need early aggressive therapy, referral to a specialist, and accurate information about their disease, Lappin stressed the importance of patient self-management and emphasized research results dispelling the myth that people with arthritis shouldn't exercise.

Relating her personal experience with rheumatoid arthritis-related employment difficulties, Dr. Saralynn Allaire of Boston University said arthritis is the leading cause of work loss in working-age people and the second leading cause of Social Security disability payment. A former nurse, she had to change occupations to keep working.

Allaire added that studies have identified many risk factors associated with arthritis-related work disability, including physical demands of the job, ability of the worker to control pace of work, self confidence in work ability, degree of physical limitation, and age. "Early medical and vocational rehabilitation treatments may reduce work disability and enable the person to keep [his or her] job," she said, although this still needs to be tested.

"Most people are not aware that chronic conditions such as arthritis and musculoskeletal disorders account for three out of every four deaths in the United States," said Dr. Matthew Liang of Brigham and Women's Hospital. Studies have shown that patients with arthritis may have improved quality of life from exercise and self-help courses, he said. These methods have been shown to reduce health costs, which is becoming more important in planning health care for individuals with arthritis. "For people with chronic disease, psychological and social factors and health policy are powerful determinants of their ability to maintain independence and general health," he said.

Dr. Peter Lipsky of the University of Texas Southwestern Medical Center said rapidly identifying genes involved in disease and studying their biology can generate new treatments for patients. He said when arthritis patients see a doctor, their primary concern is pain. The doctor will usually prescribe a nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen to suppress the inflammation and pain. "NSAIDs are probably the largest selling drugs in the world and are taken by 15 to 30 million Americans," he said. However, "between 2 and 4 percent of all patients taking NSAIDs will have a major gastrointestinal problem that may put them in the hospital."

Lipsky said researchers have discovered an inhibitor of inflammation and pain that has very few side effects. Called a COX-2 inhibitor, this substance affects the COX-2 enzyme that is only expressed in the body when you have inflammation. NSAIDs block the action of COX-2, but also inhibit a related enzyme, COX-1, which helps protect the stomach lining from irritation.

Summarizing themes from the conference, Koopman concluded, "New information holds great promise for future therapeutic targets, better understanding, and ultimately better health for the patient."

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