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Show Approximately one of every six Americans has been diagnosed with arthritis, and it is the leading cause of disability (CDC, 2001). In Utah, approximately one of every five residents over the age of 18 has been diagnosed with arthritis. Importantly, many Utah adults with arthritis have not been diagnosed and therefore are not being treated by a physician for these conditions. When these individuals are considered with those who have been diagnosed, it is estimated that nearly one of every three Utah residents over the age of 18 have arthritis. While these numbers may seem high, they are in line with national data and the data being reported from other states. There are effective interventions for arthritis that may serve as adjuncts to conventional medical therapy, but these interventions appear to be greatly underutilized. As discussed in more detail in the introduction, one of the most promising, longest-evaluated, and yet underutilized interventions is the Arthritis Self-Help Course (ASHC). This course has been shown to reduce pain, increase self-efficacy, and save money (Kruger et al., 1998). Other effective interventions for the treatment and reduction of arthritis-related symptoms focus on increased physical activity. These interventions have shown that physical activity may decrease joint pain, increase self-efficacy, improve the general perception of health in individuals with arthritis (Rejeski et al., 1998) and improve joint function including passive range of motion (Petrella and Bartha, 2000). The magnitude of arthritis prevalence and burden, the fact that there are effective yet underutilized interventions, and the fact that many with arthritis are undi-agnosed and perhaps untreated clearly support the need for a public health approach to addressing the burden of arthritis in the United States. There are several potential caveats in the study of arthritis that should be addressed. Perhaps most important among these is that there are many case definitions for arthritis. Arthritis means inflammation of a joint, usually accompanied by pain, swelling, and changes in structure. Rheumatism is a term for acute and chronic conditions characterized by inflammation, muscle soreness and stiffness, and pain in joints and associated structures. Clinically, arthritis comprises over 100 separate conditions and diseases. Also, different levels of severity of the disease (mild, moderate, severe) may affect reporting, and studies of particular locations of the disease (hands, hips, wrists, knees) are difficult to join together to provide overall prevalence estimates. Additionally, the diseases may go into remission, possibly affecting prevalence estimates. Because of these factors, it may be difficult to accurately measure arthritis through surveys, and not all surveys utilize the same definition of arthritis. Therefore, readers should be aware of differences in arthritis definitions when reviewing arthritis data and should consider the implications of these definitions. It should also be noted that the findings in this report are subject to the following limitations. First, the BRFSS case definition for arthritis has not been validated. However, validation studies are under way and it is the definition currently supported by the CDC. Second, unhealthy days may be overestimated for persons who report both physical and mental unhealthy days when these days overlap. Third, because BRFSS excludes persons without telephones, those in institutions (e.g. nursing homes), and persons less than 18 years old, the prevalence rates do not represent the entire population. Also, relying on self-reporting for documenting the presence of arthritis, as is done in the BRFSS, presents limitations because many people do not know the type of arthritis they have. Therefore, studying arthritis based on this survey does not make it possible to gain accurate information about relationships between certain risk factors and specific forms of arthritis. Of particular interest is the large number of apparently undiagnosed individuals with arthritis. As noted, 29% of those with arthritis (an estimated 9% of the state's adult population) reported that they had chronic joint symptoms but had not been told by a doctor that they have arthritis. It may be inferred from this that these individuals are either not being treated for their arthritis or are self-treating. This is particularly important because there are treatments that may offset or lessen the impacts and progression of these conditions. One of the primary objectives of the Utah Arthritis Program is to utilize these data, along with information about effective treatments for arthritis, to encourage individuals with chronic joint pain to see a physician and, if appropriate, initiate treatment. The fact that arthritis is more prevalent in Utah women is consistent with national data (CDC, 2001). This finding will allow for focused efforts directed toward women. When considered together with prevalence by age data, women aged 40 to 64 become a primary target for efforts to educate about the benefits of early diagnosis and treatment for arthritis. Also, the high prevalence in those over 50 years allows for focused efforts to engage these individuals in self-help, physical activity, and related measures proven to be effective in improving outcomes related to arthritis. Nationally it appears that prevalence is higher in white individuals than in non-white individuals (CDC, 1996 No. 18). However, due to the small sample size in Hispanic and non-white Hispanic populations in Utah, this relationship remains unclear. Continued efforts will be made to further describe prevalence and risk in 18 Utah's Health: An Annual Review Volume VIII |