Editorials

Arthritis, ethics, and Editorial Board musings

Thomas C. Meyer, MD, Medical Editor, WMJ

The WMJ Editorial Board met late in October for our annual face-to-face meeting and covered a lot of ground in a short time. We were gratified to learn that the Journal has a growing core of support amongst the readership, and for that we thank all of you. Besides a favorable showing for the Journal on the Society’s recent membership survey, we were pleased to learn that there has been a steady increase in the requests for both individual articles (2000-3000 a month) and issues (5000-6000 a month) on the Society’s Web site—www.wisconsinmedicalsociety.org.


Author Affiliations: Medical Editor

Corresponding Author: Wiscosnin Medical Society 330 E. Lakeside St Madison, WI 53715

A New Era in Rheumatoid Arthritis Treatment

Jill C. Costello, MD; Paul B. Halverson, MD

Rheumatoid Arthritis (RA) is a systemic autoimmune disease that primarily manifests as a chronic symmetric polyarthritis. Treatment in the past was aimed at symptomatic pain relief. The initiation of disease modifying anti-rheumatic drugs (DMARDs) was historically started only after significant disease activity was present in order to reduce side effects from drug toxicities. Unfortunately, irreversible joint damage may occur early in the disease course. Evidence of bony destruction is common on radiographs within the first 2 years after disease onset. Therefore, more aggressive treatment became the standard with earlier introduction of DMARDs in hopes of preventing joint destruction. Within the past few years, greater understanding of the pathophysiology of RA has permitted development of therapies targeted at specific cytokines. Tumor Necrosis Factor-alpha (TNF-a) is a pro-inflammatory cytokine believed to play a key role in the inflammatory response in RA. Three drugs—etanercept, infliximab, and adalimumab—are anti-TNF-a agents approved in the United States for the treatment of RA. This article is a review of indications, clinical trials, and toxicities of these 3 agents.



Author Affiliations: Doctor Costello is a fellow in the division of Rheumatology at the Medical College of Wisconsin. Doctor Halverson is a Professor of Medicine in the division of Rheumatology at the Medical College of Wisconsin.

Corresponding Author: Please address correspondence to Jill Costello, MD, Rheumatology Associates, FMLH East Clinics-Fourth Floor, 9200 W Wisconsin Ave, Milwaukee, WI 53226; phone 414.456.7024; fax 414.456.6205; e-mail costello@mcw.edu.

Juvenile Idiopathic Arthritis: An Update

Judyann C. Olson, MD

Juvenile idiopathic arthritis (JIA) is the most common chronic arthropathy of childhood. Previous terminology identified this entity as juvenile rheumatoid arthritis. The 7 subsets of JIA identified under the new classification system are discussed, as are current treatments. A differential diagnosis of JIA is included as this condition continues to be diagnosed by exclusion. Recent studies, which discuss the outcome of adults with previous childhood arthritis, are reviewed.



Author Affiliations: Doctor Olson is with the Medical College of Wisconsin and Children’s Hospital of Wisconsin in Milwaukee, Wis. She has received funding from Amgen and Children’s Hospital Foundation.


Corresponding Author: Wisconsin Medical Society 330 E. Lakeside St Madison, WI 53715

Commentaries

Behind the scenes in arthritis care

Lynnette Horwath

If you are reading this, you probably treat patients with arthritis. The Arthritis Foundation is here to help. We provide assistance for both the medical professional and for those with any of the more than 120 forms of arthritis. The Arthritis Foundation exists to support arthritis-related efforts in Wisconsin and to fulfill our mission: taking the lead in the prevention, control and cure of arthritis and related diseases. Click here to go to the the Arthritis Foundation Wisconsin Chapter website.



Author Affiliations: Ms Horwath is Health Promotion Director at the Arthritis Foundation, Wisconsin Chapter.

Corresponding Author: Please address correspondence to Lynnette Horwath, 1650 S 108 St, West Allis, WI 53214-4021; phone 414.329.4603, ext 206; fax 414.321.0365; e-mail lhorwath@arthritis.org

The Wisconsin Arthritis Program– A new partnership to reduce the leading cause of disability

Nancy E. Chudy, MPH; Virginia Thomas, BSN, MS; Chetna Mehrotra, MPH; Peter D. Rumm, MD, MPH

The current and projected growth of the proportion of persons 65 years and older in the United States has focused attention on quality of life and independence in daily life. The maintenance of physical abilities with prevention and treatment of musculoskeletal conditions (e.g. arthritis and other rheumatic conditions, osteoporosis, chronic back conditions) is vital for preserving quality of life.



Author Affiliations: Ms Chudy, Ms Mehrotra and Doctor Rumm are with the Wisconsin Division of Public Health (DPH), Bureau of Chronic Disease Prevention and Health Promotion. Ms Chudy is an epidemiologist and program director; Ms Mehrotra is chronic disease epidemiologist; Dr

Corresponding Author: Wisconsin Medical Society 330 E. Lakeside St Madison, WI 53715

Original Research

Pain Management in Arthritis: Evidence-Based Guidelines

Sridhar V. Vasudevan, MD; Eric E. Potts, MD; Chetna Mehrotra, MPH

Pain is a complex biological, psychological, and social process and a significant factor that influences function and quality of life for individuals with arthritis. Arthritis is a generic term that describes many different and usually painful conditions, the most common of which is osteoarthritis.1,2 Despite significant advances in the understanding of pain mechanisms, many people with arthritis experience levels of acute and chronic pain that decrease their function and quality of life.2 In 2002, the American Pain Society (APS), a multidisciplinary pain organization committed to the improvement of the management and study of pain associated with many conditions, published evidence-based guidelines for management of pain in osteoarthritis, rheumatoid arthritis and juvenile chronic arthritis.2 Optimal management of individuals with arthritis, in addition to appropriate diagnosis and management of the underlying condition when possible, should address pain management. This article provides highlights of the assessment and management of individuals with pain associated with arthritis.



Author Affiliations: Doctor Vasudevan is Clinical Professor of Physical Medicine & Rehabilitation, Medical College of Wisconsin, and Clinical Professor of Orthopedics and Rehabilitation, University of Wisconsin-Madison. He was a member of American Pain Society panel on develo

Corresponding Author: Please address correspondence to Sridhar V. Vasudevan, MD, PO Box 240860, Milwaukee, WI 53224-9023.

The State of Arthritis in Wisconsin

Chetna Mehrotra, MPH, OTR; Virginia Thomas, MS; Nancy Chudy, MPH

Arthritis is the leading cause of disability and functional limitation in Wisconsin1 and trails only heart disease as the leading cause of work disability. In 2001, the estimated prevalence of arthritis/chronic joint symptoms (CJS) among US adults was 33%, representing approximately 69.9 million adults. Wisconsin has established a statewide program to address this chronic condition. Prior to its inception, no state-based arthritis surveillance was available. The Wisconsin Behavioral Risk Factor Surveillance System (BRFSS) first included questions on chronic joint symptoms and doctor-diagnosed arthritis in 2000. That data provides a baseline to describe the burden of arthritis in Wisconsin. This report summarizes the prevalence of arthritis and its distribution among Wisconsin adults. Proven public health interventions should be applied and new interventions developed to improve function, decrease pain, and delay disability among persons with arthritis, particularly those at highest risk for functional impairment and disability.



Author Affiliations: Authors are from the Bureau of Chronic Disease Prevention and Health Promotion, Division of Public Health, Wisconsin Department of Health and Family Services. Ms Mehrotra is an epidemiologist; Ms Chudy is unit supervisor; Ms Thomas is the Arthritis Progra

Corresponding Author: Please address correspondence to: Chetna Mehrotra, 1 W Wilson St, Room 218, Madison, WI 53703; phone 608.267.9007; fax 608.266.8925; e-mail mehroc@dhfs.state.wi.us.

Obesity and Physical Inactivity Among Wisconsin Adults with Arthritis

Chetna Mehrotra, MPH, OTR; Nancy Chudy, MPH; Virginia Thomas, MS

Introduction: Arthritis is the leading cause of disability in Wisconsin, and affects approximately 34%1 of Wisconsin adults. Obesity is an established risk factor for arthritis; however, the relationship between arthritis and obesity has not been well characterized at the population level in Wisconsin.

Objectives: Describe the relationship between arthritis, obesity, physical inactivity, and efforts to lose weight among Wisconsin adults. Methods: Wisconsin Behavioral Risk Factor Surveillance System 2000-2001. Arthritis was defined by either doctor diagnosis or self-reported chronic joint symptoms.

Results: Overall, 36% of respondents had arthritis. Among adults with arthritis, 28% were obese (BMI>30) compared to 16% without arthritis. The prevalence of leisure time physical inactivity was substantially higher among those with arthritis compared to those without arthritis (27.8% vs. 19.2%). Although prevalence of obesity was higher among those with arthritis, only 46% of adults with arthritis made an effort to lose weight.

Conclusions: A high proportion of adults with arthritis are obese and are physically inactive, even though studies have shown that weight loss and regular physical activity relieve arthritis symptoms. Efforts should be made to promote weight loss and physical activities among adults with arthritis.



Author Affiliations: Authors are from the Bureau of Chronic Disease Prevention and Health Promotion, Division of Public Health, Wisconsin Department of Health and Family Services. Ms Mehrotra is an epidemiologist; Ms Chudy is unit supervisor; Ms Thomas is the Arthritis Progra

Corresponding Author: Please address correspondence to: Chetna Mehrotra, 1 W Wilson St, Room 218, Madison, WI 53703; phone 608.267.9007; fax 608.266.8925; e-mail mehroc@dhfs.state.wi.us.

The Epidemiology of Agriculture-related Osteoarthritis and Its Impact on Occupational Disability

Steven Kirkhorn, MD, MPH; Robert T. Greenlee, PhD, MPH; Jonathan C. Reeser, MD, PhD

Background: Hip and knee osteoarthritis and undiagnosed chronic joint pain are more prevalent in agricultural workers than other occupational groups, significantly impacting the ability of small farm operators and farm workers to maintain a livelihood.

Methods: Agricultural risk factors, economic impacts, national and state AgrAbility data, gender, and farm/non-farm prevalence differences of arthritis and joint arthropathy in a Wisconsin farm cohort are reviewed.

Results: Agricultural workers (primarily male) are at increased risk for developing osteoarthritis of the hip and knee. In Wisconsin, the prevalence rate of osteoarthritis is higher in a male farm vs. a male rural non-farm cohort. Arthritis comprises 10%-12% of the disability referrals to state and national AgrAbility programs. Back pain, joint injury, and orthopedic injury account for another 38%. The ability to perform agricultural job duties is significantly affected by arthritis and lack of access to health care. Obesity is an additional independent risk factor for osteoarthritis in the rural population.

Conclusions: The agricultural work force is at particular risk for arthritis-related disability. Improved access to health care for diagnosis and treatment can lessen disability. Prevention of arthritis is multi-factorial, involving ergonomic improvements, lifestyle modification to prevent obesity, and adequate medical treatment of arthritis.



Author Affiliations: Doctor Kirkhorn and Dr Greenlee are with Marshfield Clinic Research Foundation, and Dr Reeser is with Marshfield Clinic, Marshfield, Wis. Doctor Kirkhorn is Medical Director of National Farm Medicine Center, a program of Marshfield Clinic Research Foundat

Corresponding Author: Steven Kirkhorn, MD, MPH, Medical Director, National Farm Medicine Center, Marshfield Clinic Research Foundation, 1000 N Oak Ave, Marshfield, WI 54449; phone 715.389.3545; fax 715.389.3808; e-mail kirkhorn.steven@mcrf.mfldclin.edu

Your Practice

Make your retirement plan a priority

Jonathan W. Hill, Retirement Plan Consultant SVA Planners, Inc., Registered Investment Advisor

What will your financial situation look like when you decide to retire? Do you have a strategy in place for making systematic withdrawals from your retirement accounts? Are you prepared to do whatever it takes in order to be able to retire with the lifestyle you choose?

Author Affiliations: Based in Madison, Wis, Hill is a retirement plan consultant with SVA Planners Inc., Registered Investment Advisor. In this role, he acts as a resource for individuals and businesses evaluating their current retirement plan.

Corresponding Author: For more information, call Wisconsin Medical Society Insurance and Financial Services, Inc. toll free at 866.442.3810.

Your Profession

Arthritis efforts at Medical College aimed at damage control, prevention

Michael J. Dunn, MD, Dean and Executive Vice President, Medical College of Wisconsin

For the 43 million Americans affected by arthritis, pain is an all-too-common part of daily life. The irreparable damage the disease often causes, however, drives the search for effective treatment and prevention measures.


Author Affiliations: Medical College of Wisconsin

Corresponding Author: Wisconsin Medical Society 330 E. Lakeside St Madison, WI 53715