Improve the health of the people of Wisconsin by supporting and strengthening physicians' ability to practice high-quality patient care in a changing environment.

Volume 102, Issue 7 (2003)

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Thomas C. Meyer, MD, Medical Editor, WMJ
Arthritis, ethics, and Editorial Board musings
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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.

Jill C. Costello, MD; Paul B. Halverson, MD
A New Era in Rheumatoid Arthritis Treatment
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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.

Judyann C. Olson, MD
Juvenile Idiopathic Arthritis: An Update
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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.


Lynnette Horwath
Behind the scenes in arthritis care
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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.

Nancy E. Chudy, MPH; Virginia Thomas, BSN, MS; Chetna Mehrotra, MPH; Peter D. Rumm, MD, MPH
The Wisconsin Arthritis Program– A new partnership to reduce the leading cause of disability
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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.

Original Research

Sridhar V. Vasudevan, MD; Eric E. Potts, MD; Chetna Mehrotra, MPH
Pain Management in Arthritis: Evidence-Based Guidelines
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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.

Chetna Mehrotra, MPH, OTR; Virginia Thomas, MS; Nancy Chudy, MPH
The State of Arthritis in Wisconsin

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.

Chetna Mehrotra, MPH, OTR; Nancy Chudy, MPH; Virginia Thomas, MS
Obesity and Physical Inactivity Among Wisconsin Adults with Arthritis
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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.

Steven Kirkhorn, MD, MPH; Robert T. Greenlee, PhD, MPH; Jonathan C. Reeser, MD, PhD
The Epidemiology of Agriculture-related Osteoarthritis and Its Impact on Occupational Disability
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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.

Your Practice

Jonathan W. Hill, Retirement Plan Consultant SVA Planners, Inc., Registered Investment Advisor
Make your retirement plan a priority
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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?

Your Profession

Michael J. Dunn, MD, Dean and Executive Vice President, Medical College of Wisconsin
Arthritis efforts at Medical College aimed at damage control, prevention
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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.