Kristina A. Theis

Updated Projected Prevalence of Self-Reported Doctor-Diagnosed Arthritis and Arthritis-Attributable Activity Limitation Among US Adults, 2015-2040.

To update the projected prevalence of arthritis and arthritis‐attributable activity limitations among US adults, using a newer baseline for estimates.

Hip Osteoarthritis and the Risk of All-Cause and Disease-Specific Mortality in Older Women: A Population-Based Cohort Study

To determine the risk of all‐cause and disease‐specific mortality among older women with hip osteoarthritis (OA) and to identify mediators in the causal pathway.

Social Participation Restriction Among US Adults With Arthritis: A Population-Based Study Using the International Classification of Functioning, Disability and Health†

To examine arthritis impact among US adults with self‐reported doctor‐diagnosed arthritis using the International Classification of Functioning, Disability and Health (ICF) framework (including the impairments, activity limitations, environmental, and personal factors domains and social participation restriction [SPR] as the outcome) overall and among those with and without SPR, and to identify the correlates of SPR.

Meeting Physical Activity Guidelines and the Risk of Incident Knee Osteoarthritis: A Population‐Based Prospective Cohort Study

Knee osteoarthritis (OA) is a leading cause of disability and joint pain. Although other risk factors of knee OA have been identified, how physical activity affects incident knee OA remains unclear.

Shut-In? Impact of Chronic Conditions on Community Participation Restriction among Older Adults

Community participation may be especially important for older adults, who are often at risk for unwanted declines in participation. We estimated the prevalence of community participation restriction (PR) due to perceived environmental barriers among older adults (≥50 years) and compared the impact among those with selected chronic conditions. Individuals with low-prevalence conditions reported high community PR (9.1–20.4%), while those with highly prevalent conditions (e.g., arthritis) had relatively low community PR (5.1–10.0%) but represented the greatest absolute numbers of condition-associated burden (>1 million). Across all conditions, more than half of those with community PR reported being restricted “always or often.” Community PR most often resulted from modifiable environmental barriers. Promising targets to reduce community PR among adults ≥50 years with chronic conditions, particularly arthritis, include building design, sidewalks/curbs, crowd control, and interventions that improve the built environment.

Geographic Variations in Arthritis Prevalence, Health-Related Characteristics, and Management — United States, 2015

Problem/Condition Doctor-diagnosed arthritis is a common chronic condition affecting an estimated 23% (54 million) of adults in the United States, greatly influencing quality of life and costing approximately

Arthritis Restricts Volunteer Participation: Prevalence and Correlates of Volunteer Status Among Adults With Arthritis

300 billion annually. The geographic variations in arthritis prevalence, health-related characteristics, and management among states and territories are unknown. Therefore, public health professionals need to understand arthritis in their areas to target dissemination of evidence-based interventions that reduce arthritis morbidity. Reporting Period 2015. Description of System The Behavioral Risk Factor Surveillance System is an annual, random-digit–dialed landline and cellular telephone survey of noninstitutionalized adults aged ≥18 years residing in the United States. Self-reported data are collected from the 50 states, the District of Columbia, Guam, and Puerto Rico. Unadjusted and age-standardized prevalences of arthritis, arthritis health-related characteristics, and arthritis management were calculated. County-level estimates were calculated using a validated statistical modeling method. Results In 2015, in the 50 states and the District of Columbia, median age-standardized prevalence of arthritis was 23.0% (range: 17.2%–33.6%). Modeled prevalence of arthritis varied considerably by county (range: 11.2%–42.7%). In 13 states that administered the arthritis management module, among adults with arthritis, the age-standardized median percentage of participation in a self-management education course was 14.5% (range: 9.1%–19.0%), being told by a health care provider to engage in physical activity or exercise was 58.5% (range: 52.3%–61.9%), and being told to lose weight to manage arthritis symptoms (if overweight or obese) was 44.5% (range: 35.1%–53.2%). Respondents with arthritis who lived in the quartile of states with the highest prevalences of arthritis had the highest percentages of negative health-related characteristics (i.e., arthritis-attributable activity limitations, arthritis-attributable severe joint pain, and arthritis-attributable social participation restriction; ≥14 physically unhealthy days during the past 30 days; ≥14 mentally unhealthy days during the past 30 days; obesity; and leisure-time physical inactivity) and the lowest percentage of leisure-time walking. Interpretation The prevalence, health-related characteristics, and management of arthritis varied substantially across states. The modeled prevalence of arthritis varied considerably by county. Public Health Action The findings highlight notable geographic variability in prevalence, health-related characteristics, and management of arthritis. Targeted use of evidence-based interventions that focus on physical activity and self-management education can reduce pain and improve function and quality of life for adults with arthritis and thus might reduce these geographic disparities.

Self‐Management Education Participation Among US Adults With Arthritis: Who's Attending?

To estimate, among adults ages ≥45 years with arthritis, the prevalence and correlates of 1) volunteering, 2) arthritis‐attributable restrictions among volunteers, and 3) arthritis as the main barrier to volunteering (AMBV) among non‐volunteers.

No One Dies of Old Age Anymore: A Coordinated Approach to Comorbidities and the Rheumatic Diseases

Self‐management education (SME) programs teach people with chronic conditions skills to manage their health conditions. We examined patterns in SME program participation among US adults with arthritis ages ≥18 years.

Education and Employment Participation in Young Adulthood: What Role Does Arthritis Play?

Introduction “Any idiot can face a crisis; it’s the day-to-day living that wears you out,” so said Anton Chekhov, himself a practicing physician, as well as a prolific author. For a growing number of people, day-to-day living means managing long-term conditions that co-exist and often exacerbate other ailments, resulting in multiple morbidities, multiple chronic conditions, or comorbidities. Whatever they are labeled, co-existing, co-occurring, etc., “the simultaneous presence of two (or more) chronic diseases or conditions in a person,” is a substantial medical and public health challenge. This special theme issue in Arthritis Care & Research spotlights this under-recognized and underaddressed problem, which has significant impact on people, medicine, and public health. Comorbidities are a common problem in the US and internationally, and arthritis and other rheumatic diseases are among the most common comorbidities. Failure to recognize and address comorbidities leads to, at best, diminished quality-of-life, and, at worst, increased mortality. Our editorial addresses comorbidities first from the exceptional perspective of rheumatic diseases, and then from a more general perspective, which is influenced by the high prevalence and impact of rheumatic disease. We use the term “comorbidities” and its derivatives throughout, with the exception of some specific quotes, to mirror the language of the original call for submissions that Arthritis Care & Research published on the theme of Comorbidities and the Rheumatic Diseases. Comorbidities and rheumatic diseases In their provocatively titled and insightful qualitative study, “‘It’s a toss-up between my hearing, my heart, and my hip’: Prioritizing and Accommodating Multiple Morbidities by Vulnerable Older Adults,” Schoenberg et al explored the time, money, and worry spent on individual conditions and their synergistic effects among a small sample of communitydwelling adults ages 55–90 years (1). The investigators were prompted to conduct this study by results of a previous project in which they learned that other conditions, often those of a less medically demanding or nonfatal nature, regularly took priority over congestive heart failure in the daily lives of individuals. Rheumatic diseases, as a group, seem to be the quintessential example of these generally nonfatal but demanding conditions that require a great deal of daily time, attention, and concern. Arthritis and other rheumatic diseases are highly prevalent (2), projected to increase in occurrence and impact (3), cause extensive disability by any measure (4), and are expensive to individuals and society (5). They also have an exquisite potential to disrupt the quality of people’s daily lives (6), both by themselves as they impose limits on functioning and as they interact with other chronic conditions. Rheumatic diseases, especially broadly defined arthritis ascertained in survey and administrative data, are some of the most common comorbid conditions of all those regularly measured. In a recent population-based US study, the authors presented the top 5 most common comorbid condition dyads and triads for each of 3 age/sex groups (i.e., 30 dyad groupings and 30 triad groupings) (7). Arthritis appeared in 15 of the dyad groups and 25 of the triad groups. Only hypertension, a generally silent condition and frequent comorbidity of arthritis, appeared more often. Importantly, arthritis was in the most prevalent dyad and most prevalent triad for every age/ sex group. The role of arthritis is particularly important for some of the major chronic conditions that get greater attention than rheumatic diseases. For example, national surveys have shown arthritis to be present in 49% of adults with heart disease, 47% of those with diabetes mellitus, and 31% of those with obesity (2), 3 conditions with major impact on health. Conversely, half of adults with arthritis have at least 1 other chronic condition (8). People with arthritis have high The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Supported by the Centers for Disease Control and Prevention. Kristina A. Theis, PhD, Teresa J. Brady, PhD, Charles G. Helmick, MD: Centers for Disease Control and Prevention, Atlanta, Georgia. Address correspondence to Charles G. Helmick, MD, Arthritis Program, Centers for Disease Control and Prevention, 4770 Buford Hwy, F78, Atlanta, GA 30341. E-mail: chelmick@cdc.gov. Submitted for publication September 29, 2016; accepted in revised form September 30, 2016.