Effective help is available now for people with arthritis. In addition to medications and physical therapy, knowing how to manage their arthritis can greatly benefit people with this disease. A course developed at Stanford University, the Arthritis Self-Help Course, teaches people about arthritis and how to minimize its symptoms. This 6-week course, taught in a group setting, has been shown to reduce arthritis pain by 20% and physician visits by 40%. However, in 1997, it still reached fewer than 1% of people with arthritis. More widespread use of this course nationwide would save money as well as reduce the impact of arthritis.

With fiscal year 1999 funding of more than $9 million, CDC will implement programs in up to 10 states to reduce the onset and consequences of arthritis.

To support state-based programs, CDC will continue to build the foundation for arthritis prevention and control at the national level. A cornerstone for this foundation is the National Arthritis Action Plan: A Public Health Strategy. Released in November 1998, this Plan was developed under the leadership of CDC, the Arthritis Foundation, and the Association of State and Territorial Health Officials. The plan delineates for the first time the action necessary to better understand the arthritis burden in the United States and to more fully apply known, effective interventions. The document, which will serve as a blueprint for public health efforts targeting arthritis, represents the combined effort of nearly 90 organizations, academic institutions, governmental agencies, community interest groups, and others with an interest in arthritis prevention and control.

The National Arthritis Action Plan proposes a national coordinated effort for reducing the occurence of arthritis and its accompanying disability by focusing on these three areas:

• Surveillance, epidemiology, and prevention research to strengthen the science base.

• Communications and education to increase awareness and provide accurate information about arthritis.

• Programs, policies, and systems that promote increased quality of life for people with arthritis and facilitate prevention measures.

To enhance the science base, CDC will expand on the following innovative activities already under way:

• Limiting Disability From Arthritis. Hip and knee osteoarthritis, the leading causes of arthritis disability and the primary reasons for expensive joint replacement surgery, are becoming more prevalent as the population ages. CDC, in collaboration with the University of North Carolina at Chapel Hill and the National Institutes of Health, is assessing risk factors for the incidence and progression of these conditions among residents of Johnston County, a rural area of North Carolina. About 3,200 participants have been enrolled in this study, the first ever to look at a biracial population over time with the goal of learning more about how to prevent and limit the occurrence and progression of arthritis and associated disabilities.

• Clarifying the Important Role of Good Nutrition and Physical Activity. CDC continues to accumulate scientific knowledge on the benefits of physical activity. Certain forms of arthritis, particularly osteoarthritis of the knee, are more common among people who are overweight or obese. Because healthy eating reduces a person's risk of becoming overweight, good nutrition plays an important role in preventing knee osteoarthritis. In addition, moderate physical activity is essential for maintaining the health of joints.

• Measuring the Burden of Disease. Information on arthritis trends and prevalence is essential for effectively targeting prevention measures. One mechanism for collecting this information is CDC's unique state-based Behavioral Risk Factor Surveillance System (BRFSS), used by all 50 states to collect information from adults on knowledge, attitudes, and practices related to a variety of health issues. CDC has worked with states to develop an optional arthritis module for the BRFSS that will allow states to develop their own estimates of the prevalence of joint problems in different populations and to monitor trends. The 12 states using this module have gained a better understanding of the numbers and characteristics of people reporting joint-related symptoms.

• Evaluating Intervention Strategies. To better direct public health efforts targeting arthritis, CDC helps support a project conducted by Kaiser Permanent Rocky Mountain Division to evaluate the effectiveness of self-help patient education programs for arthritis patients in managed care settings.

Another key element of the National Arthritis Action Plan is effective health communication and education tailored to the public, to people with arthritis and their families, and to health professionals. An example of one such effort is CDC's Physical Activity and Health: A Report of the Surgeon General. Published in 1996, the report provides critical information for health professionals on the benefits of moderate physical activity in promoting healthy joints, relieving arthritis symptoms, and improving function among people with arthritis. CDC will continue to expand on communications activities to increase awareness of arthritis and its impact, the importance of early diagnosis and appropriate management, and effective prevention strategies.

The Plan also calls for going beyond research and communications to promote policy and environmental changes that are conducive to prevention efforts. Effecting such changes will require active partnerships between CDC and state and local health agencies, health care providers, voluntary and professional organizations, and others. Examples of such changes include developing standards of care for arthritis, broadening dissemination of the Arthritis Self-Help Course, building effective self-management education programs such as the Arthritis Self-Help Course into routine arthritis care, and encouraging the development and implementation of appropriate physical activity programs for people with arthritis.