missouri’s fight against arthritis · acknowledgements 6 missouri’s fight against arthritis...

Conditions

Missouri’sFight Against

Arthritis&Related

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1Missouri’s Fight Against Arthritis & Related Conditions

Missouri’s Fight AgainstArthritis &

Related ConditionsA State Plan for 2002-2007

Compi led By:

Mary Ellen Ankeney, MEd, OTR

Virginia A. Beatty

Nisreen Kabeer, MPH

Editor ial Review By:

Gordon Sharp, MD,

Missouri Arthritis Advisory Board

Chad Helmick, MD,

Centers for Disease Control & Prevention

Brad Ziegler,

Arthritis Foundation-Western Chapter

Brenda Arndt,

Arthritis Foundation-Eastern Chapter

Anjali Deshpande, MPH, PhD,

Department of Health & Senior Services

Deborah Markenson, MS, RD


Andy Shea,


Design:

Lori Englund; Mac Media;

Jefferson City, Missouri

This plan is a public document and designed for the Internet. You may copy any

part or this entire plan to share with potential partners in the fight against

arthritis. Each time you distribute a copy of this plan, please notify the Missouri

Department of Health and Senior Services, Missouri Arthritis and Osteoporosis

Program, P.O. Box 570, Jefferson City, MO 65102-0570, 800-316-0935.

2 Missouri’s Fight Against Arthritis & Related Conditions

FOREWARD .................................................................................................. 4

PREFACE ....................................................................................................... 5

ACKNOWLEDGEMENTS .............................................................................. 6

EXECUTIVE SUMMARY ............................................................................... 7

PART I: ISSUE ............................................................................................... 8

PART II: OPPORTUNITY: Lessening The Burden .................................... 12

PART III: CURRENT PROGRAMS............................................................... 14

Missouri Arthritis Alliance ................................................................... 14

Missouri Arthritis & Osteoporosis Program ....................................... 14

Missouri Arthritis Advisory Board ...................................................... 15

Regional Arthritis Centers ................................................................... 16

Juvenile Arthritis Care Coordination .................................................. 16

Arthritis Foundation ............................................................................ 17

Missouri Rehabilitation Research and Training Center ..................... 19

Lupus Foundation of American, Inc. ................................................. 19

Partnerships ......................................................................................... 20

Part IV: CALL TO ACTION ........................................................................ 24

Part V: ACTION PLAN: Taking Stock in Missouri’s Health ...................... 28

Mission/Goals ...................................................................................... 28

Success Indicators/Evaluation ............................................................ 29

STRATEGY 1: Communication/Education ......................................... 32

STRATEGY 2: Community & Health Systems Based Programs ........ 36

STRATEGY 3: Surveillance, Research & Evaluation .......................... 40

STRATEGY 4: Partnerships & Advocacy ............................................ 43

REFERENCES .............................................................................................. 47

Healthy People 2010 Objectives ............................................................... 48

APPENDICES .............................................................................................. 48

Appendix 1: Missouri Arthritis Alliance (Current Membership) ....... 49

Appendix 2: MAOP Organizational Chart 2002 ................................. 52

Appendix 3: Regional Arthritis Centers .............................................. 53

Appendix 4: Operational Plan ............................................................ 54

Arthritis Action Plan Survey ....................................................................... 57

Contents


Stories of Arthritis

Kaitlyn ClarkPage 23

Rosalind FrenchPage 11

Suzanne PfefferPage 27

Robert Green6

Stories contributed byDianna Borsi O’Brien, Osamu Fujimaruand Andy Shea.

Forward


The Missouri Arthritis Action Plan for 2002-2007 and thesupportive documentation is meant to provide acomprehensive framework to direct the efforts of all partnersin a coordinated approach to reduce disability and improvethe quality of life of Missourians with arthritis and relatedconditions. The purpose of the plan is:

■ To clearly describe what arthritis and its related diseaseprocesses are, and that it affects 1 out of 3 Missourians;

■ To describe arthritis disease management interventionstaking place in Missouri;

■ To identify opportunities for reducing disability andimproving the quality of life for Missourians with arthritis;

■ To offer information regarding arthritis diseasemanagement activities that can be implemented to helpcontrol the debilitating disease;

■ To call upon Missourians to take action by becomingmembers of the Missouri Arthritis Alliance and byincluding arthritis related activities in daily personal,business and community life. By doing so, we hope toreduce the burden of arthritis in Missouri.

Your participation is crucial to the success of this plan. Pleasejoin our efforts by initiating the Missouri Arthritis Action Planin your community. With your commitment to implement thegoals, aims and strategies outlined in this plan, the burden ofarthritis will be lessened in Missouri.

Chris Kerns, ChairMissouri Arthritis Advisory Board


Preface

“The 20th century brought remarkable andunprecedented improvements in the livesof the people of the United States. We sawthe infant mortality rate plummet and lifeexpectancy increase by 30 years”, saidDonna E. Shalala in a message included inthe national Healthy People 2010.Advancements in medical technology andhealth care have contributed to anincreased life span. However, mostadvances came from prevention efforts.Public health emphasis has been to reducemortality (death) from disease. While thiswill remain an effort of public health, theincrease in life span now makes itimperative to refocus the emphasis onpreserving quality of life, sustainingproductivity, and fostering good physicaland mental health. Arthritis has beenrecognized as the leading cause ofdisability, affecting an estimated 1.5 million(37%) Missouri adults. Arthritis impactsindividuals physically, economically,psychologically, and socially. Arthritisefforts in Missouri need to focus onprevention, when possible, and propermedical and self-management, if affected,in order to help preserve quality of life,sustain productivity of its citizens, and toassure physical and mental well being.

In an effort to address the issuessurrounding arthritis in Missouri, analliance has formed that is comprised ofnumerous partners including not-for-profitorganizations, academic institutions, publichealth agencies, and private organizations.A current member listing can be found inApendix 1. As members of the alliance, we

are proud to present the Arthritis ActionPlan: Missouri’s Fight Against Arthritis andRelated Conditions. This plan is a result ofthe collaborative efforts of many individualsand agencies that have contributed their timeand expertise. This plan serves as acomprehensive framework that includes keystrategies and aims. It provides guidance todesign, implement, and evaluate arthritis-related activities for three target populations:the general public, people with arthritis andtheir families, and health care systems. Thealliance is committed to coordinating effortsthat will produce the most effective, efficient,and comprehensive benefits for these groups.

Sincere gratitude is extended to everyonewho has contributed to the development ofthis plan. Every Missouri citizen, organization,community group, industry, business, andhealth care system is invited to become amember of the alliance and be involved inthe implementation and evaluation of thisplan. Together we can look forward to abrighter future where Missourians livehealthy, productive and happy lives.

Sincerely,

2002 Members of theMissouri Arthritis Alliance

Acknowledgements


This plan is a result of collaborative efforts of many individuals andagencies. The Missouri Arthritis and Osteoporosis Program would like togratefully acknowledge and thank these individuals and committedorganizations that generously shared their time and expertise to create thisplan. It is only with the continued commitment of the individuals andorganizations in the Alliance that the goals, aims, and strategies outlined inthe Missouri Arthritis Action Plan will be realized. A special thank you isextended to the following individuals and organizations for helping tocreate a vision for Missouri’s future in arthritis initiatives:

Area Agencies on Aging

Marilee Bomar, RN, MSN, Central Missouri Regional Arthritis Center

Debbie Braby, RHIT, Northwest Missouri Regional Arthritis Center

Crystal Brady, Arthritis Foundation – Central Missouri Branch

Doris Fountain, RNC, CDE, Northeast Missouri Regional Arthritis Center

Chad Helmick, MD, Centers for Disease Control and Prevention

Robert Jackson, DO, Kirksville College of Osteopathic Medicine

Chris Kerns, RN, Heartland Health System

Margaret Lindsey, RNC, Southwest Missouri Regional Arthritis Center

Local Public Health Agencies

Sheila Luetkemeyer, PT, Greater Kansas City Regional Arthritis Center

Arletha Manlove, Greater Kansas City Regional Arthritis Center

Marian Minor, RPT, PhD, Missouri Arthritis Rehabilitation, Research and Training Center

Missouri Arthritis Advisory Board Members

Saint Louis University Division of Rheumatology

Saint Louis University School of Public Health

Yvette Senter, Centers for Disease Control and Prevention

Gordon Sharp, MD

Linda Sherwin, Arthritis Foundation – Eastern Missouri Chapter

University Outreach and Extension

Carrie Warren, MS, Eastern Missouri Regional Arthritis Center

Washington University Division of Rheumatology

Brad Ziegler, Arthritis Foundation – Western Missouri Chapter

Mary Ellen Ankeney, MEd

Virginia Beatty

Nisreen Kabeer, MPH

Missouri Department of Health & Senior Services –

Bureau of Chronic Disease Control

Missouri Arthritis & Osteoporosis Program


ExecutiveSummary

Nationally, arthritis and related conditionsaffect approximately 43 million Americans, orone out of every six people. It is a costlyhealth problem and the leading cause ofdisability in the United States. Arthritis is oneof Missouri’s most common chronic healthproblems affecting more than one in three(37%) residents 18 years or older. Contrary topopular belief that arthritis afflicts only theelderly, it is estimated that 41.5% of adultsbetween the ages of 35 and 64 and 4,000children under the age of 18 suffer from thisdisabling condition.

This Action Plan sets out to identify primary,secondary and tertiary prevention mecha-nisms to address the needs of Missourianswith arthritis. The goals identified are: (1) toreduce disability caused by arthritis orchronic joint symptoms; (2) to increasepublic awareness of arthritis and relatedconditions as the leading cause of disability,the mechanisms of prevention and manage-ment, and available resources; (3) to expandarthritis education, programs and supportservices throughout the state for people witharthritis and their families, particularly theelderly, women and children, underservedpopulations who may lack access tohealthcare services, and other high-riskpopulations; (4) to improve quality of healthcare practices and enable a responsible andaccountable health care system for all Mis-sourians with arthritis and related conditions;and (5) to enhance and strengthen surveil-lance/monitoring of disease prevalence,related risk factors, and the national healthobjectives (Healthy People 2010).

A comprehensive review of the current andfuture needs for addressing arthritis and relatedconditions was completed through planningmeetings and workshops. Furthermore, endorse-ment and support of this plan was establishedthrough the same venue. Incorporating publichealth approaches: health communication andeducation; community and health systems-basedinterventions; surveillance, research and evalua-tion; and partnerships and advocacy; will beintegral in guiding all governmental and non-governmental agencies, health systems/provid-ers, voluntary and community organizations, andother partners to enhance current endeavors andbecome involved in activities that will improveMissourians’ lives.

Knowledge and awareness surrounding arthritisand the effective mechanisms for controlling andmanaging the disease is growing. The diligentefforts of those involved in the prevention andmanagement of arthritis will make significantinroads and positively impact the lives ofMissourians affected by this debilitating disease.

This plan provides a framework to guide arthritisefforts, a blueprint for achieving goals. Theplan is for use by governmental and non-governmental agencies, health systems,community organizations, and others. Thisplan is a dynamic document, and only afew suggested activities for each aimhave been noted in order to initiateideas. This plan will unify effortsand initiate action of individualsand organizations involved inarthritis care, research,management, andeducation.

PART I: Issue


and related conditions,for the purpose of this document the word arthritis is used asan umbrella term. Nationally, arthritis affects nearly 43 millionAmericans, or one out of every six people (adults and children),1, 2

making it one of the most common diseases in the United States.Arthritis is a serious, often misunderstood, and costly publichealth problem. Arthritis is the leading cause of disability in theUnited States3, and people with arthritis are also more likely to beaffected by co-morbidities (other chronic diseases or illnesses).Among all adults with disabilities, 17.5% reported that the mainhealth condition associated with their disability was arthritis orrheumatism, making it the number one cause of disability in theUnited States.3

AdultsFor the purposes of monitoring the burden of arthritis, the Centersfor Disease Control and Prevention (CDC) defines arthritis asthose individuals reporting doctor-diagnosed arthritis and/orchronic joint symptoms. According to this definition, an estimated1.5 million4 Missouri adults are living with arthritis and relatedchronic joint symptoms. Arthritis affects every segment of thepopulation, but most commonly affects older individuals 65-74years (55%), women (40%), people with low incomes (<$20K/year) (46%), and people with less than a high school education(51%). More than 25% of those reporting arthritis were not doc-tor-diagnosed, implying that additional effort is needed to in-crease awareness of the importance of early diagnosis and treat-ment.

Children and AdolescentsWhile prevalence of arthritis increases with age, it should berecognized that children are also affected by any of the 100 formsof arthritis. According to Dr. Cassidy at the University of Missouri-Columbia, an estimated 4,000 children have arthritis in Missouri.The impact of arthritis on children can dramatically affect theirquality of life, even as they age. Therefore, addressing the needsand promoting proper management of their disease is paramountand can have profound benefits in terms of their productivity,psychosocial benefits and long-term health outcome.

Osteoarthritis: The mostcommon type of arthritis affectingthe breakdown of the cartilagelayer causing the bones to rubtogether resulting in pain,swelling, and loss of motion ofthe joint.

Fibromyalgia: A disorder thatcauses general pain in themuscles and joints (ligamentsand tendons).

Rheumatoid Arthritis: Anautoimmune disease in which thejoint lining becomes inflamed aspart of the body's immune systemactivity.

Gout: A disease that causessudden, severe periods of pain,tenderness, redness, andinflammation in some joints.

Systemic Lupus Erythemato-sus: A serious autoimmunedisorder that can inflame anddamage joints and other connec-tive tissues throughout the body.Also known as Lupus or SLE.

Juvenile Rheumatoid Arthritis:A common form of rheumatoidarthritis in children.

Though there are more than 100 different types of arthritis

Six MostCommon Types


Geographic DistributionGeographically, the prevalence of arthritis does not substantially vary amongBehavioral Risk Factor Surveillance System (BRFSS) districts in Missouri. Yet, whencomparing metropolitan to non-metropolitan areas, there appears to be a slightlyhigher prevalence in non-metropolitan areas (35% and 41%, respectively).4

ImpactArthritis imposes a tremendous economic, psychological and social impact on theindividual arthritis patient and their family. People with arthritis are often disabledand unable to work. Of Missourians unable to work, 74% have arthritis. Sinceadults with arthritis are four times more likely to be unable to work than thosewithout arthritis, this greatly impacts them and their families economically.Approximately 35% of adults with arthritis are also limited in some activity due to ahealth problem and 40% require aid for personal care. The costs of arthritis, bothdirect and indirect, can affect one’s quality of life. In Missouri, arthritis costs anestimated $1.3 billion, with $294 million spent on medical care in 2000. Missouri’scosts were derived using the state’s proportion of the adult population affected byarthritis and national arthritis cost estimates. Hip and knee osteoarthritis is theleading cause of arthritis disability and the primary reason for high costs associatedwith expensive joint replacement surgery. Arthritis and related disorders were the7th leading cause of Missouri hospitalizations in 1995.5

Who Is At Risk?In addition to the elderly, women, and those with low income or education, thereare other populations at high risk. Farmers are at increased risk for developingwork-related disabilities including arthritis. Over 20% of Missouri’s farmers,ranchers and agricultural workers have a disease, disorder or disability that limitstheir ability to perform some work-related or daily-living tasks.6

Individuals who are severely overweight are also more likely to have arthritisresulting in disability.7, 8 Among Missouri adults with arthritis, 30% are obese and39% are physically inactive, compared to 16% and 25% of adults withoutarthritis.4 Obesity has been shown to play a causal role in osteoarthritis ofthe knee.9, 10, 11, 12 These lifestyle factors compound the problem of arthritis,leading to greater pain and disability.

If an individual is overweight or obese, reduction in weight, in somecases, may prevent the onset of osteoarthritis. Other forms ofprevention for osteoarthritis can result from preventing injuries,joint trauma and repetitive joint usage caused by sports/athletics or occupational sources.10 A history of jointtrauma is the strongest risk factor for unilateralosteoarthritis at either the knee11 or the hip.12

PART I: Issue


Modifiable Risk FactorsAlthough some risk factors that put populations at greater riskcannot be changed, such as age, gender and race, there areseveral modifiable factors. Physical inactivity, overweight/obesityand poor nutritional habits play a significant role in arthritis.Controlling modifiable risk factors can greatly improve mobility,minimize pain and disability, and improve quality of life.

Plan DevelopmentWith the burden of arthritis clearly defined, an action plan toaddress arthritis issues was initiated. The Missouri Arthritis andOsteoporosis Program convened the planning process thatinvolved persons with arthritis, physicians, allied healthprofessionals, researchers, public health officials, business andcommunity interest groups, and state, professional and non-profitagencies. The process included: (1) an in-depth review of 1999National Arthritis Action Plan and current Missouri arthritisprograms and initiatives; (2) input gathered from the MissouriArthritis Advisory Board, Regional Arthritis Centers and theArthritis Foundation; (3) a series of regional planning meetings incollaboration with the Regional Arthritis Centers in sevendesignated regions of the state facilitated inclusion of communitypartners to review the plan, provide comments and makesuggestions; and (4) review and concurrence provided by theMissouri Arthritis Advisory Board, Regional Arthritis Centers, andArthritis Foundation Chapters. In the planning and development ofthe arthritis action plan, the Missouri Arthritis Advisory Boardidentified and prioritized the outcomes to be achieved in 3-5years, thus impacting the long-term (10-year) goals. Theindividuals convened as part of the planning process are thefoundation of a network of organizations and individuals witharthritis interests and resources that will be the basis of a newlyformed Missouri Arthritis Alliance. The Alliance is acommunication network of partners that share informationabout current research, opportunities for partnerships,programs, and plan accomplishments.

PART I: Issue

Early diagnosis andappropriate,

ongoing arthritismanagement are

known to reduce orimprove long-term

discomfort anddisability and

improve emotionalhealth and overall

quality of life.


Education Is The Key

To Coping With ArthritisRosalind French was 24 when first diagnosed with rheumatoid arthritis.By the time she was 40, the disease had taken its toll and French wasforced to take an early retirement. After 16 years of fighting an illnessthat forced her to give up regular exercise and retire from her job as asenior medical technologist, surgery to her foot left her confined to a bed.She was practically housebound until a friend convinced her to volunteerat a local chorus.

“That got me going 100 percent. It triggered me to get up and not justvegetate in the house,”said French. “It motivated me.”

Once on her feet, French signed up for an arthritis self-help course and an exercise classthrough her local regional arthritis center (RAC). Today, some five years later, the northern

St. Louis County, MO, resident is back in the swing of things.French says it’s all due to an arthritis self-help course she tookseveral years ago. There, she learned how to live with arthritis.“Education is key,” said French.

At the classes, French learned several new techniques to live a full life despitehaving arthritis. For example, mornings are not as difficult as they once werebecause she now sets her clothing and breakfast items out the night before.French keeps a bar stool in the kitchen so she can sit while preparing food, and

to make sweeping easier, she uses a long-handleddust pan.

French has learned how to make things easier, andshe has learned not to sweat the small stuff. Today,French continues to volunteer in her community,works at a part-time job and stays physically active.“You just keep on going. You don’t let it get youdown,” she said.

“You just keep on going. Don’t let arthritis get you down.”

- Rosalind French, St. Louis County

Education iskey to arthritismanagement.


With proper disease management and management ofmodifiable risk factors, people with arthritis, osteoporosisand other chronic diseases can achieve improvements inmobility, minimization of pain, and improvement in overallhealth. Physical activity is just one critical activity that hasmultiple health benefits: it reduces the risk of developing anumber of other chronic health conditions like diabetes,heart disease and possibly osteoarthritis. Physical activitycan improve muscle strength, increase endurance andflexibility;13 strengthen bones, help reduce and maintainappropriate body weight, reduce hypertension, helpcontrol or prevent diabetes, and provide better overallhealth. Additional strategies are listed below.

While researchers search for an arthritis cure, pain anddisability can be reduced. Reducing pain and discomfort,preventing deformities and loss of joint function, andmaintaining a productive and active life are major treatmentgoals. A comprehensive treatment plan and programshould include medical management, options to reducejoint stress, physical and occupational therapy, drugtherapy, surgical intervention, pain managementtechniques, self-management techniques, and social andemotional support for the individual and their family. Thefirst step should be visiting a doctor and getting a properdiagnosis. Early diagnosis can allow the individual tointercept the process at an early stage and reduce thepotential disability that may result.

Self-management is another important step. Self-management education has been shown to be effective inreducing pain and minimizing disability from arthritis andrelated conditions.14, 15 Management of arthritis and related

PART II: Opportunity

Lessening The Burden: Opportunities for Improvement


PART II: Opportunity

conditions can be achieved by following a regimen of regularphysical activity that is appropriate for the individual that hasarthritis, osteoporosis, or a combination of both. Since beingoverweight or obese compounds the effects of arthritis,maintaining a healthy body weight by being physically activeand having a well balanced diet is another component of self-management. Weight management can reduce the pain anddisability and, in some cases, prevent the onset of the disease.11

Missouri has a number of self-management programs that areavailable to facilitate healthy lifestyle changes.

In some cases, the risk of developing arthritis may be reducedby mechanisms of primary prevention like joint protection.Using recommended injury prevention strategies (warm-ups,stretching and appropriate use of equipment) helps to avoidjoint injuries and damage to cartilage and ligaments. Takingprecautions to avoid repetitive joint use and resulting jointinjury can help to prevent arthritis. Raising awareness amongyouth, in particular athletes, encouraging adoption of healthyways to be active, and avoiding or reducing trauma or overuseof joints may also help reduce the risk.

Recent breakthroughs in biomedical research have increasedthe understanding and treatment of arthritis. A number of newmedications are available to treat rheumatoid arthritis,osteoarthritis, osteoporosis, and related conditions. Additionally,surgical interventions may be an option when the pain anddeterioration of the joint can no longer be managed by othertreatment plans.

Using properjoint protection

techniquesdaily is animportantarthritis

preventionstrategy.


PART III: Current Programs

Missouri’s Arthritis Alliance

The Missouri Arthritis Alliance is made up of existing programs andpartners, as well as individuals and organizations, that indicate aninterest in helping people with arthritis at the local, regional, andstate level. Membership is open to anyone who wants to becomeactive in the fight against arthritis. The Alliance is a communicationnetwork of partners that share information about current researchpartnerships, programs and plan accomplishments.

Missouri arthritis advocates have an excellent history of workingtogether to reduce the burden of arthritis. A list of current partnersand individuals (Alliance members) who have indicated they wantto be involved in the implementation of this plan is included asAppendix 1. Members of the Alliance correspond through a listservthat is managed by the Missouri Arthritis and OsteoporosisProgram. To become a member, please complete the form andfollow the instructions found at the back of this publication.

Missouri Arthritis & Osteoporosis Program: 16+ Years of Experience: www.dhss.state.mo.us/maopThe Bureau of Chronic Disease Control, a part of the MissouriDepartment of Health and Senior Services (DHSS), Division ofChronic Disease Prevention and Health Promotion (CDPHP),administers the Missouri Arthritis and Osteoporosis Program(MAOP). Appendix 2 provides a schematic of the organizationalstructure of the program. Missouri has the longest standing statearthritis program in the nation. Figure 1 illustrates the program’shistory. The Missouri Arthritis Task Force was established in 1976.Early arthritis advocates held hearings across the state anddeveloped a three-volume report for the Governor. The keyrecommendations included: (1) establishment of a network ofRegional Arthritis Centers that support activities in three programareas (education for health professionals, improved patient careand education of patients, their families and the public);



(2) support for the advancement of arthritisresearch; and (3) support for the training ofrheumatologists. Ultimately, passage oflegislation in 1984 created a statewide arthritisprogram within the Department mandating thecreation of a state arthritis advisory board andthe establishment of Regional Arthritis Centersin seven designated regions of the state. Mostrecently, the arthritis program joined forceswith the osteoporosis program to become theMissouri Arthritis and Osteoporosis Program(MAOP). In 2001, the Missouri 91st GeneralAssembly passed legislation establishing a statelupus program that will be administered by theDepartment. The MAOP serves a leadershiprole in the coordination and implementation ofarthritis, osteoporosis and lupus prevention andeducation. The program’s mission is to promoteoptimal health and quality of life for allMissourians affected by arthritis, rheumaticdisease and related musculoskeletal conditions.Missouri’s program continues to be a leader inestablishing a public health approach forarthritis.

Missouri Arthritis Advisory BoardIn 1985 the Missouri Arthritis Advisory Board(MAAB) was legislatively mandated andestablished to provide expertise and resourcesto empower Missourians with arthritis andguide strategic planning for the MAOPprogram. The MAAB consists of a variety ofhealth care professionals, people with arthritis,community partners, and arthritis advocates.MAAB members address issues ofcommunication, programs, and surveillancethrough standing committees. The MAAB is anintegral part of the MAOP. The Board’sexecutive committee provides guidance andsupport to the standing committees, MAOP, andthe Regional Arthritis Centers.

1 9 7 6

• Arthritis TaskForce Established

1 9 8 4

• ArthritisLegislation Passed

1 9 8 5• Arthritis Program

Established• Funding Received• MAAB Created

1 9 8 6

• RACs Established

1 9 9 2

• Arthritis QuestionsAdded to BRFSS

1 9 9 5

• JA ProgramCreated & Funded

1 9 9 5

• OsteoporosisLegislation Passed

1 9 9 6

• OsteoporosisProgramEstabished

1 9 9 9

• CDC ArthritisFunding (capacitybuilding)

2 0 0 0

• Arthritis &OsteoporosisPrograms Merged

2 0 0 1

• Lupus Bill Passed• Burden Report

Released• Program Website

Online• Arthritis State Plan

Development

Figure 1: Program History Schematic


Regional Arthritis CentersIn 1986, after a thorough review process by the Peer ReviewCommittee of the MAAB, eight Regional Arthritis Centers(RACs) were officially designated in seven regions of the state.Currently, there are seven centers. The RACs are locatedwithin facilities (hosting institutions) that provide or haveaccess to comprehensive health care for individuals witharthritis or other related rheumatic diseases. Centers are lo-cated in St. Louis, Southeast Missouri, Northeast Missouri,Northwest Missouri, Central Missouri, Southwest Missouri, andKansas City (see Appendix 3). RACs are an integral part of theMAOP because they provide care for people with arthritisthrough a variety of programs and services such as:

■ Self-management programs;■ Physical activity programs;■ Professional education programs;■ Public awareness activities; and■ Individual education.

RACs are funded in part by the MAOP.

Juvenile Arthritis Care CoordinationBegun in 1995, this program is a joint effort of the MissouriRACs and the Missouri DHSS’ Bureaus of Special Health CareNeeds and Chronic Disease Control. These Bureaus recognizeand help with the special needs of families of children witharthritis and other rheumatic conditions. Since 1995, fivepediatric rheumatology centers throughout Missouri have beenawarded contracts to provide service coordination dedicatedto helping families of children with rheumatic disease.

The diagnosis of a rheumatic disease in a child often comes asa surprise to many, including the child and the family. TheJuvenile Arthritis Service Coordination Program understandsthat the family has a need for education about their child’sdisease and that they may need help educating others about




the diagnosis. The family may encounter several new areas of concern:medical, financial, HMO/Insurance, transportation and scheduling. Familiesmay also want to be connected to support services or to become active incommunity events where they can meet with other families affected byrheumatic disease.

Juvenile Arthritis Service Coordinators help families secure the servicesand support they need:

■ Identification of children and ■ Family advocacy services,teenagers with arthritis, ■ Family support groups,

■ Referral services, ■ Summer camp information,■ Education and medical ■ Kids on the Block puppet shows and

information, ■ Links to community events.■ Resource library,■ Community education workshops,

Arthritis FoundationThe Arthritis Foundation is a national, non-profit organization with a historyof providing arthritis programs and services to Missouri residents for over 50years. Currently, there are two chapters in Missouri. The Eastern MissouriChapter was established in 1949 and the Western Missouri Chapter wasfounded in 1979. The Arthritis Foundation’s overall mission is to improve livesthrough leadership in the prevention, control, and cure of arthritis and relateddiseases. In order to achieve this mission, the Missouri Arthritis Foundationchapters provide and/or partner to provide programs for people with arthritis,including public education, professional education, and support for research.

Such partners include, in part, the MAOP, Regional Arthritis Centers,and Universities. The Foundation chapters and the MAOP meeton a regular basis to coordinate,plan, and streamline programimplementation, public’s awarenessabout arthritis, and diseasereporting. In addition, theFoundation chapters work locallywith the Regional Arthritis Centers inthe areas of informationdissemination, presentations, andtraining of volunteer leaders.



The Arthritis Foundation chapters offer several educationand exercise programs to help people with arthritis orrelated diseases better control and manage their disease.The programs include: Arthritis Self-Help Course;Fibromyalgia Self-Help Course; People with Arthritis CanExercise (PACE); Arthritis Foundation/YMCA AquaticsClass; and Arthritis and Fibromyalgia Support Groups. TheChapters work with MAOP and the RACs to implementthese programs in communities across the state.

The Missouri chapters also provide public education andinformation on arthritis through literature, communityeducational forums, community health fairs, physicianreferral information, and speakers to community groups.

In addition, the Foundation is an important educationalresource for children with arthritis and their families. TheMissouri chapters and the American Juvenile ArthritisOrganization (part of the Arthritis Foundation) provideeducation activities throughout the year for children withjuvenile arthritis and their families. These activities alsoprovide peer support for kids and parents affected byjuvenile arthritis.

Finally, the Missouri chapters have long been supporters ofarthritis research. The Arthritis Foundation funds arthritisand arthritis related research to find cures for and todevelop better ways to treat the many forms of arthritis.Currently, the Arthritis Foundation funds research projectsat universities and medical institutions, and supportsfellowships to train and recruit new rheumatologists.



Missouri Arthritis Rehabilitation Research and Training CenterThe Missouri Arthritis Rehabilitation Research and Training Center(MARRTC) plays a significant role in improving the quality of life forMissourians with arthritis. Funded by the National Institute on Disabil-ity and Rehabilitation Research of the U.S. Department of Education,MARRTC is a national leader in the area of arthritis rehabilitationresearch and training. MARRTC is the only federally funded centerdedicated to arthritis rehabilitation and research in the United States.

For more than 15 years, MARRTC has made significant contributions inresearch on the bio-psychosocial aspects of arthritis, the effects ofexercise on arthritis, the association of depression and arthritis, dis-semination of information, and other topics. Currently, MARRTC re-search projects include investigations into the effects of managed careon people with arthritis, vocational rehabilitation for people witharthritis, providing information and technical assistance to farmers witharthritis, and the dissemination of arthritis information.

In 2002, MARRTC co-sponsored the first international conference onarthritis and exercise. MARRTC hosts an award winning website andpartners with the MAOP, the RACs and the Missouri chapters of theArthritis Foundation to disseminate arthritis information, maintain anelectronic calendar of activities and events, and maintains web pagesfor each RAC.

Lupus Foundation of America, Inc.The Lupus Foundation of America, Inc.,is a non-profit organization that currentlyhas two chapters in Missouri. One chap-ter is in Kansas City and the other is in St.Louis. The Foundation works to improvethe quality of the lives of people livingwith lupus through community aware-ness and public education, research andpatient services and support. The twochapter offices in Missouri work jointlywith the RACs and the MAOP in theplanning process.



Partnerships

Partnerships are organizations, providers, and citizensjoining together to communicate, cooperate, coordinate,and collaborate to achieve a common goal or outcomewithin a geographic area. Every partner brings a uniquepoint of view, set of resources, and range of abilities.Partnerships are critical in order to achieve Missouri’s visionfor people with arthritis. Alliance members have theopportunity to build partnerships among themselves, theircommunities, existing partnerships, and state and regionalentities to implement activities that are appropriate, and thatwill improve the quality of life, of people with arthritis.

Strong and committed partnerships already exist betweenthe hosting institutions of the RACs, the ArthritisFoundation, the Lupus Foundation of America, Inc.,MARRTC, Washington University, and St. Louis University,which have contributed to the success of statewidecommunity arthritis interventions. Individuals from theseorganizations regularly participate in advisory and planningmeetings at the regional or state level. The MAOP hasestablished internal partnerships and coordinates activitieswith the DHSS’ Office on Women’s Health, Office onMinority Health, Division of Maternal Child and FamilyHealth, Division of Aging, and other chronic diseaseprograms (cardiovascular disease, diabetes, asthma, obesity,cancer, and tobacco control programs).

Partnerships will continue to build Missouri’s infrastructureand ability to provide programs and resources for the targetpopulations. A few examples of community partnershipsinclude:

■ Referring patients/clients to nearest self-help course, i.e.,arthritis self-help, chronic disease self-help, orfibromyalgia self-help or to the nearest Regional ArthritisCenter or Arthritis Foundation Chapter office forinformation;

It is imperative,if Missouri is going to

reduce it's burdenof arthritis, thathealth agencies,

medical societies,academic institutions,

nonprofitorganizations, health

professionals,patients, and

volunteers worktogether to improve

the health andquality of life of

Missourians affectedby this disease.



■ Becoming a trained leader in the arthritis self-help, chronic disease self-help, or fibromyalgia self-help course. In turn, annually provide theprogram(s) for individuals with arthritis and/or other chronic conditionsas part of your job expectations or as a community volunteer;

■ Hosting a forum and/or workshop in your community on arthritis, lupus,osteoporosis, weight management, physical activity, or nutrition;

■ Advocating for environmental changes in your community, such aswalking trails, healthy food choices in the break room or dining hall,lunch-n-learns, public forums, and ergonomically correct workingfacilities;

■ Providing low cost home modifications for people with arthritis orosteoporosis to improve home safety and to help them remainindependent;

■ Providing and promoting marked, safe greenways (walking trails and/orpaths that are wide enough to incorporate walkers, cyclists, etc.) aroundyour business and/or your community. Local governments have theopportunity to consider requiring greenways and sidewalks whendesigning and/or expanding communities, subdivisions, housing units,and industrial parks;

■ Incorporating physical activity, nutrition educationand their affect on bone health, joint health, andcardiovascular health into existing schoolprograms. This may include calculating calciumintake for a period of time as part of a mathassignment, the amount of energy expendedduring different activities as part of a scienceexperiment, joint protection techniques as part ofa physical education or health course;

■ Providing the use of a church classroom as ameeting place for a course, public forum, orsupport group.



Examples of how partners can integrate arthritismessages into existing programs includes:

■ Including articles about arthritis, osteoporosis, lupus,and juvenile arthritis in your program ororganizational newsletters;

■ Providing lunch-n-learns for employees;

■ Providing PACE or self-management courses as partof an employee wellness program;

■ Referring clients who are concerned about agingissues, arthritis, or osteoporosis, to local and/or stateresources.


Strong Heart

When her six-year old daughter said she wanted toplay T-ball, Christy Clark, of Booneville, MO, hesi-tated. She later picked up the telephone and called

Kaitlyn’s doctor. Christy Clark is not an overprotective mother –rather, she is the parent of a child with juvenile arthritis.

“Kaitlyn has gone through lab tests every eight weeks to checkher blood,” said Christy. “She visits her pediatric rheumatologist and her eye doctor every four to sixmonths. It’s been difficult.”

Kaitlyn’s mother knows all too well that her daughter is especially vulnerable to eye damage, that her knees and ankles frequently ache with stiffness and swelling . . . that the disease can affect internal organs and lead to permanent joint damage. “I’m the parent of a child with arthritis. I deal with it every day,” said Christy.

But unlike many patients across the nation, Christy is fortunate to have the help of a juvenile arthritis program. Missouri is one of the few states in the country that

operates such a program – there are fivejuvenile arthritis care coordinators acrossthe state. Each coordinator assistsMissouri parents deal with various issuesof juvenile arthritis. “[The centralMissouri juvenile arthritiscoordinator] has beenwonderful,” says Christy.

Today, Kaitlyn appears to be going into remission, but Christy knows thiscould be temporary. Sometimes juvenile arthritis continues intoadulthood and sometimes it stops getting worse or gets betteras the child grows past adolescence. But for now, Kaitlyn’smother just takes things one day at a time.

“I’m the parent of a child with arthritis. I deal with it all day, every day.”

-Christy Clark, Booneville

Juvenile arthritisaffects nearly 4,000Missouri children.

Nationally, the diseaseaffects more than

285,000 kids.


PART IV: Call To Action

In this plan lies a strategic framework thatoutlines some of the major long-term goals to be achieved inthe next 10 years and measurable, intermediate outcomes to beachieved over the next 3-5 years.

Key partners will guide the efforts of the Missouri ArthritisAlliance in the development, implementation, and evaluationof this plan’s goals, outcomes, aims, and activities. A draftand template for an operational plan is included as part ofthis publication (See Appendix 4). The target population,evaluation, partnerships, and time period are also part of theoperational plan.

This Call to Action is aimed at:

■ People with arthritis;

■ Health care providers including rheumatologists, physicians,nurse practitioners, physical and occupational therapists, andhealth educators;

■ Health care organizations including hospitals, health plans,local public agencies, and nursing home facilities;

■ Human service agencies, such as senior centers, independentliving centers, adult day care centers, and vocationalrehabilitation centers;

■ Policy makers and employers;

■ Partners and advisory boards with emphasis on health andaging; and

■ Individuals who want to help others.

Join Us in implementingthis action plan.



Complete the operational plan template and submit acopy to the Missouri Arthritis and Osteoporosis Program (SeeAppendix 4). With collaboration, coordination, and an increase in theavailability of programs, services, and quality of care throughoutMissouri, arthritis efforts will be strengthened to ensure the bestpossible health outcomes for Missourians with arthritis and relatedconditions. By providing direction and combining resources, theoverall goal of improving the quality of life among all Missourians willbe achieved.

The following paragraphs contain information toassist you.

Disease Prevention & Management – Control of arthritis and relatedconditions can be categorized into three components: primary,secondary and tertiary prevention. Each component addresses theissue at different stages of the disease spectrum.

Primary Prevention: to prevent the occurrence of disease;

Secondary Prevention: to decrease the duration and severity ofthe disease through early detection and treatment before signsand symptoms occur;

Tertiary Prevention: to reduce complications and disabilities thatcan result from the existing disease.

Target Populations – This planaddresses the needs of Missourians byfocusing on three primary targetpopulations: people with arthritis andtheir families, the general public, andhealth care system. By focusing efforts onthese groups, the development of acomprehensive action plan can be usedto improve the health of Missourians witharthritis.

Join the effort!


People With Arthritis and Their Families: Once individualshave been diagnosed with arthritis or have developedchronic joint symptoms, measures must be taken to managetheir disease. Provision of services and programs that rangefrom self-help courses (self-management) or exerciseprograms, to support groups for people with arthritis andtheir families are essential in improving physical and mentalquality of life. Tailoring programs for specific populations isnecessary to fully reach all those affected.

The General Public: Increasing awareness of the severity anddisability associated with arthritis and related conditions willhelp promote early diagnosis and appropriate managementand prevention or reduction of severe disability and pain.

Health Care Systems: Health care systems (physicians,physical therapists, nurses, HMO’s, and employers) arefrequently unaware of programs and services availablethroughout the state. Health care professionals are the mostcredible source of health-related information. Advice andreferral from a health care professional is a powerful tool.Therefore, increasing awareness among health careprofessionals and providers of the appropriate clinicalguidelines and standards of care, the importance of earlydiagnosis in minimizing the extent of disability and theservices available for people with arthritis, health careproviders can be better equipped to impact the quality of lifeof people with arthritis.



Every time Suzanne Pfeffer stops taking her PACE(People with Arthritis Can Exercise)/Rebuild class for aweek or two, an exercise class designed by the Arthritis

Foundation, stiffness creeps back to her legs.

Pfeffer, 71, has osteoarthritis in her right knee, and has beentaking a PACE/Rebuild class for about three years. Sheattends the classes one hour a day, three days a week. “It hasdefinitely helped me,” she said. “I get some relief from thestiffness that I have.” Exercises in the class are designed toimprove flexibility, strength, endurance and balance.

Pfeffer likes to travel, and she has been to Spain and theCanary Islands. But when she travels, Pfeffer finds thatshe does not exercise on her own. That means thestiffness of osteoarthritis returns.

“I need a group, the group setting, doing it with otherpeople who have thesame problems andthe encouragement ofthe instructor,” saidPfeffer.

People With Arthritis Can Exercise!

Being in a group setting, with theencouragement of an instructor,makes all the difference for manypatients with arthritis.

Osteoarthritis is the mostcommon form of arthritis,

and it affects nearly21 million Americans.

Symptoms include painand stiffness in the joints,most often in the knees.


PART V: Action Plan

Mission■ Improve the quality of life among Missourians with arthritis

and related conditions.

Rationale: Quality of life encompasses an overall sense of wellbeing, including aspects of happiness and satisfaction with life asa whole. Health-related quality of life encompasses those aspectsof overall quality of life that can be shown to impact eitherphysical or mental health. On an individual level, this includesphysical and mental health perceptions and their correlates,including health risks and conditions, functional status, socialsupport, and socioeconomic status. On a community level, itincludes resources, conditions, policies, and practices thatinfluence a population’s health perceptions and functional status.

Goals■ Reduce the disability caused by arthritis or joint symptoms.

Disability is defined as a limiting health condition thatinterferes with the performance of socially defined activitiesand roles such as work;16

■ Increase public awareness of arthritis and related conditions asthe leading cause of disability, the mechanisms of preventionand management, and the resources available throughout thestate;

■ Increase expansion and continuation of arthritis education,programs, and support services in Missouri for people witharthritis and their families; particularly the elderly, women andchildren, underserved populations who may lack access tohealthcare services; and other high-risk populations;

■ Improve the quality of health care practices and enableaccountable health care systems for all Missourians witharthritis and related conditions;

Taking Stock In Missouri’s Health

The goalsset forth in this

plan providegeneral

direction toMissouri'sArthritisAlliance.


PART V: Action Plan

■ Enhance and strengthen surveillance/monitoring of diseaseprevalence, related risk factors, and Healthy People 2010;

■ Sustain and strengthen support of partners and policy-makers toaddress issues and policies for the advancement of this plan’svision.

Success IndicatorsThe mission has guided the development of strategies and intermediateoutcomes for people with arthritis. In order to achieve the identifiedgoals and outcomes presented in this plan, specific aims need to beaddressed through the application of several strategies: healthcommunication and education; interventions in the community andhealth systems; surveillance, research and evaluation; and partnershipsand advocacy. Figure 2 illustrates that through implementation ofstrategies, intermediate outcomes can be achieved. Through theachievement of intermediate outcomes over a period of time, themission can be reached. The Following is an overview of the strategies,associated aims, and some suggested activities that are important inorder to achieve the aims. Process, impact and outcome evaluation ofactivities, aims, and outcomes will be achieved through surveillancesystems such as BRFSS, special surveys, RAC electronic database, and anumber of other measurement tools. For measuring plan progress overthe next five years, intermediate measurable outcomes are necessary toassess the success of Missouri’s efforts in the fight against arthritis.

EvaluationTo guide efforts and provide valuable information regarding theeffectiveness of activities, a comprehensive approach must be taken toevaluate the outcomes, aims, activities and strategies carried out in thisplan. Mechanisms for ongoing evaluation include process, impact, andoutcome measures. Process evaluation, or formative evaluation,consists of measuring the immediate outputs related to theimplementation of activities (for example, the number of participants).Impact evaluation, or summative evaluation, measures intermediateobjectives (3-5 years), (for example, changes in knowledge, attitudes,beliefs and behaviors of participants). Outcome evaluation measuresthe long-term (5-10 year) effects on health status, morbidity,mortality, disability, and quality of life. Strategies can be evaluatedthrough the use of a program activity database, standardizedprogram evaluations, special surveys or use of anexisting surveillance system such as the Behavioral

Figure 2

S T R A T E G I E S

• Health Communication& Education

• Interventions:Community & HealthSystems

• Surveillance, Research& Evaluation

• Partnerships & Advocacy

I N T E R M E D I A T EO U T C O M E S

Increase the proportionof people with arthritiswho report:• Leisure-time physical

activity,• Healthy weight,• Fruit and vegetable

consumption,• Good general health,• Fewer activity

limitations due to betterphysical and mentalhealth,

• Attending arthritiseducation programs.

M I S S I O N

Improve quality of lifeamong Missourians witharthritis and relatedconditions.


PART V: Action Plan

Risk Factor Surveillance System (BRFSS). Sharing ofaggregate information between individuals andorganizations that collect data on the same targetpopulations is also essential to monitoring success. Adescription of the three components of evaluation follows.

Process Evaluation: Process evaluation is accomplishedthrough regular monitoring and reporting of activities. Forexample, an electronic database will be utilized by theRACs to maintain a record of participants, programs offeredand utilized, and other program-related questions for theMAOP.

Impact Evaluation: Impact evaluation measures changesin knowledge and behaviors over 3-5 years. Surveillanceusing Missouri’s BRFSS data will aid in measuring changesin behaviors, such as physical activity and weight status.Special surveys may need to be developed to measurechanges in the public’s perceptions of arthritis, educationabout prevention and management of arthritis, andutilization of the programs and services;

Outcome Evaluation: Outcome evaluation assesses theimpact of activities over the long-term (5-10 years).Measuring changes in activity limitations and other qualityof life indicators will be the greatest measure of success.BRFSS data will provide the necessary surveillanceinformation to accomplish this type of evaluation. Othersources of information on hospitalizations and surgerieswill be an important source for measuring changes in theeconomic burden of arthritis.


PART V: Action Plan

Intermediate Outcome/Measures:

■ Proportion of the population with arthritis who have engaged inany physical activity, other than work;

■ Proportion of the population with arthritis who report beingobese;

■ Proportion of the population with arthritis who report consumingthe recommended five or more servings of fruits and vegetables aday;

■ Proportion of the population with arthritis who report theirgeneral health status as fair or poor;

■ Proportion of the population with arthritis who report activitylimitations due to poor physical or mental health problems;

■ Proportion of organizations (i.e., health departments, hospitals,and healthcare organizations) providing community diseaseprevention and health promotion education and activities;

■ Proportion of the population with arthritis who have ever takenan arthritis education or disease management program;

■ Proportion of the population of health professionals attendingeffective arthritis education programs.

In order to achieve the intermediate outcomes, twelve aims havebeen identified for Missouri and are addressed through the strategiesof communication, intervention,surveillance/evaluation, andpartnerships/advocacy strategies. Foryour convenience in planning andevaluating activities that you conduct,use the operational plan template (SeeAppendix 4).

Appropriate communication is the cornerstone for all ourefforts, whether it is in developing partnerships, educatingthe public on arthritis, administering management tools, orinfluencing legislators. Identifying the appropriate media forvarying audiences makes communication efforts cost-effective. Development of communication strategies tailoredto target audiences will aim at increasing awareness ofarthritis, its impact, management, and available services andresources, among the general public and especially amonghigh risk populations.

Communication is necessary to raise awareness. We mustdevelop collective strategies with consistent messages toreach entire populations. Many people with arthritis believethere is little they can do to affect their disease. Manyaffected by arthritis lack knowledge about their disease andeffective means to prevent further disability. They need toknow about programs and resources available and how toaccess these services. Public awareness and education arenecessary to dispel widespread misunderstanding aboutarthritis and to link people to credible, accurate and usefulinformation.

Health care providers are a crucial link in communicatingwith people with arthritis and their families. In order tosupport high quality care and maximize the effectiveness ofthose health care interactions, we need to enhance theavailability of accurate arthritis-related information and skilldevelopment for health care providers. Health careproviders need communication tools that will support theirefforts to provide quality care.

A well balanced dietthat includes the

daily recommendedservings of fruits,

vegetables and grainplus regular physicalactivity are importantelements in achieving

and maintaining ahealthy body weight.

Strategy 1Communication/Education


PART V: Action Plan

(Aims 1-3)


PART V: Action Plan

Suggested Activities■ Develop tailored messages and identify and use appropriate media to meet

the needs and concerns of target audiences;

■ Educate policy makers on arthritis as a tremendous public health problemand the leading cause of disability;

■ Educate the general public, health care professionals, health insuranceproviders, employers, and other relevant organizations on the treatment, self-management, economic burden, the severity of the disease, and its impact ondisability and quality of life;

■ Promote professional education courses;

■ Promote early diagnosis by encouraging those who experience chronic jointsymptoms to seek medical advice;

■ Integrate arthritis messages within existing DHSS’ divisions, bureaus andprograms (Cardiovascular disease diabetes, women’s health, minority health,aging, WIC, etc);

■ Integrate arthritis messages within other state programs;

■ Communicate to the general public, health care professionals, healthinsurance providers, employers, and other relevant organizations, the benefitsof physical activity and weight management in terms of primary, secondary,and tertiary prevention;

■ Participate in the National Press Conference focused on arthritis;

■ Provide arthritis and osteoporosis information through Brown Bag Lunchprograms, company display boards, and company/industry newsletters;

■ Disseminate arthritis related data and research findings;

■ Educate coaches, athletic directors, and athletic trainers about injuryprevention and the importance of strengthening/conditioning techniques toreduce the risk of immediate injury and the long-term effects –

osteoarthritis;

■ Integrate osteoporosis prevention messages into existing curriculum inelementary, secondary, and higher education programs. Examples

of such messages include appropriate calcium intake

information, information on the reduction in soda

consumption, tobacco use cessation, the importance

of appropriate physical activity, and the

importance of a balanced diet.

A I M

1By 2005, develop and implement a comprehensive marketingplan to increase awareness of arthritis; its seriousness, cost,prevention, benefits of early diagnosis; and to heighten theemphasis of its effect on quality of life.


PART V: Action Plan

Suggested Activities■ Increase statewide awareness of resources available for persons

with arthritis and their families;■ Promote self-management programs offered by Regional

Arthritis Centers, Arthritis Foundation Chapters, Local PublicHealth Agencies, and other organizations;

■ Increase knowledge among health care professionals on theimportance of self-management and referral to availableprograms;

■ Promote effective disease management behaviors and practicesamong people with arthritis and related conditions;

■ Empower people with arthritis with knowledge about theirdisease;

■ Communicate the benefits of physical activity, weightmanagement and other healthy behaviors for minimization ofarthritis pain and disability among people with arthritis andhealth care professionals;

■ Implement CDC tailored messages for people with arthritis;■ Integrate arthritis messages into other programs that reach the

same target audiences;■ Become a provider of physical activity programs, self-

management courses, and/or support groups for people witharthritis;

■ Provide facility space for on-going physical activity programs,self-management courses, and/or support groups at reduced orno charge rate;

■ Incorporate messages about physical activity and a balanceddiet into presentations;

■ Integrate weight management/osteoarthritis messagesinto existing weight management programs.

A I M

2By 2005, increase the number of individuals witharthritis attending effective arthritis education anddisease management programs.


PART V: Action Plan

A I M

3By 2005, develop and implement a systemto improve access to and dristribution ofinformation for all Missourians.

Suggested Activities■ Create a systematic and efficient dissemination plan for

information;

■ Utilize current technologies to provide arthritis andosteoporosis educational programs through video/satellite conferencing;

■ Establish a media database to efficiently and effectivelydistribute and track arthritis-related messages;

■ Develop and maintain an arthritis website and link toother valid websites;

■ Generate and disseminate press releases, researcharticles, and other documents to create awareness ofarthritis, programs available and advancing research inthe field of rheumatology, exercise, health relatedquality of life, aging and nutrition;

■ Develop a system to share existing presentationsamong partners.


Identifying and targeting populations at greatest risk is apriority. The actual implementation of specific, effectiveinterventions that led to a continuum of health services thatincludes primary, secondary and tertiary prevention, andsupportive policies and environments conducive toprevention and improved quality of life are necessary toensure sustainable programs. Interventions geared at thecommunity and health systems need to incorporate strategiesfor primary (for example, reduction of risk factors), secondary(for example, early diagnosis), and tertiary (for example, self-management) prevention. Programs to facilitate change inknowledge, attitudes, and beliefs and behaviors that promotehealth and alleviate arthritis-related problems can ensurequality health care and services to people with arthritis.Activities must be tailored to reach different audiences, suchas minorities, low income/low education level households,health care providers, seniors, athletes, or children.

Development and implementation of effective community-based programs will positively affect the physical, mental,social, and economic impacts on people with arthritis andtheir families. Implementation of health systems-basedinterventions can ensure quality health care and services topeople with arthritis.

With most typesof arthritis,

regular physicalactivity and

maintaining anappropriate body

weight can behelpful in keepingarthritis-relateddiscomfort to aminimum, while

maximizingphysical ability.

PART V: Action Plan

Strategy 2 Community & Health-SystemsBased Programs(Aims 4-6)


A I M

4By 2005, increase the proportion of partners providingcommunity programs and services to enhance andstrengthen existing services and programs.

Suggested Activities■ Develop and/or adopt more evidence-based programs;

■ Incorporate the inclusion of educational programs to reduceinjury occurrence and the relationship between injury andarthritis;

■ Incorporate into health/physical education courses, the inclusionof joint protection, body mechanics, arthritis risk factors, nutrition,and osteoporosis into the curriculum as standard practice;

■ Conduct interventions at the worksite and school settings onprotection from occupational and sports-related joint trauma andrepetitive joint usage;

■ Tailor interventions to target juvenile arthritis patients, women,elderly, minorities, the underserved (rural, innercity), and farmers;

■ Train arthritis partners in advancing skills to provide state-of-the-art information and services;

■ Recruit and retain more trainers and leaders to administer self-management programs;

■ Become a provider of physical activity, self-management, andsupport group programs designed for people with arthritis andrelated conditions;

■ Serve as a volunteer/counselor at activities designed for childrenwith arthritis i.e., camps, aquatic programs, and walks.

PART V: Action Plan


A I M

5Assist people with arthritis in remainingengaged in routine acts of daily living, school,employment, and social activities.

PART V: Action Plan

Suggested Activities■ Assist facilities in adapting accommodations and resources to

aid people with arthritis in daily living activities;

■ Promote adaptive tools and arthritis resources to people witharthritis to assist them in daily living activities;

■ Provide educational programs to assist people with arthritis inoptimally utilizing the available tools;

■ Implement worksite wellness programs, like increasedphysical activity, nutrition forums, healthy lunch choices,weight management courses, smoking cessation programs,and self-management programs;

■ Promote and advocate for ergonomically safe worksites;

■ Provide education and appropriate modification forindividuals with arthritis so they can remain employed;

■ Identify high risk occupations and develop messages andmodification recommendations to reduce occupational injuryand repetitive motion trauma from such jobs;

■ Encourage referral to appropriate services for people witharthritis, like vocational rehabilitation, Americans withDisabilities, occupational/physical therapy, and employeeassistance programs;

■ Provide transportation to/from physical activity, self-management, and support groups at minimal or at no cost;

■ Promote accessible parks and trails;

■ Develop, maintain, promote, and/or provide programs tominimize pain and disability associated with chronicconditions.


A I M

6Improve knowledge, beliefs, andpractices of health careprofessionals.

PART V: Action Plan

Suggested Activities■ Include arthritis education in allied health education

programs, medical schools, and residency programs;

■ Provide up-to-date arthritis information to healthorganizations and medical institutions;

■ Assist organizations in implementing education and diseasemanagement programs within their institutions;

■ Provide training opportunities and/or professionaldevelopment programs for health professionals;

■ Partner with organizations specializing in medical education;

■ Advocate for core rheumatology training in all primary carephysician training;

■ Develop training modules for early diagnosis, self-management, physical activity, early rehab services, andmental health;

■ Publish tailored arthritis education articles in medicalsocieties and professional organization newsletters/publications;

■ Distribute Primer on Arthritis and standards of care for bestpractices for people with arthritis to healthcare professionals;

■ Provide and promote internships/community fieldwork forhealth professionals to include arthritis self-managementprograms;

■ Refer patients/clients to physical activity and/or self-management programs designed for people with arthritis andchronic diseases.


PART V: Action Plan

Surveillance: Defining the burden of arthritis is animportant step in efforts to target high-risk populationsand to guide the development of interventions that lessenthe impact arthritis places physically, economically, andemotionally on the person with arthritis and their families.Surveillance efforts need to be enhanced and gaps insurveillance need to be assessed. Assessment of allexisting data that are available for defining the burden ofarthritis must be identified. Further improvements insurveillance and research are imperative in guiding effortsand monitoring progress over time.

Research: Epidemiological, medical and pharmacologicalresearch will greatly advance efforts to improve thequality of life among Missourians. Examination of datawill enhance our understanding of arthritis and the factorsthat play a role, the populations most affected, and thebarriers faced. This data should be applied to planningand development of health promotion programs/interventions. Research on disease management programsprovides us with effective evidence-based interventions.Dissemination of program and population-based data willbe invaluable to members of Missouri’s Arthritis Alliance.

Evaluation: Integration of adequate evaluation measuresto the action plan’s activities will help determine theeffectiveness of efforts and detect improvements inoutcomes. Providing a strong evaluative foundation isbeneficial in future program planning.

Strategy 3 Surveillance,Research & Evaluation(Aims 7-9)


PART V: Action Plan

A I M

7By 2005, develop, coordiante and implement aplan for on-going data collection, analysis anddistribution of information.

Suggested Activities■ Explore new avenues/opportunities for data acquisition;

■ Monitor activities of RAC participants, programs and servicesthrough an electronic database;

■ Determine methods for juvenile arthritis and lupussurveillance;

■ Support the inclusion of additional BRFSS questions/modulesto better understand the burden of arthritis-related factors inMissouri;

■ Conduct analysis of BRFSS data annually/bi-annually todevelop/update burden reports or fact sheets;

■ Monitor progress of Healthy People 2010 objectives related toarthritis;

■ Publish summaries of Healthy People 2010 arthritis objectives;

■ Disseminate current arthritis research findings;

■ Support, coordinate, develop, administer, and/or conductanalysis of special surveys related to arthritis issues.


PART V: Action Plan

A I M

9Develop and coordinate a plan for evaluatingprocess, impact and outcome measures ofarthritis and osteoporosis program activities.

A I M

8Conduct epidemiological research to improve ourunderstanding of factors related to arthritis, barriersto services and related health care issues.

Suggested Activities■ Support and promote research to better understand treatment and

management of arthritis; risk factors; cost analysis – physical,emotional, and economic; disability; and quality of life;

■ Publish reports and other documents for public health organizationsand health professionals to increase knowledge and understanding ofarthritis and related factors;

■ Develop and implement a prioritization model based on morbidity/quality of life/healthy life years for chronic diseases to show theimpact arthritis has in relation to other chronic diseases;

■ Collaborate with academic institutions to develop epidemiologicalstudies to evaluate arthritis self-management programs/materials.

Suggested Activities■ Integrate process, impact and outcome evaluation measures into all

relevant activities;

■ Develop a systematic plan for evaluating future activities;

■ Develop annual reports with a compilation of evaluated activities;

■ Evaluate existing disease management programs to assesseffectiveness;

■ Publish reports directed at specific audiences to relay findings;

■ Develop a data collection system for monitoring arthritis andosteoporosis program activities.


PART V: Action Plan

Partnerships: Partnerships are an essential component inachieving the goals set out in this action plan. Only throughcoordinating efforts with the MAOP, Arthritis FoundationChapters, MARRTC, and the other members of the MissouriArthritis Alliance, can Missouri implement and sustain abroad range of activities. The Alliance, through this plan, willenhance, strengthen, and sustain links that address issues thatare complimentary with the efforts of DHSS to improve thequality of life for people with arthritis: physical activity, earlydiagnosis and treatment, and self-management. Establishingpartners at the state and local levels will enable Missouri tobe comprehensive in its approach to planning andimplementing activities. It is also important that partners inthe fight against arthritis assist in the dissemination of thisaction plan and in the recruitment of partners who arewilling to incorporate activities intotheir organizational structure and/or daily activities.

Advocacy: Changes in knowledge and behavior cansubstantially impact a person’s health. However,improvements in access to care and medications,increased research and funding, and implementation ofpolicies to promote equity can have a far-reaching impact onquality of life for people with arthritis.

Strategy 4Partnerships & Advocacy

(Aims 10-12)


PART V: Action Plan

A I M

10Create, strengthen and enhance partnerships with organizations,businesses, and community organizations (community partners)to develop, coordinate, and maximize resources.

Suggested Activities■ Comprehensively address the issues of primary, secondary, and tertiary

prevention that affect the quality of life of Missourians with arthritis orchronic joint symptoms with community partners (schools and worksites);

■ Identify and develop partnerships to strengthen and expand existing arthritisefforts;

■ Build collaborations/partnerships with existing DHSS programs, agencies,and organizations that address the needs of minority populations, women,children, and aging populations;

■ Develop and maintain a coordinated, statewide grassroots volunteer network;

■ Develop a communication committee and listserv to keep all partners awareof messages that are being distributed and activities held that are gearedtowards specific populations to prevent duplication of efforts;

■ Develop a work plan (in-depth evaluation) of all efforts in terms of resourcesand responsibility allocations;

■ Link website to reputable arthritis sites such as the MAOP, MARRTC, and AFsites to assist individuals seeking arthritis information obtain current, accurateand reliable information.

Suggested Activities■ Coordinate strategies and activities to maximize/optimize resources in com-

municating messages and providing programs and services;

■ Keep abreast of funding opportunities/resources and disseminate theinformation in a timely manner;

■ Inform partners of available funding opportunities and assist them inacquiring funding in the areas of research, treatment and interventions;

■ Become informed about available research and programs/interventionsoffered (more evidence-based; information on research that can have animpact on how we practice) and disseminate the information in a timelymanner;

■ Assist partners to acquire adequate funding to support arthritis andosteoporosis initiatives.

A I M

11Enhance funding for arthritis and related diseases interms of research, treatment and interventions toreduce disability and pain.


PART V: Action Plan

A I M

12Advocate for more emphasis on arthritis andrelated disability as a priority issue, especiallyfor the increasing aging population.

Suggested Activities■ Advocate for medical reimbursements for PT/OT, surgery,

medication, and orthodontics (use economic burden data toadvocate change in HMO reimbursements);

■ Keep abreast of policies (insurance, legislative, etc.) that may/will affect the lives of people with arthritis;

■ Advocate for physical activity, quality of life and arthritismodules to be asked in the same BRFSS year to observe trendsover time;

■ Promote physical activity and self-management programs forpeople with arthritis through insurance provider newsletters;

■ Support the development of a chronic disease prioritizationmodel focused on morbidity, quality of life and healthy lifeyears vs. mortality;

■ Advocate for cost coverage of arthritis self-management,physical activity, and educational programs;

■ Advocate for an adequate number of specialists who treatpeople with arthritis, i.e., rheumatologists, physical therapists,etc.;

■ Advocate for the referral of people with arthritis to appropriatespecialty care;

■ Sponsor events and activities focused on children with arthritis,like camps, aquatic programs, and walks.


Robert Green, age 69, knows thatremaining active is important tomanaging his arthritis, and he does not

let the disease stop him from enjoying theoutdoors. In fact, you can frequently findGreen playing in the dirt as he tends to hisbackyard garden. “I’m retired, and I neededsomething to help me pass the time,” he said.“I really enjoy how gardening keeps me activeand I love the wonderful flavors you get fromhome grown foods.” Green, of Centralia, MO,made some minor adjustments in form andstyle and found gardening an ideal way to beoutside and keep moving.

Most of the changes Green made were easy,like choosing the tools that allow him togarden with gusto without hurting himself. “Iuse a tiller that is much smaller than theregular sized ones,” said Green. “It wasinexpensive and I can operate it easily and not put too much stress onmy joints. You just learn to adapt to your situation.” Green also uses aspecial, low-to-the-ground stool that keeps him close to his garden floor.This helps to keep stress off of his knees, where he experiences most of his arthritis pain. Cushioned kneepads put the finishing touch on his routine, as sometimes he needs to kneel.

Moderate physical activity, like gardening, is an important part of arthritis self- management. Starting a regular physical activity program makes everyday activities like carrying groceries and getting in and out of the tubor car easier; it also gives those with arthritis a chance to think aboutother things.

“Gardening gets my mind off of the pain. It’s always in the background,sure, but it is out of your mind,” Green said. “Plus, it cuts down on thegrocery bills!”

Gardening with Arthritis

Missouri’s arthritiscommunity workshard to educate

Missourians witharthritis about the

benefits of moderatephysical activity.Through proper

self-management,patients can realize

their dreams withoutthe constraints ofarthritis and begin to take control of

their disease.

“Look atwhat you can do,

not what youcan’t do.”

– Karen Funkenbusch,Missouri AgrAbility

Project


References1. Lawrence RC, Helmick CG, Arnett, FC, et al. Estimates of the prevalence of arthritis and

selected musculoskeletal disorders in the United States. Arthritis Rheum 1998; 41:778-99.2. Helmick CG, Lawrence RC, Pollard RA, Lloyd E, Heyse SP. Arthritis and other rheumatic

conditions: who is affected now, who will be affected later? Am J Rheumatology 1995; 8 (4):203-211.

3. CDC. Prevalence of disabilities and associated health conditions among adults-UnitedStates, 1999. MMWR 2001; 50(07): 120-5.

4. Missouri Department of Health. Behavioral Risk Factor Surveillance System, 1999. AnkeneyME, Vradenburg JA, Shetty G, et al. Missouri Arthritis Repot 2001. Missouri Department ofHealth and Senior Services. Behavioral Risk Factor Surveillance System, 1999.

5. Missouri Department of Health and Senior Services, Center for Health Information Manage-ment and Evaluation, Patient Abstract System.

6. USDA Cooperative State Research and Education Services. Downs W, Funkenbusch K, andMarsh B. Missouri AgrAbility Project Final Report. Missouri AgrAbility Project Final Report1998-2002, University of Missouri-Columbia and Services for Independent Living.

7. CDC. Factors associated with prevalent self-reported arthritis and other rheumatic conditions– United States, 1989-1991. MMWR 1996; 45 (23): 487-491.

8. Verbrugge LM, Gates DM, Ike RW. Risk factors for disability among US adults with Arthritis. JClin Epidemiol. 1991;44:167-182.

9. Felson DT. The course of osteoarthritis and factors that affect it. Rheum Dis Clin North AM.1993; 19 (3): 607-15.

10. Felson DT, Zhang Y. An update on the epidemiology of knee and hip osteoarthritis with a viewto prevention. Arthritis Rheum 1998; 41 (8): 1343-55.

11. Felson DT, Hannan MT, Naimark A, et al. Occupational physical demands, knee bending, andknee osteoarthritis: results from the Framingham Study. J Rheumatol 1991; 18: 1587-92.

12. Felson DT, Chaisson CE. Understanding the relationship between body weight and osteoar-thritis. Baillieres Clin Rheumatol 1997; 11 (4): 671-81.

13. U.S. Department of Health and Human Services. Physical activity and health: a report of theSurgeon General. Atlanta, GA: U.S. Department of Health and Human Services, PublicHealth Service, Centers for Disease Control and Prevention; 1996.

14. Lorig KR, Sobel DS, Stewart AL, Brown BW Jr, Bandiera A, Ritter P, Gonzalez VM, LaurentDD, Holman HR. Med Care 1999; 37 (1): 5-14

15. Lorig KR, Mazonson PD, Holman HR. Evidence suggesting that health education for self-management in patients with chronic arthritis has sustained health benefits while reducinghealth care costs. Arthritis Rheum 1993:36 (4): 439-46

16. Adams PF, Marano MA. Current estimates from the National Health Interview Survey, 1994.Vital Health Stat. (Series 10, No. 193) 1995; DHHS publication PHS 96-1521.


Healthy People 2010 objectives marked by an asterisk (*) will bemonitored and used as an evaluation mechanism to ensure proposedoutcomes are being achieved.2-1 (Developmental) Increase the mean number of days without severe

pain among adults who have chronic joint symptoms.2-2 Reduce the proportion of adults with chronic joint symptoms who

experience a limitation in activity due to arthritis.*2-3 Reduce the proportion of all adults with chronic joint symptoms who

have difficulty in performing two or more personal care activities,thereby preserving independence.*

2-4 (Developmental) Increase the proportion of adults aged 18 yearsand older with arthritis who seek help in coping if they experiencepersonal and emotional problems.

2-5 Increase the employment rate among adults with arthritis in theworking-aged population.

2-6 (Developmental) Eliminate racial disparities in the rate of total kneereplacements.

2-7 (Developmental) Increase the proportion of adults who have seen ahealth care provider for their chronic joint symptoms.

2-8 (Developmental) Increase the proportion of persons with arthritiswho have had effective, evidence-based arthritis education as anintegral part of the management of their condition.

2-9 Increase the proportion of local health departments that haveestablished culturally appropriate and linguistically competentcommunity health promotion and disease prevention programs.*

2-10 Increase the proportion of adults who are at a healthy weight.*2-11 Reduce the proportion of adults who are obese.*2-12 Reduce the proportion of adults who engage in no leisure-time

physical activity.*2-13 Increase the proportion of adults who engage regularly, preferably

daily, in moderate physical activity for at least 30 minutes per day.*7-11 Increase the proportion of adults who engage in vigorous physical

activity that promotes the development and maintenance of cardio-respiratory fitness three (3) or more days per week for 20 or moreminutes per occasion.*

19-1 Increase the proportion of adults who perform physical activitiesthat enhance andmaintain muscular strength and endurance.*

19-2 Increase the proportion of adults who perform physical activitiesthat enhance and maintain flexibility.*

Healthy People 2010 Objectives


Missouri Arthritis Alliance

Area Health Education Center-Northeast MissouriArthritis Foundation

Eastern Missouri ChapterCentral Missouri Branch Office

Western Missouri ChapterBJC Health SystemBaptist Home, TheBell City Methodist ChurchBlack River ColiseumBoone ClinicCape Girardeau Senior CenterCape Physician AssociatesCarter County Nutrition Center, EastCaruthersville Community CenterCaruthersville Nursing HomeCenter for Clayton, TheCenter VFW Hall, City ofCenter Town Hall, City ofCentral Missouri State UniversityChaffee Medical ClinicChaffee Nutrition CenterCharleston ManorChateau GirardeauClub WoodrailCity of Independence Housing AuthorityClark County Nursing HomeColumbia Mayor’s Council on Physical ActivityDelta Community CenterEllington Senior Nutrition SiteFamily Resource CenterFirst Baptist Church – Oak RidgeForget Me Not Senior CenterGovernor’s Council on DisabilityGovernor’s Council on Fitness and Physical ActivityGregg Community CenterHammon’s Heart InstituteHealth ConnectionHealthNetHealthSouthHealthSouth RehabHealthwise Center, St. PetersHeritage Physical TherapyHoover EldercareHospitals:

Audrain Medical CenterBarnes/Jewish St. Peters HospitalBoone Hospital CenterChildren’s Mercy HospitalChristian Hospital NE/NW, Graham Medical CenterDes Peres HospitalGolden Valley Memorial HospitalHannibal Regional HospitalHeartland Health SystemNortheast Regional Medical CenterSaint Luke’s Regional HospitalSt. Anthony’s Medical CenterSt. Francis Medical Center

Center for Health and RehabSt. John’s Mercy Hospital

This is a list of the initial partners representing professional organizations, academia, business,general public, and government (individuals/organizations) working to improve the lives ofpeople with arthritis. If your name and/or institution have been left off inadvertently, pleasecall the 800 number immediately. Also, if you or your organization is interested in becominginvolved in the Missouri Arthritis Action Plan, please join the Missouri Arthritis Alliance bycalling 800-36-0935 or completing and mailing the form in Appendix 1 on page 51.

St. John’s Mercy Medical CenterSt. Joseph Medical CenterSt. Joseph’s Hospital & Health Center

KirkwoodSt. Charles

St. Mary’s Hospital Physical Therapy DepartmentSamaritan HospitalScotland County Memorial HospitalSkaggs Hospital-BransonSullivan County Memorial Hospital

Hotels/Motels:Super 8, KennettCharleston InnDays Inn: Kirksville, SikestonSmalley’s Motel, Van Buren

Independent Living Center of Southeast Missouri Department of Healthand Senior Jewish Community Center Association,Creve Coeur and Chesterfield

ServicesKansas City Missouri Parks and Recreation DepartmentKirksville College of Osteopathic Medicine

Internal Medicine/GeriatricsGrants and Program DevelopmentCommunity Development Elder Lynk

Kirksville Parks and Recreation DepartmentKirksville Physicians & SurgeonsLIFE Independent LivingLocal Public Health Agencies

Iron County Health DepartmentJefferson County Health DepartmentKansas City Missouri Department of HealthKnox County Health DepartmentMercer County Health DepartmentNew Madrid County Health DepartmentPutnam County Health DepartmentStoddard County Health Center

Longview Community CollegeLupus Foundation of America, Inc.

Missouri Chapter (St. Louis)Kansas City Chapter

Lincoln UniversityMarble Hill Senior CenterMeadowbrook Residential – IrontonMid America Regional Council in Kansas City,

Missouri and Senior CentersMissouri’s Area Agencies on Aging


Missouri Centers for Independent LivingMissouri Department of Health and Senior Services

Division of AgingDivision of Chronic Disease Prevention & Health Promotion

Diabetes Control ProgramBreast Cervical Cancer Control ProgramCardiovascular Health ProgramHealth PromotionOffice of Surveillance, Research, and Evaluation

Office on Women’s HealthOffice on Minority HealthOffice of Public InformationDivision of Maternal Child Family Health

Bureau Special Health Care NeedsCenters for Local Public HealthCommunity Health Assessment Resource Team

Missouri Hospital AssociationMissouri League of NursingMissouri Medical AssociationMissouri Nurses AssociationMissouri Occupational Therapy AssociationMissouri Osteoporosis FoundationMissouri Patient Care Review FoundationMissouri Physical Therapy AssociationMissouri Public Health AssociationMissouri Silver Hair LegislatureMissouri Society of Health EducatorsMissouri Vocational RehabilitationMonett Senior CenterMontgomery County Care Share ProgramNational Chronic Fatigue Syndrome and Fibromyalgia AssociationNortheast Regional Health & Fitness CenterNortheast Regional Medical CenterNutrition Center/Community Building – PortagevilleOlder Women’s LeagueOrthopedic Associates-Cape GirardeauPalmyra Rural HousingParish Nurses Association, Kansas CityParkland TherapyPerry Park CenterPharmaceutical

CentocorPharmacia/SearleMerckWyeth-Ayerst/ImmunexPfizerAventisProctor and GambleSearleMGI Pharma, Inc.Ortho-McNeilPurdue Pharm LPEli LilyBoehringer IngelheimAmgen, Inc.Barr Laboratories

Portageville Public PoolQueeny Park/Greensfelder Recreation ComplexRainbow Village Community CenterRegional Arthritis Centers

Central Missouri Regional Arthritis CenterEastern Missouri Regional Arthritis CenterGreater Kansas City Regional Arthritis CenterNortheast Missouri Regional Arthritis CenterNorthwest Missouri Regional Arthritis CenterSoutheast Missouri Regional Arthritis Center

Southwest Missouri Regional Arthritis CenterReStartReynolds County Sheltered WorkshopRiverside Regional LibraryRural Advocates for Independent LivingSt. John’s Regional Health System—Springfield/JoplinSt. Louis University

School of Public HealthSchool of Medicine-Division Rheumatology

Samuel U. Rodgers Health Care CenterScleroderma Support GroupSears Youth CenterSenior Citizen’s Housing Authority Center – Van BurenShepherd Centers, Kansas CitySjogren’s Syndrome Support GroupSSM Health and WellnessSwope Parkway Health Care CenterTruman Medical CenterTruman State University

Nursing DepartmentHealth and Exercise Science

Twin Rivers Fitness CenterTwin Towers – Popular BluffUnited HealthCareUniversal Health and Fitness – Cape GirardeauUniversity of Missouri – Columbia Campus

Missouri Arthritis Rehabilitation Research Training CenterFamily Health CenterHealth Information CenterCollege of Agriculture, Food and Natural ResourcesUniversity ExtensionSchool of Health Professions

Health ConnectionElderCare

Department of Cardiopulmonary and Diagnostic ProfessionsDepartment of Physical TherapyDepartment of Occupational TherapyDepartment of PsychologySchool of MedicineDepartment of RheumatologyDepartment of Physical Medicine and RehabilitationDepartment of Family and Community MedicineSchool of Nursing

University of Missouri – Kansas City CampusUniversity of Missouri – St. Louis CampusUniversity Outreach & ExtensionWashington University

Division RheumatologySchool of Medicine

Wegener’s Granulomatosis Association, InternationalWellAwareWellbridge by SSMWestside Church of God, Popular BluffYarco GroupYMCAs/YWCAs

4 Rivers YMCACarondelet Family YMCAEdward Jones Family YMCAEmerson Family YMCAKirkwood Family YMCAMid-County Family YMCAMonsanto Family YMCANorthwest County Family YMCASikeston YMCASouth County Family YMCASouthside YMCAWebster Groves Family YMCAWest County Family YMCAO’Fallon YMCAJoplin YMCA

Missouri Arthritis Alliance


AppendicesAppendix 1

If you are interested in being a part of the MissouriArthritis Alliance, please complete this form and mail,e-mail, or fax it to:

Missouri Arthritis AllianceMissouri Arthritis & Osteoporosis ProgramP. O. Box 570Jefferson City, Missouri 65102-0570Fax: 573-522-2898Email: [email protected]

Name: _____________________________________ Credentials: ________________________

Title: _________________________________________________________________________

Agency: ______________________________________________________________________

Address: ______________________________________________________________________

Phone: ____________________________________ Fax: ______________________________

Email: ________________________________________________________________________

Web: _________________________________________________________________________

I would like to:

Serve as a member of the Missouri Arthritis Advisory Board

Become a self-management course leader

Become a physical activity course leader

Serve as a member of a Speakers Bureau

Provide a facility for course(s)

Advocate for greenways/sidewalks/walking paths

Learn more about opportunities/needs in my community

Become a member of my local Arthritis Foundation Chapter

Become a member of my Regional Arthritis Advisory Board

Other: ____________________________________________________________________

Other: ____________________________________________________________________


AppendicesAppendix 2:

Division of ChronicDisease Prevention &

Health Promotion

Office ofSurveillance, Research

& Evaluation

Bureau ofCancer Control

Bureau ofChronic Disease

Control

Bureau ofHealth Promotion

CardiovascularHealth Program

MissouriDiabetes Control

Program

Missouri Arthritis& Osteoporosis

Program

Chronic DiseaseNutrition

Interventions

MissouriAsthmaProgram

Heartland Regional Medical

Arthritis Foundation – Eastern

Kirksville College of Osteopathic Medicine

St. Francis Medical Center

St. John’s Health System

Saint Luke’s Hospital

University of Missouri-Columbia

Missouri ArthritisAdvisory Board

Arthritis FoundationChapters

MARRTCLupus Foundation

Chapters

ContractualAdvisory/Major Partner

RegionalArthritis Centers

MAOP Organizational Chart 2002



The MAOP has a statewide network of Regional Arthritis Centers (RACs) that provideinformation and support for persons and families affected by arthritis. This includes organizingcommunity support groups, arthritis self-help courses, and land and aquatic exercise classes.

The RACs also organize continuing education coursesfor physicians, nurses, and allied health professionalsand offer public forums and general presentations onstate-of-the-art care for rheumatic diseases.

Missouri Regional Arthritis Centers

BOONE

AUDRAIN

HOWARD

CHARITON

SALINE

MORGAN

PETTIS

CARROLL

COLE

COOPER

MILLER

CAMDEN

MO

NT

GO

ME

RY

GA

SC

ON

AD

E

PULASKI

LACLEDE DENTPOLK

GREENE

WEBSTER WRIGHT

DOUGLAS HOWELL

SHANNON

CARTER

WAYNE

MADISON

BO

LL

ING

ER

ST

.

FR

AN

CO

IS STE.

GENEVIEVE

WASHINGTON

JEFFERSON

PERRY

CAPE

GIRARDEAU

SCOTT

MISSISSIPPI

STODDARD

BUTLER

PE

MIS

CO

T

DUNKLIN

ST. LOUIS

ST. CHARLES

LINCOLN

PIKE

MACON

MONROE

JOHNSON

LAFAYETTE

JACKSON

RAY

CLAY

PLATTE

CLINTON

BUCHANAN

ATCHISON NODAWAY

LAWRENCE

JASPER

BARRY

TANEY

WORTH HARRISON MERCER PUTNAM SCHUYLER

SCOTLAND

CLARK

HOLT

ANDREW

GENTRY

DEKALB

GRUNDY

DAVIES

SULLIVAN

ADAIR

LINN

LIVINGSTON

CALDWELL

KNOX

SHELBY

RANDOLPH

LEWIS

MARION

RALLS

CALLAWAY

CASSWARREN

FRANKLIN

CRAWFORD

IRON

REYNOLDSTEXAS

MARIES

NEW

MADRID

RIPLEYOREGON

DALLAS

HICKORY

BENTON

ST. CLAIR

HENRY

CEDAR

DADE

BARTON

VERNON

BATES

STONE

McDONALD

NEWTONCHRISTIAN

OZARK

MONITEAU

OSAGE

ST. LOUIS

CITY

PHELPS

Regional Arthritis Center

Arthritis Foundation Office

Eastern Chapter Office Region

Western Chapter Office Region

Central MO Regional Arthritis Center

573-882-8097

Arthritis Foundation, Central Branch

573-256-1092

Southeast MO Regional Arthritis Center

888-216-3293

Southwest Missouri


800-835-5197

Eastern MO Regional

Arthritis Center

314-991-9333

Northeast MO Regional Arthritis Center

800-626-5266

Northwest MO Regional Arthritis/

Osteoporosis Center

800-443-8858

Greater Kansas City


816-932-2351

Arthritis Foundation-Western

888-719-5670

Arthritis Foundation-

Eastern

314-991-9333

NEED MORE HELP?Contact your local RAC.

Hearing-impaired citizens’ telephone1-800-735-2966.

EEO/AAP services provided on a non-discriminatory basis



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Appendix 4

Arthritis Action Plan: Missouri’s Fight Against Arthritis

Please take a moment to provide feedback about thispublication. The information you provide will assist with thedevelopment of future plans and initiatives.

Where did you obtain a copy of the plan? ❏ Mail ❏ Internet ❏ Other

Was this plan useful to you? ❏ Yes ❏ NoDid this plan increase your knowledge of:Arthritis? ❏ Yes ❏ Partially ❏ No

Juvenile Arthritis? ❏ Yes ❏ Partially ❏ No

How you can help? ❏ Yes ❏ Partially ❏ No

Programs/Services available? ❏ Yes ❏ Partially ❏ NoI/we will be able to use this plan in my job/community ❏ Agree ❏ Disagree ❏ Unknown/Uncertain

If YES, what did you find particularly useful?______________________________________________________________________________________________________________________________________________________________________

If NO, what would have made this plan useful?______________________________________________________________________________________________________________________________________________________________________

Was the plan content practical and understandable? ❏ Yes ❏ NoIf NO, what changes would you recommend?______________________________________________________________________________________________________________________________________________________________________

What additional information would you have liked included?______________________________________________________________________________________________________________________________________________________________________

Are you interested in receiving a copy of the Missouri Arthritis Report 2001?❏ Yes, please send me a copy of the report.

❏ Yes, please send additional information as it becomes available.

❏ No, do not send any information at this time.

Name: ____________________________________________________________

Title: _____________________________________________________________

Agency: __________________________________________________________

Address: __________________________________________________________

Please return this survey to:Missouri Arthritis & Osteoporosis ProgramMissouri Department of Health & Senior ServicesP.O. Box 570Jefferson City, MO 65102-0570Fax: 573-522-2898


Arthritis and OsteoporosisMissouri Department of Health & Senior ServicesBureau of Chronic Disease Control

This publication was supported by Grant/Cooperative Agreement Number 99038 from the Centers forDisease Control and Prevention (CDC). Its contents are solely the responsibility of the authors and do notnecessarily represent the official views of the CDC.

Alternate forms of this publication for persons with disabilities may be obtained by contacting the MissouriDepartment of Health and Senior Services, Division of Chronic Disease Prevention and Health Promotion,P.O. Box 570, Jefferson City, MO 65102-0570, 1-800-316-0935.Hearing impaired citizens telephone 1-800-735-2966.

AN EQUAL OPPORTUNITY/AFFRIMATIVE ACTION EMPLOYERServices provided on a non-discriminatory basis.

missouri’s fight against arthritis · acknowledgements 6 missouri’s fight against arthritis...

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