Hootman et al. Respond

Abstract

We are glad that Roberts found our article informative, and we appreciate her clinical experience insights. Increasing awareness and knowledge of arthritis and other rheumatic conditions among health care professionals is critical. Because of the dearth of rheumatologists in some parts of the country and the predicted workforce shortages to come,1 we must rely on primary care providers to recognize and initiate treatment of many patients with arthritis and other rheumatic conditions. As we stated,2 early recognition and appropriate treatment is particularly important for persons with systemic and inflammatory types of rheumatic disease. Although no disease-modifying treatments are yet available for osteoarthritis, instituting lifestyle changes such as exercise and weight-loss management early in the disease course can prevent pain and disability in the long term. There are several ongoing initiatives that can provide much needed rheumatology training resources for health care providers. The American College of Rheumatology has developed two online training programs for health care professionals treating patients with rheumatic diseases. The Fundamentals of Rheumatology Course3 targets office staff, nurses, medical assistants, nurse practitioners, and physician assistants, and focuses on the multifaceted care and management of rheumatic disease patients. The Advanced Rheumatology Course4 (three tracks: pediatric, adult, and combined) targets physicians, fellows-in-training, advance practice nurses, and physician assistants, and focuses on building competence in caring for persons with various rheumatic diseases. There is good evidence of arthritis’ effects on costs, morbidity, quality of life, and interference with recommended interventions for other diseases5 that supports Roberts’ suggestion that arthritis should be considered equally with heart disease, diabetes, chronic obstructive pulmonary disease, and asthma in health care and public health initiatives. We have seen small changes in funding for public health efforts in arthritis (the Centers for Disease Control [CDC] arthritis funding increased from $10 million in 1999 to $14 million in 2012), and the CDC has also received separate congressional funding for lupus registries. Arthritis-specific objectives were included for the first time in Healthy People 20106 and were expanded in Healthy People 2020.7 Most recently, arthritis was listed as one of nine exemplar conditions in the Institute of Medicine report Living Well with Chronic Illness: A Call for Public Health Action.8 These initiatives are helping to raise the visibility of arthritis as an important public health problem.