Self-reported Doctor-diagnosed Arthritis Research Articles

Associations of current and childhood socioeconomic status and health outcomes amongst patients with knee or hip osteoarthritis in a Mexico City family-practice setting

ObjectivesTo examine the association of current and childhood socioeconomic status (SES) with patient-reported functional status, quality of life and disability in patients with knee or hip osteoarthritis (OA).MethodsCross-sectional study amongst individuals seeking care for any medical reason in a primary care family-practice clinic in Mexico City. We included individuals with self-reported doctor-diagnosed arthritis, recruited through waiting-room posters and invitations by treating family physicians. We administered a survey using validated Spanish language versions of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Osteoarthritis of Lower Limbs and Quality of Life (AMICAL), and the Stanford Health Assessment Questionnaire-Disability Index (HAQ-DI). To estimate current and childhood SES, we collected data on education level and occupation type for both the patient and their parents, as well as using a validated tool to estimate income quintile.ResultsWe recruited 154 patients and excluded 8 patients. There was a high correlation between outcome scores. Estimated income and education levels were correlated with WOMAC, AMICAL and HAQ-DI scores, and significant differences were found in all scores by occupation type. The associations for current SES variables and outcome scores remained significant independently of age, sex, BMI, and presence of diabetes or hypertension, and were largely explained by current income in mutually adjusted models. Childhood SES – in particular as measured through maternal education – was best correlated with AMICAL scores, though its effect seemed largely mediated by its association with current SES.ConclusionsCurrent Socioeconomic Status impacts functional status, quality of life and disability amongst OA patients in Mexico City. The WOMAC, AMICAL and HAQ-DI scores correlate with each other and are all potentially useful markers of disease severity. More research is needed to elucidate the relationships between childhood SES and OA outcomes. Awareness of life-course SES may be useful in identifying patients at risk for worse outcomes.

Exposure to the Chinese famine in early life and self-reported arthritis risk in adulthood

ABSTRACT Evidence shows that undernutrition during early life is associated with an increased risk of chronic diseases in adulthood. We aimed to investigate whether exposure to the Chinese famine in the fetal or infant stage was associated with self-reported arthritis risk in adulthood. A total of 3,622 participants were included in the final analysis. Participants were classified into non-, fetal-, and infant-exposed group. Arthritis was self-reported doctor-diagnosed arthritis. A multivariate logistic regression model was used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) of arthritis. The prevalence of arthritis was 27.07%, 27.74%, and 34.09% among individuals in non-, fetal-, infant-exposed group, respectively. Infant-exposed group (OR: 1.32; 95% CI: 1.12-1.56) had a higher arthritis risk then non-exposed group after adjustment for gender, age, area, education level, smoking status, drinking status, and physical activity. Participants who experienced severe famine during infant and fetal period had higher (41.46%, OR=1.71 and 32.94%, OR=1.36) arthritis risk than those exposed to less severe famine. Exposure to the Chinese famine in early life was associated with an increased risk of arthritis in adulthood, which was partially influenced by some factors (e.g., gender, area, body mass index, and born in severely affected area or not).

Impact of arthritis on the perceived need and use of mental healthcare among Canadians with mental disorders: nationally representative cross-sectional study

ObjectiveTo evaluate the association between having arthritis and the perceived need for mental healthcare and use of mental health support among individuals with mental disorders.DesignA cross-sectional analysis using data from...

Prevalence rates of arthritis among US older adults with varying degrees of depression: Findings from the 2011 to 2014 National Health and Nutrition Examination Survey.

Arthritis and depressive symptoms often interact and negatively influence one another to worsen mental and physical health outcomes. Better characterization of arthritis rates among older adults with different levels of depressive symptoms is an important step toward informing mental health professionals of the need to detect and respond to arthritis and related mental health complications. The primary objective is to determine arthritis rates among US older adults with varying degrees of depression. Using National Health and Nutrition Examination Survey 2011 to 2014 data (N=4792), we first identified participants aged ≥50years. Measures screened for depressive symptoms and self-reported doctor-diagnosed arthritis. Weighted logistic regression models were conducted. Prevalence of arthritis was 55.0%, 62.9%, and 67.8% in participants with minor, moderate, and severe depression, respectively. In both unadjusted and adjusted regression models, a significant association between moderate depression and arthritis persisted. There were also significant associations between minor and severe depression with arthritis. Arthritis is commonly reported in participants with varying degrees of depression. This study highlights the importance of screening for and treating arthritis-related pain in older adults with depressive symptoms and the need for future geriatric psychiatry research on developing integrated biopsychosocial interventions for these common conditions.

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

To update the projected prevalence of arthritis and arthritis-attributable activity limitations among US adults, using a newer baseline for estimates. Baseline prevalence data were obtained from the 2010-2012 National Health Interview Survey. Arthritis was defined as an answer of "yes" to the question "Have you ever been told by a doctor or other health professional that you have some form of arthritis, rheumatoid arthritis, gout, lupus or fibromyalgia?" Arthritis-attributable activity limitation was defined as an answer of "yes" to the question "Are you limited in any way in any of your usual activities because of arthritis or joint symptoms?" The baseline prevalence of arthritis and arthritis-attributable activity limitation was stratified according to age and sex and was statistically weighted to account for the complex survey design. The projected prevalence of doctor-diagnosed arthritis and arthritis-attributable activity limitation was calculated by multiplying the age- and sex-stratified population estimates projected for 2015-2040 (in 5-year intervals; provided by the US Census Bureau) by the baseline estimates. Age- and sex-specific prevalences were summed to provide the total prevalence estimates for each year. In 2010-2012, 52.5 million adults in the US (22.7% of all adults) had doctor-diagnosed arthritis, and 22.7 million (9.8%) had arthritis-attributable activity limitation. By 2040, the number of US adults with doctor-diagnosed arthritis is projected to increase 49% to 78.4 million (25.9% of all adults), and the number of adults with arthritis-attributable activity limitation will increase 52% to 34.6 million (11.4% of all adults). Updated projections suggest that arthritis and arthritis-attributable activity limitation will remain large and growing problems for clinical and public health systems, which must plan and create policies and resources to address these future needs.

Psychometric properties of the 8-item english arthritis self-efficacy scale in a diverse sample.

Arthritis self-efficacy is important for successful disease management. This study examined psychometric properties of the 8-item English version of the Arthritis Self-Efficacy Scale (ASES-8) and differences in ASES-8 scores across sample subgroups. In 401 participants with self-reported doctor-diagnosed arthritis, exploratory factor analysis and tests of internal consistency were conducted. Concurrent validity was examined by associating ASES-8 scores with disease-specific, psychosocial, functional, and behavioral measures expected to be related to arthritis self-efficacy. All analyses were conducted for the full sample and within subgroups (gender, race, age, education, and weight status). Exploratory factor analysis for the entire sample and in all 12 subgroups demonstrated a one factor solution (factor loadings: 0.61 to 0.89). Internal consistency was high for measures of Cronbach's alpha (0.87 to 0.94), omega (0.87 to 0.93), and greatest lower bound (0.90 to 0.95). ASES-8 scores were significantly correlated with all measures assessed (P < 0.05), demonstrating concurrent validity. Those with a high school education or greater had higher ASES-8 scores than those with less than a high school education (P < .001); no other subgroup differences were found. The ASES-8 is a valid and reliable tool to measure arthritis self-efficacy efficiently and thereby reduce participant burden in research studies.

Independent associations of childhood and current socioeconomic status with risk of self-reported doctor-diagnosed arthritis in a family-medicine cohort of North-Carolinians

BackgroundAssociations of socioeconomic status (SES) with the prevalence of various forms of arthritis are well documented. Increasing evidence suggests that SES during childhood is a lasting determinant of health, but its association with the onset of arthritis remains unclear.MethodsCross-sectional data on 1276 participants originated from 22 family practices in North-Carolina, USA. We created 4-level (high, medium, low, lowest) current SES and childhood SES summary scores based on parental and participant education, occupation and homeownership. We investigated associations of individual SES characteristics, summary scores and SES trajectories (e.g. high/low) with self-reported arthritis in logistic regression models progressively adjusted for race and gender, age, then BMI, and clustered by family practice.ResultsWe found evidence for independent associations of both childhood and current SES with the reporting of arthritis across our models. In covariate-adjusted models simultaneously including current and childhood SES, compared with high SES participants in the lowest childhood SES category (OR = 1.39 [95% CI = 1.04, 1.85]) and those in the low (OR = 1.66 [95% CI = 1.14, 2.42]) and lowest (OR = 2.08 [95% CI = 1.16, 3.74]) categories of current SES had significantly greater odds of having self-reported arthritis.ConclusionsCurrent SES and childhood SES are both associated with the odds of reporting arthritis within this primary-care population, although the possibly superseding influence of existing circumstances must be noted. BMI was a likely mechanism in the association of childhood SES with arthritis onset, and research is needed to elucidate further pathways linking the socioeconomic environment across life-stages and the development of rheumatic diseases.

Social participation restriction among US adults with arthritis: a population-based study using the International Classification of Functioning, Disability and Health.

To examine arthritis impact among US adults with self-reported doctor-diagnosed arthritis using the International Classification of Functioning, Disability and Health (ICF) framework (including the impairments, activity limitations, environmental, and personal factors domains and social participation restriction [SPR] as the outcome) overall and among those with and without SPR, and to identify the correlates of SPR. Cross-sectional 2009 National Health Interview Survey data were analyzed to examine the distribution of the ICF domain components. Unadjusted and multivariable-adjusted prevalence ratios (PRs) and 95% confidence intervals (95% CIs) were estimated to identify the correlates of SPR. Analyses using SAS, version 9.2 survey procedures accounted for the complex sample design. SPR prevalence was 11% of adults with arthritis (5.7 million). After initial multivariable adjustment by ICF domain, serious psychological distress (impairments domain; PR 2.5 [95% CI 2.0-3.2]), ≥5 medical office visits (environmental domain; PR 3.4 [95% CI 2.5-4.4]), and physical inactivity (personal domain; PR 4.8 [95% CI 3.6-6.4]) were most strongly associated with SPR. A combined measure (key limitations [walking, standing, or carrying]; PR 31.2 [95% CI 22.3-43.5]) represented the activity limitations domain. After final multivariable adjustment incorporating all ICF domains simultaneously, the strongest associations with SPR were key limitations (PR 24.3 [95% CI 16.8-35.1]), ≥9 hours of sleep (PR 1.6 [95% CI 1.3-2.0]), and income-to-poverty ratio <2.00 and severe joint pain (PR 1.4 [95% CI 1.2-1.6] for both). SPR affects 1 of 9 adults with arthritis. This study is the first to use the ICF framework in a population-based sample to identify specific functional activities, pain, sleep, and other areas as priorities for intervention to reduce negative arthritis impacts on disability, including SPR. Increased use of existing clinical and public health interventions is warranted.

Factors associated with disability in a sample of adults with arthritis

BackgroundArthritis is the most common cause of disability among US adults. Few studies have comprehensively examined factors associated with disability in this population. ObjectiveTo investigate the relationship between a number of disease and non-disease related factors and disability in sample of adults with self-reported doctor-diagnosed arthritis. MethodsParticipants (n = 396) taking part in a randomized controlled trial of arthritis self-management completed a comprehensive survey assessing a number of demographic, arthritis-specific, health-related, behavioral, and psychological variables at baseline. Disability, as measured by the Health Assessment Questionnaire (HAQ), was also measured. Hierarchical regression models examined the independent associations between blocks of variables and disability. ResultsDemographic variables (R2 = 0.13), arthritis-specific demographics (i.e., type, medication use; ΔR2 = 0.16), physical health-related variables (ΔR2 = 0.06), arthritis-specific symptoms (ΔR2 = 0.12), health behaviors (ΔR2 = 0.00), and psychological variables (ΔR2 = 0.03) explained 50% of the variance in disability score (R2 = 0.50). With the exception of health behaviors, the addition of each block of variables significantly improved the model, explaining additional variance in HAQ scores (p < 0.0001). In the final model, older age, less than a high school education, rheumatoid arthritis, greater arthritis duration, taking steroids, taking narcotics, greater pain, greater stiffness, greater depressive symptoms, and lower arthritis self-efficacy were associated with greater disability whereas male gender, fibromyalgia, and excellent/very good health were associated with less disability. ConclusionsA number of disease and non-disease related variables were associated with disability. These findings suggest that disability in adults with arthritis may be a complicated phenomenon; such complexity may make decreasing disability in this population challenging.

Physical Activity and Frequent Sleep Insufficiency Among US Adults with Arthritis

Sleep problems occur in 30-80% of adults with arthritis. Physical activity may be a non-pharmaceutical approach to improving sleep. PURPOSE: To assess the prevalence of sleep insufficiency and its association with physical activity (PA) level among adults with self-reported doctor-diagnosed arthritis (ARTH). METHODS: Using the 2009 Behavioral Risk Factor Surveillance System (BRFSS, n=424,592; n=153,914 with ARTH) we calculated moderate-intensity-equivalent minutes/week (2*vigorous min/wk + moderate min/wk) of self-reported PA for each respondent. Three PA levels were defined as: Active (ACT) (≥150 min/wk), insufficiently active (INSUF) (>10 - 149 min/wk), and inactive (INACT) (no PA for at least 10 min/wk). Frequent sleep insufficiency (FSI) was defined as reporting not getting enough sleep or rest for 14 or more days in the past 30. Weighted prevalence estimates (%) and 95% confidence intervals (CI) were calculated accounting for the complex sample design. Multivariable logistic regression models (adjusted odds ratios, AOR) were used to assess the association between PA level (INACT = referent) and FSI among adults with ARTH. RESULTS: The prevalence of FSI was significantly higher (p<0.0001) among adults with ARTH (31.9%, CI 31.5-32.4) compared to adults without ARTH (25.9%, CI 25.6-26.3). Among adults with arthritis, FSI prevalence decreased as PA level increased (39.4% INACT, 31.1% INSUF, 29.9% ACT, p<0.0001). Compared to INACT, INSUF (crude OR=0.71, CI 0.67-0.75) and ACT (crude OR=0.75, CI 0.71-0.80) PA levels were associated with lower odds of FSI. These adjusted associations remained statistically significant (INSUF AOR=0.89, CI 0.84-0.95; ACT AOR=0.83, CI 0.77-0.89) after adjustment for demographic variables (age, sex, race/ethnicity, education), health status variables (body mass index, self-rated health, arthritis-attributable activity limitation, joint pain) and co-morbid conditions (diabetes, hypertension, heart disease, asthma, frequent mental distress). CONCLUSION: 1 in 3 adults with ARTH report FSI. Adults with ARTH meeting ACT levels of PA were 17% less likely to report FSI than INACT, suggesting physical activity may be a promising strategy to decrease FSI in this population. These findings need to be verified in prospective studies.

Prevalence of Meeting the Physical Activity Guidelines for Americans among Adults With and Without Arthritis

In October 2008, the US Department of Health and Human Services released the 2008 Physical Activity Guidelines for Americans (PAG), which defines the amount of physical activity (PA) needed to achieve health benefits. PURPOSE: To estimate the prevalence of meeting the PAG among adults with and without self-reported doctor-diagnosed arthritis (ARTH). METHODS: Using the 2007 National Health Interview Survey (n=23,393), minutes of vigorous intensity PA were translated into moderate-intensity-equivalent min/week (1 min vigorous = 2 min moderate). Active (ACT) was defined as at least 150 min/week of moderate-intensity equivalent PA. Insufficiently active (INSUF) was defined as some PA but not enough to meet ACT. Inactive (INACT) was defined as no moderate or vigorous-intensity PA for at least 10 minutes. Respondents reporting muscle strengthening activities 2+ days per week were classified as meeting the muscle strengthening (MS) PAG. Compliance with the overall PAG was defined as meeting both the aerobic and MS components. Prevalence estimates (%) and 95% confidence intervals (CI) were calculated using statistical weights to account for the complex sample design. Significant (p<0.05) differences in prevalence was determined using Wald Chi-Square tests. Logistic regression (odds ratio=OR) assessed the association between ARTH and meeting the PAG. RESULTS: The prevalence of meeting recommendations was significantly lower for adults with ARTH (ACT=31.9%, CI 30.3-33.5; MS=15.6%, CI 14.4-16.9) compared to adults without ARTH (ACT=44.1%, CI 43.2-44.9; MS=20.9%, CI 20.2-21.7). The prevalence of INACT was significantly higher among those with ARTH (47.5% CI 45.9-49.2) versus without ARTH (36.9%, CI 36.1-37.7). Overall compliance with the PAG was low for both adults with (11.5%, CI 10.4-12.6) and without ARTH (17.8%, CI 17.1-18.5). Adults with ARTH were 40% (crude OR 0.60, CI 0.53-0.68) less likely to meet the PAG than those without ARTH. This relationship remained significant (adjusted OR 0.85, CI 0.72-1.00, p=0.04), after adjusting for age, sex, race/ethnicity, body mass index, and activity limitation. CONCLUSION: Only 1 in 10 adults with ARTH meet national PA guidelines. Expanding the reach of evidence-based, community-delivered PA programs may help adults with ARTH achieve recommended levels of PA.

Quantifying the impact of transient joint symptoms, chronic joint symptoms, and arthritis: A population‐based approach

To estimate the prevalence and co-occurrence of self-reported doctor-diagnosed arthritis, chronic joint symptoms (pain, aching, stiffness, or swelling on most days for a month), and transient joint symptoms (pain, aching, stiffness, or swelling but not on most days for a month), and to compare the sociodemographic characteristics, activity limitations, and health-related quality of life (HRQOL) of people with joint conditions with those who have no self-reported doctor-diagnosed arthritis and no joint symptoms. Data from the 2004 population-based South Australian Health Omnibus Survey (n = 2,840, ages 18-96 years) were used in the study. Activity limitations were assessed using 10 activity limitations questions from the Short Form 36 health survey. HRQOL was assessed using the Assessment of Quality of Life scale. Half of all respondents reported having joint problems, with 26%, 11%, and 13% reporting self-reported doctor-diagnosed arthritis, chronic joint symptoms, and transient joint symptoms, respectively. Chronic joint conditions (self-reported doctor-diagnosed arthritis and chronic joint symptoms) accounted for 74% of all joint problems and were associated with higher odds of activity limitations and poorer HRQOL. The frequency of transient and chronic joint symptoms was highest among middle-aged participants (ages 45-54 years for transient and 45-64 years for chronic joint symptoms) and those who had a body mass index in the obese range. Prevalence of self-reported doctor-diagnosed arthritis increased with age and was higher among women and those who were overweight or obese. This study documented the high prevalence and impact of joint conditions in the community. Chronic joint conditions affect daily life and are substantial barriers for effective public health interventions aimed at reducing obesity and inactivity.

Physical activity in women with arthritis: Examining perceived barriers and self‐regulatory efficacy to cope

To examine whether the theory-based social cognitions of perceived barrier frequency, barrier limitation, and self-regulatory efficacy to cope were predictors of planned physical activity among adult women with arthritis. A secondary purpose was to identify and provide a phenomenologic description of the relevant barriers and coping strategies reported by study participants. Eighty adult women (mean +/- SD age 49.09 +/- 12.89 years) with self-reported doctor-diagnosed arthritis participated in this observational study. Participants completed online survey measures of barriers to physical activity and, for each barrier, reported the frequency of occurrence and the extent of limitation. Measures of coping strategies for each barrier, efficacy to cope, and physical activity were also obtained. A multiple hierarchical regression analysis resulted in a model that significantly predicted physical activity (F[9,70] = 6.80, P < 0.01, adjusted R(2) = 0.40). Barrier limitation (standardized beta = -0.56) and efficacy (standardized beta = 0.20) were significant independent predictors. Phenomenologic findings indicated that arthritis-specific personal barriers (e.g., pain and fatigue due to arthritis) and arthritis-specific coping strategies (e.g., activity modification) were more commonly reported than generic barriers and coping strategies. Self-regulatory efficacy to cope and relevant perceived physical activity barriers, which were primarily arthritis-specific and moderately or more limiting to planned physical activity, were important social cognitive predictors of physical activity, a key nonpharmacologic arthritis treatment, among women with arthritis. Future research direction should examine potential moderators of the relationship between these predictors and physical activity, such as pain acceptance.

Estimates of the prevalence of arthritis and other rheumatic conditions in the United States: Part I

To provide a single source for the best available estimates of the US prevalence of and number of individuals affected by arthritis overall, rheumatoid arthritis, juvenile arthritis, the spondylarthritides, systemic lupus erythematosus, systemic sclerosis, and Sjögren's syndrome. A companion article (part II) addresses additional conditions. The National Arthritis Data Workgroup reviewed published analyses from available national surveys, such as the National Health and Nutrition Examination Survey and the National Health Interview Survey (NHIS). For analysis of overall arthritis, we used the NHIS. Because data based on national population samples are unavailable for most specific rheumatic conditions, we derived estimates from published studies of smaller, defined populations. For specific conditions, the best available prevalence estimates were applied to the corresponding 2005 US population estimates from the Census Bureau, to estimate the number affected with each condition. More than 21% of US adults (46.4 million persons) were found to have self-reported doctor-diagnosed arthritis. We estimated that rheumatoid arthritis affects 1.3 million adults (down from the estimate of 2.1 million for 1995), juvenile arthritis affects 294,000 children, spondylarthritides affect from 0.6 million to 2.4 million adults, systemic lupus erythematosus affects from 161,000 to 322,000 adults, systemic sclerosis affects 49,000 adults, and primary Sjögren's syndrome affects from 0.4 million to 3.1 million adults. Arthritis and other rheumatic conditions continue to be a large and growing public health problem. Estimates for many specific rheumatic conditions rely on a few, small studies of uncertain generalizability to the US population. This report provides the best available prevalence estimates for the US, but for most specific conditions, more studies generalizable to the US or addressing understudied populations are needed.

Projected prevalence of US adults with self-reported doctor-diagnosed arthritis, 2005 to 2050

Using population-based survey data from the 2003 Behavioral Risk Factor Surveillance Survey (BRFSS), we estimated the population prevalence of self-reported, doctor-diagnosed arthritis in the US from 2005 to 2050. Projected arthritis-prevalence data were estimated in 5-year increments along sex- and age-specific categories by multiplying the 2003 BRFSS arthritis prevalence data by the sex-stratified US Census projections. During this 45-year period, we estimate that the total number of US adults aged 20 years or older with arthritis will increase from 60 million to 96 million, a 1.6-fold increase. The increase is projected to be greater in those aged 65 years or older (a 2.3-fold increase) than for those aged 20 to 65 (a 1.3-fold increase). Given increases in the prevalence of known arthritis risk factors (e.g., obesity, Hispanic origin) our projections might underestimate the prevalence of arthritis in the coming years.

National Rates Of Provider Advice For Exercise And Weight Loss Among Adults With Arthritis

PURPOSE The purpose of this study is to estimate the national rate of health care provider advice for exercise and weight loss among adults with self-reported doctordiagnosed arthritis. METHODS Data were from the 2002 National Health Interview Survey, a nationally representative annual sample of US adults aged 18 and older. Adults with self-reported doctor-diagnosed arthritis were asked: 1.) “Has a doctor or other health care provider EVER suggested losing weight to help your arthritis or joint symptoms?” and 2.) “Has a doctor or other health care provider EVER suggested physical activity or exercise to help your arthritis or joint symptoms?” Associations between demographic (age, sex, race/ethnicity, education, income, body mass index, physical activity level, smoking status), health care use (have usual place for health care, number of health care visits past 12 months), and general health (activity limitation, work limitation, number of co-morbid conditions, frequent anxiety/depression, joint symptoms) factors and receipt of health care advice for weight loss and exercise were investigated using logistic regression in separate models. National rates of receipt of health care advice for weight loss and exercise were determined and regression models were analyzed using SUDAAN to account for the complex sample size. RESULTS In 2002, 42.7 million (20.8%) US adults reported doctor-diagnosed arthritis. Of these, 52.4% had been advised to exercise and 28.9% were advised to lose weight by a health care provider. Among inactive adults with arthritis, 47.9% were advised to exercise; 24.5% of overweight and 62.5% of obese adults with arthritis were advised to lose weight. Factors significantly associated with higher likelihood of receipt of health care advice for weight loss and exercise were similar, and included: female gender, overweight/obese, physically active, higher education, having a usual place for health care, number of health care visits and more co-morbid conditions. Adults who were older and reported current smoking, activity limitations, work limitations, frequent anxiety/depression and joint symptoms were less likely to receive advice. Race/ethnicity and income level were not significantly associated with receiving advice. CONCLUSION These data suggest that many adults with arthritis, even those with highest need (e.g. inactive, overweight), are not receiving advice to lose weight or exercise from their health care provider despite the fact that both weight loss and exercise have been shown to have disease-specific benefits including decreased pain, improved function and mental health among this population.