Arthritis Center focuses attention on rehab options
Arthritis Center focuses attention on rehab options
Center has its own space starting this year
Arthritis treatment has undergone a revolution in recent years as new medications make it possible to suppress inflammation better, which may eventually reduce the rate of joint destruction or disability related to arthritis. While a great deal of media attention is paid to the pharmaceutical management of arthritis, many patients still are uneducated about arthritis treatments, especially about the role physical therapy and rehabilitation play in treatment.
Several decades ago, physicians and the public believed that people with arthritis should not exercise. Although research has proven that belief to be a fallacy, many people still are unaware of how important exercise and physical therapy are to arthritis treatment, says Rowland Chang, MD, MPH, medical director of the Arthritis Center at the Rehabilitation Institute of Chicago. Chang also is a professor of medicine, preventive medicine, and physical medicine and rehabilitation at Northwestern University Medical School in Chicago.
A community survey of more than 800 respondents conducted by the Rehabilitation Institute of Chicago found that 50% of the people surveyed over age 45 reported having chronic joint symptoms. Of these arthritis sufferers, nearly 30% have never discussed it with their physicians, presumably because they erroneously believe that nothing can be done about the symptoms or consequences of arthritis, Chang says.
"We need to educate the public that arthritis is the most common cause of disability in this country and that something can be done about it," Chang says. "Patients need to know they can take some control over their own fate, since among our most useful interventions are self-management and physical activity." This is where an arthritis center based in a rehabilitation facility plays an important role, Chang says.
The Rehabilitation Institute of Chicago’s Arthritis Center opened in its own physical space in January 2001 on the ninth floor of the institute. The physical move marks a philosophical change in which outpatient services offered by the arthritis center have been enhanced and expanded.
Making arthritis a public-health issue
Chang is actively involved with the Arthritis Foundation, both at its national headquarters in Atlanta and its Greater Chicago Chapter. The Arthritis Foundation has partnered with the Centers for Disease Control and Prevention in Atlanta to create the National Arthritis Action Plan, a public health blueprint for the prevention of arthritis and its related disability.
"For the first time in history, there is a full chapter devoted to arthritis and related conditions in the Healthy People 2010 document, which specifies the United States’ public health goals and objectives for this decade. After the Arthritis Foundation took a public-health view of arthritis prevention and control, we proposed to the Rehabilitation Institute of Chicago’s board that our arthritis center also take a public-health stance," Chang says.
The result is an arthritis center that provides inpatient and outpatient services, medical management, and prevention education for the public. The center also is part of the Multidisciplinary Clinical Research Center in Rheumatology at Northwestern University Medical School. Here’s a quick explanation of the center’s services and mission:
1. Medical management.
"Surgery has been a very important part of treating disability as a result of arthritis for the past 25 years, and so our arthritis center is affiliated with several experienced arthritis surgeons," Chang says. "That’s one of the reasons we got involved with developing a larger Arthritis Center: so we could develop more relationships with surgeons."
Physical therapy and occupational therapy play important roles in the medical management of arthritis, both after surgery and in cases where surgery is not the recommended course of treatment.
Medication is another crucial part of the medical management of arthritis patients. "Rheumatology is undergoing a major revolution presently because of the advent of biologics, a group of medicines for treating inflammatory arthritis," Chang says. The first biologics for inflammatory arthritis to hit the market are blockers of tumor necrosis factor (TNF) -alpha, such as Enbrel, a soluble receptor for TNF-alpha, and Remicade, which is an antibody against TNF-alpha.
"These new medicines increase our ability to suppress inflammation in inflammatory arthritis, so that right now, the goal of most rheumatologists is to completely suppress inflammation," Chang explains. In addition, there likely will be similarly effective pharmaceutical agents in the near future that will reduce the progression of osteoarthritis, which is a significant cause of disability in the United States, Chang predicts.
A fourth aspect of medical management emphasized at the arthritis center is complementary medicine. The center’s staff talk to patients about nutritional supplements and what the literature says about the effectiveness of such products, some of which are being studied in clinical trials. Other complementary medicine treatments, such as acupuncture and pool therapies, are available.
2. Outpatient services.
Most of the activities based in the arthritis center are outpatient services. Patients first are evaluated by a rheumatologist or a physiatrist; in either case, the other specialist is available for an immediate consultation, Chang says. "So if the physiatrist sees a patient who has inflammatory arthritis that would need to be seen by a rheumatologist, then the rheumatologist is there and the patient can have an immediate consultation instead of having to wait for another appointment," Chang explains.
"The idea is to get a comprehensive evaluation from the musculoskeletal and rheumatological perspectives, and the physical therapists who see our patients also are right on site," Chang adds. "So it’s very easy for the physicians and therapists to communicate."
The center also makes referrals to other departments when necessary, such as to the facility’s pain management program or to the physical therapy department for pool therapy.
Center offers exercise program
Soon the Arthritis Center will have a group exercise program for patients called PACE, meaning Persons with Arthritis Can Exercise. An aerobic exercise program for arthritis patients began in June. Other available services include psychological evaluations on a consultation basis, massage therapy, acupuncture, and other complementary medical treatments.
3. Reimbursement.
Inpatient services and most traditional outpatient services, such as physical therapy and physician consultations, are paid for by Medicare, Medicaid, and private insurers just as they would be if the services were provided in any other type of rehab site. "Complementary and alternative medicine services generally are not reimbursed and need to be paid out of pocket," Chang says.
4. Prevention services and public education.
"The public-health aspects of the center are very important," Chang says, adding that the chief executive officer of the Rehabilitation Institute of Chicago has a doctorate in public health and particularly wants to emphasize that aspect of the program. "We are planning a series of community forums that will include screenings to educate the public about arthritis and what can be done about it," Chang says.
Also, there will be a patient education resource center that will feature Internet kiosks and CD-ROM players in the center’s waiting area. These will give patients the opportunity to learn more about arthritis, medications, therapies, and surgeries. "This will enhance the patient’s understanding of their disease management, and this is all in the spirit of trying to get them to be better self-managers of their disease process," Chang says.
Public education also will focus on prevention and highlight research showing that obesity is a significant risk factor for arthritis of the knee, Chang says. "Since obesity is so prevalent in our population, we estimate that perhaps 20% to 30% of all knee osteoarthritis would go away if obesity was wiped out in this country," he says. "The other thing is that sports medicine people understand that there probably is an epidemic of knee injuries in adolescent females going on right now as a result of sports programs."
Adolescent girls have more lax ligament structure than boys, and the muscles around their knees are not as well developed, which makes them more prone to injury and therefore could place them at greater risk for osteoarthritis, Chang explains. "Prevention is a new idea in arthritis treatment, but you don’t have to look too hard to think of some strategies," Chang adds.
5. Research.
The Arthritis Center will continue in the rehab institute’s tradition of being involved in research studies that could lead to better understandings of treatment, injury, and disease. For example, the arthritis center was involved this year in a surveillance project that entailed a community survey of zip codes contiguous to the hospital’s service area. The survey measured the prevalence of chronic joint symptoms in adults aged 45 or older and assessed their functional limitations. It also provided a needs assessment for those with arthritis, including a look at their need for education and clinical services.
"We contracted with Northern Illinois University, which has a large survey research program, and they conduct the annual Illinois Department of Public Health survey," Chang says. "We modeled a lot of our questions on that annual survey."
Need more information?
• Rowland Chang, MD, MPH, Medical Director, Arthritis Center, Rehabilitation Institute of Chicago, Room 915, 345 East Superior St., Chicago, IL 60611. Telephone: (312) 503-2952.
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.