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Progress in Chronic Disease Prevention Arthritis Program -- Missouri

Over the past 11 years, efforts to meet arthritis-related needs in Missouri have evolved through several stages: 1) development of an informal group of concerned citizens, 2) appointment of the Missouri Task Force on Arthritis, 3) passage of legislation regarding arthritis and funding of a State Arthritis Program, 4) creation of regional arthritis centers, and 5) collection of state data to target arthritis-related efforts in Missouri.

Missouri began working toward a state arthritis plan in 1976, when concerned citizens formed a coalition to address the state's needs regarding arthritis. The Missouri Task Force on Arthritis, officially appointed by the Missouri Board of Health in 1977, was asked to assess arthritis-related needs and formulate recommendations. Members were organized into several working groups focusing on health-care facilities, manpower needs, professional education, public education, research, and public affairs.

Public hearings were held in all regions of the state in 1979. Task force members, assisted by the Eastern and Western Missouri Arthritis Foundation chapters, mobilized local community leaders, regional news media, and concerned individuals to promote the hearings. From the public hearings and the findings of the working groups, the task force wrote a three-volume report that reflected a consensus of recommendations (1). These recommendations included establishing a statewide network of regional arthritis centers for diagnostic, treatment, and educational services; providing educational programs for physicians and allied health professionals; training and recruiting more rheumatologists for underserved areas; improving public education; and increasing research efforts.

A bill encompassing the recommendations of the State Arthritis Plan and modeled on congressional legislation that led to the enactment of the National Arthritis Act in 1976 was first submitted to the Missouri legislature in 1980. The bill, which was signed into law in 1984, gave the Department of Health the authority to establish a network of regional arthritis centers and to appoint two advisory bodies. The 25-member Missouri Arthritis Advisory Board was formed and charged with making recommendations to the Department of Health on the statewide arthritis plan and with assisting in issuing guidelines for the services provided by the regional arthritis centers. A separate Program Review Committee was created to select regional centers. Eight regional arthritis centers were selected from applications from health- care institutions, and funds were awarded to seven by contract in the fall of 1985 (2).

During their first 2 years, the regional arthritis centers educated 2,600 health professionals and reached 4,600 persons through public education sessions. Also, over 1,000 persons with arthritis attended specially tailored programs, such as an aquatic exercise program and a self-help course taught in Spanish for the Kansas City Hispanic population. Two centers established newsletters and a WATS line. Television presentations have also been developed. Activities within each region have involved the collaboration of private physicians, the Arthritis Foundation, local hospitals, and other resources to maximize the impact of the programs in the community (3).

Because the regional and national data available on attitudes and knowledge concerning arthritis and care-seeking behaviors are limited, a statewide telephone survey was conducted in early 1987. The goals were to determine specific beliefs and levels of awareness about arthritis among the general public to better focus program efforts (4). The Media Research Bureau of the University of Missouri School of Journalism administered a survey of 2,533 households. The major findings from the survey were 1) arthritis symptoms are severe before persons seek care; 2) the causes of arthritis are misunderstood; 3) the public has limited knowledge of specific arthritis diagnoses, types of effective treatments, and available sources for optimal care; 4) programs and advertisements on television and articles in newspapers and magazines are the most likely and effective mechanisms for changing knowledge and attitudes about arthritis (4).

Funding for the Missouri Arthritis Program began in October 1985. State funding has been augmented with Federal Preventive Health and Health Services Block Grant monies. Further information may be obtained by contacting Marsha Dubbert, R.N., Bureau of Chronic Diseases, Missouri Department of Health, Box 570, Jefferson City, Missouri 65102; telephone, (314) 751-6252. Reported by: BH Singsen, MD, GC Sharp, MD, Health Sciences Center, Univ of Missouri; DM Markenson, MS, RG Harmon, MD, HD Donnell, Jr, MD, MPH, State Epidemiologist, Missouri Dept of Health. Div of Chronic Disease Control, Center for Environmental Health and Injury Control, CDC.

Editorial Note

Editorial Note: Arthritis, one of the most common and disabling disorders, is not a single disease but a manifestation of more than a hundred diseases. According to the 1980 National Health Interview Survey, approximately 37 million people in the United States consider that they have arthritis (5). Extrapolation from the U.S. Health and Nutrition Examination Survey I indicates that 33% of the adult population has clinical evidence of joint swelling, tenderness, limitation of movement, or pain during movement (6).

The disabling effects of arthritis can be forestalled either by preventing musculo- skeletal impairment or by preventing impairment from becoming a disability. The goal of state arthritis programs is to make optimal diagnostic, treatment, educational and rehabilitation services accessible to all individuals with arthritis and musculoskeletal diseases.

In a survey conducted by the Association of State and Territorial Health Officials in February 1987, 10 of the 49 state and territorial health agencies with formal written health plans cited arthritis as part of this plan. According to the survey, seven state chronic disease units included arthritis in their activities (7).


  1. Missouri Task Force on Arthritis. Report of the Missouri Task Force on Arthritis. Vol 1-3. Columbia, Missouri: University of Missouri Multipurpose Arthritis Center, 1980.

  2. Hazelwood SE, Singsen BH, Sharp GC, Oliver CL, Hall PJ. Methods to implement a state-wide arthritis program (Abstract). Arthritis Rheum 1986;29:S159.

  3. Hazelwood S, Singsen B, Sharp G, Markenson D, Oliver C, Hall P. A state-wide Regional Arthritis Center (RAC) Program (Abstract). Arthritis Rheum 1987;30:S194.

  4. Singsen B, Sylvester J, Markenson D, et al. Arthritis knowledge and attitudes in the Missouri statewide survey. Arthritis Rheum Rheum 1986;29:S159.

  5. Hazelwood S, Singsen B, Sharp G, Markenson D, Oliver C, Hall P. A state-wide Regional Arthritis Center (RAC) Program (Abstract). Arthritis Rheum 1987;30:S194.

  6. Singsen B, Sylvester J, Markenson D, et al. Arthritis knowledge and attitudes in the Missouri statewide survey. Arthritis Rheum (in press).

  7. McDuffie FC, Felts WR Jr, Hochberg MC, et al. In: Amler RW, Dull HB, eds. Closing the gap: the burden of unnecessary illness. New York: Oxford University Press, 1987:19-28.

  8. Cunningham LS, Kelsey JL. Epidemiology of musculoskeletal impairments and associated disability. Am J Public Health 1984;74:574-9.

  9. Centers for Disease Control. Survey of chronic disease activities in state and territorial health agencies. MMWR 1987;36:565-8.

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