Arthritis

This newly developed bibliography contains the defining literature on both osteo- and rheumatoid arthritis. Articles include clinical trials, behavioral and self-management support literature, as well as publications describing the Chronic Care Model. Links to the citations on the National Library of Medicine (NLM) Web site are provided if the article is indexed in the NLM online database. The NLM site gives access to the article abstract when available, as well as other information. For information regarding the research methodology used to produce this bibliography, see the Bibliography Overview.
 
Articles referencing clinicial guidelines may not reflect current standards.  For up-to-date clinical guidelines, please consult the National Guideline Clearinghouse (NGC), a public resource for evidence-based clinical practice guidelines. NGC is an initiative of the Agency for Healthcare Research and Quality.
 
General
MacLean CH, Louie R, Leake B, McCaffrey DF, Paulus HE, Brook RH, Shekelle PG. Quality of Care for Patients with Rheumatoid Arthritis. JAMA 2000; 284(8): 948-992. [Link]

This is an assessment of quality of health care received by patients with RA using a nationwide historical cohort. Quality scores were 62% for arthritis care, 52% for co-morbid disease care, and 42% for health maintenance care. Care that included relevant specialist was associated with higher quality across all domains. Inclusion of generalists provided higher quality health maintenance. 

Sloss EM, Solomon DH, Khekelle PG et al. Selecting target conditions for quality of care improvements in older adults. J Am Geriatr Society 2000; 48 (4); 363-9. [Link]

Clinical experts in geriatric care narrowed an initial listing of 78 to 21 conditions considered “targets for quality improvement” to improve care of vulnerable older adults based on contributions to morbidity, mortality, or functional decline, and opportunities for improvement. Osteoarthritis is included. Estimates on prevalence among community dwelling and nursing home residents, hospital discharges, and physician office visits are reported.
Clinical Care:  Guidelines
American College of Rheumatology Subcommittee on Rheumatoid Arthritis Guidelines. Guidelines for the Management of Rheumatoid Arthritis. 2002 Update. Arthritis Rheum 46:2, 328-346, 2002. [Link]
 
A subcommittee of the ACR revised guidelines for the management of RA. These guidelines when possible are evidence based. In some situations the guidelines are based on the consensus of the committee.

American College of Rheumatology Subcommittee on Osteoarthritis Guidelines. Recommendations for the Management of Osteoarthritis of the Hip and Knee. Arthritis Rheum 2000; 43: 1905-1915. [Link]

A subcommittee of the ACR revised guidelines for the management of Osteoarthritis of the hip and knee. These guidelines when possible are evidence based. In some situations the guidelines are based on the consensus of the committee.

Pendleton A, Dougados AN, Doherty M, Bannwarth B, Bijlsma JW, Cluzea F, Cooper C, Dieppe PA, Gunther KP, Hauselmann HJ, Herrero-Beaumont G, Kaklamanis PM, Leeb B, Lequesne M, Lohmander S. Mazieres B, Mola EM, Pavelka K, Serni U, Swoboda B, Verbruggen AA, Weseloh G, Zimmerman-Gorska I. EULAR recommendations for the management of knee osteoarthritis: a report of a task force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Ann Rheum Dis, 2000; 59:(12):936-944. [Link]

These are clinical guidelines on the management of osteoarthritis of the knee combining an evidence-based approach and consensus.
 
Clinical Care:  Early and Aggressive Treatment in RA
Mottonen T, Hannonen P, Korpela M, Nissila M, Kautiainen H, Ilonen J, Laasonen L, Kaipiainen-Sppanen O, Franzen P, Helve T, Koski J, Gripenberg-Gahmberg M, Myllykangas-Luosujarvi R, Leirisalo-Repo M. for the FIN-RACo Trial Group. Delay to Institution of Therapy and Induction of Remission Using Single-Drug or Combination-Disease-Modifying Anti rheumatic Drug Therapy in Early Rheumatoid Arthritis. Arthritis Rheum 46:4, 894-898. 2002. [Link]
In this Finnish Rheumatoid Arthritis Combination therapy trial in early RA, a combination of DMARDs was compared with a single DMARD. A delay of four months in use of a single DMARD decreased the ability to induce remission.

Wiles NJ, Lunt M, Barrett EM, Bukhari M, Silman AJ, Symmons DPM, Dunn G. Reduced Disability at Five Years with Early Treatment of Inflammatory Polyarthritis. Arthritis Rheum 44:5, 1033-1042, 2001. [Link]

This is an analysis at five years of a primary care based observation cohort of patients with inflammatory polyarthritis with monitoring of treatment and outcomes (HAQ). Patients treated with DMARDs within six months of symptom onset had reduced odds of disability at five years.
Clinical Care:  General Clinical Management
del Rincon I, Williams K, Stern MP, Freeman GL, Escalante A. High Incidence of Cardiovascular Events in a Rheumatoid Arthritis Cohort Not Explained by Traditional Cardiac Risk Factors. Arthritis Rheum 44:12, 2737-2745, 2001. [Link]
This is a study of 236 consecutive RA patients to determine cardiovascular-related hospitalizations. There was an increased incidence of cardiovascular events, primarily coronary artery disease. RA is an independent risk factor for cardiovascular disease.

Turesson C, O’Fallon WM, Crowson CS, Gabriel SE, Matteson EL. Occurrence of Extraarticular Disease Manifestations is Associated with Excess Mortality in a Community Bas e d Cohort of Patients with Rheumatoid Arthritis. J of Rheumatol. 29:1, 62-67, 2001. [Link]

This community based study of extraarticular manifestations of RA showed that all mortality occurred in RA patients with severe extraarticular features.

McAlindon TE, Cooper C, Kirwan JR, Dieppe PA. Determinants of disability in osteoarthritis of the knee. Ann Rheum Dis 1993; 51(4):258-262. [Link]

This is a study of patients with osteoarthritis of the knee to determine factors that influence disability. Quadriceps strength, knee pain, and age influence functional impairment more than x-ray changes.

McAlindon TE, Felson DT, Zhang Y, Hannan MT, Aliabadi P, Weissman B, Rush D, Wilson PW, Jacques P. Relation of dietary intake and serum levels of vitamin D to progression of osteoarthritis of the knee among participants in the Framingham Study. Ann Intern Med 1996; 125(5):353-359. [Link]

This is a longitudinal study of the Framingham cohort who had knee OA by X-ray. Low intake and low serum levels of vitamin D were associated a increased risk for progression of knee OA.
Clinical Care:  Medication Management
Cannella AC, O’Dell JR. Is there still a role for traditional disease-modifying anti-rheumatic drugs (DMARDS) in rheumatoid arthritis. Curr Opin Rheumatol 2003; 15(3): 185-192. [Link]
This article reviews recent drug trials in the treatment of rheumatoid arthritis. The paper reviews effects and risk profile for traditional DMARDSs and proposes a treatment algorithm based on American /college of Rheumatology guidelines.

Genovese MC, Bathon JM, Martin RW, Fleishmann RM, Tesser JR, Schiff MH, Keyston EC, Wasko MC, Moreland LW, Weaver AL, Markenson J, Cannon GW, Spencer-Green G, Finck BK. Etanercept versus Methotrexate in Patients with Early Rheumatoid Arthritis. Arthritis Rheum 2002; 46(6): 1443-1450. [Link]

This is a comparison study of clinical and x-ray outcomes at two years in patients with early RA treated with etanercept or methotrexate. There was a slight increase in the percent who achieved ACR 20, 72% with etanercept versus 59% with methotrexate. More on Etanercept had no increase in sharp score than on methotrexate.

van Everdingen AA, Jacobs JWG, van Reesema DRS, Bijlsma JWJ. Low-Dose Prednisone Therapy for Patients with Early Active Rheumatoid Arthritis: Clinical Efficacy, Disease-Modifying Properties, and Side Effects. Ann Intern Med 2002; 136:1-12. [Link]

This is a two-year randomized, double-blind, placebo controlled study of efficacy and side effects of low dose of prednisone (10 mg/d) in the treatment of early RA. Prednisone treatment was associated with reduced joint tenderness at six months, less bony damage at two years, and less use of joint injections and pain medications.

Cohen S, Cannon GW, Schiff M, Weaver A, Fox R, Olsen N, Furst D, Sharp J, Moreland L, Caldwell J, Kaine J. Two-year, Blinded, Randomized, Controlled Trial of Treatment of Active Rheumatoid Arthritis with Leflunomide Compared with Methotrexate. Arthritis Rheum 2001; 44:9, 1984-1992. [Link]

This is an analysis of the North American Trial Comparing Leflunomide with Methotrexate in the treatment of RA after two years. The percent of patients achieving 20% ACR was similar. The sharp scores and the side effects were similar.

Keane J, Gershon S, Wise RP, Mirabile-Levens E, Kasnica J, Schwieteran WD, Siegel JN, Braun MM. Tuberculosis Associate with Infliximab, a Tumor Necrosis Factor a-Neutralizing Agent. N Engl J Med 2001; 345(15): 1098-1104. [Link]

This is a review of reports of tuberculosis after infliximab therapy through the med watch spontaneous reporting system of the FDA. There were 70 reported cases after a median of twelve weeks of treatment. Forty had extra pulmonary disease.

Towheed TE, Anastassiades TP, Shea B, Houpt J, Welch V, Hochberg MC. Glucosamine therapy for treating osteoarthritis. Cochrane Database Syst Rev 2001; (1): CD002946. [Link]

This is a Cochrane review of randomized controlled trials evaluating the effectiveness and toxicity of glucosamine in osteoarthritis. In comparison to placebo, glucosamine was superior in all but 1 RCT; in comparison to NSAIDS, results were equivocal.

Lipsky PE, van der Heijde D, St. Clair EW, Furst DE, Breedveld FC, Kalden JR, Smolen JS, Weisman M, Emery P, Feldmann M, Harriman GR, Maini RN. Infliximab and Methotrexate in the Treatment of Rheumatoid Arthritis. N Engl J Med 2000; 343:15-94-1602. [Link]

This is a one-year study of 428 patients with active RA on methotrexate and adding either Infliximab or placebo to the methotrexate. 42% of the infliximab (3mg/kgm for eight weeks) improved 20%. The Infliximab treated patients had less bony progression.

O’Dell JR, Haire CE, Erikson N, Drymalski W, Palmer W, Eckhoff PJ, Garwood V, Maloley P, Klassen LW, Wees S, Klein H, Moore Gerald F. Treatment of Rheumatoid Arthritis with Methotrexate Alone, Sulfasalazine and Hydroxychloroquine, or a combination of all three medications. N Engl J Med 1996; 334(20):1287-1291. [Link]

This is a two year, double-blind, randomized study of patients with RA treated with methotrexate alone, methotrexate and sulfasalazine or methotrexate, sulfasalazine and hydroxychloroquine 77% of the triple therapy group achieved 50% improvement.

Fries JF, Williams CA, Ramey D, Bloch DA. The Relative Toxicity of Disease-Modifying Anti rheumatic Drugs. Arthritis Rheum 1993; 36 (3): 297-306. [Link]

This is a multi-center, longitudinal, descriptive study of 2747 patients with RA. This study reports the comparable toxicities of NSAIDs and DMARDs.

Fries JF, Spitz PW, Mitchell DM, Roth SH, Wolfe F, Bloch DA. Impact of Specific Therapy upon Rheumatoid Arthritis. Arthritis Rheum 29:5, 620-627, 1986 [Link]

This is a multi-center prospective study of the outcome of specific therapy in RA. This study showed the beneficial effect of the DMARDs, gold, methotrexate, and penicillamine and the lack of effect on disease course of NSAIDs.
Clinical Care (Exercise & Physical Activity)
Fransen M, McConnell S, Bell M. Therapeutic exercise for people with osteoarthritis of the hip or knee. A systematic review. J Rheumatol 2002; 29: 1737-45. [Link]
Standard mean differences were compared for RCT of land-based exercise in OA of the hip or knee. Limited data were available on hip OA, but land based therapeutic exercise was shown to reduce pain and improve physical function for people with OA of the knee.

Westby MD. A health professionals guide to exercise prescription for people with arthritis: a review of aerobic fitness activities. Arthritis Rheum 2001; 45: 501-11. [Link]

Baker K, McAlindon T. Exercise for knee osteoarthritis. Curr Opin Rheumatol 2000; 12(5): 456-63. [Link]

This article reviews recent studies on the impact of aerobic and strengthening exercise as a treatment for knee osteoarthritis. A majority of studies showed positive effects on pain or disability.

Ettinger WH, Burns R, Messier SP, Applegate W, Rejeski WJ, Morgan T, Shumaker S, Berry MJ, O’Toole M, Monu J, Craven T. A Randomized Trial Comparing Aerobic Exercise and Resistance Exercise With a Health Education Program in Older Adult With Knee Osteoarthritis. The Fitness Arthritis and Seniors Trial (FAST). JAMA 1997; 277:25-31. [Link]

This RCT compared the effects of aerobic exercise, resistance exercise and health education control group on health status in seniors with knee OA. Modest improvements were documented in disability, physical performance, and pain from participating in either the aerobic or resistive exercise programs.

Kovar PA, Allegrante JP, MacKenzie CR, Peterson MG, Gutin B, Charlson ME. Supervised fitness walking in patients with osteoarthritis of the knee. A randomized, controlled trial. Ann Intern Med, 1992; 116(7):529-534. [Link]

This seminal RCT study shows that supervised fitness walking and patient education can improve function without worsening pain in osteoarthritis of the knee.

Minor MA, Hewett JE, Webel RR, Anderson SK, Kay DR. Efficacy of physical conditioning exercise in patients with rheumatoid arthritis and osteoarthritis. Arthritis Rheum 1989; 32:1396-1405. [Link]

This seminal RCT demonstrated the safety and efficacy of aerobic walking or aquatics, in comparison to non-aerobic range of motion exercise in both rheumatoid arthritis and osteoarthritis. Health outcomes improved while number of clinically active joints remained unchanged.
Psychological Interventions
Astin JA, Beckner W, Soeken K, Hochberg MC, and Berman B. Psychological Interventions for rheumatoid arthritis: a meta-analysis of randomized controlled trials. Arthritis Rheum (Arth Care Res) 2002; 47(3): 291-302. [Link]
Twenty-five RCT met inclusion criteria and were included in this meta-analysis of psychological/behavioral interventions (i.e. meditation, relaxation, cognitive behavioral therapy). Significant pooled effect sizes were found for pain, disability, psychological status, coping, and self-efficacy post intervention.

Parker JC, Frank RG, Beck NC, et al. Pain management in rheumatoid arthritis patients. A cognitive-behavioral approach. Arthritis Rheum 31(5):593-601, 1988. [Link]

This study examines the effectiveness of a cognitive-behavioral pain management program for RA patients. Patients in the cognitive behavioral program showed greater use of coping strategies and more confidence in their ability to manage pain.

Bradley LA, Young LD, Anderson KO, et al. Effects of psychological therapy on pain behavior of rheumatoid arthritis patients. Treatment outcome and six-month follow up. Arthritis Rheum 1987; 30(10):1105-14. [Link]

This is a randomized clinical trial study demonstrating psychological treatment intervention and social support reduces pain and disease activity in RA.
Clinical Care:  Surgical Interventions
Jones CA, Voaklander DC, Johnson DW, Suarez-Alamzor ME. The effect of age on pain, function, and quality of life after total hip and knee replacement. Arch Intern Med 2001; 161(3): 454-60. [Link]
This prospective cohort study compared pain , function, and health related quality of live outcomes in a patient group over 80 years old with the outcomes of a group 55-79. There were no age-related differences in joint pain, function, or QOL preoperatively or 6 months postoperatively. Results suggest age alone should not be a limiting factor in surgical referral decisions.
Changing Provider Behavior
Ray WA, Stein CM, Byrd V, Shorr R, Pichert JW, Gideon P, Arnold K, Brandt KD, Pincus T, Griffin MR. Educational program for physicians to reduce use of non-steriodal anti-inflammatory drugs among community dwelling elderly persons: a randomized controlled trial. Medical Care 2001: 39(5) 425-35. [Link]

Education on management of elderly OA patients with an emphasis on avoidance of NSAIDS was evaluated in RCT. Guideline-based education was provided in face to face visits by another physician, and resulted in an intervention attributable reduction of 7% in days of prescribed NSAID use, without negative consequences to patients.
 Grahame R, Gibson T, Dale E, et al. An evaluated programme of rheumatology training for general practitioners. BR J Rheumatol 25(1):7-12, 1986. [Link]
The effect of a three month mentorship of general practitioner working with a consulting rheumatologist was evaluated. Short term there were significant increase in the use of appropriate treatments, fewer requests for investigations and fewer rheumatology referrals.
Primary Care Interventions:  Delivery System Design
Weinberger M. Telephone-Based Intervention in Outpatient Care. Ann of Rheum Dis 1998; 57:196-197. Maisiak R, Austin J, Heck L. Health outcomes of two telephone interventions for patients with rheumatoid arthritis or osteoarthritis. Arthritis Rheum 1996 39 (8): 1391-9. [Link]

RCT compared effects of telephone counseling with symptom monitoring by telephone. In comparison to usual care, the telephone counseling group showed significant improvements in both RA and OA, but the symptom monitoring group did not. Specific types of benefits differed between OA and RA.

Hill J, Bird HA, Harmer R, Wright V, Lawton C. An evaluation of the effectiveness, safety and acceptability of a nurse practitioner in a rheumatology outpatient clinic. Br J Rheumatology 33(30):283-288, 1994. [Link]

Patients with RA were randomly assigned to either a rheumatology nurse practitioner or a consultant rheumatologist. At 48 weeks those seen by the nurse practitioner had less pain, more knowledge and satisfaction.

Rene J, Weinberger M, Mazzuca SA, Brandt KD, Katz BP. Reductions of joint pain in patients with knee osteoarthritis who have received monthly telephone calls from lay personnel and whose medical treatment regimens have remained stable. Arthritis Rheum 1992;35(5):511-515. [Link]

Periodic telephone support interventions are effective in improving joint pain and physical function after one year, and effects are not a function of intensifying medical management.

Weinberger M, Tierney WM, Booher P, Katz BP. Can the provision of information to patients with osteoarthritis improve functional status? A randomized, controlled trial. Arthritis Rheum 1989; 32(12):1577-1583. [Link]

This is a study of the functional status of patients with osteoarthritis followed by phone contact, in person in the clinic or both. Pain, physical and psychological health improved in those contacted by phone, with or without clinic contact. Contact at the clinic did not improve outcomes.

Ahlmen M, Sullivan M, Bjelle A. Team versus non-team outpatient care in rheumatoid arthritis. A comprehensive outcome evaluation including and overall health measure. Arthritis Rheum 1988: 31(4):471-479. [Link]

This is a study comparing multi-disciplinary team care and regular outpatient care for rheumatoid arthritis. Disease activity and specific joint function was similar; mental well-being and overall health perceptions were improved in the multi-disciplinary treatment group.
Self-Management Support
Riemsma RP, Kirwan JR, Taal E, Rasker JJ. Patient education for adults with rheumatoid arthritis. Cochrane Database Syst Rev 2002; (3): CD003688-CD003688. [Link]
This is a Medline, EMBASE, Psych Info and Cochrane Controlled Trials Register search for randomized controlled trials evaluating patient education interventions in patients with arthritis. This showed moderate short tem effects on patient global assessment, disability, joint counts and psychological status.

Lorig KR, Ritter P, Stewart AL. Chronic disease-self management program: 2 year health status and health care utilization. Med care 2001; 39 (11): 1217-23. [Link]

This follow-up study to the original RCT of the generic Chronic Disease Self Management Program demonstrated that improvements in self efficacy, health distress and ER/outpatient visits were maintained at 1- and 2-year follow-up.

Donovan JL, Blake DR. Qualitative study of interpretations of reassurance among patients attending rheumatology clinics: “just a touch of arthritis, doctor”. BMJ 2000;320 (7234): 541-4. [Link]

This qualitative study investigated patients perceptions of the reassurance they received from their physicians at rheumatology clinics. Doctors’ emphasis on mildness or earliness of condition raised concerns about future pain and disability rather than providing reassurance. Patients who felt their problems were properly acknowledged felt more reassured.

Fries JF, Carey C, McShane DJ. Patient education in arthritis: Randomized controlled trial of mail delivered program. J Rheumatol 1997; 24 (7): 1378-83. [Link]

This randomized controlled trial demonstrated the effectiveness of a computer-tailored, mail delivered self management education program. Significant improvements, in contrast to controls were seen in pain, function, vitality, exercise, self-efficacy, physician visits, and days missed from work. At one year, the experimental group continued to improve. This program is alternately called Arthritis Home Help, and Self Management Arthritis Treatment (SMART).

Hawley DJ. Psycho-educational interventions in the treatment of arthritis. Ballieres Clin Rheumatol 1995; 9(4): 803-23 [Link]

This meta-analysis of self management education and cognitive-behavioral therapy is useful because it summarizes the effects of arthritis education programs, and provides effect sizes for pain, function and depression by disease (RA, OA, mixed community sample). Overall, there were improvements in symptoms, coping, and self management behaviors, with a trend for greater improvement in OA than RA.

Stenstrom CH. Home exercise in rheumatoid arthritis functional class II: goal setting versus pain attention. J Rheumatol 1994; 21(4):627-634. [Link]

This study evaluates a twelve week home exercise program for patients with RA. This program improves mood, fatigue, physical capacity and pain. [also Community-based Interventions]

Lorig KR, Holman H. Arthritis self-management studies: A 12 year review. Health Educ Q 1993; 20(1): 17-28. [Link]

This concise review summarizes the empirical base for the Arthritis Self-Management Program, also know as the Arthritis Self Help Course (ASHC). It provides information on the development and initial testing, surprising finding of low correlations between health behavior and health outcomes, and the emergence of a theoretical framework from the program.

Lorig KR, Mazonson PD, Holman HR. Evidence suggesting that health education for self-management in patients with chronic arthritis has sustained health benefits while reducing health care costs. Arthritis Rheum 1993; 36 (4) 439-446. [Link]

This paper gives the results of the six weeks Arthritis Self Management Program with appropriate controls at eight months and four years after participation. The self- management group experiences less pain and physician visits.

Goeppinger J, Arthur MW, Galioni AJ JR., Brunk SE, Brunner CM. A reexamination of the effectiveness of self care education for person with arthritis. Arthritis Rheum 1989; 32(6):706-716. [Link]

This is a comparison study of arthritis self care with a home study model and a small group model. The small group model was more effective in improving pain and depression and the home study model was more effective in maintaining improvement in perceived helplessness.

Lenker SL, Lorig KR. Gallagher D. Reasons for lack of association between changes in health behavior and improved health status: an exploratory study. Pat Educ Couns 1984; 6(2); 69-72. [Link]

In-depth interviews were used to elucidate the low association between health behaviors and health outcomes following participation in the Arthritis Self Help Course. Individuals with positive health outcomes indicated they had more control over their disease, and had positive emotional status while individuals with poor health outcomes indicated a lack of control and had negative emotional status.
Community-based Interventions
Brady TJ, Kruger J, Helmick CG, Callahan LF, and Boutaugh ML. Intervention Programs for Arthritis and Other Rheumatic Diseases. Health EducBehav 2003; 30(1) 44-63. [Link]
The evidence-base for nine self-management education or physical activity programs is summarized in this review article. The nine programs are “packaged” or have materials and training to facilitate community dissemination.

Baker KR, Nelson ME, Felson DT, Layne JE, Sarno R, Roubenoff. The efficacy of home based progressive strength training in older adults with knee osteoarthritis: a controlled randomized trial. J Rheumatol 2001; 28: 1655-65. [Link]

RCT evaluated 4 month high intensity, home based strength training for persons with knee OA. Results demonstrated substantial improvements in strength, pain, function and quality of life.
Cost-effectiveness
Patrick DL, Ramsey SD, Spencer AC, Kinne S, Belza B, Topolski TD. Economic evaluation of aquatic exercise for persons with osteoarthritis. Med Care 2001; 39(5):409-412. [Link]
This is a randomized trial of patients with osteoarthritis participating in a twenty week aquatics class. Cost per quality-adjusted life year gained was estimated.

Servick MA, Bradham DD, Muender M, Chen GJ, Enarson C, Dailey M, Ettinger WH. Cost-effectiveness of aerobic and resistance exercise in seniors with knee osteoarthritis. Med Sci in Sport Exercise 2000 35(9): 1534-1540. [Link]

RCT used to determine cost-effectiveness of aerobic exercise versus weight, compared to an educational control intervention. Compared to the education control, resistance training was slightly more economically more efficient than aerobic exercise in improving physical function, but the difference was small.

Kruger JMS, Helmick CG,Callahan, LC, Haddix, AC. Cost-Effectiveness of the Arthritis Self-Help Course. Archives of Internal Medicine 1998; 158: 1245-1249. [Link]

Using a decision model, the cost –effectiveness of the Arthritis Self Help Course was analyzed from the societal and health care system perspective. ASHC was cost-saving, reducing pain by 0.9 units while saving $320 from the societal perspective, and $267 from the health care system perspective, in base-case analyses.

Chang RW, Pellisier JM, Hazen GB. A Cost effectiveness analysis of total hip arthroplasty for osteoarthritis of the hip. JAMA 1996 275 (11.11) 858-865. [Link]

This study examined the costs and quality-adjusted life expectancy in patients who had total hip arthroplasty for osteoarthritis of the hip.

Weinberger M, Tierney WM, Cowper PA, Katz BP, Booher PA. Cost-effectiveness of increased telephone contact for patients with osteoarthritis. A randomized controlled trial. Arthritis Rheum 1993; 36(2): 243-6. [Link]

Annual costs for a one-unit improvement in function and pain, as measured by the Arthritis Impact Measurement Scales, were $70.86 and $31.00, respectively.
Bibliography Editors
Teresa J. Brady, Ph.D.
Dr. Brady is a Senior Behavioral Scientist with the Arthritis Program at the Centers for Disease Control and Prevention. She was the Collaborative Director for the first Arthritis Collaborative. Dr Brady is licensed as both a psychologist and occupational therapist, and has been working in the area of chronic disease management for more than twenty five years.
 
Doyt L. Conn, M.D.
Dr. Conn is Professor of Medicine and Director of Rheumatology at Emory University School of Medicine, as well as Chief of Rheumatology at Grady Health System in Atlanta, Georgia. He is editor of "Bulletin on the Rheumatic Diseases." Previously, Dr. Conn was Senior Vice President for Medical Affairs at The Arthritis Foundation and Consultant in Rheumatology and Chairman, Division of Rheumatology, at the Mayo Clinic in Rochester, Minnesota.