The national bone and joint decade: Impact for rheumatic diseases

In 2002, President Bush declared the years 2002–2011 to be the National Bone and Joint Decade (www.boneandjointdecade.org/us; see Figure 1), signaling America's entry into a global campaign to improve the quality of life for people with conditions affecting the musculoskeletal system and to advance understanding and treatment through research, prevention, and education. This worldwide initiative has already been embraced by a large number of professional and lay organizations; its principles, in fact, were outlined earlier in the pages of this journal (1).

Figure 1. Logo of the National Bone and Joint Decade.

The Decade encompasses not only bone conditions such as osteoporosis and osteogenesis imperfecta, but also the many forms of arthritis and other rheumatic diseases. Its declaration is indeed timely, because all of these conditions affect hundreds of millions of people worldwide. Even more will be affected by the year 2020, when the number of people over the age of 50 is expected to double. The diseases and conditions under the Decade umbrella constitute a leading cause of disability in the United States, costing the nation billions of dollars in medical expenses and lost productivity. A recent study, for example, has identified arthritis and back problems as 2 of the 15 conditions that account for much of the increase in health care spending in the United States from 1987 to 2000 (2).

The Decade initiative coincides with an extraordinarily exciting time for research. The genetics/genomics revolution has given us fantastic tools and databases that will speed research and help us to understand the genetic factors that influence rheumatic conditions and musculoskeletal health and disease. The complex genetics of several of these diseases are beginning to be illuminated, as illustrated by work in arthritis (3), bone (4), and lupus (5–7). Powerful new imaging tools will allow us to delve more deeply into bone, joint, and tissue health, so that we can better understand, track, treat, and prevent disease. And funding support from the Administration and Congress has been generous over the past years, allowing us to pursue large clinical research studies and trials that were not possible before. In addition, the high visibility of the musculoskeletal system afforded by Decade activities and the recently released Surgeon General's Report on Osteoporosis and Bone Health (http://www.surgeongeneral.gov/library/bonehealth/) create an atmosphere for making great strides in research.

A longtime major contributor to research, training, and education in rheumatic and musculoskeletal conditions, the US Department of Health and Human Services' National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)—along with other institutes and centers at the National Institutes of Health (NIH)—is already reflecting this atmosphere of progress. NIAMS, along with the National Institute on Aging, has been a prime force in developing the Osteoarthritis Initiative, which is an innovative public/private partnership that is developing a large research resource that will help identify biomarkers for this most common form of arthritis (http://www.niams.nih.gov/ne/oi/index.htm). NIAMS also recently cosponsored a Consensus Development Conference on total knee replacement (http://www.nih.gov/news/pr/dec2003/od-10a.htm). Thanks to generous funding increases, NIAMS, along with other institutes and centers of the NIH, has been able to support large clinical trials, such as those assessing surgical interventions for various causes of low back pain (http://www.niams.nih.gov/ne/press/1999/09_20.htm), testing the effects of statins on fat buildup in the blood vessels of children with lupus (http://www.niams.nih.gov/ne/highlights/spotlight/2003/apple.htm), assessing combination therapy (parathyroid hormone and antiresorptive agents) in osteoporosis (http://www.niams.nih.gov/ne/press/2003/10_03.htm), and measuring the effectiveness of the anticonvulsive agent gabapentin in reducing symptoms of fibromyalgia (http://www.niams.nih.gov/ne/highlights/spotlight/2003/fibromed.htm).

But the advent of the National Bone and Joint Decade offers us more than the opportunity to recount our present successes. It challenges us to 1) raise awareness about the growing burden of arthritis and other rheumatic diseases on society, 2) promote prevention and empower patients through education programs, 3) advance research and training in prevention, diagnosis, and treatment, and 4) improve diagnostic and treatment options. And—as with all challenges—it presents obstacles that must be surmounted to achieve further success.

First and foremost, we must increase the number of physician-scientists conducting clinical research, and address the shortage of physicians in the research pipeline. The NIH's loan repayment programs and clinical research career training and mentoring grants are steps in the right direction. We also need to nurture those physician-scientists who are already doing clinical research, but who are challenged by daunting oversight burdens and the task of carving out protected research time. A large and critical element of the NIH Roadmap for Medical Research is meant to provide some of the infrastructure needed to facilitate and accelerate clinical research (http://nihroadmap.nih.gov/clinicalresearch/index.asp).

Second, we need to ensure that we apply fundamental advances in cellular and molecular biology, immunology, genetics, tissue engineering, and bioengineering to such clinically important areas as osteoarthritis, along with other rheumatic diseases. To accomplish this, we need more scientists who can bridge the gap between bench and bedside.

Third, we must have a greater effect on the behavioral changes that will result in better health. It is particularly important that we extend prevention strategies to all people—regardless of age, sex, race, or socioeconomic condition—and deliver health messages in culturally sensitive and effective ways.

The work that we do in arthritis and rheumatic and musculoskeletal conditions is critically important. Although at this stage in the National Bone and Joint Decade we have perhaps the greatest array of research tools ever known, true research success can only lie in a broad-based coalition of individuals and groups working together at international, national, regional, and local levels: patients and practitioners, researchers, voluntary and professional associations, and industry. Our efforts in areas such as communication, research, and education depend on these collaborative partnerships.

Top leaders of the NIH, the American College of Rheumatology, the Orthopaedic Research Society, the American Academy of Orthopaedic Surgeons, the American Society for Bone and Mineral Research, and the American College of Osteopathic Physicians, among others, have met—and will continue to meet—to develop and promote Decade initiatives. The Decade represents a unique opportunity to enhance the image of rheumatic and musculoskeletal medicine in the eyes of the public, policy makers, and the medical student population, and to nurture an environment that will produce more researchers and clinical scientists in these areas.

In the end, the way we approach research issues may evolve and change. But our overall goal must remain the same: to advance the scientific enterprise so that no one lives with daily rheumatic disease or musculoskeletal pain, discomfort, or disability, and the life-altering changes they can bring about.