RheumPAC Advocates for Department of Defense Arthritis Research Funding

RheumPAC is the ACR’s nonpartisan political action committee that promotes the needs of rheumatology providers and patients. Advocacy efforts often focus on legislation to improve the day-to-day clinical care of rheumatology patients, such as establishing clinical exceptions to step therapy requirements and reforming the prior authorization process. In addition, the ACR and RheumPAC recognize the importance of both clinical and basic science research and advocate vigorously to preserve and promote research funding opportunities within the field of rheumatology.

In recent years, the ACR was able to help influence Congress to increase medical research funding through the National Institutes of Health by $1.25 billion, despite a proposal by the Trump administration to decrease funding. Similarly, the ACR continues to advocate for the Centers for Disease Control and Prevention’s Arthritis Program. Despite these successes, the ongoing unmet need for arthritis research funding is demonstrated by the fact that arthritis is the leading cause of disability in the U.S. As a rheumatology community, we must continue to advocate for additional, much needed resources.

Advocating for DOD Arthritis Research Funding
The U.S. Department of Defense (DOD) is explicitly charged with funding research on diseases that affect our military members. The incidence of osteoarthritis is more than twice as high in the military population over the age of 40 compared with the general population, showing a clear need for better prevention and treatment of this condition.^1,2 Osteoarthritis affects both the number and readiness of available service members, because it is the most common condition resulting from battle injury that leads to medical discharge from the military.^3,4 In addition, arthritis is the leading cause of disability among veterans, with 32% reporting doctor-diagnosed arthritis compared with 22% of non-veterans.⁵

The physical demands of the military put service members at significantly increased risk of developing post-traumatic osteoarthritis. Despite the call for research to enhance prevention and management of joint injuries to minimize the disabling effect of joint degeneration in this young patient population, arthritis does not yet have its own dedicated research program at the DOD.⁴

Meanwhile, funding increases annually for diseases more weakly correlated with military service. Currently, more than 30 designated disease areas are funded through the DOD’s Congressionally Directed Medical Research Program (CDMRP), including spinal cord injury ($30 million in FY19), Gulf War illness ($22 million in FY19) and breast cancer ($130 million in FY19). We believe that arthritis deserves a similar focus.

For the past several years, the ACR and RheumPAC have teamed up with the Arthritis Foundation and advocated for dedicated arthritis research funding as part of the CDMRP, which was created in 1992 to promote biomedical research that benefits both service members and the American public.

Currently, DOD funding for arthritis research can be obtained through broader programs, such as the Peer Review Medical Research Program. Over the past 20 years, an average of $4.25 million per year has been awarded for arthritis-focused projects.⁶ These awards have yielded important advances, such as the development of new cartilage-penetrating nanocarriers for improved drug delivery to treat osteoarthritis.⁷ However, these grants are difficult to secure; researchers across many disciplines compete for the same funding, making the grants unreliable as a consistent source of arthritis research funding. The ACR and RheumPAC are advocating for a dedicated arthritis line item in the CDMRP to allocate $20 million a year for arthritis research. This would provide funding stability to ensure investigators have the longitudinal support they need to improve arthritis prevention and treatment in a meaningful way.

How You Can Help
The current political climate and the shifting landscape of medicine in the U.S. make it more important than ever for rheumatologists and interprofessional team members to stand up with a unified voice and advocate for our patients and our profession.

Although appropriations season for 2019 has ended, the ACR will kick off 2020 by again advocating for arthritis to be represented in the CDMRP. Your support of RheumPAC will help advocate for expanded research opportunities that will ultimately benefit us all. Visit www.RheumPAC.org to learn more about how to help continue our efforts to increase rheumatology research funding.

Matthew C. Baker, MD, MS, is a clinical instructor in the Division of Immunology and Rheumatology at Stanford University, Palo Alto, Calif., with a focus on patient care, bench research and clinical trials. He studied at Harvard Medical School and trained in internal medicine at Massachusetts General Hospital. He subsequently went to Stanford for his fellowship in rheumatology, and before becoming clinical instructor, spent a year as a postdoctoral fellow in the laboratory of William Robinson, MD, PhD.

References

1. Cameron KL, Hsiao MS, Owens BD, et al. Incidence of physician-diagnosed osteoarthritis among active duty United States military service members. Arthritis Rheum. 2011 Oct;63(10):2974–2982.
2. Kopec JA, Rahman MM, Berthelot JM, et al. Descriptive epidemiology of osteoarthritis in British Columbia, Canada. J Rheumatol. 2007 Feb;34(2):386–393.
3. Cross JD, Ficke JR, Hsu JR, et al. Battlefield orthopaedic injuries cause the majority of long-term disabilities. J Am Acad Orthop Surg. 2011;19 Suppl 1:S1–S7.
4. Rivera JC, Wenke JC, Buckwalter JA, et al. Posttraumatic osteoarthritis caused by battlefield injuries: The primary source of disability in warriors. J Am Acad Orthop Surg. 2012;20 Suppl 1:S64–S69.
5. Dominick KL, Golightly YM, Jackson GL. Arthritis prevalence and symptoms among US non-veterans, veterans, and veterans receiving Department of Veterans Affairs Healthcare. J Rheumatol. 2006 Feb;33(2):348–354.
6. Department of Defense. Congressionally directed medical research programs. https://cdmrp.army.mil/search.aspx.
7. Geiger BC, Wang S, Padera RF Jr., et al. Cartilage-penetrating nanocarriers improve delivery and efficacy of growth factor treatment of osteoarthritis. Sci Transl Med. 2018 Nov 28;10(469). pii: eaat8800.