Friday, October 15, 2010

Painful Arthritis Afflicts 50 Million Americans

Arthritis Painful arthritic conditions afflict more than 1 in every 5 American adults at an estimated annual cost of $128 billion, according to a new report. This makes arthritis the most common cause of disability; yet, relatively few national resources are dedicated to arthritis research and treatment.

According to the U.S. Centers for Disease Control and Prevention (CDC), which examined data from the National Health Interview Surveys (NHIS) of 2007 to 2009, 22.2% of all adults aged ≥18 years (about 50 million) had self-reported physician-diagnosed arthritis, and 42% of those persons (or 21 million) also experienced arthritis attributable activity limitations (AAAL) [Cheng et al. 2010]. In the survey, arthritis prevalence was defined rather broadly by affirmative answers to the question, “Have you ever been told by a doctor or other healthcare professional that you have some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia?”

Persons responding “yes” were then asked, “Are you limited in any way in any of your usual activities because of arthritis or joint symptoms?” Consequently, an affirmative response to both questions was categorized as AAAL. Sample sizes were very large, totalling more than 72,000 persons during the 3 survey years examined. A number of trends were evident in the study data:
  • Arthritis was much more common among older people, as might be expected.

  • Prevalence of arthritis was a third greater in women than men.

  • Obesity, defined as body mass index (BMI) ≥30, appeared to play a critical role: roughly 30% of obese adults had been diagnosed with arthritis compared with 20% of persons categorized as overweight and 17% in adults of normal or lower-than-normal weight.

  • Tobacco smokers also suffered more arthritis: 24% of regular current smokers and even 25% of former smokers had arthritis, as compared with 19% of lifetime non-smokers.

  • Activity also made a difference: 24% of physically inactive people compared with 19% of physically active people had arthritis.
The CDC-report authors noted that arthritis and AAAL prevalence trends have been escalating strongly in recent years by about 1 million adults per year. They believe that increasing obesity in the population, its impact on knee osteoarthritis in particular, and subsequent disability and lowered quality of life are playing important roles. The lifetime risk for painful knee osteoarthritis (OA) alone is about 61% in obese persons; however, the good news is that even small amounts of weight loss, such as 11 lbs. (5 kg.), can reduce risks of knee OA by half and may also reduce mortality risk in these patients by half.

COMMENTARY: This report is limited by being cross-sectional in nature and relying on self-reports rather than verified arthritis diagnoses. The definition of arthritis was somewhat broad in the survey, yet the term “arthritis” could be expanded further to cover dozens of medical conditions. Therefore, the total American population afflicted with all forms of arthritis is no doubt very much larger.

Of significant concern, the report predicts that the prevalence of arthritis and arthritis-attributable activity limitations (AAAL) will continue to rise strongly during the next twenty years as people live longer and if obesity continues as a problem in the American population. The data indicated that 34% of obese females and 25% of obese males said they were diagnosed with arthritis. However, there is always a cause-effect question of which came first; development of arthritis brought on by obesity, or obesity due to inactivity imposed by painful arthritis. For those patients already afflicted the distinction is probably of little concern; pain-relieving therapies that foster greater activity and weight loss might be of paramount importance.

It is interesting to observe, as we have noted in the past, that the government seems very good at reporting problem prevalence but is much less effective at finding and implementing solutions. There is only a single, multi-tasked government organization researching answers for the 50 million adults having painful arthritis (as defined in the CDC report) — namely, the National Institute of Arthritis and Musculoskeletal and Skin Disease (NIAMS). In contrast, the 23.5 million persons with substance abuse and addiction disorders are the focus of at least 4 large U.S. government organizations, including NIDA, NIAAA, SAMHSA/CSAT, and the ONDCP.* Readers can draw their own conclusions about why substance-use problems clearly trump pain when it comes to the allocation of government resources in America.

REFERENCE: Cheng YK, Hootman JM, Murphy LB, et al. Prevalence of Doctor-Diagnosed Arthritis and Arthritis-Attributable Activity Limitation – United States, 2007-2009. Morbidity and Mortality Weekly Report (MMWR). 2010(Oct 8);59(39):1261-1265 [PDF available].

*NIDA = National Institute on Drug Abuse; NIAAA = National Institute on Alcohol Abuse and Alcoholism; SAMHSA/CSAT = Substance Abuse and Mental Health Services Administration / Center for Substance Abuse Treatment; ONDCP = Office of National Drug Control Policy.