CDC reports 70 million have arthritis or chronic joint pain
Physicians can help by promoting a program of physical activity that patients can adhere to.

By Susan J. Landers, AMNews staff. Nov. 18, 2002. Additional information

Washington -- A new head count by the Centers for Disease Control and Prevention revealed that one in every three adults in the United States has arthritis or chronic joint pain, resulting in a total of 70 million people -- a major increase over the previous estimate of 43 million.

"Arthritis is the No. 1 cause of disability, and the new data confirm that arthritis and chronic joint symptoms are one of our most common public health problems," said CDC Director Julie L. Gerberding, MD, MPH.

Demographics dictate that the numbers of those with the debilitating condition will only continue to grow, as the main causes of most degenerative arthritis are aging and obesity. Baby boomers' quality of life in retirement will likely become an important health care consideration.

Those experiencing pain are advised to take their disease seriously and "see a [physician] at the earliest warning signs of arthritis so that they can continue to enjoy active life and avoid future limitations," said John H. Klippel, MD, medical director of the Arthritis Foundation.

In arriving at its 70 million figure, the CDC telephoned more than 212,000 adults 18 and older and asked them if their physician had ever told them they had arthritis or if they had experienced chronic joint symptoms during the past 12 months.

Asking about chronic joint symptoms was something that hadn't been done before and is the primary reason for the large leap in the numbers of those identified, said Chad Helmick, MD, a medical epidemiologist with the CDC's arthritis program.

A third of American adults have arthritis or chronic joint pain.

While the figures don't represent a new epidemic of arthritis, they do more accurately reflect the numbers of people with arthritis and joint pain, said Dr. Helmick. "We're capturing them better because we're using different questions," he said.

The CDC's survey results also support an earlier research finding that women are at higher risk than men, whites and blacks have a higher risk than some other ethnic groups and those with little education or who are physically inactive and overweight have a higher prevalence of arthritis, said Dr. Helmick.

In separate research, Dr. Helmick found that people who are separated, divorced or unemployed or who are current or former smokers are also more likely to have arthritis.

The fact that the CDC is even examining the public health impact of arthritis represents one of the first times that a nonfatal, chronic condition is the focus of attention, said Dr. Helmick. The big research dollars generally go to the "killer diseases" like cancer, heart disease and stroke. Arthritis is just one example of a condition that can have a major impact on a person's life, he noted.

People are living longer, and one of the big questions is: What are those extra years going to be like, he said. Easing the symptoms of chronic disabling conditions such as arthritis will play a big role in improving quality of life, he noted.

In addition, the strains of the baby boom cohort on the nation's social security system will mean that most people will be working beyond 65. "If people have arthritis, it will limit the things they are going to be able to do," said Dr. Helmick.
What to do

The survey results probably do not surprise primary care physicians, who only have to look to their own patients for evidence. "We see quite a bit of chronic joint pain and arthritis in our rural practice," said Richard Wherry, MD, a family physician in Dahlonega, Ga., about 60 miles north of Atlanta.

And Dr. Wherry suspects that many of his older patients probably haven't even told him about their joint pain, believing it is simply a natural part of aging. He tries to ferret out that information during routine examinations.

Arthritis is the No. 1 cause of disability.

When the issue does surface, counseling on exercise and weight loss is a priority, said Dr. Wherry.

But there are many types of arthritis. Rheumatoid arthritis, the prototypic form of inflammatory arthritis affecting about 2 million people, is one of them. And unlike the more common forms of arthritis, there are medications that can reverse the damage caused by the disease.

"If I diagnose rheumatoid arthritis or am suspicious of it, I will refer those people early to get a plan of action and then I will maintain that plan of action," said Dr. Wherry.

Rheumatoid arthritis is really a medical emergency and requires urgent referral to a rheumatologist, agreed Jonathan Kay, MD, clinical director of the Rheumatology Unit at Massachusetts General Hospital in Boston.

In the mid-1980s, he said, new medications became widely available that effectively arrest the bone destruction that occurs if the disease is untreated. Additional drugs introduced over the past five years help reduce the fatigue and malaise associated with the disease as well, he noted.

Dr. Kay applauded a trend by primary care physicians to diagnose and refer cases of rheumatoid arthritis to the necessary specialist. "The key to diagnosing joint disease is to listen to the patient," he said. "Sometimes they need guidance based on the physician's experience, but if you don't give the patient time to describe their symptoms and don't listen to the nuances of the patient's description, you might miss the diagnosis."

Arthritis is most common among smokers and those who are separated, divorced or unemployed.

When he examines a patient, Dr. Kay focuses on functional questions, asking them how they carry out their daily lives, how they feel when they get up in the morning, whether they have trouble making a fist or buttoning a shirt. Difficulties at such times can be a sign of a musculoskeletal problem that could be treated medically, said Dr. Kay.

But appropriate self-management techniques are also important to patients with arthritis, said Dr. Helmick. "People are managing themselves 99.99% of the time, whereas physicians only see them for a tiny fraction of a percentage of the time," he said.

"As physicians, we want to make sure we are dealing with the main outcomes of interest to people, which are pain, function and independence," he noted.

Remaining physically active is probably the most important advice for patients. "If you get the disease and stay physically active and keep those muscles up, you are doing what you need to slow the progression of the disease," said Dr. Helmick.