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Arthritis in General

While the word arthritis is used by clinicians to specifically mean inflammation of the joints, it is used in public health to refer more generally to more than 100 rheumatic diseases and conditions that affect joints, the tissues that surround the joint, and other connective tissue. The pattern, severity, and location of symptoms can vary depending on the type of disease. Typically, rheumatic conditions are characterized by pain and stiffness in or around one or more joints. The symptoms can develop gradually or suddenly. Certain rheumatic conditions can also involve the immune system and other internal organs of the body.

I. Background

  • Arthritis can be defined clinically, epidemiologically, or in other ways depending on the analyst's perspective. For public health purposes, we use two standard approaches for defining arthritis:
    • For estimating population prevalence using self-report surveys, we use the case definition of “doctor-diagnosed arthritis”—defined by answering ‘yes’ to the question “Have you EVER been told by a doctor or other health professional that you have some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia?” This question is used by the Behavior Risk Factor Surveillance System (2002 and later) and the National Health Interview Survey (2002 and later). Many people who self-report arthritis diagnoses do not know the different types of arthritis and only know about the general definition of arthritis.
    • For estimates from health care system or other data using ICD-9-CM codes, we use a standard set of ICD-9-CM code [PDF - 908KB] for “arthritis and other rheumatic conditions” (AORC) developed by the National Arthritis Data Workgroup in 1994.
  • Diagnosis: Most of these diseases are clinically diagnosed using the patient’s history, physical examination, X-rays, and blood work. Only a few of these diseases (e.g., gout) have a definitive diagnosis.
  • Treatments: Non-inflammatory types (e.g., osteoarthritis) are usually treated with pain medications, physical activity, weight loss (if overweight), and self-management education. Inflammatory types (e.g., rheumatoid arthritis) are treated the same way but with the addition of anti-inflammatory medications (corticosteroids and nonsteroidal anti-inflammatory drugs (NSAIDs)), disease-modifying anti-rheumatic drugs (DMARDs), and a relatively new class of drugs known as biologics.

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II. Prevalence

  • About 52.5 million adults aged 18 years or older in the civilian, non-institutionalized population, have self-reported doctor-diagnosed arthritis.1
  • Prevalence proportions for adults were higher among
    • Older adults (49.7% for people aged >65 years, 30.3% for people aged 45–64 years, and 7.3% for people aged 18–44 years).1
    • Females (age-adjusted: 26% among women versus 19.1% among men).1
    • Non-Hispanic whites and blacks and American Indian/Alaska Natives (age-adjusted: 22.3%, 21.8% and 28.6% respectively) versus Hispanics (15.6%) and Asian/Pacific Islanders (10.6%).8
    • Obese and overweight people. Obese (age-adjusted: 28.9%) versus overweight (20.3%) versus underweight/normal weight (16.3%).1
    • Physically inactive people (age-adjusted: 24% for physically inactive versus 18.6% among adults with arthritis meeting physical activity recommendations).1
  • About 9.8% of US adults, or 22.7 million people aged 18 years or older, have arthritis attributable activity limitations defined as a yes answer to "Are you now limited in any way in any of your usual activities because of arthritis or joint symptoms?"1
  • Among children infancy to 17 years of age, an estimated 294,000 have arthritis or other rheumatic conditions, including 16,000 classified as rheumatoid arthritis and other inflammatory polyarthropathies.5

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III. Incidence

  • Incidence data are not available.

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IV. Mortality

  • Mortality data for 20-year period 1979-1998 showed 146,377 deaths with an underlying cause of arthritis and other rheumatic conditions (AORC). Deaths rose from 5,537 per year to 9,367 per year during that period, corresponding to an age-standardized annual rate of about 3 people per 100,000.2
  • Deaths occurred among all age groups, including children; 12.1% of deaths occurred among people aged 15–44.2
  • Age-standardized death rates were higher for women and blacks.2
  • Using 10 categories of AORC, just three categories accounted for almost 80% of deaths: diffuse connective tissues diseases (34%; mostly systemic lupus erythematosus and systemic sclerosis), other specified rheumatic conditions (23%, mostly vasculitis), and rheumatoid arthritis (22%).2
  • During the 20-year period an additional 585,446 people had AORC listed as an associated cause of death.2
  • These estimates may not capture mortality from treatment-related adverse effects, such as NSAID-induced gastrointestinal bleeds.

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V. Hospitalizations

  • An analysis of 2011 data from the Nationwide Inpatient Sample estimated 6.7 million hospitalizations for AORC.4
  • Only 1% of the hospitalizations for AORC had this listed as the first diagnosis.4
  • In 2011 60% of the AORC hospitalizations were among women. 4
  • People aged 65 years and older account for 41% of AORC-associated hospitalizations.4

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VI. Ambulatory Care

  • Using 2010 data from the National Hospital Care Survey (NHCS) there were an estimated 100 million visits among adults for a diagnosis of AORC.4
  • AORC was listed as the presenting diagnosis for between 2.6% and 5.7% of all visits.4
  • These occurred in physician offices (84%), and acute care hospital outpatient (6%) and emergency departments (5%).4
  • Three of 11 AORC categories accounted for more than 50% of visits: osteoarthritis and allied disorders (25%), joint pain/effusion/ other unspecified joint disorders (23%), and fibromyalgia (6%).4
  • Among children (from infancy to 17 years of age) there were an estimated 827,000 annual ambulatory care visits for arthritis or other rheumatic conditions, including 61,000 for rheumatoid arthritis and other inflammatory polyarthropathies.5

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VII. Cost

  • Conservative analyses based on the 2003 Medical Expenditures Panel Survey (MEPS) estimated costs due to arthritis of $128 billion, up 48% from $86.2 billion in 1997 (or up 24% in constant 2003 dollars). The direct cost (medical expenditures) attributable to AORC were $80.8 billion and the indirect cost (earnings losses) were $47.0 billion [these analyses adjusted for 6 demographic characteristics, 9 expensive comorbidities, and health insurance status].6
  • The largest components of direct costs were for ambulatory care (52.1%), inpatient care (20.0%), and prescription drugs (19.3%).6
  • Trends in AORC costs from 1997 to 2005 showed that mean ambulatory and prescription expenditures increased far above the rate of medical inflation, offsetting a relative decline in inpatient expenditures.9

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VIII. Impact on Health-Related Quality of Life (HRQOL)

  • Of adults ages 18 and older with arthritis, 27% reported fair/poor health compared with 12% of those without arthritis. The mean number of physically unhealthy, mentally unhealthy, and activity-limited days were significantly higher for adults with arthritis.9

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IX. Unique Characteristics

  • State specific prevalence estimates for 2013 and projections to 2030 for doctor-diagnosed arthritis and arthritis-attributable activities limitations are available.
  • These generic arthritis estimates are driven primarily by the most common type of arthritis—osteoarthritis.

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X. References

  1. Barbour KE, Helmick CG, Theis KA, Murphy LB, Hootman JM, Brady TJ, Cheng YJ. Prevalence of doctor-diagnosed arthritis and arthritis-attributable activity limitation-United States, 2010-2012. MMWR Morb Mortal Wkly Rep. 2013;62(44):869-873. PubMed PMID: 24196662. abstract
  2. Sacks JJ, Helmick CG, Luo YH, Ilowite HT, Bowyer S. Prevalence of and annual ambulatory health care visits for pediatric arthritis and other rheumatologic conditions in the United States in 2001–2004. Arthritis Rheum. 2007;57(8):1439-1445. PubMed PMID: 18050185. abstract
  3. Cisternas MG, Murphy L, Yelin E, Foreman AJ, Pasta DJ, Helmick CG. Trends in medical care expenditures of adults with arthritis and other rheumatic conditions: 1997 to 2005. J Rheumatol. 2009;36:2531-2538. PubMed PMID: 19797505. abstract
  4. United States Bone and Joint Initiative: The Burden of Musculoskeletal Diseases in the United States (BMUS), Third Edition, 2014. Rosemont, IL.  Available at Accessed on April 19, 2014.
  5. Yelin E, Murphy L, Cisternas MG, Foreman AJ, Pasta DJ, Helmick CG. Medical care expenditures and earnings losses among persons with arthritis and other rheumatic conditions in 2003, and comparisons with 1997. Arthritis Rheum. 2007;56(5):1397-1407. PubMed PMID: 17469096. abstract
  6. Bolen J, Schieb L, Hootman JM, Helmick CG, Theis K, Murphy LB, Langmaid G. Differences in the prevalence and impact of arthritis among racial/ethnic groups in the United States, National Health Interview Survey, 2002, 2003, and 2006. Prev Chronic Dis. 2010;7(3). PubMed PMID: 20394703. abstract
  7. Furner SE, Hootman JM, Helmick CG, Bolen J, Zack MM. Health-Related Quality of Life of US Adults with Arthritis: Analysis of Data from the Behavioral Risk Factor Surveillance System, 2003, 2005 and 2007. Arthritis Care Res (Hoboken). 2011;63(6):788-799. PubMed PMID: 21538946. abstract