CDC Telebriefing Transcript

Arthritis and Chronic Joint Symptoms
More Common than Previously Thought

October 24, 2002

CDC MODERATOR: Thank you. Good afternoon and welcome to the MMWR telephone briefing. Today's topic from the October 25th issue of the Morbidity and Mortality Weekly Report is on Arthritis and Chronic Joint Symptoms.

Our speaker today is Dr. Chad Helmick. His name is spelled H-E-L, as in Larry, M, as in Michael, I-C-K, and he will give a brief summary, and then we'll open up for questions.

Thank you.

DR. HELMICK: Good afternoon. I'm Dr. Chad Helmick. I work with the arthritis program here at the Centers for Disease Control and Prevention. What I'll be talking about today is an article that comes out tomorrow called, "Prevalence of Self-Reported Arthritis or Chronic Joint Symptoms Among Adults, United States 2001."

We did this article on arthritis because arthritis is a leading cause of disability, even by past measures, but we wanted to get a better sense of what was happening in each state of the country because states have not had direct measures of arthritis in their states. Previously, they've had only indirect measures. For example, data in national surveys might be extrapolated to what's happening in each state.

For the first time, there were actually people polled in each of the 50 states and asked questions about arthritis, and these questions included those that asked about what we call chronic joint symptoms, as well as questions that asked about whether a doctor had told them that they had arthritis. These questions were asked in the year 2001 of adult respondents only, and there were several key findings from this study.

First of all, we do now have estimates for all 50 states of their arthritis or chronic joint symptom burden.

Secondly, when you put together all of these estimates from the 50 states, you get a national estimate of 69.9 million, and that number is much larger than the number we had previously, which was 43 million.

The third thing is that we looked at the 69.9 million and examined them and found typically what we find among people with arthritis. In other words, women have higher risk than men,; whites and blacks have higher risk than some other racial and ethnic groups, and those with low education, those who are physically inactive, and those who are obese or overweight have a higher prevalence of arthritis.

So I think the key issue here is that we do have for the first time estimates for each of the 50 states, and we have a new national estimate. This new national estimate is much larger than before, and this, in our minds, does not represent an epidemic, it really represents a better way of capturing the people that have always been out there with arthritis or chronic joint symptoms, and we're capturing them better because we're using different questions.

Some of the take-home messages from this is really that all groups are affected. There are no demographic groups unaffected by arthritis, that really all of us are affected, and that includes children, and although that was not addressed in this study, but even young adults, middle age and old adults, both genders, all racial and ethnic groups.

This sort of information is very useful to help states address arthritis as a public health issue, which we need to do in the future because the population is aging. That means there will be more people in the future with arthritis and chronic joint symptoms, and that can be a problem because we're all living extra years now, compared to our parents, and what are those extra years going to be like?

Also, we're maybe working longer years than our parents did, too. The Bureau of Labor Statistics came out with some estimates earlier this year that showed that the composition of the workforce by the year 2010 will have many more people age 45 and older than it currently does. So how are people with arthritis and chronic joint symptoms going to keep working during that era?

Also, addressing arthritis is part of a larger effort that's ongoing within the public health system. National Arthritis Action Plan, a Public Health Strategy, is a document that was created by the Arthritis Foundation, the Association of State and Territorial Health Officials and CDC to help lay out a strategy for addressing arthritis as a public health problem.

As part of that, the Healthy People 2010 process, which sets health objectives for the nation, for the first time has arthritis objectives.

Internationally, we're currently in the decade of the bone and joint. The bone and joint decade process is happening supported by the World Health Organization and many countries around the world.

I think those are the main points I wanted to make. I'll be glad to take any questions on this.

CDC MODERATOR: Thank you.

We're now ready for questions.

AT&T OPERATOR: Thank you. Ladies and gentlemen, if you wish to ask a question, please depress the one on your phone. You will hear a tone indicating that you have been placed in queue. You may remove yourself from queue at any time by depressing the pound key on your phone, and if you are using a speaker phone, please pick up your handset before pressing the number.

Our first question comes from the line of Adam Marcus with Health Scout. Please go ahead.

QUESTION: I have two questions. The first is what constitutes chronic joint symptoms and how is that different from full-blown arthritis?

And, also, what are the questions, the new questions that you asked to tease out the numbers?

DR. HELMICK: Yes, I'll be glad to address that, and that reminds me of one thing I forgot to say is that we use these new questions because the way we measured arthritis in the past, using the National Health Interview Survey, could not be done. They had changed the way they did that survey, so there really was not a chance to measure it in the same way.

We took that opportunity to actually address what was realized to be a weakness in those questions, which is there are many people with arthritis and chronic joint symptoms who don't see a doctor, so they may not label what they have as arthritis, and you can't use health care system-based data sources to get at this.

So what we did is we did use new questions, and the questions are these. You are defined as having chronic joint symptoms if you answered yes to these two questions:

First, in the past 12 months, if you had pain, aching, stiffness or swelling in or around the joint; and, secondly, were these symptoms present on most days for at least a month?

Again, you had to answer yes to both of those questions on whether you had symptoms and some measure of chronicity to be called having chronic joint symptoms.

The other question was simply have you ever been told by a doctor that you have arthritis, which is a pretty standard question used in a lot of surveys. And for this study could have either chronic joint symptoms or doctor-diagnosed arthritis or both. And when you combine all of those sets together, that's how you get the 69.9- million number.

QUESTION: Thank you.

AT&T OPERATOR: Our next question is from the line of Alice Demner with the Boston Globe. Please go ahead.

QUESTION: Good morning. I'm wondering if you could talk to us about what the implications are for society and for our health care system of this many more people with chronic joint problems, and if you could talk about how many of these people, in your best guess, are truly disabled and actually need medical care for these conditions?

DR. HELMICK: Right. What should people do and what are the implications for the public and for individuals.

There are several ways of thinking about this, and let me give you just one--let me reiterate one thing, that these numbers are bigger numbers than before, but again I think we're just capturing what's been always going on. So that what I would say about, in terms of disability, is we would use different data sets to measure the seriousness or impact of this, and those data sets are the ones that we have looked at that show that arthritis, by all measures, is the number one cause of disability in the United States.

I don't think the numbers we have here change the number of people we would estimate having disability from arthritis and chronic joint symptoms.

QUESTION: So that's still about 7 million?

DR. HELMICK: Yeah, 7, maybe 8 million people now, depending on the surveys that you look at.

The other implication, though, is that there are a lot of people out there who are telling us that they have chronic joint symptoms. Again, people were asked in all 50 states, so that was actually 212,000 people being asked these questions. That's a lot of people, and they're telling us they have chronic joint symptoms or doctor-diagnosed arthritis.

Now because of larger societal trends, in other words, more older workers in the future, that's a concern of society to have to deal with. For individuals, again, we'll probably be living, on average, longer than people in the past, and what are those extra years going to be like? What is the independence going to be? What's the health-related quality of life? And arthritis, already the number one cause of disability, is obviously something we need to think about there.

The public health implications for doing something are relatively clear. We, at CDC, support 36 state health departments to try to address arthritis as a public health issue and raise public awareness of just how important this is. That can be a difficult problem because people tend to dwell on the killer diseases, like heart disease and cancer, and not so much on diseases that don't kill you, but may interfere with your quality of life or your independence.

As individuals, if you're having these chronic joint symptoms, I think there's several messages there. One is to take these more seriously. And what we would suggest to people is that they go to a doctor and get an early diagnosis because there are things you can do if you get an early diagnosis.

Some of these relate to appropriately manage it, both clinically with your doctor and by yourself. And the things you can do with self-management are to maintain your physical activity, which helps keeps your joints strong. Even though it may hurt a little bit at the beginning, it's better in the long term, including it reduces pain in the long term;

The second thing people can do is try to achieve an appropriate weight and maintain that, lose weight if they need to; and,

Third, to get educated about arthritis, and there are a variety of programs at the Arthritis Foundation, including the Arthritis Self-Help course, and that course, in particular, has helped people not only to learn about arthritis, but actually to reduce their pain and to reduce the number of clinical visits they make.

QUESTION: To what extent does this population need actual drugs or other medical treatment as opposed to self-help?

DR. HELMICK: Well, there are plenty of medications to deal with the main symptom that people complain about, which is pain. But there are non-drug ways to deal with it, too. For example, physical activity has been shown to, in the long run, reduce pain. Losing weight should help reduce pain for people who have arthritis already. And, again, getting educated about your disease and knowing how to deal with the health care system, trying to anticipate situations which might be a problem, are ways to reduce pain as well.

QUESTION: Are there any estimates of how many of these people actually do need medical treatment as opposed to the kinds of management that you're talking about, physical activity, things that they can control themselves?

DR. HELMICK: I don't think there are any data on that yet, but I think the main point is when people do have chronic joint symptoms, they should see a doctor for it and see if it's something that could be called arthritis, or whatever it is, and do something about it.

People tend to minimize these symptoms too often, and this loses valuable time in terms of treating and preventing worse outcomes.

QUESTION: Thank you.

AT&T OPERATOR: And our next question comes from the line of Steve Mitchell with United Press International. Please go ahead.

QUESTION: I was wondering if you could tell me if this included rheumatoid arthritis as well as osteoarthritis.

DR. HELMICK: Yeah, you're asking about specific types of arthritis, and we're not able to get at that with this survey or really with any self-report survey, because people frankly are never quite sure what type of arthritis they have. So we put them in this large basket.

But, yes, people with rheumatoid arthritis should be answering this question yes. People with osteoarthritis probably will be, too, and there are a hundred different types of arthritis and other rheumatic conditions. Those are the people we're trying to capture with these questions.

QUESTION: Okay. Thanks.

AT&T OPERATOR: If there are any additional questions, please depress the 1. And we now have a question from the line of Patricia Guthrie with the Atlanta Journal Constitution. Please go ahead.

QUESTION: Hello. Can you tell me how much the obesity epidemic ties into the arthritis problem? And is there any studies that say if you're X amount overweight, you're more likely to get arthritis?

DR. HELMICK: Yeah, that's a good question. There's certainly been a coincidence of the obesity epidemic and the increase in arthritis, and certainly clinicians have recognized that connection for a long time.

As far as actual studies showing the connection, there's one good study from the Framingham Study in Massachusetts that looked at women, and women there who were overweight but lost--I believe it was on average 11 pounds, actually reduced their incidence of disease, in other words, reduced the chance of getting the disease in the first place. And there's certainly clinical opinion and others who believe that once you have the disease, if you lose weight, that should help. And there's certainly biomechanical principles behind that. For example, every pound of weight you have extra is an extra three pounds across your knee when you're walking. So that puts a lot more stress on the knee.

I'm sorry. Was there a part of your question I didn't get at.

QUESTION: No. I had heard that the 11-pound figure was just--being just 11 pounds overweight could increase your risk of--and I can't remember what the percentage was.

DR. HELMICK: This was looking at knee osteoarthritis, which is just one type, but it's a very common type. In fact, total knee replacements are one of the most common procedures done in hospitals, over 250,000 a year. So it's a common disease, and we try to look at these issues because physical activity and overweight and previous occupational, sports, or recreational injuries play into what the outcome of arthritis is. This still needs to be worked out.

Let me add just one thing I forgot to mention earlier. In the past, when we estimated 43 million people with arthritis, that was 43 million people in the entire population, including children. So you'll often hear the figure one in six Americans have arthritis based on those data from 1997.

The important difference with this survey is that we did not look at children at all. We looked only at adults. So what that means is here we're saying one of three adults has arthritis. That one in three number should not be compared to the one in six number before because that one in six number included so many tens of millions of children who have a very low risk of arthritis.

If you were to actually compare it, try to make a comparison, our one in three number today might be compared to something like one in four or one in five back in 1997.

AT&T OPERATOR: And our next question is from the line of Alice Demner (ph) with the Boston Globe. Please go ahead.

QUESTION: I actually have two questions, one in response to what you just said and another unrelated. So the past numbers, was there a separate figure for just adults from '97?

DR. HELMICK: There was no published separate figure on that, but we had run those figures just for ourselves one time because we helped create those data. And at that time we were estimating about 15--and I guess 16 percent of the overall population affected. If we restricted it to just those 18 and older, I think it was 22 percent. That's between one in four and one in five.

QUESTION: And my other question had to do with the geographic differences, looking at the Northeast, for example, New England, there's a chunk of New England that has a slightly lower rate, and then obviously there's a big section of the Midwest that has a lower rate. Can you explain that at all?

DR. HELMICK: Well, let me just say, first of all, the way we calculated these rates was to give an absolute measure for each state of their problem. So you can look at a measure within a state that we published and say that's what's going on in these states.

Now, if you want to compare states, you have to take into account that states have different age distributions. Some states are older than others, and there may be occupational differences and other things like that that you really need to adjust for before you think about saying, you know, one state has a higher rate of arthritis than the other.

Really what may be going on is they have identical rates by age, sex, and race, but, you know, Florida, for example, has a lot more older people, so they have higher rates of disease.

But we did see that pattern there, too, and even adjusting for age won't change things a tremendous amount. I don't have any real explanation for that right now.

QUESTION: Okay. Thank you.

AT&T OPERATOR: And our next question comes from the line of Colin Nelson with the Sports Medicine Digest. Please go ahead.

QUESTION: Hi. I had two questions. One is just interpreting some of the statistics here. Do I understand correctly that if you add up all the physician-diagnosed arthritis, it would come to about 23 percent of the total 33 percent?

DR. HELMICK: That's right. We had--you know, it's about 10 percent that just has the chronic joint symptoms only, about 10 percent that has doctor-diagnosed only, and about 10 percent that have both.

QUESTION: Okay.

DR. HELMICK: We put those percentages in there. Yeah, you can see that.

QUESTION: The other question I had was: Would you say that there is a mismatch between the prevalence of arthritis and chronic joint symptoms and funding for research on those problems? I realize you may not have at hand the research funding numbers.

DR. HELMICK: I don't handle funding around here. I can say that certainly, you know, addressing the leading cause of disability in the United States and a cause that's likely to increase in the future would seem to be a high priority. Certainly addressing conditions that don't kill you but do interfere with health-related quality of life are important as well, especially since we are going to be living extra years. And a lot of these conditions have not been examined very well. We don't have a good understanding of what's happening in the population.

QUESTION: May I ask another follow-up question to that?

DR. HELMICK: Sure.

QUESTION: I think some people might argue that arthritis actually is a life-threatening condition. Would you give some credence to that? That is, clearly, when you have arthritis, you begin to slow down; you become less active; the less active you become, perhaps you develop cardiovascular disease and things of that sort that eventually kill you.

DR. HELMICK: Yeah, well, there are two points on that. One, there are a hundred different types of arthritis, and most of them don't kill you, but some of them do. We actually just did an article in the MMWR last May about systemic lupus erythematosus which showed that mortality rates among middle-aged black women had actually been going up about 70 percent over the past 20 years. So there are types of arthritis that can kill you.

The other angle on that is really the one you mentioned and the one that's difficult to tease apart. If you get arthritis and you start doing less, you become perhaps more socially isolated, you gain weight, that that puts you at risk for other diseases like diabetes and heart disease and things like that. That's a question we really can't answer very well now. Certainly the Framingham Study showed that, you know, obesity, if it comes first, can put you at higher risk for knee osteoarthritis. But it's still an unanswered question about whether arthritis itself can slow you down enough and let you gain weight, become de-conditioned, weaken your other joints because of inactivity to put you at higher risk for other bad outcomes. That's a very interesting question.

QUESTION: Thank you.

AT&T OPERATOR: And there are no further questions in queue.

CDC MODERATOR: If there are no other questions, that is the end of today's telebriefing. The transcript will be posted this afternoon on the CDC website.

Thank you very much.

DR. HELMICK: Thank you.

AT&T OPERATOR: And, ladies and gentlemen, that does conclude our conference for today. Thank you for your participation and using AT&T Executive Teleconference. You may now disconnect.

[Whereupon, the teleconference was concluded.]

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