Arthritis

 WHAT IS ARTHRITIS?

Typically, pain, aching, stiffness and swelling in and around one or more joints characterize rheumatic conditions. The symptoms can develop gradually or suddenly. Certain rheumatic conditions can also involve the immune system and various internal organs of the body.⁶

The term "arthritis" is used to describe numerous rheumatic diseases and conditions that affect joints.

Some forms of arthritis, such as rheumatoid arthritis and lupus, can affect multiple organs and cause widespread symptoms.

Arthritis is more common among adults aged 65 years or older, but people of all ages (including children) can be affected.

PREVALENCE OF ARTHRITIS

There are 52.5 million adults in the US, equating to 22.7% of the population, reported to have a form of arthritis, rheumatoid arthritis, gout, lupus or fibromyalgia.¹

With people living longer in the US, the prevalence of doctor-diagnosed arthritis is expected to increase. It has been estimated that by the year 2030, 67 million, 25% of the projected total adult population aged 18 years and older, will have doctor-diagnosed arthritis.

Arthritis has a significantly higher age-adjusted prevalence in women (23.9%) than men (18.6%), with the prevalence increasing with age and higher among women than men in every age group.

An estimated 294,000 children under the age of 18 have some form of arthritis or rheumatic condition; this represents approximately 1 in every 250 children in the US.⁴

IMPACT OF ARTHRITIS

Arthritis has a significant impact on individuals, for example:¹

• Almost 43.2% (22.7 million) of adults with arthritis report limitations in their usual activities
• 40% report that it is "very difficult" or they "cannot do" at least 1 of 9 important daily functional activities
• Almost 8 million adults who report an activity limitation due to arthritis also report severe limitation in their ability to stoop, bend, or kneel, and 6 million cannot walk 0.25 miles
• 31% (8.3 million) of working age adults with arthritis report limitations in work.

Impairment in the ability of people with arthritis to perform essential daily tasks may interfere with their work, their purpose in their community, or the care they can provide for their family.

DISABILITY

Around 18% of total disabilities are caused by arthritis or rheumatism, making it the most common cause of disability in the US.

EMOTIONAL HEALTH

Arthritis has a strong association with major depression, with a risk of 18.1%. This could be due to its role in creating functional limitation. Around 6.6% of adults with arthritis report severe psychological distress.

BMI

Prevalence of arthritis increases with body mass index (BMI). Prevalence increases from 16.3% among underweight and normal adults to 20.3% of overweight adults and 28.9% of obese adults.

Reports among adults by BMI show the following groups express activity limitations:

• 38.2% of underweight and normal
• 37.2% of overweight
• 44.8% of obese.

ARTHRITIS AND EXERCISE

Physical activity and exercise have been shown to benefit people with arthritis by improving pain, function and mental health. However, around 24% of adults with arthritis report being physically inactive compared with 18.6% of adults without arthritis.

By partaking in low levels of exercise, individuals with arthritis face placing themselves at risk of conditions associated with lack of activity such as cardiovascular disease, diabetes, obesity and functional limitations.

RISK FACTORS

Certain factors have been shown to be associated with a greater risk of arthritis. Some of these risk factors are modifiable while others are not.

Non-modifiable risk factors:

• Age: the risk of developing most types of arthritis increases with age
• Gender: most types of arthritis are more common in women; 60% of all people with arthritis are women. Gout is more common in men than women
• Genetic: specific genes are associated with a higher risk of certain types of arthritis, such as rheumatoid arthritis (RA), systemic lupus erythematousus (SLE) and ankylosing spondylitis.

MODIFIABLE RISK FACTORS:

• Overweight and obesity: excess weight can contribute to both the onset and progression of knee osteoarthritis
• Joint injuries: damage to a joint can contribute to the development of osteoarthritis in that joint
• Infection: many microbial agents can infect joints and potentially cause the development of various forms of arthritis
• Occupation: certain occupations that involve repetitive knee bending and squatting are associated with osteoarthritis of the knee.

THE COST OF ARTHRITIS

Cost attributable to arthritis and other rheumatic conditions (AORC) in the US in 2003 was approximately:²

• $128 billion in total costs - 1.2% of the 2003 US gross domestic product (GDP)
• $80.8 billion direct costs - the largest components were for ambulatory care (52.1%), inpatient care (20.0%) and prescription drugs (19.3%)
• $47.0 billion indirect costs - lost earnings
• By state, a total ranging from $226 million in the District of Columbia to $12.1 billion in California.

COMORBIDITIES

The CDC reports that 47% of US adults with arthritis also have at least one comorbid condition (the presence of more than one disease or condition in the same person at the same time).³

Among people with arthritis the most common comorbidities are:

• Heart disease - 24% (11.2 million)
• Chronic respiratory conditions - 19% (9.0 million)
• Diabetes - 16% (7.3 million)
• Stroke - 6.8% (3.2 million).

Risk factors for other chronic conditions are common among US adults with arthritis, such as:

• High blood pressure - 53%
• Physical inactivity - 47%
• High cholesterol - 47%
• Obesity - 36%
• Smoking - 19%.

More than half (53%) of US adult with arthritis report high blood pressure. High blood pressure is associated with heart disease - the most common comorbidity among adults with arthritis.

Approximately 1 in 5 (19%) of US adults with arthritis are smokers. Smoking is associated with chronic respiratory conditions - the second most common comorbidity among adults with arthritis.

JOINT REPLACEMENTS

In 2004, joint replacements for arthritis included:⁴

• 454,652 total knee replacements
• 232,857 total hip replacements
• 41,934 shoulder replacements
• 12,055 other joint replacements.

MORTALITY

Between the years of 1979-1998, the AORC deaths increased from 5,537 to 9,367.⁴ The approximate death rate from AORC in 1979 was 2.46 per 100,000 population and 3.48 per 100,000 population in 1998. Both rates age-standardized to the year 2000 population were 2.75 and 3.51, respectively.

Using 10 categories of AORC, just three categories accounted for almost 80% of deaths:⁹

1. Diffuse connective tissues diseases: 34% - mostly SLE and systemic sclerosis
2. Other specified rheumatic conditions: 23% - mostly vasculitis
3. RA: 22%.

WHAT CAUSES ARTHRITIS?

There is no one cause for arthritis; the cause depends on the type or form of arthritis. Potential causes for arthritis may include:

• Injury - leading to degenerative arthritis
• Abnormal metabolism - leading to gout and pseudogout
• Inheritance - such as in osteoarthritis
• Infections - such as in the arthritis of Lyme disease
• Overactive immune system - such as RA and SLE.

For many arthritis conditions, there is a strong element of chance involved as to what is the main cause. However, for most types of arthritis, the cause is a combination of many factors working together.

A person may naturally be more susceptible to certain conditions due to genetic makeup. If more susceptible, external factors such as previous injury, infection, smoking and physically demanding occupations could play a part. 

Osteoarthritis is caused by a reduction in the normal amount of cartilage tissue through wear and tear throughout life.

There are some foods that appear to exacerbate arthritis, although diet or food sensitivity or intolerance is unlikely to cause arthritis.

Cartilage is a flexible, connective tissue in joints that absorb the pressure and shock created from movement like running and walking. It also protects the joints and allows for smooth movement.³⁴

Some types of arthritis are caused by a reduction in the normal amount of cartilage tissue through wear and tear throughout life, such as osteoarthritis.

RA, on the other hand, occurs when the body's immune system attacks the tissues of the body.

 

Child antibiotic exposure linked to juvenile arthritis

Children prescribed courses of antibiotics were found to have twice the risk of developing juvenile arthritis than children who did not receive antibiotics, according to the findings of a new study published in Pediatrics.

Arthritis: Causes, Symptoms and Treatments

ARTHRITIS CAUSES

The causes of arthritis depend on the form of arthritis. Causes include injury (leading to degenerative arthritis), abnormal metabolism (such as gout and pseudogout), inheritance (such as in osteoarthritis), infections (such as in the arthritis of Lyme disease), and an overactive immune system (such as rheumatoid arthritis and systemic lupus erythematosus). Treatment programs, when possible, are often directed toward the precise cause of the arthritis.

More than 21 million Americans have osteoarthritis. Approximately 2.1 million Americans suffer from rheumatoid arthritis

ARTHRITIS SYMPTOMS

Symptoms of arthritis include pain and limited function of joints. Inflammation of the joints from arthritis is characterized by joint stiffness, swelling, redness, and warmth. Tenderness of the inflamed joint can be present. Loss of range of motion and deformity can result. Certain forms of arthritis can also be associated with pain and inflammation of tendons surrounding joints.

Some forms of arthritis are more of an annoyance than a serious medical problem. However, millions of people suffer daily with pain and disability from arthritis or its complications. Moreover, many of the forms of arthritis, because they are rheumatic diseases, can cause symptoms affecting various organs of the body that do not directly involve the joints. Therefore, symptoms in some patients with certain forms of arthritis can also include fever, gland swelling, weight loss, fatigue, feeling unwell, and even symptoms from abnormalities of organs such as the lungs, heart, or kidneys.

WHEN TO SEEK MEDICAL CARE

If joint pain, swelling, stiffness, redness, loss of motion or deformity occurs, medical evaluation by a health-care professional is warranted. Even minor joint symptoms that persist unexplained for over one week should be evaluated. For many forms of arthritis, it is essential that patients have an early evaluation as it is clear that this can both prevent damage and disability as well as make optimal treatment easier.