More than 54 million adults in the United States have some form of arthritis and, for nearly half of them, the pain, stiffness and joint damage make daily life harder, according to a new report released in early March by the Centers for Disease Control and Prevention (CDC). While the report notes that the prevalence of arthritis has not changed significantly since 2002, it does highlight a 20 percent jump in the percentage of people who have arthritis-attributable limitations in activities – that is, trouble with simple tasks such as lifting a grocery bag or walking a few blocks.
CDC acting director Anne Schuchat, MD, says the increase is alarming. “Millions of people are unable to go about their daily routines because of their symptoms…significantly more adults than a decade ago,” she says, noting that African-Americans, Hispanics and non-Hispanic multiracial adults report arthritis-related limitations more frequently than do whites.
Ann M. Palmer, president and CEO of the Arthritis Foundation, says, “This isn’t a surprise to us, but will be to many people. Arthritis is the leading cause of disability in this country, but that’s, unfortunately, almost a well-kept secret.”
An Arthritis Foundation survey conducted by Harris Poll in June-July 2016 found daily living is a challenge for around half of Arthritis Foundation constituents with arthritis surveyed. Fifty-six percent reported difficulty picking up something from the floor, and 47 percent reported difficulty getting in and out of bed.
“When arthritis limits mobility and function, it tends to also cause isolation and have an emotional impact,” says Palmer. “Sixty percent reported feeling left out of activities due to their arthritis, and around half reported little interest or pleasure in doing things, and feeling down, depressed or hopeless. This is a huge concern.”
The CDC findings are based on 2013, 2014 and 2015 data from the National Health Interview Survey, an in-person interview survey of the health status and behaviors of roughly 35,000 U.S. adults. Participants are asked, among other things, ‘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?” If the answer is yes, they are asked, “Are you now limited in any way in any of your usual activities because of arthritis or joint symptoms?”
Cause and Impact
It’s not clear why a greater proportion of people with arthritis struggled with daily activities in 2013–2015 (43.5 percent) compared to 2002 (36 percent), but Cynthia Crick, CDC spokesperson for arthritis-related matters, says obesity may play a part. This and other reports have shown that almost two-thirds of adults who have arthritis are overweight or obese, and many have other chronic health problems, including heart disease and diabetes. People who are obese are more likely to have severe arthritis, and chronic conditions make arthritis harder to manage. Among this survey’s respondents, 49 percent of those with heart disease, 47 percent of those with diabetes and 30 percent of those with obesity reported having arthritis.
There’s also a growing number of young and middle-aged adults who have joint disease – of the more than 54 million adults in the U.S. with doctor-diagnosed arthritis, nearly two-thirds (59 percent) are younger than 65.
“Contrary to popular opinion, arthritis is not an old person’s disease,” Dr. Schuchat says. “Sixty percent are working-age adults, and we know they have lower employment than those without arthritis.” Limitations due to arthritis likely play a role in employment rates, too.
In other words, arthritis doesn’t just make life more difficult; it can also cut deep into patients’ wallets. The annual direct medical costs for arthritis are around $81 billion. Indirect costs in terms of lost wages and productivity run about half that, according to CDC data.
Exercise is Power
It’s estimated approximately 78 million U.S. adults will have arthritis by 2040 – the vast majority osteoarthritis – but that doesn’t have to mean a corresponding increase in pain and disability, as long as people keep moving, experts say. The CDC report emphasizes physical activity as an effective therapy for many arthritis-related problems; earlier CDC studies have found it decreases pain and improves function by almost 40 percent. Yet according to research, few arthritis patients get the recommended 150 minutes of exercise a week, and a good third barely move at all.
That may be because they don’t have the right information, Dr. Schuchat says.
“In the past, people with arthritis may have been told not to be active for fear of making their arthritis worse. But it’s now been proven that physical activity can be helpful, and there are ways to be active that can accommodate limitations from arthritis. We want people to know that it’s best to address their arthritis before symptoms become severe,” she explains.
Crick says CDC studies have shown participating in a disease-management program can reduce pain, fatigue and depression by another 10 to 20 percent. Yet only 1 in 10 people with arthritis takes advantage of these programs now. She encourages doctors to recommend them to their patients.
How to Get Moving
Government guidelines suggest at least 30 minutes of moderate-intensity physical activity, such as brisk walking, swimming or biking, five days a week. Adding strength training or weight lifting two to three times a week not only strengthens muscles but also lubricates joints and reduces bone loss.
“When you’re in pain, exercise is often the last thing you want to do,” Dr. Schuchat says. “Start small by taking a short walk in the park, gardening or a lap in the pool. This can start patterns that make a big change in the long run.”
Jasvinder Singh, MD, a rheumatologist at the University of Alabama, Birmingham, who studies the comparative effectiveness of arthritis treatments, says he strongly endorses the CDC recommendations for physical activity.
“I am a big proponent of exercise [for many reasons],” he says. “[One] is that my patients come back and tell me how much better they feel in general. Exercise can also be very helpful in helping people adjust psychologically to their arthritis, and over the long term, they feel more in control of their lives.
“Exercise also helps manage other chronic conditions they may have; when you’re fit, you’re less likely to be at high risk of heart attacks, strokes and diabetes and more likely to maintain a healthy weight. So in my own practice, I strongly encourage it.”
One problem, says Dr. Singh, is that generalized exercise recommendations don’t, by necessity, take into account the needs of any particular patient, such as the severity and type of arthritis, the joints affected and other chronic health problems like obesity. He suggests doctors and patients work together to come up with an individualized exercise program, if necessary.
The Arthritis Foundation has an online tool called Your Exercise Solution (YES tool) that guides people to find the right activities and modify them to their needs, according to specific joints affected and their level of fitness.
Dr. Singh notes that only in rare and very severe cases would exercise be off-limits for most patients, even those with multiple chronic health problems.
He recommends the same types of exercises the CDC does – brisk walking, swimming, biking and rowing – with the caveat that 150 minutes a week may initially be too challenging for first-time exercisers.
“I tell them to start slowly and work their way up. The activity doesn’t have to be in 30-minute increments; it’s just as effective to exercise in three 10-minute segments a day. But I tell patients I have to see progress in two to six months,” he says.
Dr. Singh especially likes the buddy system approach, where partners work out together and hold each other accountable.
“I think peer and buddy programs are the way to go. Most people aren’t extremely motivated, but peer pressure is a powerful force, regardless of age. It’s not just for teenagers; it really works [to keep people motivated],” he says.
Author: By Linda Rath, for the Arthritis Foundation