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Severe Joint Pain and Physical Inactivity Among Adults with Arthritis


On May 3, 2019, the CDC published a report that found marked state-specific variations in the percentage of the population that is affected by arthritis, severe joint pain, and physical inactivity. The report also found that physical inactivity was more prevalent among persons with severe joint pain than among those with less pain. An estimated 54.4 million (approximately one in four) U.S. adults have doctor-diagnosed arthritis. Severe joint pain and physical inactivity are common among adults with arthritis and are linked to adverse mental and physical health effects and limitations.

 

The CDC analyzed 2017 Behavioral Risk Factor Surveillance System (BRFSS) data to estimate current state-specific prevalence of arthritis and, among adults with arthritis, the prevalences of severe joint pain and physical inactivity. In 2017, the median age-standardized state prevalence of arthritis among adults 18 and older was 22.8 percent. The District of Columbia had the lowest prevalence of arthritis at 15.7 percent, while West Virginia had the highest prevalence at 34.6 percent. The prevalence of arthritis was highest in Appalachia and Lower Mississippi Valley regions. Among 144,099 adults with arthritis, age-standardized, state-specific prevalences of both severe joint pain (median = 30.3 percent) and physical inactivity (median = 33.7 percent) were highest in southeastern states. Colorado had the lowest prevalence of severe joint pain among adults with arthritis at 20.8 percent, while Mississippi had the highest at 45.2 percent. Colorado also had the lowest prevalence of physical inactivity among adults with arthritis at 23.2 percent, while Kentucky had the highest at 44.4 percent. Physical inactivity prevalence among those with severe joint pain (47.0 percent) was higher than that among those with moderate (31.8 percent) or no/mild joint pain (22.6 percent).

 

In 2017, age-specific arthritis prevalence was higher with increasing age, ranging from 8.1 percent among those aged 18 to 44 years to 50.4 percent among those aged 65 and older. Age-standardized arthritis prevalence was significantly higher among women (25.4 percent) than among men (19.1 percent); and those unable to work/disabled (51.3 percent), compared with retired (34.3 percent), unemployed (26.0 percent), or employed/self-employed (17.7 percent). Arthritis prevalence was higher with increasing body mass index, ranging from 17.9 percent among those with healthy weight or underweight to 30.4 percent among those with obesity.

 

Among adults with arthritis, 36.2 percent reported no/mild joint pain, 33.0 percent reported moderate joint pain, and 30.8 percent reported severe joint pain. Age-specific percentages for severe joint pain declined with increasing age, ranging from 33.0 percent among those aged 18 to 44 years to 25.1 percent among those 65 and older. Age-standardized severe joint pain prevalence was 40 percent or higher among the following groups: those unable to work/disabled (66.9 percent); non-Hispanic blacks (50.9 percent); retired persons (45.8 percent); and lesbian/gay/bisexual/queer/questioning (40.7 percent; reported by 27 states).

 

Among adults with arthritis, age-specific physical inactivity prevalence was higher with increasing age (ranging from 31.0 percent among those aged 18 to 44 years to 37.0 percent among those aged 65 and older). Age-standardized physical inactivity prevalence was 40 percent or more among those unable to work/disabled (51.2 percent). Physical inactivity prevalence increased with increasing joint pain levels (ranging from 22.6 percent among those with no/mild joint pain to 47.0 percent among those with severe joint pain).

 

Age-standardized arthritis prevalence was significantly higher among non-Hispanic American Indian/Alaska Natives (29.7 percent) than among other racial/ethnic groups (range = 12.8 percent–25.5 percent). Arthritis prevalence was lower among Hispanics and non-Hispanic Asians than among other racial/ethnic groups. Age-standardized severe joint pain prevalence was 40 percent or higher among Hispanics (42.0 percent) and non-Hispanic American Indians/Alaska Natives (42.0 percent). Age-standardized physical inactivity prevalence was 40 percent or more among non-Hispanic blacks (40.4 percent).

 

Arthritis prevalence was inversely related to education and federal poverty level. Age-standardized severe joint pain prevalence was 50 percent or higher among those with less than a high school diploma (54.1 percent) and those living at or below 125 percent of the federal poverty level (51.6 percent). Age-standardized physical inactivity prevalence was 40 percent or more among those with less than a high school diploma (46.4 percent) and those living at or below 125 percent of the federal poverty level (42.6 percent).

 

Arthritis prevalence was higher among those living in more rural areas compared with urban dwellers. Severe joint pain prevalence was similar across urban/rural geographic areas, ranging from 32.7 percent–35.7 percent in all areas, except for a lower prevalence (28.6 percent) in large fringe metro areas. Physical inactivity prevalence increased with increasing rurality.

 

Joint pain is often managed with medications, which are associated with various adverse effects. The 2016 National Pain Strategy advises that pain-management strategies be multifaceted and individualized and include nonpharmacologic strategies, and the American College of Rheumatology recommends regular physical activity as a nonpharmacologic pain reliever for arthritis. Although persons with arthritis report that pain, or fear of causing or worsening it, is a substantial barrier to exercising, physical activity is an inexpensive intervention that can reduce pain; prevent or delay disability and limitations; and improve mental health, physical functioning, and quality of life with few adverse effects. Physical Activity Guidelines for Americans recommends that adults, including those with arthritis, engage in the equivalent of at least 150 minutes of moderate-intensity aerobic physical activity per week for substantial health benefits. Adults who are unable to meet the aerobic guideline because of their condition (e.g., those with severe joint pain) should engage in regular physical activity according to their abilities and avoid physical inactivity. Even small amounts of physical activity can improve physical functioning in adults with joint conditions. Most adults with arthritis pain can safely begin walking, swimming, or cycling to increase physical activity.

 

Arthritis-appropriate, evidence-based, self-management programs and low-impact, group aerobic, or multicomponent physical activity programs are designed to safely increase physical activity in persons with arthritis. These programs are available nationwide and are especially important for those populations that might have limited access to healthcare, medications, and surgical interventions (e.g., those in rural areas, those with lower income, and racial/ethnic minorities). Physical activity programs including low-impact aquatic exercises (e.g., Arthritis Foundation Aquatic Program) and strength training (e.g., Fit and Strong!) can help increase strength and endurance. Participating in self-management education programs, such as the Chronic Disease Self-Management Program, although not physical activity-focused, is also beneficial for arthritis management and results in increased physical activity. Benefits of the Chronic Disease Self-Management Program include increased frequency of aerobic and stretching/strengthening exercise, improved self-efficacy for arthritis pain management, and improved mood. Adults with arthritis can also engage in routine physical activity through group aerobic exercise classes (e.g., Walk with Ease, EnhanceFitness, Arthritis Foundation Exercise Program, and Active Living Every Day).

 

Effective, inexpensive physical activity and self-management education programs are available nationwide and can help adults with arthritis be safely and confidently physically active. This report provides the most current state-specific and demographic data for arthritis, severe joint pain, and physical inactivity. These data can extend collaborations among the CDC, state health departments, and community organizations to increase access to and use of arthritis-appropriate, evidence-based interventions to help participants reduce joint pain and improve physical function and quality of life.

 

See the CDC Report

 

Medical Risk Law Report: Lupus and Rheumatic Diseases: Inflamed Liabilities

 

Medical Risk Law Report: Arthritis Pain and Inflammation: Diagnosis and Treatment Risks

 

 

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