May was designated as Arthritis Awareness Month by Congress and the President in 1972. An estimated 53.2 million US adults (21.2%) reported being diagnosed with some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia, in response to the CDC’s National Health Interview Survey (Fallon et al., 2023). There are numerous types of arthritis. Because of its prevalence, as well as the financial impact of the various forms of arthritis – for the year 2017, the CDC estimated that osteoarthritis was the second most costly condition treated at US hospitals. Let’s look at a couple of recently published articles examining the impacts of arthritis on population health.
When we consider a condition that is as common within the population as arthritis, and as costly to treat, health disparities are a concern. In a brief report in the July 2023 issue of Arthritis Care & Research, researchers examined healthcare utilization by patients diagnosed with rheumatoid arthritis (RA) or osteoarthritis (OA), focusing on whether these patients live in rural/isolated, largely rural, or urban locations (Desilet et al., 2023) The study was based on questionnaires filled out by over 37,000 RA patients and over 8200 OA patients. A majority of the RA patients responding (74.5%) lived in a rural area, and this proportion was similar for OA patients. By analyzing questionnaire responses indicating healthcare utilization over six months, the research team found that among RA patients, urban residents were more likely to utilize healthcare provided by some type of professional than their rural counterparts. The same was true for OA patients. Patients with both types of arthritis fare better under the care of a rheumatologist, and in rural areas, access to this expertise is more limited. The findings of this study suggest the importance of extending access to rheumatology care in rural communities that are not currently well-served.
A forthcoming article in the journal Rheumatology (d'Elia et al, 2024) reports on a study of symptoms in a primary care database, which tracked prodromal (early) symptoms for the 24 months prior to diagnosis, in over 70,000 RA patients, over a period of 18 years. When analyzed demographically and socioeconomically, the findings were that symptoms were reported differently in new-onset RA across ethnic groups. While some of this may be accounted for due to the way symptoms are reported by patients, delayed diagnosis and treatment is another potential factor.
Another interesting finding of this study was the fact that of the symptoms reported, there was a discrepancy between the most common symptoms of RA (e.g. painful small joints of the hands, present in over half of RA patients) and the percentage of patients in the database who were reporting this symptom (10.2%). This may point to under-coding of symptoms, which would have an impact on treatment. Future studies may build on these findings delving more deeply into the differences in RA symptoms among different ethnic groups, including their underlying causes and their clinical implications.
Arthritis affects a large proportion of the population in the US and worldwide, and the burden falls more heavily on those who struggle to access care, as well as those who are not served equitably within healthcare settings. This Arthritis Awareness Month, consider how you might be able to contribute to our understanding of these disparities and help to cure them.
References
Fallon, E. A., Boring, M. A., Foster, A. L., Stowe, E. W., Lites, T. D., Odom, E. L., & Seth, P. (2023). Prevalence of Diagnosed Arthritis - United States, 2019-2021. MMWR. Morbidity and mortality weekly report, 72(41), 1101–1107. https://doi.org/10.15585/mmwr.mm7241a1
Desilet, L. W., Pedro, S., Katz, P., & Michaud, K. (2023). Urban and Rural Patterns of Health Care Utilization Among People With Rheumatoid Arthritis and Osteoarthritis in a Large US Patient Registry. Arthritis Care & Research (2010). https://doi.org/10.1002/acr.25192
d'Elia, A., Baranskaya, A., Haroon, S., Hammond, B., Adderley, N. J., Nirantharakumar, K., Chandan, J. S., Falahee, M., & Raza, K. (2024). Prodromal symptoms of rheumatoid arthritis in a primary care database: variation by ethnicity and socioeconomic status. Rheumatology (Oxford, England). Advance online publication.
