MANY IN MIDDLE AGE HAVE ARTHRITIS – THEY JUST DON’T KNOW IT
While the Centers for Disease Control and Prevention estimates 54 million adults have been told by a doctor they have the condition, new research suggests a much higher prevalence — especially in the 45-64 age group – totaling more than 91 million adults.
By Laura Landro | April 22, 2018 | This article originally appeared in The Wall Street Journal
A d.health Summit 2018 speaker, Laura Landro is a former Wall Street Journal Informed Patient columnist and assistant managing editor. She is the author of Survivor: Taking Control of Your Fight Against Cancer. Follow Laura on Twitter @LauraALandro
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It may start as a stiff knee, soreness in the hips, or swelling in the fingers that makes it hard to hold a coffee cup.
The joint disease arthritis is on the rise in the U.S., driven largely by the aging of the baby-boom generation and the obesity epidemic. But while the Centers for Disease Control and Prevention estimates 54 million adults have been told by a doctor they have the condition, new research suggests a much higher prevalence—especially in the 45-64 age group—totaling more than 91 million adults.
A study published in February in Arthritis & Rheumatology says relying on data about doctor-diagnosed arthritis alone may miss almost half of cases in a younger population who may see doctors less often or ignore occasional joint symptoms. Factoring in other data, including adults who report chronic joint symptoms lasting longer than three months but don’t get a diagnosis, “it became clear that this is a more prevalent disease and more commonly disabling than we thought before,” says study co-author Dr. David Felson, a rheumatologist at Boston University.
Charles Helmick, scientific lead for CDC’s arthritis program, declines to comment on the study, but says CDC stands by its surveillance methods, which project 78.4 million adults with arthritis by 2040. Joint pain could be a symptom of something else, he says, and a doctor’s diagnosis is “a better measure of true arthritis.”
What experts agree on is a dire need for better care for arthritis, a leading cause of disability and joint-replacement surgery. “People minimize the impact of arthritis because it is not a killer disease, but it has major effects on the quality of life and the ability to work and do the things you want to do,” Dr. Helmick says.
Exercise and diet
New CDC data shows arthritis prevalence ranges widely among states, from about 17% of adults in Hawaii to about a third in West Virginia. CDC is funding programs for those most in need, including initiatives to get doctors to steer patients to exercise and weight-loss programs shown to help.
In a continuing 25-year study of non-Hispanic white and African-American urban and rural adults 45 and older in Johnston County, North Carolina, the Johnston County Osteoarthritis Project, researchers found a higher rate of arthritis than previously thought in African-Americans. Due to a growing Hispanic population in the county, they will be included in the study going forward.
“Any level of symptoms where it is impacting activity or function should be brought to a doctor’s attention because there is something they can do about it,” says Amanda Nelson, co-principal investigator of the study and assistant professor of medicine at the University of North Carolina Chapel Hill’s UNC Thurston Arthritis Research Center.
Studies show adults with arthritis can reduce pain and activity limitations 40% with exercise and other management strategies, yet 1 in 3 is inactive. According to the nonprofit Osteoarthritis Action Alliance, which is launching an online education campaign this month, StandUp2OA, only half of patients with arthritis report that their health-care provider recommended physical activity and only 41% of overweight patients had a recommendation from their doctor to lose weight.
“People worry that exercise is going to exacerbate their arthritis, when it’s exactly the opposite,” says Leigh Callahan, an epidemiologist at the UNC Thurston Arthritis Research Center and director of the Alliance, which was started by the Centers for Disease Control and Prevention and the nonprofit Arthritis Foundation and has its headquarters at UNC. Moreover, she says, because many people with arthritis also have diabetes and heart disease, exercise has important benefits for other conditions.
Arthritis can be diagnosed with a combination of a physical exam, history-taking, X-rays and lab tests. There are 100 types of arthritis, and it’s important to rule out inflammatory forms such as rheumatoid arthritis, in which the immune system mistakenly attacks the joints, producing symptoms such as red, warm or very swollen joints. The disease causes bone erosion and joint deformity. It also can damage skin, eyes, heart, lungs and blood vessels. Prescription drugs for rheumatoid arthritis include powerful biologic medications sold under brand names Humira and Enbrel, which act on the immune system to slow the disease.
The majority of cases are osteoarthritis, which means degeneration of joint cartilage that leaves bones rubbing together. It can be caused by normal wear and tear, or trauma such as sports injuries including tears in the knee’s anterior cruciate ligament, or ACL. Hereditary factors are at play, as is weight gain; two-thirds of obese adults will develop knee osteoarthritis.
Over-the-counter anti-inflammatory medications such as ibuprofen can help with arthritis pain, and doctors may prescribe a related drug, celecoxib, which has been shown to have fewer intestinal side effects. The Alliance says athletes can prevent or reduce the risk for ACL tears and other traumatic injuries by as much as 80% with neuromuscular training. That includes lower limb and core strengthening, balance training and plyometric jump training, which coaches athletes on how to safely jump and land. But even for the average sedentary patient, weight control and exercise can make a big difference.
Don’t just sit there
Research has shown that a rigorously monitored program combining exercise and weight loss of 10% of body weight can improve arthritis symptoms. The problem, Dr. Callahan says, is that most doctors with arthritis patients have no practical means to provide such programs. She is now coleading a study with more than 800 overweight or obese arthritis patients over 50 years of age in three North Carolina counties to test whether a community-based, intensive 18-month diet and exercise program can serve as a blueprint for urban and rural communities to improve outcomes for arthritis patients. The study will use local facilities such as a former textile factory that has been converted into a medical mall.
Dianne and Lennie Rosenbluth, who both suffer from arthritis, agreed to serve as honorary co-chairs of the Osteoarthritis Action Alliance to spread the message through regular blog posts about how to live with arthritis. Both say their joints cause them pain and fatigue, but regular exercise has become a vital part of their regimen.
Mr. Rosenbluth, 85, is a 1957 UNC college basketball champion, and later played professionally and coached the sport. Years of pounding on the basketball court took a toll on his knees, he says; he now gets regular cortisone injections to help with pain and function and has avoided the need for knee-replacement surgery.
‘We do our thing’
Though climbing stairs and standing for a long time can be hard, he and his wife walk with their dog, go to the gym, and travel frequently to games and to visit grandchildren.
“We go out and we do our thing, we just go a little slower,” he says.
Mrs. Rosenbluth, 75, says her parents both had osteoarthritis, and she was diagnosed in her early 60s. She had two hip-replacement surgeries, three years apart.
“Arthritis is not my best friend, but I’ve learned to live with it,” she says. In addition to the gym and dog-walking regimen, she takes two ibuprofens in the morning to help her get moving.
“Arthritis starts in your joints, but it is also in your head,” Mrs. Rosenbluth says. “You have to make the decision that you are going to get up in the morning and move, and not be defeated by it.”
[PHOTO: ‘People worry that exercise is going to exacerbate their arthritis, when it’s exactly the opposite,’ says Dr. Leigh Callahan, right, seen here with Dianne Rosenbluth. CREDIT: UNC THURSTON ARTHRITIS RESEARCH CENTER]
Ms. Landro is a former Wall Street Journal assistant managing editor. Email her at firstname.lastname@example.org.
Appeared in the April 23, 2018, print edition as ‘Many in Middle Age Have Arthritis, but Don’t Know It.’