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Forty-Six Million Americans Have Arthritis: True or False?
May 8th, 2008
"Does it matter that 46 million Americans have arthritis, or would the reaction of the recipients of this information be the same if it were 40, 50, or even 60 million?," ponders Professor Alan J. Silman, Medical Director of the Arthritis Research Campaign, in the May 2008 issue of Arthritis & Rheumatism (www.interscience.wiley.com/journal/arthritis). His aim is not to dispute estimates of the current burden of major rheumatologic disorders in the US recently released by the National Arthritis Data Workgroup, a multi-institution supported task force. Instead, Professor Silman calls attention to the challenges of defining debatable terms case and severity among them and the importance of knowing the intended audience before publishing specific morbidity data distilled from a wide array of research trials and samples.
As Professor Silman points out, a practicing clinician is interested in the frequency of different disorders for different reasons to inform diagnosisthan health 'suppliers' such as pharmaceutical companies, and government policymakers. Then, there's the common matter of methodological complexities, from whether researchers can accurately draw sweeping generalities from small study populations to whether 'prevalence' refers only to patients under active care or to everyone who's ever been diagnosed with the disorder.
Focusing on condition-specific issues, Professor Silman offers a number of critical observations and sensible proposals.
They include:
- Rheumatoid arthritis: In Professor Silman's view, prevalence figures based on surviving cases diagnosed in the past "is not a statistic of value." He argues for a shift to assessing incidence before the appearance of erosions, in light of therapeutic advances with the potential to prevent chronic destructive disease.
- Juvenile arthritis: To help separate early signs of adult inflammatory disorders from distinct juvenile arthritis symptoms, pediatricians need data on childhood incidence for instance, the likelihood that a child age 16 or younger would have an arthritic condition severe enough to require medical attention.
- Spondylarthritides: Imaging results frequently miss this disease's weak marker, 'inflammatory back pain.' Consequently, the true rate of spondylarthrites in the population could be much higher than diagnosed cases, Professor Silman contends. He suggests considering 'ever-diagnosis' as the case definition for this condition.
- Osteoarthritis: Since this most common joint disease is almost universal in the very elderly, knowledge of age distribution within a population is vital to any attempt to assess disease burden. In addition, since osteoarthritis can affect several joints, in different combinations for different patients, as Professor Silman notes, it is much more difficult to obtain a global figure for 'all OA' than to determine the burden of knee OA or hip OA or hand OA.
- Pain disorders: Numerically more widespread than OA, the range of disorders causing joint pain may or may not be related to arthritis. What's more, there are many questionable issues, such as what constitutes activity limitation.
"It is easy to be nihilistic about the data that are available, and we do a dis-service by not attempting to provide some estimates of burden for our 'ology' to compete for our share of the pie and awareness by the public," Professor Silman acknowledges. "Our job is also to educate the audience about the difficulties we encounter as much as about the bottom line."
Finally, he argues that applying different approaches to measuring the burden for different disorders is best way to serve the needs of patients. "There may be 46 million Americans with arthritis, although how this figure aids health care planning is much less certain," Professor Silman concludes.
"As the public and media become more aware of the limitations of the data they are fed, the task is to make sure that the credibility of what is produced can withstand that scrutiny."
Article: Forty-Six Million Americans Have Arthritis: True or False? Alan J. Silman, Arthritis & Rheumatism, May 2008; 58:5 pp. 1220-1225.
Source: John Wiley & Sons
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