Among the approximately 20% of people who live with arthritis in the US, nearly half report having activity limitations, and more than 1 in 3 have arthritis-related work limitations, particularly veterans and people with lower incomes, according to findings published on December 15 in Arthritis Care & Research.

Three studies reported on activity limitations, arthritis-related work limitations, and nonmedical factors — social determinants of health (SDOH) and health-related social needs (HRSN) — that affect adults living with arthritis in the US. The three reports are the culmination of a mid-decade assessment on the Healthy People 2030 public health initiative goals and how far along the nation is in addressing major concerns related to arthritis.

“Key benchmarks have been established to move the needle in reducing problems associated with arthritis, and these papers were a report on how we’re doing with that progress,” explained Daniel White, ScD, MS, an associate professor of medicine in physical therapy at the University of Delaware, Newark, Delaware, and a co-author on two of the papers.

The verdict is not a rosy one. “It’s terrible,” White said. “It is just awful. We are not doing well at all.”

While the lack of progress was not necessarily a surprise, the sheer volume of the numbers was striking, White said. “This is long-standing public health problem that affects millions of people,” White said. “It’s just surprising to look at the magnitude of how big of a problem we are talking about.”

Arthritis-Related Activity Limitations

One of the studies, based on cross-sectional data from the 2019 and 2023 National Health Interview Surveys, found that an estimated 24.8 million adults with arthritis, or 47.8% of all adults with arthritis, reported activity limitations, falling short of meeting the Healthy People 2030 objective of 46.8%. Prevalence of arthritis-related activity limitations was higher among veterans, people with lower income, people with disabilities, and people with heart disease, cancer, or symptoms of anxiety or depression.

“There is still progress to be made to achieve the Healthy People 2030 goal as the prevalence of arthritis-related activity limitations among adults with arthritis has declined slightly but not changed significantly since 2019,” the authors wrote.

Arthritis-Related Work Limitations

The conclusion was similar for the paper on arthritis-related work limitations, which relied on 2023 National Health Interview Survey data for adults aged 18-64 years and found 38.8% of adults with arthritis have a work limitation related to their condition. That prevalence was higher in Hispanic (50.1%) and Native American and Alaska Native adults (55.9%) than in White adults (35.6%).

Further, more people with a disability reported limitations (62.1%) than those without (33.5%) as did those unable to work (61.8%) compared with employed individuals (32.2%). Over half of veterans with arthritis (52.5%) had work limitations compared with just over a third of nonveterans (37.8%). The authors recommended promotion of evidence-based interventions for arthritis to make progress toward Healthy People 2030 goals.

“Just from an economic perspective, to move the needle even a little bit would be huge for filling the major workforce shortages we have throughout society,” White said, adding that the issue hits traditional blue-collar workers particularly hard.

Nonmedical Factors’ Impact on Arthritis Prevalence

The third paper estimated prevalence of arthritis for 11 SDOH and HRSN, using cross-sectional data from the 2022 Behavioral Risk Factor Surveillance System and found higher prevalence for 10 of them, with overall prevalence of arthritis increasing as the number of HRSN did.

The SDOH/HRSN assessed included food insecurity, housing insecurity, lack of reliable transportation, lack of social and emotional support, life dissatisfaction, loss or reduced hours of employment, mental stress, receipt of food stamps or Supplemental Nutrition Assistance Program benefits, social isolation or loneliness, and cost barriers for needed medical care.

The relative difference for arthritis prevalence between those with and without certain SDOH was more pronounced for younger Americans even though they had overall lower prevalence of arthritis. For example, twice as many adults aged 18-44 years with mental stress (16.4%) had arthritis than those without mental stress (7.4%), and 17.2% of those with at least five adverse SDOH had arthritis compared with 6% with no SDOH.

“By tailoring services to address SDOH/HRSN and enhancing arthritis-appropriate, evidence-based self-management programs to increase access to social safety net programs, public health practitioners can work towards reducing the burden of adverse SDOH/HRSN and arthritis,” the authors wrote.

“These data show that arthritis remains a significant public health challenge that intersects with social and economic factors,” Kelli Allen, PhD, a professor of medicine at School of Medicine, The University of North Carolina at Chapel Hill and editor of Arthritis Care & Research, said in a prepared statement. “Healthy People 2030 provides a roadmap for addressing these challenges through community-based programs, policy change, and clinical support.”

One contributor to the problem, White said, is underutilization of existing resources.

“A lot of people think arthritis is just the disease of aging and there’s nothing [they] can do about it, but that’s not true,” White said. “There’s actually a lot people can do about it. We treat plenty of people in our clinic that have arthritis, and they have less pain and they’re able to function better when we’re done with them. But a lot of people don’t know that, so the problem is an education issue as well.”

Another major factor, however, is SDOH/HRSN. People with arthritis not only have higher barriers to paying for medical costs but also more frequently have food insecurity, housing insecurity, unreliable transportation, and poor access to healthcare, “so they can’t get care for treating the symptoms of arthritis, and lack of reliable transportation means people who have arthritis are less likely to get to their doctors or get to physical therapists who can help them,” White said.

CDC Staff Cuts Mean ‘No Follow-Up’

A key step in changing the status quo, he said, is ongoing assessment of it, something that recent cuts to federal public health agencies like the CDC have hindered.

“Bill Gates has said that a lot of the big problems we have in society we can’t even measure,” White said. “There’s no ability to measure this, and the entire group from the CDC that put this project together has been let go, so there’s going to be no follow-up. The human resources needed to produce these studies needs to be restored to even see how we are doing.”

Beyond that, work needs to be done to increase patient awareness about resources and interventions for arthritis, and healthcare providers need more education on treatments they can offer or refer patients to receive.

“Finally, as a medical community, we need to continue developing innovative ways of delivering care, whether that’s remotely, asynchronously, or with unsupervised exercises,” White said, although he acknowledged the burdens already on individual providers, particularly given workforce shortages of primary care providers, rheumatologists, and physical therapists.

“People serving as PCPs [primary care physicians] are the angels of society,” White said, “so my message to them is to refer patients for further care and encourage patients to seek additional care because there are appropriate evidence-based interventions you can do about arthritis and its symptoms that are recognized to improve health outcomes,” such as the Walk With Ease program sponsored by the Arthritis Foundation.

Individuals with suspected autoimmune arthritis need referrals to rheumatologists while those with osteoarthritis can be referred to physical therapists who can provide sustainable exercise programs that can mitigate a lot of their symptoms, White said.

“A lot of the symptoms that patients have with osteoarthritis are mainly related to or exacerbated by inactivity and obesity and having an exercise program can definitely address both of those,” he said.

Ultimately, however, White suggested these findings should be a wake-up call to broader action from society, especially from governments but also from healthcare organizations, health insurance companies, and industry, though many of those latter entities have been taking up the mantle.

“Large organizations are beginning to realize the importance of either doing self-generated public health initiatives within their organizations or partnering with health providers or health insurance companies, who both have mutual vested interests in improving the health of their employees so that medical costs go down,” White said. “A lot of these large health providers are looking forward to partnering with organizations to give out these lifestyle-type initiatives because it drops the bottom dollar of healthcare expenditures from very preventable lifestyle-oriented diseases and symptoms.”

White reported participating in two Data Safety Monitoring or Advisory Boards unrelated to the studies. All other authors from the three papers had no disclosures. Allen had no disclosures outside of her editor position.

Tara Haelle is a science/health journalist based in Dallas.