Arthritis Magnifies Effect of Other Chronic Conditions

Janis C. Kelly

June 11, 2015

The special effect of arthritis on people who have multiple chronic health problems has been underappreciated and should be included in discussions among researchers, healthcare providers, and policy makers, researchers report in an article published in the June 5 issue of the Morbidity and Mortality Weekly Report.

Jin Qin, ScD, and colleagues from the Division of Population Health and Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, analyzed data from the 2013 National Health Interview Survey and found that subjects with one or more chronic conditions also had "significant and progressively higher prevalences of social participation restriction, serious psychological distress, and work limitations."

Moreover, those who reported arthritis as one of their chronic conditions had higher prevalences of adverse outcomes on all three life domains than those whose health burdens did not include arthritis.

The authors write, "Arthritis alone had a greater impact on social participation restriction and work disability than having one of the other chronic conditions, and arthritis as one of multiple chronic conditions was associated with higher prevalences of adverse impact on all three life domains. These consequences have profound public health implications because social activity participation, mental health, and the ability to work can be important contributors to quality of life."

Stepwise Increase in Disability

The National Health Interview Survey data were from a representative sample of the noninstitutionalized civilian population (n = 34,506) who were asked about physician-diagnosed arthritis (defined as arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia), as well as hypertension, heart disease (coronary heart disease, angina pectoris, heart attack, or any other heart condition), stroke, diabetes, asthma, cancer, weak or failing kidneys, hepatitis, and chronic obstructive pulmonary disease. The authors divided subjects into 5 categories:

  • no chronic conditions (51.0% of subjects);

  • arthritis only (6.1%);

  • one nonarthritis condition (16.8%);

  • two or more chronic conditions, one of which is arthritis (16.6%); and

  • two or more chronic conditions, none of which is arthritis (9.5%).

Covariate analysis included age, sex, race/ethnicity, educational level, body mass index, and smoking status.

Life domain outcomes included restrictions on social participation such as ability to go shopping, to go to movies, to go to sporting events, to go to parties, or to visit friends; serious psychological distress; and work limitations.

Nearly three quarters of subjects with arthritis had additional chronic conditions, and this combination was more common in people older than 65 years, women, whites or blacks, adults who were overweight, and current or former smokers.

All three of the life domain outcomes were worsened by the presence of chronic conditions in a stepwise progression from no chronic conditions through one chronic condition (with or without arthritis), and then two or more nonarthritis conditions, and finally, most severely, for arthritis plus one or more other chronic conditions.

Among adults with one chronic condition, work disability affected 15.6% of those with arthritis only vs 8.6% of those without arthritis. Social participation restrictions affected 3.7% of those with arthritis only vs 2.1% of those without. In subjects with two or more chronic conditions, work disability affected 30.7% with arthritis vs 22.5% without arthritis. Social participation restrictions affected 10.4% of those with arthritis and one or more other conditions vs 6.3% without arthritis. Serious psychological distress affected 9.9% of those with arthritis vs.6.8% of those who also had two or more conditions but did not have arthritis.

The authors also emphasize the importance of self-management interventions to reduce pain, fear of pain, and other arthritis-specific barriers to physical activity. Available programs include the "Chronic Disease Self-Management Program" and "Walk with Ease," both programs developed by the US Department of Health and Human Services.

The authors have disclosed no relevant financial relationships.

Morb Mortal Wkly Rep. 2015;64:578-582. Full text

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