Arthritis Among Children and Adolescents Aged 18 Years — United States, 2017–2021

This report found that during 2017–2021, an estimated 220,000 U.S. children and adolescents had an arthritis diagnosis, and prevalence was highest among those aged 12–17 years. Previous U.S. population estimates of arthritis among children and adolescents ranged from 13,400 to 294,000 cases, and prevalences of 21 to 403 per 100,000 population (1,2). The wide range of estimates in these studies is likely attributable to a combination of factors including the relative rarity of arthritis among children and adolescents, advances in early detection and differential diagnosis of arthritis, differences in terminology and arthritis case definitions, and variations in data sources, sampling, collection, and weighting methodologies (1,2,5). Whereas the current study used parent-reported health care provider diagnosis of arthritis as the case definition, previous studies (1,2) have used medical billing codes to ascertain arthritis and rheumatologic conditions among children and adolescents.

Although arthritis can affect children and adolescents of all races and ethnicities, this study identified racial and ethnic disparities. Arthritis prevalence among Black children and adolescents was twice that among those who were White. Further, prevalence of arthritis was inversely related to the highest level of parental education attained. These disparities highlight the importance of addressing social determinants of health because the impacts on health and well-being can be seen as early as childhood.

Similar to other studies, the results of this analysis determined that arthritis prevalence was high among children and adolescents with anxiety and depression. A 2019 systematic review of depression and anxiety in patients with juvenile idiopathic arthritis (4) found higher prevalences of symptoms of depression and anxiety among juvenile idiopathic arthritis patients and their family members than among children and adolescents without juvenile idiopathic arthritis. This review also identified a need for further data on the effect of treatment of mental health symptoms on disease outcomes among children and adolescents with juvenile idiopathic arthritis. Further, the systematic review found that children and adolescents with arthritis who were experiencing anxiety and depression also had a poorer quality of life, underscoring the need to address mental health among children and adolescents with arthritis and their families (4). The U.S. Preventive Services Task Force recommends screening all persons aged 8–18 years for anxiety,^¶¶ and those aged 12–18 years for major depressive disorder.*** The rationale for routine screening is to identify youths without an anxiety diagnosis who might benefit from effective treatment for anxiety disorders.

The current study also found associations between arthritis and food insecurity as well as overweight and physical inactivity. Children and adolescents with special health care needs who are also experiencing food insecurity have been found to have increased prevalences of various negative health outcomes, including overweight or obesity (6). A healthy, age-appropriate diet is strongly recommended as a treatment strategy for children and adolescents with arthritis (7). However, more research on physical activity and weight management interventions for children and adolescents with arthritis is needed.

Arthritis therapy guidelines for children and adolescents include pharmacologic and nonpharmacologic interventions and treatments (7–9). Pharmacologic treatments include antirheumatic drugs, which help preserve joints by blocking or slowing inflammation, and nonsteroidal antiinflammatory drugs to treat stiffness, pain, and fever (8,9). The 2021 American College of Rheumatology guideline for the treatment of juvenile idiopathic arthritis recommends nonpharmacologic interventions including physical and occupational therapy to improve range of motion, muscle strength, endurance, functional deficits, and activities of daily living (7). Although this American College of Rheumatology guideline does not make specific physical activity recommendations, the 2018 Physical Activity Guidelines for Americans^††† recommend that, for optimal health and fitness, children and adolescents aged 6–17 years should engage in 60 minutes of daily moderate-to-vigorous physical activity. Physically active children and adolescents experience improved cognition and fitness, stronger bones and muscles, have lower percentages of body fat, and lower risk for depression compared with inactive children and adolescents. Although preventing some types of arthritis among children and adolescents is challenging, early diagnosis and prompt treatment might prevent permanent joint damage, improve health outcomes, reduce health disparities, and maintain quality of life (10).

Limitations

The findings in this report are subject to at least five limitations. First, because of the cross-sectional nature of this survey, causality among selected characteristics and arthritis prevalence cannot be inferred. Second, parent-reported arthritis diagnoses cannot be validated by medical records. Third, recall and social desirability biases or lack of knowledge about arthritis or other health conditions might result in misclassification. Fourth, because of the rarity of arthritis among children and adolescents, estimates for all subgroups might not be stable or precise, as evidenced by the wide CIs. Finally, the single survey question about an arthritis diagnosis does not provide the opportunity to estimate the prevalence of or distinguish among arthritis subtypes and does not assess undiagnosed arthritis cases.

Implications for Public Health Practice

This study combined data across 5 years resulting in a large sample size, providing stable prevalence estimates of arthritis among U.S. children and adolescents with the most recently available data and filling a gap in nationally representative, population-based estimates of arthritis among children and adolescents. The findings from this report highlight children and adolescents to prioritize for arthritis prevention and treatment by identifying risk factors for arthritis among children and adolescents, developing self-management interventions to improve childhood arthritis, physical activity or weight control, and screening and linking children and adolescents to needed mental health services. Addressing social determinants of health and systemic factors that might contribute to disparities in arthritis prevalence needs to be prioritized. Health systems and payors can take steps to ensure equitable access to therapies (e.g., physical therapies and medications).