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National Center for Chronic Disease Prevention and Health Promotion
Division of Adult and Community Health
Health Care and Aging Studies Branch
Arthritis Program
Mailstop K-51
4770 Buford Highway NE
Atlanta, GA 30341-3724
Phone: 770.488.5464
Fax: 770.488.5964
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Arthritis Types — Overview
Childhood Arthritis
I. Background
- There is much disagreement among experts about definitions of
childhood arthritis. At least three clinical classification schemes exist—juvenile rheumatoid arthritis (JRA), juvenile chronic
arthritis (JCA), and juvenile idiopathic arthritis (JIA). All
three schemes do not include many of the conditions considered as
arthritis and other rheumatic conditions in adults. Also, a case
counted in one classification system may not be a case in another
system; however, all schemes define childhood arthritis as occurring
in people younger than 16 years.
- Because childhood arthritis is an umbrella term covering a
number of types of arthritis and because there are a number of
different clinical case definitions for childhood arthritis, there
is a wide range of estimates of how much childhood
arthritis exists and much difficulty in describing its epidemiology.
- The most common form of juvenile arthritis is JRA (the term and
classification system used most commonly in the United States). JRA
involves at least 6 weeks of persistent arthritis in a child younger
than 16 years with no other type of childhood arthritis. JRA has three
distinct subtypes: systemic (10%), polyarticular (40%) and
pauciarticular (50%). Each type has a unique presentation and
clinical course and immunogenetic association. For the latter two
types, girls are more commonly affected (3–5:1). In all three types
about 40–45% still have active disease after 10 years. For the
systemic type, the peak age of onset is 1– to 6–years-old and about 50%
of cases show very short stature in adulthood as a result. For the pauciarticular form, there are two distinct subtypes- early onset
and late onset. Early onset is more common in girls, late onset is
more common in
boys. The genetics differ as do the clinical courses. In the polyarticular form, there are also two subtypes:
rheumatoid factor (RF)
positive and negative. RF positive usually affect girls with onset after 8
years of age and a poorer prognosis compared with RF negative
children.1
- For adults, more than 150 conditions are counted as arthritis and
other rheumatic conditions (AORC). Many of these conditions occur in
children, although much more rarely.
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II. Prevalence
- National Health Interview Survey (NHIS) data from 2001–2004 on
parentally-reported doctor or other health care professional
diagnosed arthritis among children younger than age 18 estimated an
average of 80,100 cases (95% CI = 51,500–108,600).
- NHIS data from 2001–2004 using 18 year-olds’ self reported
prevalence of ever being told by a doctor or other health
professional they had arthritis, rheumatoid arthritis, gout, lupus,
or fibromyalgia yields an estimate of 119,600 (95% CI =
79,400–159,900). This estimate assumes that incidence has not changed in the 18
years since this cohort
was born.
- Applying prevalence rates of juvenile rheumatoid arthritis (JRA) from
geographically proscribed, short term studies done in the United States2
between 1975 and 1996 (rate range = 9.2–94.3 per 100,000 children)
to the 2003 child population younger than 18 years of age yields estimates
ranging from 11,700–69,000 cases of JRA in the United States.
Applying those rates to the population under age 16, yields
estimates between 10,300 and 60,900.
- A 2007 CDC study estimates that 294,000 U.S. children under age
18 (or 1 in 250 children) have been diagnosed with arthritis or
another rheumatologic condition. This study provides for the first
time a national data-based estimate of the number of children
diagnosed with arthritis and related rheumatic conditions across the
United States and within each state, creating a benchmark to measure
future shifts in occurrence. The study was prompted by a portion of
the (proposed) Arthritis Prevention, Control, and Cure Act of 2004
which called for better determining the size of the childhood
arthritis problem.
- As a result, the CDC, in collaboration with several other
organizations, began an intensive review of options on how to
estimate the number of children with arthritis and related
conditions and also what conditions should be included. In addition
to providing these improved national estimates, the study also
provides estimates for each state. CDC's first-ever estimates of
childhood arthritis-related diagnoses show a state-by-state range
from a low of 500 children in Wyoming to a high of 38,000 children
in California. Study data also show that children diagnosed with
arthritis and other rheumatologic conditions account for
approximately 827,000 doctor visits each year, including an average
of 83,000 emergency department room visits.8 Read more
about pediatric arthritis surveillance.
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III. Incidence
- There are no national studies of the incidence of juvenile
arthritis.
- Rates from geographically proscribed, short-term studies done in
the United States between 1975 and 1996 yield incidence rate estimates ranging from
6.6–15 per 100,000 children, which translates into 4,800–11,000 new
cases of childhood (under age 18) arthritis in the United States in 2003 and
4,300–9,700 in children under age 16.2
- Overall, juvenile arthritis occurs more frequently in girls than
boys. Family studies also suggest an increased risk for certain
genetic make-ups.
- Incidence rates vary by place. Even in one area, rates vary over
time. These facts suggest an environmental component to the
occurrence of juvenile arthritis.
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IV. Mortality
- Using codes for AORC as defined in adults, the Centers for
Disease Control and Prevention’s (CDC) National Center for Health
Statistics (NCHS) death data show
that ~1,000 children younger than 15 years of age died from
arthritis and other rheumatic conditions in the 20 years from
1979–1998 (average = 50 deaths / year).3 The juvenile AORC death rate fell 25%
during
the 20-year period from 1.2 per million to 0.9 per million (average
= 1 death per million children per year).
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V. Hospitalizations
- Using codes for AORC as defined in adults, in 1997, among
children <14 years, there were 21,000 hospitalizations with
principal diagnosis of AORC (rate = 3.5/10,000) and 33,000
hospitalizations with any mention of AORC (rate = 9.2/10,000) out of
2,266,000 childhood hospitalizations (0.9%–1.45% of all
hospitalizations).4
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VI. Ambulatory Care
- Using codes for AORC as defined in adults, National Ambulatory
Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical
Care Survey (NHAMCS) found that among children <17 years in 1997-98,
there was an average of 1.3 million AORC-related ambulatory care
visits per year.5
- Pediatric arthritis-related visits were more likely to be made
by girls (67%), whites (82%), non-Hispanics (66%) and children aged
12–17 years (59%). Most visits occurred in physician offices (75%)
compared to OPDs (18%) and EDs (7%).5
- Top three conditions were: soft tissue disorders excluding back
(41%; 513,000), unspecified joint pain/effusion (31%; 387,000), and
rheumatoid arthritis (10%; 122,000).5
- Among physician office visits, the medical specialties most
commonly seen were family practice / general practitioners /
internal medicine (41%), rheumatologists / orthopedists /
neurologists (33%), while the rest (26%) saw pediatricians.5
- Using the same data source but a different definition of
childhood arthritis, a 2007 CDC study’s data show that children diagnosed
with arthritis and other rheumatologic conditions account for
approximately 827,000 doctor visits each year, including an average
of 83,000 emergency department room visits.6 Further
information on the pediatric arthritis surveillance is available.
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VII. Costs
- The economic impacts of JRA appear substantial with national
direct costs in 1989 estimated at $285 million.7
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VIII. Impact on Health-related Quality of Life
- Depending on the specific condition, the impact on quality of
life can be considerable. For example, for systemic type JRA, about
50% of cases develop short stature (<5th percentile) in adulthood.
Overall, about 30% of people with JRA had significant functional
limitations 10 or more years after onset.1
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IX. Unique characteristics
- Transient childhood arthritis may follow certain infectious
diseases.
- Many cases of childhood arthritis remit.
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X. References
- Klippel JH , ed. Primer on the Rheumatic Diseases. Edition 12.
Arthritis Foundation, Atlanta, GA;2001.
- Manners PJ, Bower C. Worldwide prevalence of juvenile arthritis why does it vary so much?
J Rheum 2002;29:1520–1530.
- Sacks JJ, Helmick CG, Langmaid G. Deaths from arthritis and
other rheumatic conditions, United States, 1979–1998. J Rheumatol
2004;31:1823–1828.
- Lethbridge-Cejku M, Helmick CG, Popovic JR. Hospitalizations for
arthritis and other rheumatic conditions. Med Care
2003;41:1367–1373.
- Hootman JM, Helmick CG. Pediatric Arthritis-Related Ambulatory
Medical Care Visits, United States, 1997–98, abstract for ACR will
appear in supplement of Arthritis and Rheumatism).
- Sacks JJ, Helmick CG, Luo YH, Ilowite NT, Bowyer S. Prevalence
of and annual ambulatory health care visits for pediatric arthritis
and other rheumatologic conditions in the United States in
2001–2004. Arthritis Care Res 2007;57(8):1439–1445.
- Allaire SH, DeNardo BS, Szer IS, Meenan RF, Schaller J. The
economic impacts of juvenile rheumatoid arthritis. J Rheumatol
1992;19:952–955.
- Sacks JJ, Helmick CG, Luo YH, Ilowite NT, Bowyer S. Prevalence
of and annual ambulatory health care visits for pediatric arthritis
and other rheumatologic conditions in the United States in
2001–2004. Arthritis Care Res 2007;57(8):1439–1445.
abstract
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XI. Resources
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* Links to non-Federal
organizations are provided solely as a service to our users. Links do not
constitute an endorsement of any organization by CDC or the Federal
Government, and none should be inferred. The CDC is not responsible for
the content of the individual organization Web pages found at this link.
Page last reviewed: June 8, 2008
Page last modified: June 8, 2008 Content Source:
Division of
Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion
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