ARTHRITIS & RHEUMATISM
Vol. 58, No. 1, January 2008, pp 26–35
© 2008, American College of Rheumatology
Estimates of the Prevalence of Arthritis and
Other Rheumatic Conditions in the United States
Reva C. Lawrence,1David T. Felson,2Charles G. Helmick,3Lesley M. Arnold,4Hyon Choi,5
Richard A. Deyo,6Sherine Gabriel,7Rosemarie Hirsch,8Marc C. Hochberg,9
Gene G. Hunder,7Joanne M. Jordan,10Jeffrey N. Katz,11Hilal Maradit Kremers,7
and Frederick Wolfe,12for the National Arthritis Data Workgroup
Objective. To provide a single source for the best
available estimates of the US prevalence of and number
of individuals affected by osteoarthritis, polymyalgia
rheumatica and giant cell arteritis, gout, fibromyalgia,
and carpal tunnel syndrome, as well as the symptoms of
neck and back pain. A companion article (part I)
addresses additional conditions.
Methods. The National Arthritis Data Workgroup
reviewed published analyses from available national
surveys, such as the National Health and Nutrition
Examination Survey and the National Health Interview
Survey. Because data based on national population
samples are unavailable for most specific rheumatic
conditions, we derived estimates from published studies
of smaller, defined populations. For specific conditions,
the best available prevalence estimates were applied to
the corresponding 2005 US population estimates from
the Census Bureau, to estimate the number affected
with each condition.
Results. We estimated that among US adults,
nearly 27 million have clinical osteoarthritis (up from
the estimate of 21 million for 1995), 711,000 have
polymyalgia rheumatica, 228,000 have giant cell arteri-
tis, up to 3.0 million have had self-reported gout in the
past year (up from the estimate of 2.1 million for 1995),
5.0 million have fibromyalgia, 4–10 million have carpal
tunnel syndrome, 59 million have had low back pain in
the past 3 months, and 30.1 million have had neck pain
in the past 3 months.
Conclusion. Estimates for many specific rheu-
matic conditions rely on a few, small studies of uncer-
tain generalizability to the US population. This report
provides the best available prevalence estimates for the
US, but for most specific conditions more studies gen-
eralizable to the US or addressing understudied popu-
lations are needed.
The purpose of this study, definitions of general ter-
minology, and methods used for ascertaining the data and
The findings and conclusions in this report are those of the
authors and do not necessarily represent the views of the Centers for
Disease Control and Prevention, the National Institutes of Health, or
the Department of Veterans Affairs.
The National Arthritis Data Workgroup is a consortium of
experts in epidemiology organized to provide a single source of
national data on the prevalence and impact of rheumatic diseases. It is
supported by the National Institute of Arthritis and Musculoskeletal
and Skin Diseases, NIH; the National Center for Chronic Disease
Prevention and Health Promotion and National Center for Health
Statistics, CDC; the American College of Rheumatology; and the
1Reva C. Lawrence, MPH: NIH, Bethesda, Maryland;2David
T. Felson, MD, MPH: Boston University School of Medicine, Boston,
4Lesley M. Arnold, MD: University of Cincinnati, Cincinnati, Ohio;
5Hyon Choi, MD, DrPH: Massachusetts General Hospital, Boston;
6Richard A. Deyo, MD, MPH: Oregon Health and Science University,
Portland;7Sherine Gabriel, MD, MSc, Gene G. Hunder, MD, Hilal
Maradit Kremers, MD, MSc: Mayo Clinic, Rochester, Minnesota;
8Rosemarie Hirsch, MD, MPH: CDC, Hyattsville, Maryland;9Marc C.
Hochberg, MD, MPH: University of Maryland School of Medicine,
Carolina at Chapel Hill;11Jeffrey N. Katz, MD: Brigham and Women’s
Hospital, Boston, Massachusetts;
Data Bank for Rheumatic Diseases, Wichita, Kansas.
Address correspondence and reprint requests to Charles G.
Helmick, MD, Arthritis Program, CDC, 4770 Buford Highway, K51,
Atlanta, GA 30341-3717. E-mail: CHelmick@cdc.gov.
Submitted for publication June 7, 2007; accepted in revised
form September 14, 2007.
3Charles G. Helmick, MD: CDC, Atlanta, Georgia;
10Joanne M. Jordan, MD, MPH: University of North
12Frederick Wolfe, MD: National
generating the estimates are described in the companion
Osteoarthritis (OA). OA is the most common
type of arthritis. We estimated prevalence for each of
the most commonly affected joints (knees, hips, and
hands) as well as for overall OA.
Estimating the prevalence of OA is difficult
because the structural changes of the disease occur in
most persons as they get older, but these changes may
not be accompanied by symptoms. Furthermore, preva-
lence estimates vary considerably depending on whether
only moderate and severe radiographic changes are
counted or mild changes are also included.
Clinically defined OA. Study examiners character-
ize a person as having OA on the basis of symptoms and
physical examination findings. The National Health and
Nutrition Examination Survey I (NHANES I) (2)
showed that 12.1% of the US population ages 25–74
years had clinically defined OA of some joint.
Radiographically defined OA. Generally, research-
ers grade radiographs according to the Kellgren/
Lawrence scale (3), which defines OA on the basis of the
presence of osteophytes (outgrowths of bone at the
margin of the joint). We summarized prevalence data
primarily from 3 recent US population-based studies:
the NHANES III, the Framingham Osteoarthritis Study,
and the Johnston County Osteoarthritis Project. In these
studies, participants had to appear in person to undergo
radiographic testing, and the validity of the estimates
could be compromised if only individuals who had
symptoms (instead of all individuals) attended. High
participation rates for radiography (?70%) in all 3
studies make this unlikely.
In phase 2 of the NHANES III (1991–1994),
prevalence of knee OA was assessed in adults age ?60
years; this was the only study to use non–weight-bearing
radiographs, a method that minimizes joint space nar-
rowing evident with weight bearing (4). The Framing-
ham Osteoarthritis Study was a survey of knee and hand
OA in ?2,400 adults age ?26 years from suburban
Boston, Massachusetts (5,6). The Johnston County Os-
teoarthritis Project was a study of hip and knee OA in
?3,000 African American and white adults age ?45
years in a rural county in North Carolina (7). The
prevalence of knee OA in adults age ?45 was 19.2% in
Framingham and 27.8% in Johnston County, and the
prevalence among adults age ?60 was 37.4% in the
NHANES III (Table 1). The prevalence of hip OA was
high (27.0%) in Johnston County adults age ?45, but in
another US community-based study of 4,855 women age
?65 years, prevalence was found to be only 7.2% (8). In
the latter study, hip OA was defined based on individual
features, but the discordance among study results leaves
uncertainty regarding to the prevalence of hip OA. The
prevalence of hand OA in Framingham adults was
27.2% overall and reached ?80% among older adults,
but only a minority of persons with radiographic OA
have pain in these joints.
OA prevalence increased with age and affected
the hands and knees of women more frequently than
men, especially in persons age ?50 years. In Johnston
County and in the NHANES III, African Americans
Prevalence of radiographic OA in the hands, knees, and hips, by age and sex, from
age, yearsSource (ref.)
% with mild, moderate,
or severe OA
Framingham OA study (6)25.928.227.2
Framingham OA study (5)
Framingham OA study (5)
Johnston County OA Project (7)
NHANES III (4)
Johnston County OA Project (10)
* Estimates represent prevalence per 100 persons age-standardized to the projected 2000 Census
population (see ref. 63) except for National Health and Nutrition Examination Survey III (NHANES III)
estimates, which were adjusted to the 1980 Census population.
† All data on radiographic knee osteoarthritis (OA) are based on anteroposterior radiographs and
therefore capture only tibiofemoral OA. Inclusion of patellofemoral imaging would probably yield higher
PREVALENCE OF RHEUMATIC DISEASES IN THE US, PART II27
were more likely than whites to have radiographic knee
OA. A study of perimenopausal women in Michigan also
demonstrated that African Americans were more likely
than whites to have radiographic knee and hand OA (9).
In the NHANES III, the prevalence of radiographic
knee OA was significantly higher in non-Hispanic Afri-
can Americans than in non-Hispanic whites or Mexican
Americans (52.4%, 36.2%, and 37.6%, respectively) (4).
In Johnston County, the prevalence of radiographic
hip OA was comparable in African Americans and
Symptomatic OA. Persons are considered to have
symptomatic OA if they have frequent pain in a joint
and radiographic evidence of OA in that joint, although
sometimes this pain may not actually emanate from the
arthritis seen on the radiograph. Most prevalence sur-
veys require that a person have pain in a joint on most
days of a recent month, to meet the definition for
presence of symptoms.
The prevalence of symptomatic knee OA was
4.9% among adults age ?26 years in the Framingham
study, 16.7% among adults age ?45 in the Johnston
County study, and 12.1% among adults aged ?60 in the
NHANES III study (Table 2). The prevalence of symp-
tomatic hip OA was 9.2% among adults age ?45 in the
Johnston County study. The prevalence was slightly
higher among women than among men for both of these
outcomes (Table 2).
The prevalence of symptomatic hand OA in the
Framingham subjects (6) was 6.8% overall and was
especially high in older adults. Among individuals age
?71 years, prevalence was 26.2% in women and 13.4%
Using the Framingham data on age/sex preva-
lence among persons age ?26 years and the correspond-
ing 2005 population estimates from the Census Bureau,
we estimated that 9,267,000 adults have symptomatic
knee OA and 13,054,000 adults have symptomatic hand
OA. The generalizability of the Framingham estimates
to the US population has not been determined.
For estimating overall OA, we calculated
weighted age/sex-specific prevalence estimates of clini-
cal arthritis for persons ages 25–74 from the NHANES I,
the only published national source of data on OA at
multiple anatomic sites and the source we used in our
1998 report (11). Using the corresponding 2005 popula-
tion estimates from the Census Bureau and additionally
applying the NHANES I estimate for those ages 65–74
to the Census population age ?75 years, we estimated
that 26.9 million adults age 25 and older have clinical
OA of some joint. Whether the 1971–1975 NHANES I
estimates reflect the 2005 US population prevalence is
Polymyalgia rheumatica (PMR) and giant cell
(temporal) arteritis (GCA). PMR and GCA, two closely
related syndromes that occur almost exclusively in per-
sons age ?50 years, appear to be much more common in
whites than in other racial or ethnic groups (12). In the
US, prevalence is highest among persons of northern
European descent (13,14).
The only population-based study of PMR and
GCA in the US is from Olmsted County, Minnesota,
where the prevalences of PMR and GCA were derived
from cumulative incidence rates. GCA was diagnosed
according to the American College of Rheumatology
(ACR) criteria (15). Among persons age ?50 years in
2000, the prevalence of PMR was 739 per 100,000 (95%
confidence interval [95% CI] 674–808) (16) and the
prevalence of GCA was 278 per 100,000 (95% CI
192–268) (17). For each, the prevalence was higher in
women than in men and increased dramatically with age
(for PMR, from 21 per 100,000 among persons ages
joint) in the hands, knees, and hips, by age and sex, from population-based studies*
Prevalence of symptomatic OA (symptoms and radiographic changes of OA in the symptomatic
age, yearsSource (ref.)
% with symptomatic OA
Framingham OA study (6) 18.104.22.168
Framingham OA study (5)
Framingham OA study (5)
Johnston County OA Project (7)
NHANES III (4)
Johnston County OA Project (10)
* Adjusted to the projected 2000 population age ?18 years (see ref. 63) except for National Health and
Nutrition Examination Survey III (NHANES III) estimates, which were adjusted to the 1980 Census
population. OA ? osteoarthritis.
28 LAWRENCE ET AL
50–54 years to 4,070 per 100,000 among those age ?90
years) (Table 3).
In addition to these data, case series of PMR
and GCA suggest that these conditions are common
throughout the US. In Europe, incidence rates in pop-
ulations in the northern area of the continent are
similar to those of Olmsted County, Minnesota, whereas
rates among southern European populations are lower
In summary, PMR is common in older adults.
GCA, which is approximately one-third as common as
PMR, is the most common form of vasculitis in the
population over 50 years of age. Using the Olmsted
County age/sex prevalence rates and the corresponding
2005 estimates from the Census Bureau, we estimated
that 711,000 Americans have PMR and 228,000 have
GCA. With the aging of the US population, these
estimates are likely to increase in coming years. These
Olmsted County estimates are generalizable to the white
US population, but their generalizability to other racial/
ethnic populations is uncertain.
Gout. Gout is an inflammatory arthritis that
results from phagocytosis of monosodium urate mono-
hydrate crystals within the joint and is usually associated
with an elevated concentration of uric acid in the blood,
i.e., hyperuricemia. Among criteria developed to classify
gout, the ACR criteria (22) have been used in recent
epidemiologic studies (23,24).
Our previous National Arthritis Data Workgroup
(NADW) report (11) reviewed the population-based
Tecumseh Community Health Study (25), the Framing-
ham Heart Study (26), and the Sudbury Study (27)
(Table 4), all of which were relatively small studies of
gout conducted in confined geographic regions. All of
these studies took place before the ACR criteria were
developed, the age populations included were not con-
sistent among studies.
The prevalence of gout also has been estimated
using self-reported information from the National
Health Interview Survey (NHIS) and the NHANES
(Table 4). Because these self-reports were not verified,
the data may produce an overestimate of prevalence.
For example, investigators in the Sudbury Study (27)
could validate only 44% of self-reported cases using
Rome (28) or New York (29) criteria, and in a study of
health professionals (23), only 70% of cases could be
validated by ACR criteria. However, in one study of
physicians (24), it was reported that 100% of self-
reported cases could be validated by ACR criteria and
medical record review. In the most recent NHIS survey
on gout (1996), the prevalence for the 1-year period was
940 per 100,000 adults age ?18 years in the US (30).
Prevalence increased with age, was higher in men than in
women at all ages, and among those age ?45 years was
higher in African Americans than in whites.
One-year period prevalence estimates derived
from the NHIS over time can be compared directly
because the instrument has not changed. In this survey,
the presence of gout is recorded if a respondent answers
“yes” to the question, “Have you or any member of your
household had gout within the past year?” From 1969 to
1985 the prevalence more than doubled, with the steep-
est increase occurring between 1969 and 1976 (30), but
the increase later slowed between 1992 and 1996 (840
and 940 per 100,000, respectively) (Table 4). In a recent
study from a US managed care population, the overall
by age and sex*
Prevalence of polymyalgia rheumatica and giant cell arteritis in Olmsted County, Minnesota,
Prevalence of polymyalgia
rheumatica†Prevalence of giant cell arteritis‡
MaleFemale TotalMale FemaleTotal
* Values are cumulative incidence rates per 100,000 persons in each age/sex group through 1999.
† Data collected 1970–1999 (16).
‡ Data collected 1950–1999 (17).
PREVALENCE OF RHEUMATIC DISEASES IN THE US, PART II29
prevalence of gout or hyperuricemia requiring a gout or
urate-lowering medication increased by 80% from 1990
to 1999 (31); however, this increase may reflect treat-
The lifetime prevalence estimate from the
NHANES III (1988–1994) (32), based on the question,
“Has a doctor ever told you that you had gout?,” was
2,600 per 100,000 overall for those age ?20 years, with a
low of 400 per 100,000 in adults ages 20–29 years and a
peak of 8,000 per 100,000 in adults ages 70–79 years
(Table 4). Gout was reported more often by men than by
women overall, but prevalence increased with age for
both, especially among women after menopause.
In summary, gout appears to be increasing in
frequency. Using 1996 NHIS and NHANES III age/sex
prevalence data and the corresponding 2005 population
estimates from the Census Bureau, we estimated that 3.0
million adults age ?18 years had gout in the past year,
and 6.1 million adults age ?20 have ever had gout. Both
are likely overestimates because they are based on
Fibromyalgia. The 1990 ACR criteria for the
classification of fibromyalgia require the presence of
widespread pain for at least 3 months and pain on
palpation in at least 11 of 18 anatomic sites (33). Despite
its acceptance, a number of problems occur when the
ACR criteria set is used to define fibromyalgia in
populations, leading to difficulties in estimating preva-
lence (34–36). Also, fibromyalgia may be more common
among persons with other medical conditions (37), so
prevalence estimates of primary fibromyalgia may be
lower than estimates that do not differentiate primary
Prevalence of gout in the United States*
Source and year of study/gout
definition (ref.) Age, years
Prevalence per 100,000
Regional population studies
Tecumseh Community Health
Study, 1960/“Rome” (25)†
Framingham Heart Study, 1964/
Sudbury Study, 1972/Rome and
New York (27)
National survey studies
NHIS, 1988/self-report (1-year
?42 (mean 58)2,850 3901,480
ND NHIS, 1992/self-report (1-year
prevalence) (65)§ 30
NDNHIS, 1996/self-report (1-year
prevalence) (30)§ 20
* ND ? no data; NHIS ? National Health Interview Survey; NHANES III ? National Health and
Nutrition Examination Survey III.
† “Rome” ? Rome criteria used “insofar as possible.”
‡ Arbitrary ? at least 2 of the following 3 features: a typical attack of arthritis, an attack of arthritis with
a prompt response to colchicine therapy, and/or hyperuricemia.
§ One-year prevalence of gout ascertained by the question, “Have you or any member of your household
had gout within the past year?”
¶ Lifetime prevalence of gout ascertained by the question, “Has a doctor ever told you that you had gout?”
Interviewers were instructed to emphasize the word “doctor.” If the respondent stated that it was another
health professional who gave the diagnosis of gout to him or her, the answer was coded as “no.”
30 LAWRENCE ET AL
fibromyalgia from fibromyalgia secondary to other dis-
Wolfe et al conducted the only study of the
prevalence of primary fibromyalgia in the US, in Wich-
ita, Kansas in 1993 (38). At the time of the study, the
population of Wichita was ?88% white, different from
that of the overall US population. From a random
sample of 3,006 adults age ?18 years, 193 individuals
with chronic widespread pain were examined and 36
cases of ACR-defined fibromyalgia were confirmed. The
overall prevalence among adults was ?2% (95% CI
1.4–2.7); prevalence was higher among women than
among men (3.4% versus 0.5%). In women, the preva-
lence of fibromyalgia rose sharply in middle age, to a
maximum of 7.4% in the 70–79-year age group, and then
dropped off. Prevalence in men similarly peaked in the
eighth decade of life, but was only slightly more than 1%
among men in this age group. Fibromyalgia was associ-
ated with depressive and anxiety symptoms, current and
past depression, and a history of depression in the
family. Other characteristic symptoms, i.e., “pain all
over,” subjective swelling, paresthesias, stiffness, sleep
disturbance, fatigue, and irritable bowel syndrome, were
also associated with fibromyalgia (38). Women experi-
enced more of these associated symptoms than men
(34). Other factors associated with fibromyalgia in-
cluded reduced income and education, higher rates of
divorce, and application for disability benefits (38).
Although no recent prevalence studies of fibro-
myalgia in the US have been published, a population
survey of 3,395 randomly selected adults (?18 years of
age) in Ontario, Canada showed 100 cases of fibromy-
algia, yielding an even higher overall age/sex-adjusted
prevalence of 3.3% (95% CI 3.2–3.4%) (4.9% in women
and 1.6% in men) (39). As in the US study, the
prevalence of fibromyalgia in women rose with age, to a
peak of 7.9% in the 55–64-year age group, and declined
thereafter. The prevalence in men also increased with
age, and peaked at 2.5% in the 45–54-year age group.
Using the Wichita age/sex prevalence and the
corresponding 2005 population estimates from the Cen-
sus Bureau, we estimated that ?5.0 million adults age
?18 years have primary fibromyalgia. The generalizabil-
ity of the Wichita estimates to the US population is
Carpal tunnel syndrome (CTS). Because there is
no gold standard for the diagnosis of CTS and no
standard definition of the syndrome, and because some
cases can be transient, challenges arise in determining
the prevalence of this condition. The clinical examina-
tion findings associated with CTS have sensitivities and
specificities in the range of 45–80% (40). The typical
location of symptoms in the median nerve distribution
has sensitivity and specificity in the range of 60–70%
(41,42). On median nerve conduction testing, ?20% of
asymptomatic individuals exhibit abnormalities consis-
tent with CTS (42,43).
The most well–accepted definitions of CTS in-
volve combinations of symptom, electrophysiologic, and
physical examination findings. Three population-based
prevalence studies have been performed in Europe,
involving a combination of history, physical examination,
and nerve conduction assessments. Atroshi and col-
leagues (44), in a Swedish study, inquired about symp-
toms typical of CTS (40,42) and studied symptomatic
and asymptomatic subjects further by history-taking,
physical examination, and nerve conduction studies.
They estimated the prevalence of symptoms typical of
CTS, of symptoms accompanied by examination findings
indicative of CTS, of symptoms accompanied by positive
electrophysiologic results, and of symptoms accompa-
nied by positive findings on all tests. The prevalence of
CTS was consistently higher in women than in men, and
rose with age. CTS prevalence ranged from 2% to 4% in
men and 3% to 5% in women, depending on the
stringency of the case definition.
Ferry and colleagues (45) administered a hand
symptom diagram (42) to a random population sample
in the UK. Persons with and persons without typical
symptoms of CTS underwent physical examination and
electrophysiologic testing. The prevalence of positive
nerve conduction findings did not differ between sub-
jects with typical CTS symptoms and asymptomatic
subjects. Thus, although the authors reported a preva-
lence of electrophysiologic evidence of CTS on the order
of 10%, it is difficult to draw conclusions about the
prevalence of symptomatic CTS.
In an earlier study, de Krom and colleagues (46)
evaluated the prevalence of CTS in 715 persons from
The Netherlands. Of the respondents, 1.6% had diag-
nosed CTS and 9% had nocturnal finger paresthesias.
The latter underwent neurologic and electrophysiologic
evaluation. The overall prevalence of CTS (either diag-
nosed or detected via this 2-stage screening process) was
5.8% in women and 0.6% in men.
Studies using a combination of self-report, phys-
ical examination, and nerve conduction testing have not
been performed in the US. Tanaka et al analyzed data
from the 1988 NHIS (47). Respondents were asked if
they had CTS. An estimated 1.55% of 170 million adults
(2.65 million) self-reported CTS. CTS was twice as
common among women as among men (47). The self-
PREVALENCE OF RHEUMATIC DISEASES IN THE US, PART II31
report nature of the case definition makes these data
difficult to interpret.
In summary, the prevalence of electrophysiologi-
cally confirmed, symptomatic CTS, based on studies
conducted outside the US, is ?1–4% in men and 3–5%
in women, with prevalence increasing with age. Using
these adult prevalence estimates and the corresponding
2005 population estimates from the Census Bureau, we
estimated that 1–4 million men and 3–6 million women
in the US have CTS.
Back and neck pain. Low back pain affects most
adults at some time. Because back pain is rarely perma-
nent, terms such as incidence and prevalence may be
ambiguous. Although neck pain is less common than low
back pain, it shares many similar characteristics. The
thoracic spine’s mobility is limited by the rib cage, and is
less often a cause of back pain except in osteoporosis.
Thus, the prevalence of thoracic spine pain is rarely
Back pain is a symptom, not a disease. For many,
a precise pathoanatomic diagnosis is impossible (48,49).
There is no definitive imaging or diagnostic test to
determine its prevalence. Investigators depend on pa-
tient self-report, and many patients have few objective
In epidemiologic surveys, back pain has been
defined in many ways. These include counting any
episode of back pain, counting pain lasting a certain
length of time, counting only “severe” pain, or counting
only pain that results in work disability. We focused on
population-based estimates of self-reported symptoms,
separating neck and low back pain, and attempting to
distinguish reports of any back pain, frequent or persis-
tent back pain, and pain with symptoms of radiculopathy
(nerve root irritation, usually manifesting as sciatica).
In the 2002 NHIS, respondents were asked
whether they had low back pain or neck pain during the
past 3 months. Respondents were instructed to report
pain that lasted a whole day or longer (50). Approxi-
mately one-fourth of all adults in the US reported
experiencing low back pain in the past 3 months, and the
prevalence of neck pain was approximately half that
estimate (Table 5). The prevalence was similar among
men and women and among most racial groups, with the
exception of a high prevalence among American Indians
and Alaskan Natives, and a low prevalence among Asian
Americans. Prevalence declined with increasing levels of
From an analysis of the 1997 NHIS, it was
estimated that 3.2% of all persons experienced activity
limitations due to chronic back conditions (51). Among
the poor, activity limitation was nearly 3 times more
frequent than in middle- and high-income adults.
Although about half of adults report low back
Prevalence of neck pain and various categories of low back pain, by race, age, and sex
Neck pain in the
past 3 months, %
Low back pain
LBP in the
past 3 months, %
Any LBP in the
past year, %†
Frequent LBP in the
past year, %‡
of LBP lasting
?2 weeks, %§
* Data from the 2002 National Health Interview Survey (50); 95% confidence intervals (95% CIs) calculated by the authors from published standard
† Data from the Louis Harris Survey Group, 1985 (52,60). Age ranges were slightly different than labeled here.
‡ Data from a citywide population survey (Dayton, OH, 1973) (57). Age ranges were slightly different than labeled here.
§ Data from the National Health and Nutrition Examination Survey II, as reported by Deyo and Tsui-Wu (53). The percentages are estimates
because the reported age categories differed slightly from the ranges presented here. Although the decline in lifetime occurrence of low back pain
(LBP) in the highest age category may be surprising, it has been noted in several surveys. Possible explanations are survey participants’ limited recall
for distant past events, selective mortality (persons with LBP have shorter survival, perhaps due to associated health habits or socioeconomic
circumstances), or a “cohort” effect, in which persons over age 65, for unexplained reasons, had a lower likelihood of LBP throughout their lives.
32LAWRENCE ET AL
pain during a given year and about two-thirds report low
back pain at some time in their lives (52–60), only
15–21% of the adult population reported frequent low
back pain (56) and only 14% reported an episode of low
back pain lasting longer than 2 weeks at any time in their
lives. Pain lasting beyond 3–6 months occurs in only
5–10% of patients with back pain. Approximately 1–2%
of adults report having received a diagnosis of a herni-
Computed tomography and magnetic resonance
imaging studies in small samples indicate that disc
degeneration, fractures, herniated discs, and spinal ste-
nosis are all common among asymptomatic persons
(61,62). Thus, the prevalence of radiographic findings is
substantially different from the prevalence of clinically
In summary, back pain is common. The etiology
is often unclear and classification is controversial, but
most episodes probably originate in muscles or liga-
ments, or are the consequences of degenerative changes
in the intervertebral discs and adjacent vertebrae. These
changes include osteoarthritic changes in the facet joints
and similar degenerative changes in and around the
intervertebral discs. Back pain remains a leading cause
of work disability.
Using 2002 NHIS age-specific prevalence and the
corresponding 2005 population estimates from the Cen-
sus Bureau, we estimated that 59.1 million adults age
?18 years have had low back pain “in the past 3
months.” Using the 1997 NHIS age-specific prevalence
and the corresponding 2005 population estimates from
the Census Bureau, we estimated that 7.1 million adults
age ?18 have activity limitation due to chronic back
conditions. Using the same sources, we estimated that
30.1 million adults age ?18 have had neck pain “in the
past 3 months.”
As discussed in the companion article (1), the
burden of a chronic condition can be measured in
various ways. The NADW has chosen to focus on
national disease prevalence as an important measure of
The prevalence of clinical osteoarthritis has
grown to nearly 27 million, up from our estimate for
1995 of 21 million (11), as would be expected for such a
strongly age-related disease. Gout appears to be increas-
ing in frequency as well, with a 1-year prevalence of 3.0
million adults, a higher frequency than in the earlier
study. These increases in such common conditions sug-
gest they will have a growing impact on the health care
and public health systems in the future, one that needs to
be anticipated in order to provide the early diagnosis
and interventions that can help reduce that impact.
We have provided estimates of prevalence and
numbers of persons affected for overall arthritis and for
selected rheumatic conditions and given a rough snap-
shot of current burden. These estimates have been made
by recognized disease experts using the best data avail-
able, but, as noted in many of the sections, must be
interpreted with several limitations in mind, including
those detailed in the companion report (1). Given the
large and growing burden of arthritis and other rheu-
matic conditions, we hope this work will inspire studies
that better address these gaps and limitations and pro-
vide a better understanding of the burden of these
Dr. Helmick had full access to all of the data in the study and
takes responsibility for the integrity of the data and the accuracy of the
Study design. Lawrence, Felson, Helmick, Choi, Gabriel, Hunder.
Acquisition of data. Felson, Helmick, Choi, Hochberg, Hunder, Jor-
dan, Katz, Maradit Kremers, Wolfe.
Analysis and interpretation of data. Felson, Helmick, Arnold, Choi,
Deyo, Gabriel, Hunder, Jordan, Katz, Maradit Kremers, Wolfe.
Manuscript preparation. Lawrence, Felson, Helmick, Arnold, Choi,
Deyo, Gabriel, Hirsch, Hochberg, Hunder, Jordan, Katz, Maradit
Statistical analysis. Helmick, Choi.
Project initiation and organization. Lawrence.
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