Arthritis in U.S. Children and Adolescents, 2017–2021

Arthritis affects people of all ages, including children and teenagers, but recent national estimates for those under 18 were lacking. Earlier estimates ranged widely — from 13,400 children (21 per 100,000) in a 1978 study using a narrow definition of juvenile arthritis, to 294,000 (403 per 100,000) in 2001–2004 using a broad definition that included other rheumatologic conditions.

The most common forms in young people are acquired autoinflammatory diseases, which cause joint pain, swelling, stiffness, disability and activity limits that often last into adulthood; depression and anxiety often occur alongside them.

The study

CDC used the National Survey of Children's Health — the largest national and state survey of U.S. children's health, run by the Census Bureau and funded by the Health Resources and Services Administration — combining 2017–2021 data on 173,406 children and adolescents. Arthritis was counted when a parent answered yes to: "Has a doctor or other health care provider ever told you that this child has arthritis?"

Findings

About 220,000 U.S. children and adolescents under 18 — 305 per 100,000 — had diagnosed arthritis.

Prevalence among Black children and teens was twice that among White children and teens, and it fell as parents' education rose.

What it means

• Wide past estimates likely reflect arthritis's rarity in children, better detection and diagnosis, different definitions and different data sources; earlier studies used billing codes, this one parents' reports of a diagnosis.
• Disparities by race and parental education point to the importance of social conditions for health, visible even in childhood.
• Mental health: a 2019 review found more depression and anxiety symptoms among young people with juvenile idiopathic arthritis and their families, and poorer quality of life among those affected. The U.S. Preventive Services Task Force recommends screening all 8- to 18-year-olds for anxiety and 12- to 18-year-olds for major depression.
• Diet and activity: a healthy, age-appropriate diet is strongly recommended for children with arthritis; the Physical Activity Guidelines for Americans call for 60 minutes of moderate-to-vigorous activity daily at ages 6–17, though more research on activity and weight management for children with arthritis is needed.
• Treatment includes antirheumatic drugs that slow inflammation to preserve joints, nonsteroidal anti-inflammatory drugs for stiffness, pain and fever, and — per the American College of Rheumatology's 2021 guideline — physical and occupational therapy. Early diagnosis and prompt treatment may prevent permanent joint damage.

The authors recommend prioritizing children and adolescents for arthritis prevention and treatment: identifying risk factors, developing self-management programs, supporting physical activity and weight control, screening for and connecting young people to mental health services, addressing the social factors behind disparities, and ensuring fair access to therapies such as physical therapy and medicines.

Limitations: the survey is cross-sectional, so it can't show cause; parents' reports can't be checked against records and may be misremembered; estimates for small groups are imprecise; and the single question can't distinguish arthritis types or catch undiagnosed cases.

Sources

• Lites TD, Foster AL, Boring MA, Fallon EA, Odom EL, Seth P. "Arthritis Among Children and Adolescents Aged <18 Years — United States, 2017–2021." Morbidity and Mortality Weekly Report 72(29), Centers for Disease Control and Prevention (corrected; an erratum was published).