Elucidating Arthritis QoL Burden in Underserved Populations, With Daniel White, MS, ScD

More than one-third of working-age United States adults with arthritis report limitations in their ability to work, and nearly half report limitations in daily activities — burdens that fall disproportionately on individuals with lower income, less education, and poorer overall health, who are simultaneously the least likely to receive adequate treatment.

RheumatologyLive spoke with Daniel White, MS, ScD, who wants clinicians to understand these as structural, not incidental, features of the arthritis burden landscape.

White, Associate Professor of Physical Therapy at University of Delaware, is a co-investigator on 2 cross-sectional analyses using data from the 2023 National Health Interview Survey examining arthritis-attributable activity limitations (AAAL) and arthritis-attributable work limitations (AAWL) against the benchmarks set by the Healthy People 2030 initiative. Among adults aged 18 to 64 years with arthritis — including gout, fibromyalgia, and rheumatoid arthritis — the age-standardized prevalence of AAWL was 38.8% (95% CI, 35.6%–42.2%), not significantly different from 2019 estimates and well above the Healthy People 2030 target. An estimated 24.8 million US adults with arthritis reported activity limitations in 2023, corresponding to an age-adjusted AAAL prevalence of 47.8% (95% CI, 45.0%–50.7%); although this represented a modest decline from 49.2% in 2019, the change was not statistically significant and fell short of the 46.8% Healthy People 2030 target. Marked disparities were observed across both measures, with higher AAWL prevalence among Hispanic adults (50.1%), non-Hispanic American Indian and Alaska Native adults (55.9%), individuals with disabilities (62.1%), veterans (52.5%), and those reporting poor or fair health (61.1%).

White described the subgroup pattern as reflecting the convergence of multiple disadvantages rather than arthritis acting in isolation. Patients with low income and limited education face not only greater disease burden but also greater barriers to accessing the providers and interventions that would reduce that burden — rheumatologists who can prescribe appropriate pharmacologic therapy, and physical therapists who can deliver exercise-based treatments with demonstrated efficacy for symptom reduction and functional preservation. These supply constraints are worsening rather than improving: as the US population ages and the prevalence of arthritis grows, the specialist workforce is not keeping pace with demand. White noted that individuals with coexisting depression or cardiovascular disease face compounding disadvantage — the presence of these comorbidities increases the probability that arthritis will translate into meaningful activity and work limitations, because each condition individually reduces functional reserve and collectively they substantially raise the threshold for effective self-management.

For clinicians, White framed the core challenge as one of awareness on two sides: patients with osteoarthritis — the most common form of arthritis — frequently misattribute their symptoms to normal aging and do not seek treatment, while some providers in single-clinician or resource-constrained practices lack the bandwidth to address the full social determinants of health context that shapes their patients' outcomes. He called for greater collaboration across rheumatology, primary care, and physical therapy to distribute the care burden more effectively, and expressed hope that the data from these analyses would be considered by guideline-writing groups and health policy stakeholders who can create structural conditions for meaningful improvement.

“The first gap is just awareness many people with arthritis, and I'm talking specifically now about people with osteoarthritis, which is the most common type of arthritis, believe that the sort of aches and pains you have from osteoarthritis are just part of normal aging, and there's nothing you can do. And that is simply not true. There are effective treatments that can reduce pain and help function and help people stay active and dependent, and a lot of people just don't are not aware of this,” White said.

References

1. Liu Y, Qin J, White D, et al. Arthritis-attributable work limitations among adults aged 18–64 years — United States, 2023. MMWR Morb Mortal Wkly Rep. 2025.

2. Liu Y, Qin J, White D, et al. Arthritis-attributable activity limitations among adults — United States, 2023. MMWR Morb Mortal Wkly Rep. 2025.