Objective
To provide a single source for the best available estimates of the national prevalence of arthritis in general and of selected musculoskeletal disorders (osteoarthritis, rheumatoid arthritis, juvenile rheumatoid arthritis, the spondylarthropathies, systemic lupus erythematosus, scleroderma, polymyalgia rheumatica/giant cell arteritis, gout, fibromyalgia, and low back pain).

Methods
The National Arthritis Data Workgroup reviewed data from available surveys, such as the National Health and Nutrition Examination Survey series. For overall national estimates, we used surveys based on representative samples. Because data based on national population samples are unavailable for most specific musculoskeletal conditions, we derived data from various smaller survey samples from defined populations. Prevalence estimates from these surveys were linked to 1990 US Bureau of the Census population data to calculate national estimates. We also estimated the expected frequency of arthritis in the year 2020.

Results
Current national estimates are provided, with important caveats regarding their interpretation, for self-reported arthritis and selected conditions. An estimated 15% (40 million) of Americans had some form or arthritis in 1995. By the year 2020, an estimated 18.2% (59.4 million) will be affected.

Conclusion
Given the limitations of the data on which they are based, this report provides the best available prevalence estimates for arthritis and other rheumatic conditions overall, and for selected musculoskeletal disorders, in the US population.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/1529-0131%28199805%2941%3A5%3C778%3A%3AAID-ART4%3E3.0.CO%3B2-V

Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States

Objective. To determine the prevalence and characteristics of fibromyalgia in the general population.

Methods. A random sample of 3,006 persons in Wichita, KS, were characterized according to the presence of no pain, non-widespread pain, and widespread pain. A subsample of 391 persons, including 193 with widespread pain, were examined and interviewed in detail.

Results. The prevalence of fibromyalgia was 2.0% (95% confidence interval [95% CI] 1.4, 2.7) for both sexes, 3.4% (95% CI 2.3, 4.6) for women, and 0.5% (95% CI 0.0, 1.0) for men. The prevalence of the syndrome increased with age, with highest values attained between 60 and 79 years (>7.0% in women). Demographic, psychological, dolorimetry, and symptom factors were associated with fibromyalgia.

Conclusion. Fibromyalgia is common in the population, and occurs often in older persons. Characteristic features of fibromyalgia–pain threshold and symptoms–are similar in community and clinic populations, but overall severity, pain, and functional disability are more severe in the clinic population.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/art.1780380104

The prevalence and characteristics of fibromyalgia in the general population

This review is a critical summary of research examining gender variations in clinical pain experience. Gender-comparative pain research was identified through Medline and Psychlit searches and references obtained from bibliographies of pertinent papers and books. Review of this research demonstrates that women are more likely than men to experience a variety of recurrent pains. In addition, many women have moderate or severe pains from menstruation, pregnancy and childbirth. In most studies, women report more severe levels of pain, more frequent pain and pain of longer duration than do men. Women may be at greater risk for pain-related disability than men but women also respond more aggressively to pain through health related activities. Women may be more vulnerable than men to unwarranted psychogenic attributions by health care providers for pain. Underlying biological mechanisms of pain and the contribution of psychological and social factors as they contribute to the meaning of pain for women and men warrant greater attention in pain research.

Gender variations in clinical pain experience.

The rate of musculoskeletal pain in adolescent and adult populations is examined, with a focus on three commonly reported pain disorders: shoulder pain, low back pain and fibromyalgia/chronic widespread pain. There is a paucity of data on musculoskeletal pain in adolescent populations. Those studies available suggest that pain is common, although the actual rates are unclear. This is probably due to differences in study methodologies and populations. Pain is commonly reported among adult populations, with almost one fifth reporting widespread pain, one third shoulder pain, and up to one half reporting low back pain in a 1-month period. The prevalence of pain varies within specific population subgroups; group factors (including socioeconomic status, ethnicity and race) and individual factors (smoking, diet, and psychological status) are all associated with the reporting of musculoskeletal pain. However, the precise nature of these relationships, and particularly the mechanisms of association, are unclear and require further investigation.

Epidemiology of chronic musculoskeletal pain.

Epidemiologic, clinical, and experimental evidence points to sex differences in musculoskeletal pain. Adult women more often have musculoskeletal problems than do men. Discrepant findings regarding the presence of such differences during childhood and adolescence continue. Biologic and psychosocial factors might account for these differences. The authors review evidence showing that mechanically induced pressure is more likely to show sex differences than other noxious stimuli and to discriminate between individuals suffering from musculoskeletal pain and matched controls. The authors suggest that a state of increased pain sensitivity, with a peripheral or central origin, predisposes individuals to chronic muscle pain conditions, and that there are sex differences in the operation of these mechanisms; women are vulnerable to the development and maintenance of musculoskeletal pain conditions.

/pdf/sex-differences-in-musculoskeletal-pain-3gmqb7xpkc.pdf

Sex differences in musculoskeletal pain.

Fibromyalgia syndrome (FS) is most common in midlife, but may be seen at any age. Its prevalence and assessment of tenderness in healthy children is not known. We assessed 338 healthy schoolchildren for tenderness thresholds and prevalence of FS. In all children a point count of 18 tender points (TP) was conducted by thumb palpation and tenderness of some of the TP sites as well as control point sites was further assessed using a Chatillon dolorimeter. All children and their parents were questioned about the presence of widespread pain or aching. Children were considered to have FS if they met the American College of Rheumatology (ACR) criteria for diagnosis of FS. Of the 338 children, 21 (6.2%) had FS. Thresholds of tenderness of 9 TP were 5.0 (1.2) (kg) [mean (standard deviation)] for boys vs 3.6 (0.8) (kg) for girls (p < 0.001). Thresholds of tenderness of the control point sites were 7.1 (1.4) (kg) for boys vs 5.5 (1.1) (kg) for girls (p < 0.001). Thresholds of tenderness of TP and control points in the children with FS were 2.5 (0.4) (kg) and 4.2 (0.5) (kg) vs 4.5 (1.2) (kg) and 6.6 (1.4) (kg) respectively in the children without FS (p < 0.001). We suggest that FS is common in the pediatric age group. Boys have lower tenderness than girls; children with FS have lower thresholds for tenderness both at control and TP compared to the subjects without FS.

Assessment of nonarticular tenderness and prevalence of fibromyalgia in children.

Assessment of diabetic autonomic neuropathy in a representative sample of 91 noninsulin-dependent diabetics was performed in 3 community clinics. A difference of less than 10 beats/min in heart rate between deep inspiration and deep expiration determined by ECG recording served as the criterion for autonomic neuropathy. By this test, 86% of the patients had diabetic autonomic neuropathy, a slightly higher proportion than that reported by others using similar criteria in more selected populations. The test is very sensitive and can be used for screening.

R Boehm

Papers

Assessment of nonarticular tenderness and prevalence of fibromyalgia in children.

Assessment of diabetic autonomic neuropathy by heart rate monitoring