ATLANTA, Georgia—Ambulatory healthcare visits for pediatric arthritis place a  significant burden on the healthcare system, according to new prevalence estimates published in the December 15th issue of Arthritis Care & Research.¹ The new surveillance approach puts the total number of pediatric patients with arthritis or other rheumatic disorders at about 294,000 and the annual number of physician visits at 827,000, ranging from 665,000 in 2001 to 1,000.000 in 2004.

The study used a new surveillance approach to estimate the national and state prevalence and number of ambulatory heath visits for significant pediatric arthritis and other rheumatologic conditions (SPARC).

Going forward, "this surveillance system will help us monitor and predict the healthcare needs of patients with these conditions," conclude researchers led by Jeffrey J. Sacks MD, MPH, of the federal Centers for Disease Control and Prevention in Atlanta.

Case numbers in US average 294,000 per year

The study estimated that in 2001, there were 236,000 children with SPARC; in 2002, there were 364,000 children with SPARC; in 2003, there were 292,000; and in 2004, there were 284,000. This translates into an annualized estimated of 294,000 children with SPARC (95% CI 188,000-400,000). Moreover, the corresponding prevalence rate was 403 children per 100,000.

The annualized number of ambulatory healthcare visits for SPARC was 827,000 (95% CI 609,000-1,044,000). This number increased from 665,000 in 2001 to 813,000 in 2002; to 828,000 in 2003; and to 1,000,000 in 2004. State estimates of children with SPARC ranged from 500 in Wyoming to 38,000 in California.

The most common conditions included synovitis and tenosynovitis, myalgia, myositis (includes codes for fibromyalgia), osteoarthrosis and allied disorders, diffuse disease of connective tissue, and rheumatoid arthritis and other inflammatory polyarthropathies.

Pediatric arthritis estimates have varied widely because "pediatric arthritis" is an umbrella term for which there are many definitions and because it is a relatively uncommon condition from a population surveillance perspective, the study authors conclude. "Our estimates suggest that arthritis-related healthcare visits impose a substantial burden on the pediatric healthcare system."

New surveillance method includes office visits, outpatient visits, and emergency visits

Researchers used physician office visit, outpatient department visit, and emergency department visit data from the 2001-2004 National Ambulatory Medical Care Survey and the 2001-2004 National Hospital Ambulatory Medical Care Survey to estimate annual visits for the International Classification of Diseases, Ninth Revision, clinical modification codes thought to represent SPARC. They then converted visit estimates into prevalence estimates using data on the number of prior annual visits per patient; synthetic estimates for states were produced using national rates.

"One advantage of this surveillance paradigm is that it has established a starting point for tracking the national prevalence of arthritis and rheumatologic conditions in children on an ongoing basis using existing infrastructure rather than expensive new surveys," the study authors write.

First step in estimating the true burden of arthritis in children

"There are a lot of limitations to this surveillance system, but it is a good start at getting a true estimate of the burden that arthritis in children poses to the healthcare system," commented Yukiko Kimura, MD, chief of pediatric rheumatology at the Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center in New Jersey.

"The true incidence and prevalence of children with arthritis is not known currently [and] the numbers we have are not based on good or complete data," she said. However, "getting a more accurate estimate of pediatric arthritis will increase the public's and the healthcare system's awareness of arthritis as a significant problem in children, which will increase the likelihood of early detection, diagnosis, and treatment."

"This will ultimately improve outcomes," Dr. Kimura added. Currently, patients who have had symptoms of arthritis for more than 6 months—sometimes years—are commonly seen for the first time by pediatric rheumatologists.

"Having a more accurate estimate will hopefully improve funding for research in the area and increase the numbers of pediatric rheumatologists in this country, which will improve health care for these children, and will increase the chances of finding a cure," Dr. Kimura ended.

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