title: Should people who have joint symptoms, but no diagnosis of arthritis from a doctor, be included in surveillance efforts?
abstract: OBJECTIVE
  In 2005, 27% of adults reported doctor-diagnosed arthritis, and 14% reported chronic joint symptoms but no doctor-diagnosed arthritis (i.e., possible arthritis). We evaluate the value of including persons classified as having possible arthritis in surveillance of arthritis.
  
  
  METHODS
  In 2005, Kansas, Oklahoma, North Carolina, and Utah added extra questions to their Behavioral Risk Factor Surveillance System (BRFSS) telephone survey targeted to a subsample of those classified as having possible arthritis.
  
  
  RESULTS
  Persons classified as having possible arthritis (n = 2,884) were younger, more often male, and had less activity limitation than persons with doctor-diagnosed arthritis. Of those classified as having possible arthritis, half had seen a doctor for their symptoms, 12.5% reported arthritis, and 61.9% gave other causes. Of the half who had not seen a doctor, most reported mild symptoms (64.8%).
  
  
  CONCLUSIONS
  Only 6.3% of those classified as having possible arthritis had what we considered to be arthritis. Most who did not see a doctor reported mild symptoms and, therefore, would be unlikely to be amenable to medical and public health interventions for arthritis. Although including possible arthritis would slightly improve the sensitivity of detecting arthritis in the population, it would increase false-positives that would interfere with targeting state intervention efforts and burden estimates. The ability to add back questions to the BRFSS survey allows for the reintroduction of possible arthritis in case national surveillance indicates it necessary or if studies document an increased rate at which possible arthritis turns into arthritis. Currently, possible arthritis does not need to be included in state arthritis surveillance efforts, and limited question space on surveys is better spent on other arthritis issues.
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia, USA. jcr2@cdc.gov
authors.forename: Julie
authors.initials: J
authors.lastname: Bolen
authors.forename: Charles G
authors.initials: CG
authors.lastname: Helmick
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Sacks
authors.forename: Ziya
authors.initials: Z
authors.lastname: Gizlice
authors.forename: Catima
authors.initials: C
authors.lastname: Potter
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001168:Arthritis / Q000175:diagnosis* / Q000453:epidemiology*; D040343:Behavioral Risk Factor Surveillance System; D005260:Female; D006801:Humans; D007407:Interviews as Topic / Q000379:methods; D007592:Joint Diseases / Q000175:diagnosis / Q000453:epidemiology; D007615:Kansas / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D009825:Oklahoma / Q000453:epidemiology; D010819:Physician's Role; D014589:Utah / Q000453:epidemiology; D055815:Young Adult