The disproportionate impact of chronic arthralgia and arthritis among women.

The heterogeneous group of diseases that causes chronic arthralgia and arthritis is the most common cause of activity limitation and disability among middle age and older women. For reasons that remain poorly understood this group of diseases affects women substantially more frequently than men. In particular, the prevalence rates of the most common causes of arthralgia and arthritis, osteoarthritis and rheumatoid arthritis, and the prevalence rates of less common diseases that cause arthralgia, including systemic lupus erythematosus, systemic sclerosis, and fibromyalgia, are between two and 10 times higher in women. Prevalence rates for most of these conditions increase with age, and may vary among populations. For example, in the United States, systemic lupus erythematosus is approximately three times as common among African-American women as among white women. All of these disorders typically have an insidious onset and variable course that can make diagnosis difficult. Yet, most patients with these diseases benefit from early diagnosis and early nonoperative treatments including patient education, patient participation in disease treatment, activity modification, assistive devices, and medications. Furthermore, early aggressive medical therapy may prevent development of permanent joint and visceral damage in patients with inflammatory diseases including rheumatoid arthritis, systemic lupus erythematosus, and systemic sclerosis. Failure to make the diagnosis of an underlying disease in patients with arthralgia may lead to inappropriate treatment or delay in treatment that can result in irreversible impairment. Because many women with these conditions seek medical care from orthopaedists, orthopaedic residency education and continuing medical education should place emphasis on early diagnosis and nonoperative treatment of patients with arthralgia and arthritis, and, when appropriate, early referral to rheumatologists.