Page 188

Descriptive Epidemiology

The prevalence of self-reported arthritis and arthralgia (rheumatism), without regard to cause, in the United States has been estimated from a number of national surveys, including the 1960-1962 National Health Examination Survey (National Center for Health Statistics, 1964), the 1971-1975 National Health and Nutrition Examination Survey (National Center for Health Statistics, 1973, 1978), and the 1987 and 1988 National Health Interview Surveys (National Center for Health Statistics, 1988, 1989). According to the 1988 National Health Interview Survey, approximately 13 percent of respondents surveyed reported currently having "arthritis of any kind or rheumatism." Prevalence rates increased with age, with approximately 0.2 percent of persons under age 18 years and 5.3 percent between ages 18 and 44 years reporting arthritis of any kind or arthralgia. Prevalence rates were higher in women of all ages, with 4.3 percent under age 45 years reporting these conditions in contrast to 2.5 percent of men in the same age group. Rates for whites and blacks under age 45 years—both sexes combined—are 3.7 and 2.4 percent, respectively. The combining of arthralgia and arthritis of any kind and the cross-sectional and self-reported nature of National Health Interview Survey data do not permit accurate assessment of the prevalence of chronic or recurrent arthritis in the U.S. population.

History of an Association with Rubella Vaccines

Acute arthralgia and arthritis following vaccination have been noted since the earliest studies of rubella vaccines (Barnes et al., 1972; Cooper et al., 1969; Horstmann et al., 1970; Lerman et al., 1971; Spruance and Smith, 1971; Thompson et al., 1971). These acute events have been associated to various degrees with all rubella vaccine strains and occur more frequently in adult women than in adult men or prepubertal children of either sex (Plotkin, 1988; Polk et al., 1982). Reports of chronic arthropathies following rubella vaccination have been fewer. In 1972, Spruance and colleagues reported recurrent joint symptoms in a group of children receiving one strain of rubella vaccine; however, it was not until the 1980s that more systematic investigation of the possible association of rubella vaccines with chronic arthritis was undertaken (e.g., Cunningham and Fraser, 1985; Tingle et al., 1983, 1985, 1986). The lack of controlled studies, coupled with continued anecdotal reports of chronic arthritis following rubella vaccination (ABC News "20/20" report; J. Hatem, York, Pennsylvania, personal communication, 1990; A. J. Tingle, University of British Columbia, personal communication, 1990), have maintained a level of concern over this possible association.