Arthritis is a prevalent medical concern in the United States, with one in every four American adults diagnosed with arthritis. Osteoarthritis is the most common form of arthritis, affecting 27 million adults in the U.S., while rheumatoid arthritis affects 1.3 million. If you suffer from arthritis, it can make daily activities a lot more difficult, especially as the disease progresses. Symptoms can be worsened by unhealthy lifestyle habits or external factors like a lack of treatment options or even weather.

Here are the five worst U.S. states to live in with arthritis:

1. Tennessee

This state is known for its notoriously high humidity and hot summers, which can be quite taxing on those with arthritis. As one of the states that has seen exponential growth in its elderly population Tennessee is ranked as having the highest rate of arthritis. In addition to this, it also ranks as being third worst for adult obesity, which also contributes to arthritis levels. The state also has a low percentage of those who have health insurance coverage, so those suffering from this chronic condition may not be able to afford treatment options or medications.

2. West Virginia

The state is ranked at number 2 among states where arthritis patients have it particularly hard. Almost 20% of adults in West Virginia suffer from arthritis according to recent studies conducted by Center for Disease Control and Prevention (CDC). It also ranks as having the highest rate of obesity in the nation, so those who suffer from arthritis will have a harder time with mobility throughout each day. Those who suffer from arthritis also commonly deal with symptoms such as chronic pain and stiffness, which is made worse by the cold winter weather that the state experiences.

3. Georgia

Georgia is ranked at number 3 on this list because it is known for its hot summers and chilly winters, making life difficult for those with arthritis. Like other states on this list, it is also ranked as having one of the nation’s highest number of obese adults (30%), who are likely to develop arthritis as they age.

4. Massachusetts

Massachusetts is one of the states where arthritis is ranked as one of the least manageable conditions for those who suffer from it, since the weather is cold throughout most of the seasons. Those with arthritis may find it more difficult to deal with winter here, making simple day-to-day activities feel even more arduous.

5. Alabama

Alabama ranks at number 5 on this list because its high humidity and extreme temperatures make it extremely difficult for those with arthritis to manage their symptoms. This state also has one of the lowest life expectancy rates among men who are 65 or older according to a 2016 CDC report, meaning arthritis will likely have taken its toll on them leading up to that age.

Arthritis is a large medical concern in the United States, with one in every three or four adults diagnosed with arthritis. As a result, it is important to find out which states arthritis patients can live most comfortably in. If you or a loved one suffer from this condition, then where you live can be of high importance for your health and well-being.