Epidemiology of Rheumatoid Arthritis
Rheumatoid arthritis (RA) has been regarded as one of modern medicine’s enigmas.6931 In individual patients, it has a variable course with remissions and exacerbations, and has variable outcome, from a remitting disease leaving minimal damage to a severe condition bringing disability and death. Due in part to a combination of hypothesized genetic and environmental triggers, numerous population-based RA incidence Incidence of Rheumatoid Arthritis and prevalence Prevalence of Rheumatoid Arthritis studies conducted over the past several decades suggest a considerable variation of disease occurrence among different populations and ethnic groups.6865
Epidemiologic studies of RA are dependent on the criteria used to define the disease.9790 This poses a significant challenge, as the etiology Etiology of Rheumatoid Arthritis of RA has not been established. In addition, there are few distinct diagnostic characteristics Diagnosis of Rheumatoid Arthritis, American College of Rheumatology Criteria that can be utilized to consistently define the disease. Subclinical disease is common with most rheumatic conditions, and timing of disease onset may be difficult to ascertain. Regarding the evaluation of the incidence and prevalence in RA, the most widely used criteria include those established in 1958 by the American Rheumatism Association, as well as the subsequent modified definition created by the American College of Rheumatology in 1987. Few studies have been conducted to compare the 1958 and 1987 criteria. One such evaluation, conducted by Dugowson, et al., found that 86% of population-based RA patients who fulfilled the 1958 criteria for definite RA also met the revised 1987 definition.6790 The criteria established in 1958, and subsequent 1987 revision, appear in Fig.2687.10280, 11090
Prevalence of Rheumatoid Arthritis
See also Incidence of Rheumatoid Arthritis.
Gender: Rheumatoid arthritis (RA) occurs 2 to 4 times more frequently in female patients, and symptom severity appears to be greater in females compared with males.9790, 10929 The prevalence of RA increases with age in both males and females,, and is generally most common in the most elderly group studied.
Age: Engel, et al., reported a prevalence of 0.3% in adults younger than age 35, but greater than 10% in people older than age 65.4661 Among persons older than age 60, prevalence may be highest among those age 70 and older, as well as among those with low educational attainment. Osler, writing on the prevalence of RA in The Principles and Practices of Medicine in 1892, remarked that it most commonly sets in between the ages of 20 and 30, but it may begin as late as 50.
Geography: Large prevalence studies conducted in North America and Northern Europe, consisting primarily of Caucasian patients, suggest an RA prevalence of 0.5% to 1%.4661, 9773, 10123, 11074, 10783, 11097 Each study consistently observed a 2- to 3-fold increase in RA prevalence among females as compared with males. Studies from southern European countries report a prevalence of 0.3% - 0.7%, while reports of RA in West and South Africa are relatively rare (See Table :Prevalence of Rheumatoid Arthritis). 4656, 10127, 10375, 10571, 10620, 10736, 10861, 10878
Ethnicity: RA prevalence in nonwhite Asians outside of the Middle East appears to be one-third of that in North American whites.6864, 10207, 10220, 10525, 10952 One of the highest rates of RA (5.3%) has been reported in the Pima Indian population in Arizona.6937 A decrease in the overall prevalence in this population, however, has also been documented.4574, 4656, 4661, 4701, 6824, 6864, 6937, 9773, 10101, 10123, 10127, 10134, 10204, 10207, 10220, 10525, 10571, 10606, 10620, 10648, 10736, 10783, 10810, 10856, 10866, 10952, 11074, 11097
| Population (Demographics/Reports) | Prevalence (per 100,000 inhabitants) |
|---|---|
|
United States | |
|
National Health Survey. Engel, et al. |
1000 |
|
Minnesota. Linos, et al. |
1020 |
|
Michigan. Mikkelsen, et al. |
500 |
|
Pima Indians - Arizona. Del Puente, et al. |
5300 |
|
Northern and Eastern Europe | |
|
Finland. Aho, et al. |
800 |
|
Sweden. Simonsson, et al. |
500 |
|
United Kingdom. Symmons, et al. |
810 |
|
Norway. Risse, et al. |
470 |
|
Hungary. Kiss, et al. |
370 |
|
Mediterranean | |
|
France. Guillemin, et al. Saraux, et al. |
310 - 500 |
|
Italy. Cimmino, et al. |
330 |
|
Greece. Drosos, et al. Andrianakos, et al. |
325 - 670 |
|
Spain. Carmona, et al. |
500 |
|
Turkey. Akar, et al. Kacar, et al. |
360 - 380 |
|
Middle East | |
|
Oman. Pountain, et al. |
360 |
|
Asia | |
|
China. Lau, et al. Dai, et al. |
280 - 350 |
|
Vietnam. Hoa, et al. |
280 |
|
Japan. Shichikawa, et al. |
170 |
|
Indonesia. Darmawan, et al. |
20 - 30 |
|
South America |
N/A |
|
Argentina. Spindler, et al. |
197 |
|
Brazil. Senna, et al. |
460 |
|
Africa |
N/A |
|
Nigeria. Plant, et al. |
(no cases detected) |
|
South Africa. Stenger, et al. Brain, et al. |
2.6 - 280 |
|
NA = not applicable. Centocor Ortho Biotech Inc. Adapted. 4574, 11074, 4656, 4661, 4701, 6864, 6937, 9773, 10101, 10123, 10127, 10134, 10204, 10207, 10220, 10525, 10571, 10606, 10620, 10648, 10736, 10787, 10810, 10856, 10866, 10952, 11097 | |
Incidence of Rheumatoid Arthritis
Because longitudinal studies are needed to determine incidence rates, the incidence of rheumatoid arthritis (RA) has been studied less often than the prevalence of RA Prevalence of Rheumatoid Arthritis. There have been relatively few hospital-based and clinic-based incidence studies conducted because this type of study calls for a prospective approach or concurrent case collection over a defined period of time, and these sites rarely have resources to provide sufficient data.9790 In addition, estimates of incidence are often imprecise due to the relatively infrequent identification of new cases of RA, even in large populations.
The annual incidence rate of RA in North America, as evaluated in the predominantly Caucasian population of Rochester, Minnesota, was 0.045%.10135, 11042 The incidence of RA in males was extremely low through age 34, after which it progressively increased through age 85.10135 In contrast, the incidence of RA in females rose until ages 55 through 64, after which it steadily declined. Age-specific incidence rates varied considerably according to gender, with a 4:1 ratio of females to males in the 35 to 44 age-group, compared with a ratio of 1.1:1 in the 75 to 84 age-category.10135 A similar overall annual incidence rate of 0.03% was observed in a study conducted in central Massachusetts.4641
The paucity of incidence studies evaluating southern European countries reflects the relatively lower occurrence of the disease compared with North America, and to some degree, Northern Europe. One French study conducted by Guillemin, et al., identified an incidence rate of 0.0088%,4676 as compared with 0.024% to 0.039% observed in Norway,10101 Sweden,11094 and Finland.6833 A British study by Symmons, et al., utilizing the Norfolk Arthritis Register, identified an RA incidence of 0.036% for females and 0.014% for males.10556 The lack of evaluations conducted in developing countries prohibits the reliable assessment of an incidence rate.
A decline in the incidence of RA over recent decades has been reported in numerous geographical locales (Finland, United Kingdom, Japan, and the United States— See Table :Prevalence of Rheumatoid Arthritis).10657 Uhlig, et al, noted that several studies from the 1970s and 1980s reported a higher incidence of RA than seen during recent years, and that the incidence of RA has flattened out at lower levels.7056 Notably, this decrease has been primarily observed in females. Speculation on potential factors that may have contributed to this observed decrease has included the introduction of oral contraceptives, changes in diagnostic criteria, general improvement of living standards, and genetic drift. Interestingly, a decline in RA incidence has paralleled a decline in incidence of other diseases, including coronary disease and stroke.
Figure 1724 – RA Incidence 1960-2000, Studies by Size. Is RA disappearing?
Uhlig, T. Kvien, T. K. Is rheumatoid arthritis disappearing?Ann Rheum Dis 2005;64:(1):7-10, Figure 2, Page 9. Reproduced with permission from the BMJ Publishing Group. http://group.bmj.com/products/journals.
Some figures may not display clearly when rendered as a PDF or printed.
| Demographics Time Period | Male Incidence (%) | Female Incidence (%) | Total Incidence (%) |
|---|---|---|---|
|
Rochester, Minnesota, | |||
|
1950 – 1954 |
0.028 |
0.068 |
0.049 |
|
1955 – 1959 |
0.027 |
0.071 |
0.050 |
|
1960 – 1964 |
0.034 |
0.092 |
0.064 |
|
1965 – 1969 |
0.039 |
0.065 |
0.052 |
|
1970 – 1974 |
0.028 |
0.040 |
0.034 |
|
Rochester, Minnesota, | |||
|
1955 – 1964 |
0.056 |
0.120 |
0.092 |
|
1965 – 1974 |
0.049 |
0.093 |
0.072 |
|
1975 – 1985 |
0.047 |
0.088 |
0.068 |
|
Rochester, Minnesota, | |||
|
1955 – 1964 |
0.037 |
0.083 |
0.061 |
|
1965 – 1974 |
0.031 |
0.062 |
0.047 |
|
1975 – 1984 |
0.032 |
0.059 |
0.046 |
|
1985 – 1994 |
0.026 |
0.040 |
0.033 |
|
Kamitonada, Wakayama, Japan, 1965 -- 1996 | |||
|
1965 – 1975 |
0.029 |
0.048 |
0.039 |
|
1975 – 1985 |
0.020 |
0.028 |
0.024 |
|
1985 – 1996 |
0.016 |
nc |
0.008 |
|
Pima Indians, 1966 -- 1990 | |||
|
1966 – 1973 |
0.059 |
1.15 |
0.89 |
|
1974 – 1982 |
0.46 |
0.75 |
0.62 |
|
1983 – 1990 |
0.27 |
0.49 |
0.38 |
|
England and Wales, 1970 – 1972 and 1981 -- 1982 | |||
|
1970 – 1972 |
0.13 |
0.32 |
nc |
|
1981 – 1982 |
0.12 |
0.26 |
nc |
|
Finland, 1980, 1985, and 1990 | |||
|
1980 |
nc |
nc |
0.031 (RF-positive RA) 0.009 (RF-negative RA) |
|
1985 |
nc |
nc |
0.029 (RF-positive RA) 0.010 (RF-negative RA) |
|
1990 |
nc |
nc |
0.027 (RF-positive RA) 0.006 (RF-negative RA) |
|
nc = not calculated; RF = rheumatoid factor. Centocor Ortho Biotech Inc. Adapted. | |||
Content on this page was last reviewed on March 31, 2008.
Content on this page was last changed on March 25, 2009.
References:| 4539. | Uhlig T, Kvien TK. Is rheumatoid arthritis disappearing? Ann Rheum Dis. 2005;64(1):7-10. |
| 4574. | Bain BJ. Some influences on the ESR and the fibrinogen level in healthy subjects. Clin Lab Haematol. 1983;5(1):45-54. |
| 4641. | Chan KW, Felson DT, Yood RA, Walker AM. Incidence of rheumatoid arthritis in central Massachusetts. Arthritis Rheum . 1993;36(12):1691-1696. |
| 4656. | Drosos AA, Alamanos I, Voulgari PV, et al. Epidemiology of adult rheumatoid arthritis in northwest Greece 1987-1995. J Rheumatol . 1997;24(11):2129-2133. |
| 4661. | Engel A, Roberts J, Burch TA. Rheumatoid arthritis in adults. Vital Health Stat 11 . 1966(17):1-43. |
| 4676. | Guillemin F, Briançon S, Klein JM, Sauleau E, Pourel J. Low incidence of rheumatoid arthritis in France. Scand J Rheumatol. 1994;23(5):264-268. |
| 4701. | Kacar C, Gilgil E, Tuncer T, et al. Prevalence of rheumatoid arthritis in Antalya, Turkey. Clin Rheumatol . 2005;24(3):212-214. |
| 6790. | Dugowson CE, Nelson JL, Koepsell TD. Evaluation of the 1987 revised criteria for rheumatoid arthritis in a cohort of newly diagnosed female patients. Arthritis Rheum . 1990;33(7):1042-1046. |
| 6824. | Jacobsson LT, Hanson RL, Knowler WC, et al. Decreasing incidence and prevalence of rheumatoid arthritis in Pima Indians over a twenty-five-year period. Arthritis Rheum . 1994;37(8):1158-1165. |
| 6833. | Kaipiainen-Seppänen O, Aho K, Isomäki H, Laakso M. Incidence of rheumatoid arthritis in Finland during 1980-1990. Ann Rheum Dis . 1996;55(9):608-611. |
| 6864. | Dai SM, Han XH, Zhao DB, Shi YQ, Liu Y, Meng JM. Prevalence of rheumatic symptoms, rheumatoid arthritis, ankylosing spondylitis, and gout in Shanghai, China: a COPCORD study. J Rheumatol . 2003;30(10):2245-2251. |
| 6865. | Abdel-Nasser AM, Rasker JJ, Valkenburg HA. Epidemiological and clinical aspects relating to the variability of rheumatoid arthritis. Semin Arthritis Rheum. 1997;27(2):123-140. |
| 6931. | Buchanan WW. Rheumatoid arthritis: another New World disease? Semin Arthritis Rheum . 1994;23(5):289-294. |
| 6937. | Del Puente A, Knowler WC, Pettitt DJ, Bennett PH. High incidence and prevalence of rheumatoid arthritis in Pima Indians. Am J Epidemiol . 1989;129(6):1170-1178. |
| 9773. | Symmons D, Turner G, Webb R, et al. The prevalence of rheumatoid arthritis in the United Kingdom: new estimates for a new century. Rheumatology (Oxford). 2002;41(7):793-800. |
| 9790. | Sangha O. Epidemiology of rheumatic diseases. Rheumatology (Oxford). 2000;39(suppl 2):3-12. |
| 10101. | Riise T, Jacobsen BK, Gran JT. Incidence and prevalence of rheumatoid arthritis in the county of Troms, northern Norway. J Rheumatol. 2000;27(6):1386-1389. |
| 10123. | Mikkelsen WM, Dodge HJ, Duff IF, Kato H. Estimates of the prevalence of rheumatic diseases in the population of Tecumseh, Michigan, 1959-60. J Chronic Dis. 1967;20(6):351-369. |
| 10127. | Guillemin F, Saraux A, Guggenbuhl P, et al. Prevalence of rheumatoid arthritis in France: 2001. Ann Rheum Dis. 2005;64(10):1427-1430. |
| 10134. | Stenger AA, Van Leeuwen MA, Houtman PM, et al. Early effective suppression of inflammation in rheumatoid arthritis reduces radiographic progression. Br J Rheumatol. 1998;37(11):1157-1163. |
| 10135. | Doran MF, Pond GR, Crowson CS, O’Fallon WM, Gabriel SE. Trends in incidence and mortality in rheumatoid arthritis in Rochester, Minnesota, over a forty-year period. Arthritis Rheum. 2002;46(3):625-631. |
| 10204. | Akar S, Birlik M, Gurler O, et al. The prevalence of rheumatoid arthritis in an urban population of Izmir-Turkey. Clin Exp Rheumatol. 2004;22(4):416-420. |
| 10207. | Minh Hoa TT, Darmawan J, Chen SL, Van Hung N, Thi Nhi C, Ngoc An T. Prevalence of the rheumatic diseases in urban Vietnam: A WHO-ILAR COPCORD study. J Rheumatol. 2003;30(10):2252-2256. |
| 10220. | Darmawan J, Muirden KD, Valkenburg HA, Wigley RD. The epidemiology of rheumatoid arthritis in Indonesia. Br J Rheumatol. 1993;32(7):537-540. |
| 10280. | Arnett FC, Edworthy SM, Bloch DA, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. 1988;31(3):315-324. |
| 10375. | Moolenburgh JD, Valkenburg HA, Fourie PB. A population study on rheumatoid arthritis in Lesotho, southern Africa. Ann Rheum Dis. 1986;45(8):691-695. |
| 10525. | Lau E, Symmons D, Bankhead C, MacGregor A, Donnan S, Silman A. Low prevalence of rheumatoid arthritis in the urbanized Chinese of Hong Kong. J Rheumatol. 1993;20(7):1133-1137. |
| 10554. | Hochberg MC. Changes in the incidence and prevalence of rheumatoid arthritis in England and Wales, 1970-1982. Semin Arthritis Rheum. 1990;19(5):294-302. |
| 10556. | Symmons DP, Barrett EM, Bankhead CR, Scott DG, Silman AJ. The incidence of rheumatoid arthritis in the United Kingdom: results from the Norfolk Arthritis Register. Br J Rheumatol. 1994;33(8):735-739. |
| 10571. | Cimmino MA, Parisi M, Moggiana G, Mela GS, Accardo S. Prevalence of rheumatoid arthritis in Italy: the Chiavari Study. Ann Rheum Dis. 1998;57(5):315-318. |
| 10606. | Pountain G. The prevalence of rheumatoid arthritis in the Sultanate of Oman. Br J Rheumatol. 1991;30(1):24-28. |
| 10620. | Carmona L, Villaverde V, Hernández-García C, Ballina J, Gabriel R, Laffon A. The prevalence of rheumatoid arthritis in the general population of Spain. Rheumatology (Oxford). 2002;41(1):88-95. |
| 10648. | Senna ER, De Barros AL, Silva EO, et al. Prevalence of rheumatic diseases in Brazil: a study using the COPCORD approach. J Rheumatol. 2004;31(3):594-597. |
| 10657. | Kvien TK. Epidemiology and burden of illness of rheumatoid arthritis, Vol II. Pharmacoeconomics. 2004;22(suppl 1):1-12. |
| 10736. | Andrianakos A, Trontzas P, Christoyannis F, et al. Prevalence of rheumatic diseases in Greece: a cross-sectional population based epidemiological study. The ESORDIG Study. J Rheumatol. 2003;30(7):1589-1601. |
| 10783. | Simonsson M, Bergman S, Jacobsson LT, Petersson IF, Svensson B. The prevalence of rheumatoid arthritis in Sweden. Scand J Rheumatol. 1999;28(6):340-343. |
| 10787. | Saraux A, Guedes C, Allain J, et al. Prevalence of rheumatoid arthritis and spondyloarthropathy in Brittany, France. Société de Rhumatologie de l’Ouest. J Rheumatol. 1999;26(12):2622-2627. |
| 10810. | Spindler A, Bellomio V, Berman A, et al. Prevalence of rheumatoid arthritis in Tucumán, Argentina. J Rheumatol. 2002;29(6):1166-1170. |
| 10856. | Plant MJ, Jones PW, Saklatvala J, Ollier WE, Dawes PT. Patterns of radiological progression in early rheumatoid arthritis: results of an 8 year prospective study. J Rheumatol . 1998;25(3):417-426. |
| 10861. | Silman AJ, Ollier W, Holligan S, et al. Absence of rheumatoid arthritis in a rural Nigerian population. J Rheumatol. 1993;20(4):618-622. |
| 10866. | Kiss CG, Lövei C, Sütö G, et al. Prevalence of rheumatoid arthritis in the South-Transdanubian region of Hungary based on a representative survey of 10,000 inhabitants. J Rheumatol. 2005;32(9):1688-1690. |
| 10878. | Brighton SW, de la Harpe AL, van Staden DJ, Badenhorst JH, Myers OL. The prevalence of rheumatoid arthritis in a rural African population. J Rheumatol . 1988;15(3):405-408. |
| 10929. | Buckwalter JA, Lappin DR. The disproportionate impact of chronic arthralgia and arthritis among women. Clin Orthop Relat Res. 2000;(372):159-168. |
| 10952. | Shichikawa K, Inoue K, Hirota S, et al. Changes in the incidence and prevalence of rheumatoid arthritis in Kamitonda, Wakayama, Japan, 1965-1996. Ann Rheum Dis. 1999;58(12):751-756. |
| 11042. | Gabriel SE, Crowson CS, O’Fallon WM. The epidemiology of rheumatoid arthritis in Rochester, Minnesota, 1955-1985. Arthritis Rheum. 1999;42(3):415-420. |
| 11074. | Aho K, Kaipiainen-Seppänen O, Heliövaara M, Klaukka T. Epidemiology of rheumatoid arthritis in Finland. Semin Arthritis Rheum. 1998 Apr;27(5):325-334. |
| 11090. | Ropes MW, Bennett GA, Cobb S, Jacox R, Jessar RA. 1958 Revision of diagnostic criteria for rheumatoid arthritis. Bull Rheum Dis. 1958;9(4):175-176. |
| 11094. | Söderlin MK, Börjesson O, Kautiainen H, Skogh T, Leirisalo-Repo M. Annual incidence of inflammatory joint diseases in a population based study in southern Sweden. Ann Rheum Dis. 2002;61(10):911-915. |
| 11097. | Linos A, Worthington JW, O’Fallon WM, Kurland LT. The epidemiology of rheumatoid arthritis in Rochester, Minnesota: a study of incidence, prevalence, and mortality. Am J Epidemiol. 1980;111(1):87-98. |
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