Incidence and Prevalence of Rheumatoid Arthritis, Based on the 1987 American College of Rheumatology Criteria: A Systematic Review

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Objectives

To conduct a systematic review of incidence and prevalence studies of rheumatoid arthritis (RA), based on the 1987 revised American College of Rheumatology (ACR) criteria, to compare their methodologies and summarize their results, and to investigate the possible geographic variations and changes over time in the frequency of the disease.

Methods

We conducted a Medline search between January 1988 and December 2005. Studies reporting the incidence and prevalence of RA in adult populations (16 to 20 years and over), based on 1987 ACR criteria, were eligible for inclusion. From each study included, we extracted the country, year of publication, type of study (retrospective, prospective, or cross-sectional), and incidence or prevalence rates. The study areas were grouped into (a) North American countries; (b) north European countries; (c) south European countries; and (d) developing countries. We examined the geographical differences of prevalence and incidence rates using the Mann–Whitney and the Kruskall–Wallis tests.

Results

A total of 28 studies were identified meeting the inclusion criteria. Nine were incidence studies, 17 were prevalence studies, and 2 estimated both prevalence and incidence rates. Incidence studies were not available from developing countries. There is a significant difference of prevalence estimates between northern European and American countries and developing countries. South European countries have lower median incidence rates than North American and north European countries. As concerning the time trends of RA occurrence, only 3 incidence studies provided secular data from the same study area, based on ACR criteria, using the same methods of case ascertainment. Two of these studies indicate a decreasing incidence of RA in Finland and United States of America.

Conclusions

The occurrence of RA varies among countries and areas of the world. A decreasing trend has been observed in countries characterized by high rates of RA incidence and prevalence. However, the relatively small number of studies for most areas of the world and the lack of incidence studies for the developing countries limits the understanding of worldwide RA epidemiology.

Section snippets

Methods

We conducted a Medline search from January 1988 to December 2005 (key words: RA AND incidence and prevalence). The search strategy is presented in Table 1. Additional relevant articles were identified using the option “related articles” in the Medline database, for the articles meeting the inclusion criteria. Articles published before 1987 were not considered, as we included only studies based on the 1987 ACR revised criteria. Studies published in any language and reporting the incidence and

Results

Twenty-eight studies were identified from the literature search meeting our inclusion criteria. Nine were incidence studies; 17 were prevalence studies, and 2 estimated both prevalence and incidence rates. All studies that finally met the inclusion criteria were English publications, although there were 2 French and 1 German publication resulting from the initial search. Table 1 summarizes the results of the Medline search (7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25

Discussion

According to the results of this systematic review, the incidence and prevalence studies of RA based on 1987 ACR criteria differ considerably in their methods and result in a wide variation of the incidence and prevalence estimates.

Methodological differences include the methods of case identification and case recording, as well as the type of incidence and prevalence rates. Some studies do not present age-adjusted rates. In addition, adjusting methods for age differ among studies or are not

References (46)

  • S.E. Gabriel

    The epidemiology of rheumatoid arthritis

    Rheum Dis Clin North Am

    (2001)
  • Y. Alamanos et al.

    Epidemiology of adult rheumatoid arthritis

    Autoimmun Rev

    (2005)
  • J.P. Ioannidis et al.

    Shared epitopes and rheumatoid arthritis: disease associations in Greece and meta-analysis of Mediterranean European populations

    Semin Arhtritis Rheum

    (2002)
  • A.J. Silman et al.

    Epidemiology and genetics of rheumatoid arthritis

    Arthritis Res

    (2002)
  • A.J. Silman

    Trends in the incidence and severity of rheumatoid arthritis

    J Rheumatol

    (1992)
  • F.C. Arnett et al.

    The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis

    Arthritis Rheum

    (1988)
  • M.W. Ropes et al.

    1958 Revision of diagnostic criteria for rheumatoid arthritis

    Bull Rheum Dis

    (1958)
  • S.E. Gabriel et al.

    The epidemiology of rheumatoid arthritis in Rochester, Minnesota, 1955-1985

    Arthritis Rheum

    (1999)
  • K.W. Chan et al.

    Incidence of rheumatoid arthritis in central Massachusetts

    Arthritis Rheum

    (1993)
  • M.F. Doran et al.

    Trends in incidence and mortality in rheumatoid arthritis in Rochester, Minnesota, over a forty-year period

    Arthritis Rheum

    (2002)
  • T. Riise et al.

    Incidence and prevalence of rheumatoid arthritis in the county of Troms, northern Norway

    J Rheumatol

    (2000)
  • T.K. Kvien et al.

    The prevalence and severity of rheumatoid arthritis in OsloResults from a county register and a population survey

    Scand J Rheumatol

    (1997)
  • T. Uhlig et al.

    The incidence and severity of rheumatoid arthritis, results from a county register in Oslo, Norway

    J Rheumatol

    (1998)
  • D. Symmons et al.

    The prevalence of rheumatoid arthritis in the United Kingdom: new estimates for a new century

    Rheumatology

    (2002)
  • D.P. Symmons et al.

    The incidence of rheumatoid arthritis in the United Kingdom: results of the Norfolk Arthritis Register

    Br J Rheumatol

    (1994)
  • D. Power et al.

    Prevalence of rheumatoid arthritis in Dublin, Ireland: a population based survey

    Ir J Med Sci

    (1999)
  • M.K. Soderlin et al.

    Annual incidence of inflammatory joint diseases in a population based study in southern Sweden

    Ann Rheum Dis

    (2002)
  • M. Simonsson et al.

    The prevalence of rheumatoid arthritis in Sweden

    Scan J Rheumatol

    (1999)
  • M. Hakala et al.

    The ARA 1987 revised criteria select patients with clinical rheumatoid arthritis from a population based cohort of subjects with chronic rheumatic diseases registered for drug reimbursement

    J Rheumatol

    (1993)
  • O. Kaipiainen-Seppanen et al.

    Incidence of chronic inflammatory joint diseases in Finland in 1995

    J Rheumatol

    (2000)
  • E. Savolainen et al.

    Total incidence and distribution of inflammatory joint diseases in a defined population: results from the Kuopio 2000 arthritis survey

    J Rheumatol

    (2003)
  • O. Kaipiainen-Seppanen et al.

    Regional differences in the incidence of rheumatoid arthritis in Finland in 1995

    Ann Rheum Dis

    (2001)
  • L. Carmona et al.

    The prevalence of rheumatoid arthritis in the general population of Spain

    Rheumatology

    (2002)
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