Rheumatoid Arthritis On The Rise Worldwide

[Sly Saint]

A new AI-powered study reveals that cases of rheumatoid arthritis (RA) are on the rise worldwide.

The autoimmune disease affected 17.9 million people in 2021, a 13% increase since 1990, according to researchers.

And while people older than 55 have the highest rates of RA, the age of onset has been trending downward since 2015 – with an increasing proportion of patients aged 20 to 54.
Rheumatoid arthritis occurs when a person’s immune system attacks tissue lining their joints causing inflammation, pain, stiffness and potential damage.

For the study, researchers analyzed rheumatoid arthritis data from 953 locations between 1980 and 2021. They used an AI program to look at global rates, the number of years people suffer from disability and mortality trends.

The death rate for RA fell more than 32% between 1980 and 2021, according to the results. But the number of years patients lived with disability or lost due to early death nearly doubled between 1990 and 2021.

The researchers predict rheumatoid arthritis will continue to increase unless steps are taken to prevent it or treat existing cases.

They say these results emphasize “the need for dietary adjustments, accessible medical policies, and innovative treatments such as cell therapy,” Higher case rates of rheumatoid arthritis were seen in Western Europe and North America, and lower rates in Africa. Only Japan showed a decline.

Source paper: Annals of the Rheumatic Diseases

 

[forestglip]

Spatiotemporal distributions and regional disparities of rheumatoid arthritis in 953 global to local locations, 1980-2040, with deep learning-empowered forecasts and evaluation of interventional policies’ benefits

Wenyi Jin, Qian Wang, Cheng Jin, Mingyang Xue, Liming Pan, You Zeng, Yubiao Zhang, Fei Li, Claire Chenwen Zhong, Yutong Lu, Dong Wang, Yuanyuan Wan, Ningning Wu, Pengpeng Ye, Xintao Zhang, Baozhen Huang, Queran Lin

[Line breaks added]

Objectives
To investigate global to local socioeconomic-driven distributions and inequalities in burdens of rheumatoid arthritis (RA) and to forecast long-term burdens.

Methods
We analysed the prevalence, incidence, mortality, disability-adjusted life years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs) of RA across 953 locations worldwide, as well as their inequalities and ideal frontiers. A deep-learning pipeline was developed to forecast long-term burdens with scenario simulations.

Results
In 2021, RA affected 17.9 million people globally, with a 13.2% increase in incidence rate from 1990-2021, trending younger and broader. The age-standardised death rate fell 32.7% from 1980 to 2021, but global DALYs nearly doubled from 1990 to 2021.

In 2021, among 652 subnational regions, West Berkshire in the UK had the highest age-standardised incidence rate (35.1; 95% uncertainty interval [UI]: 30.8-39.8). Zacatecas in Mexico had the highest age-standardised DALY rate (112.6; 95% UI: 87.2-142.7).

Regions with a high sociodemographic index (SDI) bore the heaviest burden, with regional inequalities aggravating from 1990 to 2021. Over 90% of areas lagged in RA frontiers of multiple indicators.

Japan uniquely showed declining trends (1990-2021), exemplified by Tokyo’s age-standardised DALY rate dropping by 22.4% since 1990, unlike that in other high SDI regions.

Implementing smoking control policies is forecasted to reduce RA-related deaths by 16.8% and DALYs by 20.6% among male patients in high-smoking regions like China.

Conclusions
Demographic changes and uneven health infrastructure exacerbated RA burdens and disparities worldwide, with high SDI areas hardest hit while low SDI regions saw increases. Trend analysis empowered targeted policies such as localised smoking control to address these inequities.

Link | PDF (Annals of the Rheumatic Diseases) [Open Access]

 

[Jonathan Edwards]

In 2021, among 652 subnational regions, West Berkshire in the UK had the highest age-standardised incidence rate (35.1; 95% uncertainty interval [UI]: 30.8-39.8). Zacatecas in Mexico had the highest age-standardised DALY rate (112.6; 95% UI: 87.2-142.7).

So presumably it all depends on how likely it is to be picked up. West Berkshire is where Taplow Hospital was - where UK rheumatology all started.

 

[forestglip]

Among 204 countries and territories, Ireland had the highest age-standardised incidence rate at 35.1 (95% UI: 31.8-38.8) in 2021 with an increase of 22.5% (95% UI: 15.2-29.9%) compared with 1990.

Oman displayed the fastest growth in age-standardised incidence rate in the past 31 years, with an increase of 78.6% (95% UI: 68.2-89.9%).

RA incidence was highest among those over 55 globally. However, after 2015, the age of onset of RA showed a trend towards younger age groups, with an increasing proportion of patients aged 20 to 54, especially in high SDI areas.

Regional variations existed, such as a bimodal pattern in Latin America (Appendix 2). In Latin America, the onset age of RA presents a bimodal pattern, with ages above 70 and between 30 and 60 years old (Fig 1B, Appendix 2). For example, in most subregions of Mexico, especially Chiapas, Hidalgo, and Mexico City, the age distribution of female RA patients showed a bimodal distribution (Appendix 2).

During the past 31 years, the incidence rate of RA in Tokyo continually decreased, especially among elderly women. The incidence rate of RA in Greater London continued to increase.

The overall positive correlation between SDI and RA burden aligns with prior studies [23,28], while the striking subnational inequalities (eg, high SDI regions such as the UK and Japan) highlight limitations in relying solely on economic metrics to predict disease patterns. For example, Japan’s declining DALY rates despite high SDI may reflect nationwide early diagnosis programmes and widespread use of biologic therapies [31]. Clinical trials have shown that Japanese RA patients have a higher response rate to certain biologics, including infliximab, etanercept, and tocilizumab, than patients receiving the same drug treatment in Western countries [32]. The dietary habits in Japan are rich in anti-inflammatory components, as evidenced by regional health surveys of anti-inflammatory diets [33,34].

 

[forestglip]

So presumably it all depends on how likely it is to be picked up. West Berkshire is where Taplow Hospital was - where UK rheumatology all started.

Yeah, I assume a lot of this data is just showing where there is improved diagnosis. But the opposite trend in Japan might point to them doing something right.

 

[Jonathan Edwards]

Yeah, I assume a lot of this data is just showing where there is improved diagnosis. But the opposite trend in Japan might point to them doing something right.

Maybe more often correctly diagnosing an arthritis as not RA but psoriatic or reactive?
They might have controlled smoking more effectively than other countries though.

 

[Utsikt]

Maybe more often correctly diagnosing an arthritis as not RA but psoriatic or reactive?
They might have controlled smoking more effectively than other countries though.

Wikipedia has smoking in Japan at 14.8 % of adults, compared to 12.9 % in the UK.

EU rates:

Spoiler: EU smoking rates

 

[forestglip]

Wikipedia has smoking in Japan at 14.8 % of adults, compared to 12.9 % in the UK.

Also to consider how much rates changed over time, it looks like they were both at around 30% in 1990 from charts on Wikipedia. So Japan had less of a decrease in smoking over time.

Japan, United Kingdom

 

[Sly Saint]

West Berkshire is where Taplow Hospital was

Buckinghamshire. AKA Canadian Red Cross Memorial Hospital (I was born there).

 

[Jonathan Edwards]

Buckinghamshire. AKA Canadian Red Cross Memorial Hospital (I was born there).

May well be but barely a stone's throw from Slough.