Nationwide prevalence of rheumatoid arthritis and penetration of disease-modifying drugs in Sweden
- 1Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- 2Rheumatology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Correspondence to Dr Martin Neovius, Clinical Epidemiology Unit (T2), Department of Medicine (Solna), Karolinska Institutet, SE-171 76 Stockholm, Sweden;
Contributing rheumatologists Yngve Adolfsson, Sunderby Hospital, Luleå; Ewa Berglin, Norrland's University Hospital, Umeå; Torgny Smedby, Östersund County Hospital; Rüdi Götze, Sundsvall County Hospital; Anna-Carin Holmqvist, Hudiksvall's Hospital; Sven Tegmark, Gävle County Hospital; Jörgen Lysholm, Falu Lasarett, Falun; Solveig Gustafsson, Karlstad's Central Hospital; Eva Baecklund, Akademiska Hospital, Uppsala; Rolf Oding, Västerås Hospital; Per Salomonsson, University Hospital, Örebro; Birgitta Nordmark, Karolinska University Hospital, Solna; Ingiäld Hafström, Karolinska University Hospital, Huddinge; Göran Lindahl, Danderyd's Hospital, Stockholm; Gun Sandahl, Queen Sophia Hospital, Stockholm; Martin Mousa, Visby lasarett, Visby; Anders Lindblad, Visby Privat, Visby; Åke Thörner, Mälarsjukhuset, Eskilstuna; Lars Cöster, University Hospital, Linköping; Sören Transö, County Hospital Ryhov, Jönköping; Olle Svernell, Västervik's Hospital; Claudia Jacobs, Oskarshamn's Hospital; Bengt Lindell, Kalmar County Hospital; Maria Söderlin, Växjö's Central Hospital; Olof Börjesson, Växjö Privat; Göran Kvist, Centrallasarettet Borås; Karin Svensson, Kärnsjukhuset, Skövde; Tomas Torstenson, Uddevalla Hospital; Ingeli Andreasson, Göteborg privat; Lennart Bertilsson, Sahlgrenska University Hospital, Gothenburg; Tore Saxne, University Hospital in Lund; Miriam Karlsson, Lasarettet Trelleborg; Annika Teleman, Spenshult, Oskarström; Catharina Keller, Helsingborg's Lasarett; Astrid Schröder, Ängelholm's Hospital; Jan Theander, Kristianstad's Central Hospital; Christina Book, MAS University Hospital, Malmö.
- Accepted 1 November 2010
- Published Online First 13 December 2010
Objective To provide Swedish nationwide data on the prevalence of rheumatoid arthritis (RA), including variations by age, sex, geography, demography and education level, and assess antirheumatic treatment penetration.
Methods Patients ≥16 years assigned an RA diagnosis were identified from inpatient (n=96 560; 1964–2007) and specialist outpatient care (n=56 336; 2001–2007) in the Swedish National Patient Register, and the Swedish Rheumatology Quality Register (n=21 242; 1995–2007). Data on prescriptions, demography, vital status and educational level were retrieved from national registers.
Results A total of 58 102 individuals (mean age 66 years; 73% women) assigned an RA diagnosis were alive in Sweden in 2008, corresponding to a cumulative prevalence of 0.77% (women 1.11%, men 0.43%). The 2001–2007 period prevalence was 0.70%. Restriction to patients with ≥2 visits or diagnosis from a rheumatologist/internist reduced the overall cumulative prevalence to 0.68%. Whereas urban/rural differences (crude 0.65–1.00%) were explained by age differences, the age/sex-adjusted prevalence remained higher in patients with ≤9 years education (0.86%) than for those with 10–12 years (0.82%) and >12 years (0.65%). Treatment exposures (76% any disease-modifying antirheumatic drugs (DMARDs) or steroids, 64% any DMARD, 15% biological agents) varied with age; use of biological agents decreased from 22% in 16–59 years olds to 3% in ≥80 years olds. Any DMARD use correspondingly decreased from 71% to 43%. Applying age cut-off points from previous northern European and North American prevalence studies reduced or eliminated between-study differences.
Conclusion This nationwide approach yielded a prevalence of RA similar to previous regional assessments. While displaying only modest geographical variation and no urban/rural gradient, prevalence was associated with educational level. Although most patients received antirheumatic drugs, age was a strong treatment determinant.
The ARTIS study group (in alphabetical order) E Baecklund, L Coster, C Dackhammar, N Feltelius, P Geborek, L Jacobsson, L Klareskog, S Lindblad, S Rantapaa-Dahlqvist, T Saxne and R van Vollenhoven.
Funding For the maintenance of the register, the Swedish Society for Rheumatology has received funding, independent of the conduct of these scientific analyses, from Schering-Plough, BMS, Wyeth, Abbott Laboratories and Roche.
Competing interests The ARTIS Study Group conducts scientific analyses using data from the Swedish Biologics Register ARTIS run by the Swedish Society for Rheumatology.
Ethics approval This study was conducted with the approval of the Regional Ethics Committee, Karolinska Institutet, Stockholm, Sweden.
Provenance and peer review Not commissioned; externally peer reviewed.