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Global, regional and national burden of rheumatoid arthritis 1990–2017: a systematic analysis of the Global Burden of Disease study 2017
  1. Saeid Safiri1,2,
  2. Ali Asghar Kolahi3,
  3. Damian Hoy4,
  4. Emma Smith5,6,
  5. Deepti Bettampadi7,
  6. Mohammad Ali Mansournia2,
  7. Amir Almasi-Hashiani8,
  8. Ahad Ashrafi-Asgarabad9,
  9. Maziar Moradi-Lakeh10,
  10. Mostafa Qorbani11,
  11. Gary Collins12,
  12. Anthony D Woolf13,
  13. Lyn March5,
  14. Marita Cross5
  1. 1 Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
  2. 2 Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
  3. 3 Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  4. 4 School of Population Health, University of Queensland, Herston, Queensland, Australia
  5. 5 Institute of Bone and Joint Research, Faculty of Medicine and Health, University of Sydney, St Leonards, New South Wales, Australia
  6. 6 Pain Management Research Institute, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
  7. 7 Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
  8. 8 Department of Epidemiology, School of Health, Arak University of Medical Sciences, Arak, Iran
  9. 9 Department of Epidemiology, School of Health, Bam University of Medical Sciences, Bam, Iran
  10. 10 Preventive Medicine and Public Health Research Center, Iran University of Medical Sciences, Tehran, Iran
  11. 11 Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
  12. 12 Centre for Statistics in Medicine, NDORMS, Botnar Research Centre, University of Oxford, Oxford, UK
  13. 13 Bone and Joint Research Group, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall, UK
  1. Correspondence to Dr Marita Cross, Institute of Bone and Joint Research, University of Sydney, St Leonards, NSW 2077, Australia; marita.cross{at}


Objectives To provide the level and trends of prevalence, incidence and disability adjusted life years (DALYs) for rheumatoid arthritis (RA) in 195 countries from 1990 to 2017 by age, sex, Socio-demographic Index (SDI; a composite of sociodemographic factors) and Healthcare Access and Quality (an indicator of health system performance) Index.

Methods Data from the Global Burden of Diseases, Injuries, and Risk Factors study (GBD) 2017 were used. GBD 2017 modelled the burden of RA for 195 countries from 1990 to 2017, through a systematic analysis of mortality and morbidity data to estimate prevalence, incidence and DALYs. All estimates were presented as counts and age-standardised rates per 100 000 population, with uncertainty intervals (UIs).

Results Globally, the age-standardised point prevalence and annual incidence rates of RA were 246.6 (95% UI 222.4 to 270.8) and 14.9 (95% UI 13.3 to 16.4) in 2017, which increased by 7.4% (95% UI 5.3 to 9.4) and 8.2% (95% UI 5.9 to 10.5) from 1990, respectively. However, the age-standardised rate of RA DALYs per 100 000 population was 43.3 (95% UI 33.0 to 54.5) in 2017, which was a 3.6% (95% UI −9.7 to 0.3) decrease from the 1990 rate. The age-standardised prevalence and DALY rates increased with age and were higher in females; the rates peaked at 70–74 and 75–79 age groups for females and males, respectively. A non-linear association was found between age-standardised DALY rate and SDI. The global age-standardised DALY rate decreased from 1990 to 2012 but then increased and reached higher than expected levels in the following 5 years to 2017. The UK had the highest age-standardised prevalence rate (471.8 (95% UI 428.9 to 514.9)) and age-standardised incidence rate (27.5 (95% UI 24.7 to 30.0)) in 2017. Canada, Paraguay and Guatemala showed the largest increases in age-standardised prevalence rates (54.7% (95% UI 49.2 to 59.7), 41.8% (95% UI 35.0 to 48.6) and 37.0% (95% UI 30.9 to 43.9), respectively) and age-standardised incidence rates (48.2% (95% UI 41.5 to 55.1), 43.6% (95% UI 36.6 to 50.7) and 36.8% (95% UI 30.4 to 44.3), respectively) between 1990 and 2017.

Conclusions RA is a major global public health challenge. The age-standardised prevalence and incidence rates are increasing, especially in countries such as Canada, Paraguay and Guatemala. Early identification and treatment of RA is vital especially among females, in order to reduce the ongoing burden of this condition. The quality of health data needs to be improved for better monitoring of disease burden.

  • rheumatoid arthritis
  • epidemiology
  • health services research

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  • Handling editor Josef S Smolen

  • Correction notice This article has been corrected since it published Online First. The first and tenth affiliations have been updated.

  • Contributors SS, AAK, LM and MC designed the study. SS, AAK, MAM, AA-H, AA-A and MQ analysed the data and performed the statistical analyses. SS, AAK, DB and MC drafted the initial manuscript. All authors reviewed the drafted manuscript for critical content. All authors approved the final version of the manuscript.

  • Funding The GBD study is funded by Bill and Melinda Gates Foundation, however these were not involved in any way in the preparation of this manuscript. The present report was also supported by Social Determinants of Health Research Center, Shahid Beheshti University of Medical sciences, Tehran, Iran (No. 19406).

  • Disclaimer This study is based on publicly available data and solely reflects the opinion of its authors and not that of the Institute for Health Metrics and Evaluation.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study was approved by Ethics Committee of Shahid Beheshti University of Medical Sciences, Tehran, Iran (IR.SBMU.RETECH.REC.1398.161).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available in a public, open access repository.