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. 2015 Jun;5(1):010409.
doi: 10.7189/jogh.05.010409.

Prevalence of rheumatoid arthritis in low- and middle-income countries: A systematic review and analysis

Igor Rudan  1 , Simrita Sidhu  1 , Angeliki Papana  2 , Shi-Jiao Meng  3 , Yu Xin-Wei  3 , Wei Wang  4 , Ruth M Campbell-Page  5 , Alessandro Rhyll Demaio  6 , Harish Nair  7 , Devi Sridhar  7 , Evropi Theodoratou  7 , Ben Dowman  7 , Davies Adeloye  7 , Azeem Majeed  8 , Josip Car  9 , Harry Campbell  7 , Wei Wang  10 , Kit Yee Chan  11 ; Global Health Epidemiology Reference Group (GHERG)
Affiliations

Prevalence of rheumatoid arthritis in low- and middle-income countries: A systematic review and analysis

Igor Rudan et al. J Glob Health. 2015 Jun.

Abstract

Background: Rheumatoid arthritis (RA) is an autoimmune disorder that affects the small joints of the body. It is one of the leading causes of chronic morbidity in high-income countries, but little is known about the burden of this disease in low- and middle-income countries (LMIC).

Methods: The aim of this study was to estimate the prevalence of RA in six of the World Health Organization's (WHO) regions that harbour LMIC by identifying all relevant studies in those regions. To accomplish this aim various bibliographic databases were searched: PubMed, EMBASE, Global Health, LILACS and the Chinese databases CNKI and WanFang. Studies were selected based on pre-defined inclusion criteria, including a definition of RA based on the 1987 revision of the American College of Rheumatology (ACR) definition.

Results: Meta-estimates of regional RA prevalence rates for countries of low or middle income were 0.40% (95% CI: 0.23-0.57%) for Southeast Asian, 0.37% (95% CI: 0.23-0.51%) for Eastern Mediterranean, 0.62% (95% CI: 0.47-0.77%) for European, 1.25% (95% CI: 0.64-1.86%) for American and 0.42% (95% CI: 0.30-0.53%) for Western Pacific regions. A formal meta-analysis could not be performed for the sub-Saharan African region due to limited data. Male prevalence of RA in LMIC was 0.16% (95% CI: 0.11-0.20%) while the prevalence in women reached 0.75% (95% CI: 0.60-0.90%). This difference between males and females was statistically significant (P < 0.0001). The prevalence of RA did not differ significantly between urban and rural settings (P = 0.353). These prevalence estimates represent 2.60 (95% CI: 1.85-3.34%) million male sufferers and 12.21 (95% CI: 9.78-14.67%) million female sufferers in LMIC in the year 2000, and 3.16 (95% CI: 2.25-4.05%) million affected males and 14.87 (95% CI: 11.91-17.86%) million affected females in LMIC in the year 2010.

Conclusion: Given that majority of the world's population resides in LMIC, the number of affected people is substantial, with a projection to increase in the coming years. Therefore, policy makers and health-care providers need to plan to address a significant disease burden both socially and economically.

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Figures

Figure 1
Figure 1
Flowchart presenting the literature search and the process of study selection (WoK = Web of Knowledge; G.H. = global health).
Figure 2
Figure 2
The relationship between mean and median prevalence of rheumatoid arthritis in low and middle–income countries in six WHO regions of the world.
Figure 3
Figure 3
Regional median, minimum and maximum observed value and inter–quartile range for the prevalence of rheumatoid arthritis in low and middle–income countries in six WHO regions of the world.
Figure 4
Figure 4
Meta–analysis of rheumatoid arthritis prevalence in men, based on all available information from low and middle–income countries in six WHO regions of the world.
Figure 5
Figure 5
Meta–analysis of rheumatoid arthritis prevalence in women, based on all available information from low and middle–income countries in six WHO regions of the world.
Figure 6
Figure 6
A scatterplot of observed prevalence rates of rheumatoid arthritis in six WHO regions based on urban or rural residency of the examinees. No statistical differences were noted (see Online Supplementary Document(Online Supplementary Document) for further detail).
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