The prevalence of rheumatoid arthritis in Spain

Abstract

Rheumatoid arthritis (RA) prevalence is believed to be around 1% worldwide, although it varies considerably among different populations. The aim of EPISER2016 study was to estimate the prevalence of RA in the general adult population in Spain. We designed a population-based cross-sectional study. A national survey was conducted between November 2016 and October 2017 involving a probabilistic sample from the general population aged 20 years or older. Subjects were randomly selected for phone screening using a computer-assisted telephone interviewer system. Positive RA screening results were evaluated by a rheumatologist. Cases fulfilled the 1987 ACR and/or the 2010 ACR/EULAR criteria; previous diagnosis established by a rheumatologist and clearly identified in medical records were also accepted regardless of the criteria used. Prevalence estimates with 95% CI were calculated taking into account the design of the sample (weighting based on age, sex, and geographic origin using as a reference the distribution of the population in Spain). 4916 subjects participated in the study and 39 RA cases were confirmed. RA estimated prevalence was 0.82% (95% CI 0.59-1.15). Mean age of RA cases was 60.48 (14.85) years, they were more frequently women (61.5%), from urban areas (74.4%), non-smokers (43.6%), and with a high body mass index (53.8% with overweight). Extrapolating to the population in Spain (approximately 37 million are ≥ 20 years old), it was estimated that there were between 220,000 and 430,000 people aged 20 years or older with RA. No undiagnosed cases were detected, which could be related to the establishment of early arthritis clinics around the country, increasing the rates of diagnosis during early phases of RA.

Figure 1

Symptom-based screening flowchart in EPISER2016 for individuals not previously diagnosed with Rheumatoid Arthritis. RA rheumatoid arthritis. ¹Subject was questioned about pain with swelling that lasted more than 4 consecutive weeks in a row without any fall, blow or trauma, particularly in the hands, hips/groins, knees, ankles and feet, specifying if location was on the left side, right side or both. ²These questions were referred only to the areas previously referred to as painful. ³In the case of an affirmative answer, there was an additional question consulting if duration was greater than 30 min. ⁴Considered suggestive of RA: an affirmative answer to pain improvement with activity, plus a negative answer to improvement with rest.