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. 2023 Sep 25;5(10):e594-e610.
doi: 10.1016/S2665-9913(23)00211-4. eCollection 2023 Oct.

Global, regional, and national burden of rheumatoid arthritis, 1990-2020, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021

GBD 2021 Rheumatoid Arthritis Collaborators
Collaborators

Global, regional, and national burden of rheumatoid arthritis, 1990-2020, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021

GBD 2021 Rheumatoid Arthritis Collaborators. Lancet Rheumatol. .

Abstract

Background: Rheumatoid arthritis is a chronic autoimmune inflammatory disease associated with disability and premature death. Up-to-date estimates of the burden of rheumatoid arthritis are required for health-care planning, resource allocation, and prevention. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, we provide updated estimates of the prevalence of rheumatoid arthritis and its associated deaths and disability-adjusted life-years (DALYs) by age, sex, year, and location, with forecasted prevalence to 2050.

Methods: Rheumatoid arthritis prevalence was estimated in 204 countries and territories from 1990 to 2020 using Bayesian meta-regression models and data from population-based studies and medical claims data (98 prevalence and 25 incidence studies). Mortality was estimated from vital registration data with the Cause of Death Ensemble model (CODEm). Years of life lost (YLL) were calculated with use of standard GBD lifetables, and years lived with disability (YLDs) were estimated from prevalence, a meta-analysed distribution of rheumatoid arthritis severity, and disability weights. DALYs were calculated by summing YLLs and YLDs. Smoking was the only risk factor analysed. Rheumatoid arthritis prevalence was forecast to 2050 by logistic regression with Socio-Demographic Index as a predictor, then multiplying by projected population estimates.

Findings: In 2020, an estimated 17·6 million (95% uncertainty interval 15·8-20·3) people had rheumatoid arthritis worldwide. The age-standardised global prevalence rate was 208·8 cases (186·8-241·1) per 100 000 population, representing a 14·1% (12·7-15·4) increase since 1990. Prevalence was higher in females (age-standardised female-to-male prevalence ratio 2·45 [2·40-2·47]). The age-standardised death rate was 0·47 (0·41-0·54) per 100 000 population (38 300 global deaths [33 500-44 000]), a 23·8% (17·5-29·3) decrease from 1990 to 2020. The 2020 DALY count was 3 060 000 (2 320 000-3 860 000), with an age-standardised DALY rate of 36·4 (27·6-45·9) per 100 000 population. YLDs accounted for 76·4% (68·3-81·0) of DALYs. Smoking risk attribution for rheumatoid arthritis DALYs was 7·1% (3·6-10·3). We forecast that 31·7 million (25·8-39·0) individuals will be living with rheumatoid arthritis worldwide by 2050.

Interpretation: Rheumatoid arthritis mortality has decreased globally over the past three decades. Global age-standardised prevalence rate and YLDs have increased over the same period, and the number of cases is projected to continue to increase to the year 2050. Improved access to early diagnosis and treatment of rheumatoid arthritis globally is required to reduce the future burden of the disease.

Funding: Bill & Melinda Gates Foundation, Institute of Bone and Joint Research, and Global Alliance for Musculoskeletal Health.

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Conflict of interest statement

B Antony reports grants or contracts from Rebecca Cooper Foundation, and a Nat Rem grant for an investigator-initiated trial biomarkers assessment support; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Nat Rem through a speaker fee and IRACON through travel support; all outside the submitted work. A M Briggs reports grants or contracts from Bone and Joint Decade Foundation, AO Alliance, Canadian Memorial Chiropractic College, Australian Rheumatology Association, Pan-American League of Associations for Rheumatology, World Federation of Chiropractic, and Asia Pacific League of Associations for Rheumatology, all as payments to their institution; consulting fees from WHO as personal payments; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from the American College of Rheumatology (ACR) as personal payments; all outside the submitted work. R Buchbinder reports grants from the Australian National Health and Medical Research Council (NHMRC), HCF Foundation, Cabrini Foundation, Arthritis Australia, and Federal Department of Health to their institutions; royalties or licenses from UpToDate for plantar fasciitis authorship; all outside the submitted work. I Fillip and A Radfar report payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing or educational events from Avicenna Medical and Clinical Research Institute, outside the submitted work. C L Hill reports grants or contracts from NHMRC, Vifor Pharmaceuticals, and Arthritis Australia; leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid, with the Australian Rheumatology Association, Australian & New Zealand Vasculitis Society, Arthritis SA, and APLAR; all outside the submitted work. N Ismail reports leadership or fiduciary role in other board, society, committee, or advocacy group, unpaid, as Council Member and Bursar of the Malaysian Academy of Pharmacy outside the submitted work. K Krishan reports non-financial support from UGC Centre of Advanced Study, CAS II, Department of Anthropology, Panjab University, Chandigarh, India, outside the submitted work. A-F A Mentis reports grants or contracts from MilkSafe: a novel pipeline to enrich formula milk using omics technologies, a research co-financed by the European Regional Development Fund of the EU and Greek national funds through the Operational Program Competitiveness, Entrepreneurship and Innovation, under the call RESEARCH–CREATE–INNOVATE (project code T2EDK-02222), as well as from ELIDEK (Hellenic Foundation for Research and Innovation, MIMS-860); payment as an external peer reviewer for Fondazione Cariplo, Italy; serves as an editorial board member for the journals Systematic Reviews and Annals of Epidemiology, and is an associate editor for Translational Psychiatry; stocks in a family winery; other financial or non-financial support from the BGI group as a scientific officer; all outside the submitted work. V Shivarov reports stock or stock options with ICON; other financial or non-financial interests in ICON through salary payments; all outside the submitted work. J A Singh reports consulting fees from Crealta/Horizon, MediSys, Fidia Farmaceutici, PK Med, Two Labs, Adept Field Solutions, Clinical Care Options, Clearview Healthcare Partners, Putnam Associates, Focus Forward, Navigant Consulting, Spherix Global Insights, Mediq, Jupiter Life Science, UBM, Trio Health, Medscape, WebMD, and Practice Point Communications, the National Institutes of Health, and the ACR; payment or honoraria for speakers bureaus from Simply Speaking; support for attending meetings or travel from the steering committee of OMERACT; participation on a data safety monitoring board or advisory board with the US Food and Drug Administration Arthritis Advisory Committee; membership of the steering committee of OMERACT, a role as Chair (unpaid) of the Veterans Affairs Rheumatology Field Advisory Committee, and roles as Editor and Director (unpaid) with the UAB Cochrane Musculoskeletal Group Satellite Center on Network Metaanalysis; stock or stock options in TPT Global Tech, Vaxart Pharmaceuticals, Aytu BioPharma, Adaptimmune Therapeutics, GeoVax Labs, Pieris Pharmaceuticals, Enzolytics, Seres Therapeutics, Tonix Pharmaceuticals, and Charlotte's Web Holdings, and previous stock options in Amarin, Viking Therapeutics, and Moderna Pharmaceuticals; all outside the submitted work. H Slater reports grants from Australian Government Department of Health, Medical Research Future Fund, Western Australian Government Department of Health, Bone and Joint Decade Foundation (Sweden), Curtin University (Australia), Institute for Bone and Joint Research (Australia), Canadian Memorial Chiropractic College (Canada), all through their institution; support for attending meetings or travel from the Australian Pain Society; all outside the submitted work. All other authors declare no competing interests.

Figures

Figure 1
Figure 1
Global prevalence, DALY, and YLD rates of rheumatoid arthritis in 2020 by sex and age (A) Prevalent cases per 100 000 population. (B) DALYs per 100 000 population. (C) YLDs per 100 000 population. Shaded areas represent 95% uncertainty intervals. DALY=disability-adjusted life-year. YLD=years lived with disability.
Figure 2
Figure 2
Age-standardised prevalence rate of rheumatoid arthritis for male and female sexes combined in 2020
Figure 3
Figure 3
Total global cases of rheumatoid arthritis forecasted to the year 2050 Shaded areas represent 95% uncertainty intervals.
Figure 4
Figure 4
Decomposition of projected change in the number of prevalent rheumatoid arthritis cases by region, 2020–50
See this image and copyright information in PMC

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