Time trends in the incidence, prevalence, and severity of rheumatoid arthritis: A systematic literature review.
BACKGROUND
Rheumatoid arthritis (RA) generates a heavy socioeconomic burden. The ability to predict the frequency and severity of socioeconomic effects due to RA is crucial to the development of public health policies.


OBJECTIVE
To conduct a systematic literature review of data on the prevalence, incidence, and severity of RA.


METHODS
Medline, EMBASE, the Cochrane Library, and online American College of Rheumatology communications were searched for articles on the prevalence and incidence of RA, as well as on selected severity and activity criteria. Relevant articles were then selected by two investigators.


RESULTS
Frequency data are conflicting. No proof exists from cohort studies that the incidence of RA has changed over time. Overall, the prevalence of RA is stable or on the rise. Studies consistently demonstrated a decrease in severity over time, with lower activity, fewer extraarticular manifestations, a diminished need for surgery to treat joint destruction, and less severe radiological changes. The excess mortality, in contrast, despite a trend toward a decrease over time, remains significant.


CONCLUSIONS
The activity and deleterious effects of RA have diminished over time, in conjunction with recent therapeutic advances (new drugs and improved patient selection). However, there seems to be no decrease in the frequency of RA, which continues to induce significant excess mortality.
Service de Rhumatologie, APHP, CHU Hôpitaux Universitaires de Paris Seine Saint-Denis, 93017 Bobigny, France; Université Sorbonne Paris Cité, Université Paris 13, 93017 Bobigny, France.
Emeline
E
Minichiello
Service de Rhumatologie, APHP, CHU Hôpitaux Universitaires de Paris Seine Saint-Denis, 93017 Bobigny, France; Université Sorbonne Paris Cité, Université Paris 13, 93017 Bobigny, France; Inserm UMR 1125, 93017 Bobigny, France.
Luca
L
Semerano
Service de Rhumatologie, APHP, CHU Hôpitaux Universitaires de Paris Seine Saint-Denis, 93017 Bobigny, France; Université Sorbonne Paris Cité, Université Paris 13, 93017 Bobigny, France; Inserm UMR 1125, 93017 Bobigny, France. Electronic address: marie-christophe.boissier@aphp.fr.
Marie-Christophe
MC
Boissier
D000328:Adult; D017677:Age Distribution; D017668:Age of Onset; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D015331:Cohort Studies; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D012720:Severity of Illness Index; D017678:Sex Distribution; D015996:Survival Rate; D013997:Time Factors
Epidemiology; Rheumatoid arthritis; Severity