Increased Incidence but Lower Mortality From RA Seen Over Last 3 Decades

While rheumatoid arthritis (RA)–related mortality seems to be dropping, the prevalence of disease continues to increase across the globe, a new analysis found. The analysis highlights the need for research and health care policies addressing certain risk factors, according to the authors.1

Published in Scientific Reports, the analysis showed increasing numbers of RA over the last 3 decades. Between 1990 and 2021, the incidence of RA increased from 11.66 (95% UI, 9.60-13.94) to 13.48 (95% UI, 11.08-16.06) per 100,000 people. Focusing on patients aged between 20 and 54 years, the researchers found that in 2021, 508,185 (95% UI, 417,807-605,687) people had the disease.

“The rising incidence of RA in high-SDI regions reflects enhanced disease recognition and the adoption of advanced diagnostic technologies, such as rheumatology diagnostic equipment, anti-cyclic citrullinated peptide (CCP) antibody testing, and imaging techniques,” described the researchers. “These advancements have facilitated earlier diagnosis and improved case reporting, meaning that the observed increase in incidence is not indicative of a higher disease burden, but rather a result of improved diagnostic and reporting capabilities.”

Throughout the study period, the number of DALYs associated with RA increased by 82.63%, rising across all age groups. | Image credit: Evrymmnt - stock.adobe.com

Patient data used for this study came from a cohort of patients from Global Burden of Disease 2021, the largest measure of global disease estimates of incidence, prevalence, and disability-adjusted life years (DALYs) for over 300 diseases.2 The dataset, noted the researchers, does not include certain data, including those on race/ethnicity.

Throughout the period, mortality from RA dropped from 0.09 (95% UI, 0.08-0.1) to 0.06 (95% UI, 0.05-0.07) per 100,000 people. In line with previous findings, this study showed females face a burden of disease compared with men, including both mortality and incidence. Throughout the study period, rates of RA increased more rapidly among women (0.22; 95% CI, 0.15-0.28; P < .001) than men (0.08; 95% CI, 0.01-0.15; P < .001). Similarly, compared with the men included in the study, who had a mortality rate of 0.04 (95% UI, 0.03-0.05), the women had a significantly higher mortality rate at 0.08 (95% UI, 0.07-0.10).

Increased susceptibility among women has been tied to the effects of estrogen and other hormonal imbalances, with particular vulnerability during middle and older age.

This finding from the study, suggest the researchers, warrants further research focused on gender-related differences in the burden of RA. The group also highlighted the importance of health care policies, particularly for education on risk factors affecting RA morbidity, including smoking.

Smoking has previously been identified as a risk factor significantly impacting DALYs, a measure of the overall burden of disease. Mortality due to RA and DALYs related to smoking continued to drop over the years included in the study, largely attributable to smoking regulations. These drops were particularly noticeable among women.

“The decline in smoking-related [population attributable fraction] and DALYs serves as a key indicator of the effectiveness of tobacco control policies and public health interventions,” explained the researchers, recognizing stricter smoking guidelines. “Looking ahead, it is essential to develop more personalized and regionally tailored public health strategies.”

Throughout the study period, the number of DALYs associated with RA increased by 82.63% (95% UI, 0.74-0.89), rising across all age groups. Women had a significantly higher number of DALYs (834,310; 95% UI, 567,949-1,190,281) compared with men (323,562; 95% UI, 218,169-465,243).

References

1. Zhang Z, Gao X, Liu S, et al. Global, regional, and national epidemiology of rheumatoid arthritis among people aged 20–54 years from 1990 to 2021. Sci Rep. Published online March 28, 2025. doi:10.1038/s41598-025-92150-1

2. Global Burden of Disease (GBD). Institute for Health Metrics and Evaluation. Accessed May 21, 2025. https://www.healthdata.org/research-analysis/gbd