Impact of rheumatoid arthritis

Rheumatoid arthritis can severely affect a person’s quality of life and cause significant disability. Physical limitations, pain, fatigue and mental health issues are symptoms of rheumatoid arthritis that can impact a person’s ability to engage in daily activities [1]. In Australia, rheumatoid arthritis accounted for 15% of the total burden of disease due to musculoskeletal conditions in 2015 [2]. Additionally, there is an economic impact of rheumatoid arthritis. In 2015–16, Rheumatoid arthritis cost the Australian health system an estimated $1.2 billion, representing 9.6% of disease expenditure on Musculoskeletal conditions and 1% of total disease expenditure [3].

Perceived health status

3.2x

as likely to describe poor health among those with rheumatoid arthritis, compared with those without the condition

People aged 45 and over with rheumatoid arthritis had lower self-assessed health status compared with people without the condition­—based on self-reported data from the ABS 2017–18 National Health Survey. People with rheumatoid arthritis were 3.2 times as likely to describe their health as poor (18%) compared with those without the condition (5.6%) (Figure 1).

Figure 1: Self-assessed health of people aged 45 and over with and without rheumatoid arthritis, 2017–18

The vertical bar chart shows that, people aged 45 and over with rheumatoid arthritis were less likely to perceive their health as excellent (7%25), very good (21%25), or good (27%25) than people without rheumatoid arthritis (17%25, 33%25, and 31%25 respectively). People with rheumatoid arthritis were more likely to describe their health as fair (27%25) or poor (18%25) compared with those without rheumatoid arthritis (14%25 and 6%25 respectively).

Note: Rates are age-standardised to the Australian population as at 30 June 2001.

Source: AIHW analysis of ABS 2019 [4] (Data table).

Pain 

3.1x

as likely to have severe pain in those with rheumatoid arthritis, compared with those without the condition

Rheumatoid arthritis is a significant cause of physical disability. Functional limitations arrive soon after the onset of the disease and worsen with time. Joint damage in the wrist is reported as the cause of most severe limitation even in the early stages of rheumatoid arthritis [5].

In 2017–18, more than 2 in 3 people with rheumatoid arthritis aged 45 and over (68%) experienced ‘moderate’ to ‘very severe’ pain in the last 4 weeks. People with rheumatoid arthritis were 3.1 times as likely to have severe or very severe bodily pain in the last 4 weeks (30%) compared with those without the condition (10%) (Figure 2).

Figure 2: Pain(a) experienced by people aged 45 and over with and without rheumatoid arthritis, 2017–18

The vertical bar chart shows that, people aged 45 and over with rheumatoid arthritis were more likely to describe their pain as very severe (7%25), severe (24%25), or moderate (38%25) than people without rheumatoid arthritis (2%25, 8%25, and 23%25 respectively). People with rheumatoid arthritis were less likely to describe their pain as mild (14%25) or very mild (9%25) compared with those without rheumatoid arthritis (17%25 and 23%25 respectively).

a. Bodily pain experienced in the 4 weeks prior to interview.

Note: Rates are age-standardised to the Australian population as at 30 June 2001.

Source: AIHW analysis of ABS 2019 [4] (Data table).

Psychological distress

2.5x

as likely to describe very high psychological distress in those with rheumatoid arthritis compared with those without the condition 

People with rheumatoid arthritis are more likely to suffer from anxiety, depression and low self-esteem [6]. Rheumatoid arthritis can affect a person’s ability to participate in work, hobbies and social and daily activities. Combined with the chronic pain associated with rheumatoid arthritis, this can lead to mental health issues including depression, anxiety, feelings of helplessness and poor self-esteem [7].

People aged 45 and over with rheumatoid arthritis were 2.5 times as likely to describe very high levels of psychological distress (11%) compared with those without the condition (4.3%)—according to the 2017–18 NHS (Figure 3).

Figure 3: Psychological distress (a) experienced by people aged 45 and over with and without rheumatoid arthritis, 2017–18

The vertical bar chart shows that, people aged 45 and over with rheumatoid arthritis were more likely to have levels of psychological distress that were moderate (25%25), high (18%25) or very high (11%25) compared with people without rheumatoid arthritis (20%25, 8%25, and 4%25 respectively). People with rheumatoid arthritis were less likely to describe their levels of psychological distress as low (46%25) compared with those without rheumatoid arthritis (68%25).

a. Psychological distress is measured using the Kessler Psychological Distress Scale (K10), which involves 10 questions about negative emotional states experienced in the previous 4 weeks. The scores are grouped into Low: K10 score 10–15, Moderate: 16–21, High: 22–29, Very high: 30–50.

Note: Rates are age-standardised to the Australian population as at 30 June 2001.

Source: AIHW analysis of ABS 2019 [4] (Data table).

Comorbidities of rheumatoid arthritis

People with rheumatoid arthritis often have other chronic conditions, or ‘comorbidities’ (2 or more health conditions occurring at the same time). According to self-reported data from the ABS NHS 2017–18, among people aged 45 and over with rheumatoid arthritis:

  • 36% also had back problems compared with 25% of people without rheumatoid arthritis
  • 33% also had mental and behavioural conditions compared with 21% of people without rheumatoid arthritis
  • 22% also had heart, stroke and vascular disease compared with 11% of people without rheumatoid arthritis (Figure 4).

For this analysis, the selected comorbidities are heart, stroke and vascular disease, back problems, mental and behavioural conditions, asthma, diabetes, chronic obstructive pulmonary disease (COPD), kidney disease, osteoporosis and cancer.

Most chronic diseases are more common in older age groups. The average age of people with rheumatoid arthritis is older than the average age of the general population, therefore people with rheumatoid arthritis are more likely to have age-related comorbidities. The rates of back problems, mental and behavioural conditions, heart, stroke, and vascular disease, asthma, osteoporosis, and COPD as comorbidities remained significantly higher for people with rheumatoid arthritis compared with those without after adjusting for age. There was no significant difference for diabetes, cancer or kidney disease. It is important to note that regardless of the differences in age structures, having multiple chronic health problems is often associated with worse health outcomes [8], in addition to a poorer quality of life [9] and more complex clinical management and increased health costs.  Rheumatoid arthritis is also associated with increased mortality due to comorbidities and related complications [10].

Figure 4: Prevalence of other chronic conditions in people aged 45 and over with and without rheumatoid arthritis, 2017–18

This vertical bar chart compares the prevalence of chronic conditions (including back problems, mental and behavioural conditions, osteoporosis, heart stroke and vascular disease, asthma, diabetes, COPD, cancer, and kidney disease) among those with and without rheumatoid arthritis. Those with rheumatoid arthritis had higher rates of all chronic conditions compared with those without rheumatoid arthritis.

Note: these components do not total 100% as one person may have more than one comorbidity.

Source: AIHW analysis of ABS 2019 [4] (Data table).

Data notes

The comorbidity data presented here are based on self-reported data from the Australian Bureau of Statistics National Health Survey (NHS). When interpreting self-reported data, it is important to recognise that because we rely on respondents providing accurate information, the outputs may not always be a true reflection of the situation.

In the 2017–18 NHS, the number and proportion of persons with long-term health conditions is presented as those who have "a current medical condition which has lasted, or is expected to last, for 6 months or more, unless otherwise stated" [11]. For the conditions rheumatoid arthritis, asthma, cancer, heart, stroke and vascular disease (HSVD), diabetes, kidney disease and mental and behavioural conditions, the estimates are based on: persons who reported having been told by a doctor or nurse that they had the condition/s and whether they reported that their condition was current and long-term; that is, their condition was current at the time of interview and had lasted, or was expected to last, 6 months or more. 

For HSVD and diabetes, estimates also included persons who reported they had had the conditions, but that these conditions were not current and long-term at the time of interview.

The conditions data collected for back problems and COPD are 'as reported' by respondents and do not necessarily represent conditions as medically diagnosed. However, as the data relate to conditions which had lasted, or were expected to last, for six months or more, there is considered to be a reasonable likelihood that medical diagnoses would have been made in most cases. The degree to which conditions have been medically diagnosed is likely to differ across condition types. See the National Health Survey: Users’ Guide, 2017─18 [12] for more information.

References

  1. Radner H, Smolen JS & Aletaha D 2010. Comorbidity affects all domains of physical function and quality of life in patients with rheumatoid arthritis. Rheumatology 50:381-8.
  2. AIHW (Australian Institute of Health and Welfare) 2019. Australian Burden of Disease Study 2015: Interactive data on disease burden. Australian Burden of Disease Cat. no. BOD 24. Canberra: AIHW. Viewed 13 June 2019.
  3. AIHW 2019. Disease expenditure in Australia. Cat. no. HWE 76. Canberra: AIHW. Viewed 13 June 2019.
  4. ABS 2019. Microdata: National Health Survey, 2017-18, detailed microdata, DataLab. ABS cat no. 4324.0.55.001. Canberra: ABS. Findings based on AIHW analysis of ABS microdata.
  5. Koevoets R, Dirven L, Klarenbeek NB et al. 2013. Insights in the relationship of joint space narrowing versus erosive joint damage and physical functioning of patients with RA. Annals of the Rheumatic Diseases 72:870–874.
  6. Covic T, Cummin SR et al. 2012. Depression and anxiety in patients with rheumatoid arthritis: Prevalence rates based on a comparison of the Depression, Anxiety and Stress Scale (DASS) and the Hospital, Anxiety and Depression Scale (HADS). BMC Psychiatry 12:6. doi:10.1186/1471-244X-12-6.
  7. Gatchel RJ 2004. Comorbidity of chronic pain and mental health disorders: the biopsychosocial perspective. American Psychologist 59:795.
  8. Parekh AK, Goodman RA, Gordon C et al. 2011. Managing multiple chronic conditions: a strategic framework for improving health outcomes and quality of life. Public Health Reports 126:460–471.
  9. McDaid O, Hanly MJ, Richardson K et al. 2013. The effect of multiple chronic conditions on self-rated health, disability and quality of life among the older populations of Northern Ireland and the Republic of Ireland: a comparison of two nationally representative cross-sectional surveys. British Medical Journal Open 3:e002571. doi:10.1136/bmjopen-2013-002571.
  10. Lassere MN, Rappo J, Portek IJ et al. 2013. How many life years are lost in patients with rheumatoid arthritis? Secular cause-specific and all-cause mortality in rheumatoid arthritis, and their predictors in a long-term Australian cohort study. Internal Medicine Journal 43 (1): 66–72.
  11. Australian Bureau of Statistics (ABS) 2018. National Health Survey: First Results, 2017–18. ABS Cat. no. 4364.0.55.001. Canberra: ABS.
  12. Australian Bureau of Statistics (ABS) 2018.National Health Survey: Users' Guide, 2017–18. Viewed 1 May 2019.