Page highlights

  • What is rheumatoid arthritis?
     
  • How common is rheumatoid arthritis?
    • An estimated 456,000 Australians (1.9%) have rheumatoid arthritis.
    • It is most common in people aged 75 and over, although the onset of rheumatoid arthritis most frequently occurs in those aged 35–64.
    • More women than men have rheumatoid arthritis (2.3 vs 1.5%).
  • Impact
    • Rheumatoid arthritis accounted for 2.0% of total disease burden and 16% of the total burden of disease due to musculoskeletal conditions in 2022.
    • It cost the Australian health system an estimated $1.2 billion in 2019–20, representing 8.7% of disease expenditure on musculoskeletal conditions and 0.9% of total disease expenditure.
  • Treatment and management
    • There were 12,800 hospitalisations with a principal diagnosis of rheumatoid arthritis, a rate of 50 hospitalisations per 100,000 population in 2020–21.
  • Comorbidities
    • A higher proportion of people with rheumatoid arthritis also had back problems (36%) or mental and behavioural conditions (35%) compared with people without rheumatoid arthritis (25% and 22%).

What is rheumatoid arthritis?

Rheumatoid arthritis is a chronic autoimmune disease characterised by inflammation of the joints, causing inflammation, pain, swelling, stiffness and loss of function in the joints. Rheumatoid arthritis most often affects the hand joints and both sides of the body at the same time (CDC 2019). Rheumatoid arthritis can affect anyone at any age, and may cause significant pain and disability.

In a healthy joint, the tissue lining the joint (called the synovial membrane or joint synovium) is very thin and produces fluid that lubricates and nourishes joint tissues (RACGP 2009). In rheumatoid arthritis, the immune system attacks the synovial membrane (RACGP 2009). The synovial membrane becomes thick and inflamed, resulting in unwanted tissue growth (Figure 1). As a result, bone erosion and irreversible joint damage can occur, leading to permanent disability (RACGP 2009).

Rheumatoid arthritis is a systemic disease, affecting the whole body, including the organs. This can lead to problems with the heart, respiratory system, nerves and eyes (CDC 2019). Its cause is not well understood although there is a strong genetic component (CDC 2019). Genetic factors are estimated to contribute 50–60% of the risk of developing rheumatoid arthritis (Tobón et al. 2010).

Figure 1: Comparison of healthy joint and joint with rheumatoid arthritis

This diagram compares the anatomy of a healthy joint with a joint affected by rheumatoid arthritis. The image shows muscle wasting, bone destruction, inflamed synovial membrane surrounding the joint, and migration of the synovial membrane onto and into bone and cartilage in rheumatoid arthritis compared with a healthy joint.

How common is rheumatoid arthritis?

An estimated 456,000 Australians (1.9% of the total population) have rheumatoid arthritis, based on self-reported data from the Australian Bureau of Statistics (ABS) 2017–18 National Health Survey (NHS) (ABS 2018). Rheumatoid arthritis represented 13% of all arthritic conditions in 2017–18.

Rheumatoid arthritis is most common in people aged 75 years and over (Figure 2), although the onset of rheumatoid arthritis most frequently occurs in those aged 35–64 (AIHW 2009; Duarte-Garcia 2019). The prevalence of this disease is 1.5 times higher in women (2.3%) than men (1.5%).

456,000 (1.9%) Australians have rheumatoid arthritis.

There has been little change in the prevalence over the past 10 years. It is difficult to evaluate the full impact of this condition on affected individuals due to the limited national statistics available.

Figure 2: Prevalence of self-reported rheumatoid arthritis, by age and sex, 2017–18

The vertical bar chart shows that the prevalence of rheumatoid arthritis is most common in people aged 75 and over in both males (5%) and females (8%) and least common among people aged 0–44 (0.4% in males and 0.6% in females).

Note: refers to people who self-reported that they were diagnosed by a doctor or nurse as having rheumatoid arthritis (current and long term) and also people who self-reported having rheumatoid arthritis.

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

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 (Radner et al. 2010).

Burden of disease

What is burden of disease?

Burden of disease analysis is a way of measuring the impact of diseases and injuries on a population. It is the difference between a population’s actual health and its ideal health, where ideal health is living to old age in good health (without disease or disability). It combines health loss from living with illness and injury (non-fatal burden, or years lived with disability, or YLD) and dying prematurely (fatal burden, or years of life lost, or YLL) to estimate total health loss (total burden, or disability-adjusted life years, or DALY). One DALY is one year of 'healthy life' lost due to illness and/or death (AIHW 2022a).

In 2022, rheumatoid arthritis accounted for 2.0% of total disease burden (DALY); 3.7% of non-fatal burden (YLD), and 0.1% of fatal burden (YLL). Within the musculoskeletal conditions disease group, rheumatoid arthritis accounted for 15.8% of total burden (DALY).

Variation by age and sex

  • The overall burden from rheumatoid arthritis for females was 1.6 times as high as males (5.2 and 3.3 DALY per 1,000 population).
  • The burden from rheumatoid arthritis generally increased with age, peaking at 75–79 years (13.5 DALY per 1,000 population).

Figure 3: Burden of disease due to rheumatoid arthritis by sex, age and year

This bar chart shows the DALY, YLD and YLL due to rheumatoid arthritis for different age groups by sex in selected years (2003, 2011, 2015, 2018 and 2022). In 2022 there were 68,092 total DALY in females, and 42,137 total DALY in males. In total persons, DALY peaked in the 60–64 age group.

In 2022, there were 3,198 YLL in persons from rheumatoid arthritis. YLL peaked in the 75–79 age group.

In 2022, there were 107,031 YLD in persons from rheumatoid arthritis. YLD peaked in the 60–64 age group at 14,354.

Changes over time

The rate of rheumatoid arthritis burden decreased from 5.6 to 3.6 DALY per 1,000 population between 2003 and 2022 – or 2.3% per year on average, after adjusting for changes in age structure. Rheumatoid arthritis burden was largely non-fatal (97.1% YLD).

Further detail is available in the Australian Burden of Disease Study 2022.

Variation between population groups

In 2018, after adjusting for age:

  • The rate of rheumatoid arthritis burden was highest in Inner regional areas and lowest in Major cities and Outer regional areas (5.4, 3.4 and 3.4 DALY per 1,000 population, respectively).
  • The rate of rheumatoid arthritis burden was highest in the lowest socioeconomic group (people living in areas with the highest level disadvantage) (5.8 per 1,000 population) and lowest in the middle socioeconomic group (2.6) (AIHW 2021).

Further detail is available in the Australian Burden of Disease Study 2018: Interactive data on disease burden.

Figure 4: Burden of disease due to rheumatoid arthritis by sex, remoteness area, socioeconomic group and year

This data visualisation includes 2 charts, the first presents DALY, YLD and YLL due to rheumatoid arthritis by remoteness in selected years (2011, 2015 and 2018). In 2018, the DALY due to osteoarthritis was highest in Inner regional areas, and lowest in Major cities and Outer regional areas.

The second chart presents DALY, YLD and YLL due to rheumatoid arthritis by socioeconomic group and year. In 2018, DALY was highest in the lowest socioeconomic group, and lowest in socioeconomic group 3.

Health System expenditure

In 2019–20, an estimated $1.2 billion of expenditure in the Australian health system was for rheumatoid arthritis, representing 0.9% of total health expenditure and 8.7% of expenditure for all musculoskeletal conditions (AIHW 2022b).

Where is the money spent?

Figure 5 presents a detailed breakdown of estimated expenditure for back problems by area of the health system, showing that:

  • Primary care accounted for 90% of rheumatoid arthritis spending, which was more than 3 times then the proportion of total health expenditure for primary health care (28%). The pharmaceutical benefits scheme proportion of rheumatoid arthritis expenditure was especially large in comparison to the average, at over 6 times the proportion for total health expenditure (85% compared with 12%).
  • Hospital services represented 6.9% ($87.5 million) of rheumatoid arthritis expenditure, which was over 9 times lower than the hospital-portion of total health expenditure (63%).
  • Referred medical services accounted for 3.4% of rheumatoid arthritis expenditure, which was less than the referred medical services portion of total expenditure (9%). The pathology portion of rheumatoid arthritis expenditure (1.4%) was similar in comparison to the average (2.0%) total health expenditure for pathology services.

Figure 5: Amount and proportion (%) of rheumatoid arthritis expenditure attributed to each area of the health system, compared to expenditure for all disease groups, 2019–20

This icicle chart shows the health expenditure on rheumatoid arthritis compared to total health expenditure by area of expenditure, in 2019–20. In total, rheumatoid arthritis cost the Australian health system an estimated $1.3 billion. This included $88 million for hospitals, $1.1 billion for primary care services, and $43 million for referred services.

Figure 6 presents the component (%) that rheumatoid arthritis expenditure makes up for each for each area of the health system, showing that in 2019–20, rheumatoid arthritis accounted for 6.3% ($1.1 billion) of all Pharmaceutical Benefits Scheme expenditure – ranking second of all diseases/conditions.

Figure 6: Proportion of expenditure attributed to osteoarthritis, for each area of the health system, 2019–20

This bar chart shows the proportion of area expenditure for rheumatoid arthritis by sex for 2019–20. The highest proportion of expenditure was spent on the Pharmaceutical Benefits Scheme (6.3%) and the least proportion of expenditure was on public hospital emergency departments (0%).

Who is the money spent on?

In 2019–20:

  • the age distribution of spending on rheumatoid arthritis reflects the prevalence distribution of the condition, with most spending being for older age groups (82% for people aged over 45).
  • more rheumatoid arthritis expenditure was attributed to females than males ($778.3 million and $454.4 million), respectively with a remainder $41.3 million (3.4%) not specified.

Further detail is available in Disease expenditure in Australia 2019–20.

In 2018–19, it was estimated that:

  • Rheumatoid arthritis expenditure per case was 1.2 times greater for females than males ($2,000 and $1,700 per case, respectively).
  • Rheumatoid arthritis expenditure per case was 39% higher than musculoskeletal conditions as a group ($2,000 and $1,200 per case, respectively) (AIHW 2022c).

Further detail is available in Health system spending per case of disease and for certain risk factors.

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 (NHS). 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 7).

Figure 7: 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%), very good (21%), or good (27%) than people without rheumatoid arthritis (17%, 33%, and 31% respectively). People with rheumatoid arthritis were more likely to describe their health as fair (27%) or poor (18%) compared with those without rheumatoid arthritis (14% and 6% respectively).

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

Source: AIHW analysis of ABS 2019 (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 (Covic et al. 2012). 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 stress, depression and anxiety (Arthritis Australia 2017).

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 8).

Figure 8: Psychological distress 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%), high (18%) or very high (11%) compared with people without rheumatoid arthritis (20%, 8%, and 4% respectively). People with rheumatoid arthritis were less likely to describe their levels of psychological distress as low (46%) compared with those without rheumatoid arthritis (68%).
Notes: Rates are age-standardised to the Australian population as at 30 June 2001.

Source: AIHW analysis of ABS 2019 (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 (Koevoets et al. 2019).

Based on findings from the ABS NHS, 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 9).

Figure 9: 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%), severe (24%), or moderate (38%) than people without rheumatoid arthritis (2%, 8%, and 23% respectively). People with rheumatoid arthritis were less likely to describe their pain as mild (14%) or very mild (9%) compared with those without rheumatoid arthritis (17% and 23% 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 (Data table).

Deaths

How many deaths were associated with rheumatoid arthritis?

Rheumatoid arthritis was recorded as an underlying or associated cause for 1,145 deaths or 3.2 deaths per 100,000 population in Australia in 2021, representing 0.7% of all deaths and 12% of all musculosketeal deaths. Rheumatoid arthritis was the underlying cause for 232 deaths (20% of rheumatoid arthritis deaths) and an associated cause only, for 913 deaths (80% of rheumatoid arthritis deaths).

Variation by age and sex

In 2021, rheumatoid arthritis mortality (as the underlying and/or associated cause) was concentrated amongst:

  • older people (75% aged 75 and over), which was more than the proportion of people aged 75 and over for total deaths (67%)
  • females (68% of rheumatoid arthritis deaths were female compared with 48% of total deaths).

Figure 10: Age profile of rheumatoid arthritis mortality statistics, by sex

This line chart shows the death rate due to rheumatoid arthritis in 2021 as the underlying condition, an associated-only cause of conditions and any cause of condition, by sex and age group. Mortality generally increased with increasing age for both males and females. Overall, mortality was more concentrated amongst females than males. 

Trends over time

Age standardised mortality rates for rheumatoid arthritis (as the underlying and/or associated cause) between 2011 and 2021:

  • remained stable at 3.3 per 100,000 population
  • remained stable over time with the mortality rate for females always higher than males. During this period mortality rates were 1.6 to 1.8 times higher among females compared with males.

Figure 11: Historical rheumatoid arthritis mortality statistics, by sex, 2011–2021

This line chart shows the deaths due to rheumatoid arthritis as the underlying condition, an associated-only cause of conditions and any cause of condition from 2011 to 2021. Deaths increased from 849 in 2011 to 1,145 in 2021.

Variation between population groups

Remote and very remote areas had 1.6 times more rheumatoid arthritis deaths per population compared with Major cities.

The lowest socioeconomic group (people living in areas with the highest level of disadvantage) had 1.6 times more rheumatoid arthritis deaths per population than the highest group (people living in areas with the lowest level of disadvantage) in 2021.

Further detail on mortality data is available in the Chronic musculoskeletal condition mortality data tables 2023.

Treatment and management of rheumatoid arthritis

At present there is no cure for rheumatoid arthritis. The Australian Models of Care for the management of the disease focus on early diagnosis, early management, and coordination of multidisciplinary care needs (Arthritis Australia 2014; Speerin et al. 2014). The goal of rheumatoid arthritis treatment is to stop inflammation (put the disease in remission), relieve symptoms, prevent joint and organ damage, reduce complications and improve physical function. Early treatment for rheumatoid arthritis is aggressive in order to stop inflammation as soon as possible (Arthritis Australia 2014).

Medications are primarily used to treat rheumatoid arthritis, however physical therapy and surgery can also be used.

Medications

Treatment for rheumatoid arthritis has improved dramatically over the past 20 years, with new medicines now very helpful for people, particularly in the early stages of the disease.

Medications for symptoms

Simple analgesics (such as paracetamol) may be used for pain management. Based on the patient’s needs doctors may also prescribe other medications to manage pain and/or stiffness such as fatty acid supplements, nonsteroidal anti-inflammatory drugs (NSAIDs), COX-2 inhibitors and low dose corticosteroids (RACGP 2009).

Medications for slowing disease

Disease-modifying anti-rheumatic drugs (DMARDs), biologic disease-modifying anti-rheumatic drugs (bDMARDs), and corticosteroids may slow disease progression (Nam et al. 2014; RACGP 2009). Corticosteroids and DMARDs are typically prescribed and monitored by specialist rheumatologists and require close medical monitoring to ensure effectiveness and to minimise side effects (RACGP 2009). Evidence suggests initiation of aggressive treatment with DMARDs within 12 weeks of symptom onset is associated with less joint destruction and a higher chance of achieving DMARD-free remission as compared with a longer delay in assessment (van der Linden 2010).

bDMARDs are specialised immunosuppressant medications that have been shown to halt or slow the disease process sufficiently to reduce the joint destruction and disability associated with early rheumatoid arthritis (Nam et al. 2014). bDMARDs are also used for other autoimmune conditions such as juvenile arthritis, psoriatic arthritis and Crohn's disease.

Treatment options for rheumatoid arthritis, including bDMARDs are available through the Pharmaceutical Benefits Scheme (PBS) and Repatriation Pharmaceutical Benefits Scheme (RPBS) (AIHW 2013).

Physical therapy

Maintaining a healthy and active lifestyle is an important management strategy in rheumatoid arthritis. Low-impact physical activity can assist in reducing inflammation, increasing and maintaining mobility and strengthening muscles around affected joints (Cooney 2011). A physiotherapist can prescribe an exercise program to assist in the management of rheumatoid arthritis.

Joint replacement surgery

Joint replacement surgery can relieve pain and restore function to joints severely damaged due to rheumatoid arthritis.

General practitioners and rheumatoid arthritis treatment

Treatment of rheumatoid arthritis often begins with the patient visiting a general practitioner (GPs). This is an important step in the treatment of rheumatoid arthritis because it is optimal for inflammation to be managed early on to reduce the chances of joint damage occurring (Speerin et al. 2014) and improve long-term outcomes (Bakker et al. 2011). GPs often conduct initial assessment and diagnosis of rheumatoid arthritis. The time from onset of rheumatoid arthritis symptoms and referral to a specialised rheumatologist for treatment needs to be as efficient as possible to improve long-term treatment outcomes (Nam et al. 2014). The RACGP recommends GPs complete diagnosis of rheumatoid arthritis as soon as possible and refer patients to a rheumatologist if joint swelling persists beyond 6 weeks (RACGP 2009).

Hospitalisation and the treatment of rheumatoid arthritis

Data from the National Hospital Morbidity Database (NHMD) show that, in 2020–21:

  • There were 12,800 hospitalisations with a principal diagnosis of rheumatoid arthritis, a rate of 50 hospitalisations per 100,000 population.
  • Three-quarters (75%) of rheumatoid arthritis hospitalisations were for females.
  • The hospitalisation rate increased with increasing age until 75–79, and then decreased among people aged 80 and over (Figure 12).

Figure 12: Age profile of rheumatoid arthritis hospitalisation statistics, by sex

This line chart compares the rate (per 100,000 population) of hospitalisations for rheumatoid arthritis, across various age groups by sex. In 2020–21, the rate of hospitalisations with a primary diagnosis of rheumatoid arthritis was highest in the 75–79 age group for both males and females and lowest in those age 44 years and younger.

Between 2010–11 and 2020–21, the hospitalisation rate for principal diagnosis of rheumatoid arthritis peaked in 2015–16 at 55 per 100,000, compared with 50 per 100,000 in 2020–21. The hospitalisation rate peaked at 81 per 100,000 for females and at 29 per 100,000 for males, in 2015–16 (Figure 13). 

The hospitalisation rate for rheumatoid arthritis among both males and females dropped in 2019–20, more markedly among the latter. This may have been due to widespread public health mandates to pause elective surgery due to the COVID-19 pandemic. In 2020–21 the hospitalisation rate returned to near or slightly above the pre-pandemic rate. The rate of hospitalisations was higher for females than males in all years (Figure 13).

Around 20% of hospitalisation for a principal diagnosis of rheumatoid arthritis are overnight stays with the majority being same day separations. Of overnight stays, the average length of stay has increased slightly over time and was 6.1 days in 2020–21.

Figure 13: Historical rheumatoid arthritis hospitalisation statistics, by sex, 2010–11 to 2020–21

This line chart shows the hospitalisation rates (per 100,000 population) for rheumatoid arthritis between 2010–11 and 2020–21. During this time, hospitalisation rates for a primary diagnosis of rheumatoid arthritis peaked in 2015–16 for both males and females.

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). For this analysis, these selected comorbidities were considered:

  • heart, stroke and vascular disease
  • kidney disease
  • arthritis
  • mental and behavioural conditions
  • asthma
  • diabetes
  • chronic obstructive pulmonary disease (COPD)
  • osteoporosis
  • cancer.

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.
  • 35% also had mental and behavioural conditions compared with 22% of people without rheumatoid arthritis.
  • 22% also had heart, stroke and vascular disease compared with 11% of people without rheumatoid arthritis.

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 (Figure 14). 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 (Parekh et al. 2011), in addition to a poorer quality of life (McDaid et al. 2013) and more complex clinical management and increased health costs. Rheumatoid arthritis is also associated with increased mortality due to comorbidities and related complications (Lassere et al. 2013).

Figure 14: 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.

Notes:

Rates are age-standardised to the 2001 Australian population.

These components do not total 100% as one person may have more than one comorbidity.

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