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). In Australia, rheumatoid arthritis accounted for 15% of the total burden of disease due to musculoskeletal conditions in 2015 (AIHW 2019a). Additionally, there is an economic impact to 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 (AIHW 2019b).

Perceived health status

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 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 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).

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

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

Pain 

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 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 (Data table).

Psychological distress

People with rheumatoid arthritis are more likely to suffer from anxiety, depression and low self-esteem (Kovic 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 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 (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). 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 (Data table 2.4).

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 4). 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 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.

Notes:

  1. Rates are age-standardised to the 2001 Australian population.
  2. These components do not total 100% as one person may have more than one comorbidity.

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

Data notes

The National Health Survey (NHS) uses three factors to determine whether or not a person is counted as having a particular condition: whether the condition is current, whether it is long term and whether it was medically diagnosed. The combination of these factors required for a person to count as having the condition varies according to the nature of the condition. For example, some conditions, such as diabetes and HSVD, once diagnosed, are seen to be lifelong. Even if a person no longer reports symptoms, they still count as having the condition. While other conditions, such as depression, asthma, cancer or back problems, can be lifelong, episodic or in complete remission.

Most conditions do not need the respondent to have been diagnosed by a doctor or nurse. The respondent is counted if they said they have the condition. However, in cases where the respondent said they had diabetes or HSVD and that the condition was not current, they need to have received a diagnosis to be counted.

Condition

Current

Long term

Has the condition been diagnosed by a doctor or nurse?

Table 1: Definitions used for chronic conditions

Asthma

current

long term

no diagnosis required

Back problems

current

long term

no diagnosis required

Cancer

current

long term

no diagnosis required

COPD

current

long term

no diagnosis required

Diabetes

(2 combinations)

current

long term

no diagnosis required

ever had

not long term

diagnosis required

Heart, stroke and vascular disease (HSVD)

(2 combinations)

current

long term

no diagnosis required

ever had

not long term

diagnosis required

Kidney disease

current

long term

no diagnosis required

Mental and behavioural conditions

current

long term

no diagnosis required

Osteoporosis

current

long term

no diagnosis required

Rheumatoid arthritis

current

long term

no diagnosis required

Note: Please see the 2017-18 NHS User Guide for more information on the definitions of the conditions.