Advertisement

PharmacoEconomics

, Volume 22, Supplement 1, pp 1–12 | Cite as

Epidemiology and burden of illness of rheumatoid arthritis

  • Tore K. Kvien
Original Review Article

Abstract

Rheumatoid arthritis (RA) is a chronic, generally progressive autoimmune disease that causes functional disability, significant pain and joint destruction, and leads to premature mortality. It is estimated to affect between 0.5 and 1.0% of the adult population worldwide, increases in prevalence with age and affects more women than men. The magnitude of the severe long-term economic consequences of RA has been underestimated in the past. Most patients with the disease require continuous treatment to retard or stop progression and to control disease flares. Many also require surgery, such as total hip or knee replacement. In addition to these direct costs, work disability leads to reduced productivity and early retirement, and as a result, substantial indirect costs. The individual and his or her family must cope with the feeling of loss of contribution to society combined with redefined social roles, and the effects of pain, fatigue, low self-esteem, mental distress and depression.

A number of countries in North America and Europe have reported a decline in the incidence of RA in recent years, although geographical differences remain that may be associated with genetic, environmental or cultural factors. Nevertheless, patients with RA have not shared the improvements in survival rates seen with other diseases over the last 40 years, and have a mean reduction in life expectancy of between 5 and 10 years. Disease severity, activity and disability are strongly linked to premature mortality in patients with RA. The high direct and indirect costs associated with RA, together with the substantial morbidity and mortality affecting millions of people worldwide, underline the potential benefits of improved treatments for this chronic disease to patients, their families and society.

Keywords

Rheumatoid Arthritis Rheumatoid Arthritis Patient Indirect Cost Direct Cost Standardize Mortality Ratio 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgement

This study was supported by a grant from Wyeth.

References

  1. 1.
    Lubeck DP. A review of the direct costs of rheumatoid arthritis: managed care versus fee-for-service settings. Pharmacoeconomics 2001; 19 (8): 811–8PubMedCrossRefGoogle Scholar
  2. 2.
    Hunsche E, Chancellor JV, Bruce N. The burden of arthritis and nonsteroidal anti-inflammatory treatment. A European literature review. Pharmacoeconomics 2001; 19 Suppl. 1: 1–15PubMedCrossRefGoogle Scholar
  3. 3.
    Pincus T. The underestimated long term medical and economic consequences of rheumatoid arthritis. Drugs 1995; 50 Suppl. 1: 1–14PubMedCrossRefGoogle Scholar
  4. 4.
    Arnett FC, Edworthy SM, Bloch DA, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 1988; 31 (3): 315–24PubMedCrossRefGoogle Scholar
  5. 5.
    Abdel-Nasser AM, Rasker JJ, Valkenburg HA. Epidemiological and clinical aspects relating to the variability of rheumatoid arthritis. Semin Arthritis Rheum 1997; 27 (2): 123–40PubMedCrossRefGoogle Scholar
  6. 6.
    Isomäki HA. Prevalence and social impact of rheumatic diseases in Finland. J Rheumatol 1983; 10 Suppl.: 29–33Google Scholar
  7. 7.
    Knorr U. [A panorama of rheumatic diseases]. Versicherungsmedizin 1994; 46 (6): 212–5PubMedGoogle Scholar
  8. 8.
    Lawrence RC, Helmick CG, Arnett FC, et al. Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States. Arthritis Rheum 1998; 41 (5): 778–99PubMedCrossRefGoogle Scholar
  9. 9.
    Rubin LA and Voorneveld CR. High prevalence of rheumatoid arthritis among North American Native Indians (NANI): support for the New World theory of RA. Arthritis Rheum 1991; 34 Suppl. 9: S181Google Scholar
  10. 10.
    Boyer GS, Templin DW, Lanier AP. Rheumatic diseases in Alaskan Indians of the southeast coast: high prevalence of rheumatoid arthritis and systemic lupus erythematosus. J Rheumatol 1991; 18 (10): 1477–84PubMedGoogle Scholar
  11. 11.
    Boyer GS, Benevolenskaya LI, Templin DW, et al. Prevalence of rheumatoid arthritis in circumpolar native populations. J Rheumatol 1998; 25 (1): 23–9PubMedGoogle Scholar
  12. 12.
    Del Puente A, Knowler WC, Pettitt DJ, Bennett PH. High incidence and prevalence of rheumatoid arthritis in Pima Indians. Am J Epidemiol 1989; 129 (6): 1170–8PubMedGoogle Scholar
  13. 13.
    Guillemin F, Briancon S, Klein JM, Sauleau E, Pourel J. Low incidence of rheumatoid arthritis in France. Scand J Rheumatol 1994; 23 (5): 264–8PubMedCrossRefGoogle Scholar
  14. 14.
    Gran JT, Magnus J, Mikkelsen K. The incidence of classical and definite rheumatoid arthritis in Lillehammer, Norway. Scand J Rheumatol 1986; 15 Suppl. 59: 7–11Google Scholar
  15. 15.
    Uhlig T, Kvien TK, Glennas A, Smedstad LM, Forre O. The incidence and severity of rheumatoid arthritis, results from a county register in Oslo, Norway. J Rheumatol 1998; 25 (6): 1078–84PubMedGoogle Scholar
  16. 16.
    Symmons DP, Barrett EM, Bankhead CR, Scott DG, Silman AJ. The incidence of rheumatoid arthritis in the United Kingdom: results from the Norfolk Arthritis Register. Br J Rheumatol 1994; 33 (8): 735–9PubMedCrossRefGoogle Scholar
  17. 17.
    Doran MF, Pond GR, Crowson CS, O’Fallon WM, Gabriel SE. Trends in incidence and mortality in rheumatoid arthritis in Rochester, Minnesota, over a forty-year period. Arthritis Rheum 2002; 46 (3): 625–31PubMedCrossRefGoogle Scholar
  18. 18.
    Gabriel SE, Crowson CS, O’Fallon WM. The epidemiology of rheumatoid arthritis in Rochester, Minnesota, 1955–1985. Arthritis Rheum 1999; 42 (3): 415–20PubMedCrossRefGoogle Scholar
  19. 19.
    Jacobson DL, Gange SJ, Rose NR, Graham NM. Epidemiology and estimated population burden of selected autoimmune diseases in the United States. Clin Immunol Immunopathol 1997; 84 (3): 223–43PubMedCrossRefGoogle Scholar
  20. 20.
    Chan KW, Felson DT, Yood RA, Walker AM. Incidence of rheumatoid arthritis in central Massachusetts. Arthritis Rheum 1993; 36 (12): 1691–6PubMedCrossRefGoogle Scholar
  21. 21.
    Dugowson CE, Koepsell TD, Voigt LF, Bley L, Nelson JL, Daling JR. Rheumatoid arthritis in women. Incidence rates in group health cooperative, Seattle, Washington, 1987–1989. Arthritis Rheum 1991; 34 (12): 1502–7PubMedCrossRefGoogle Scholar
  22. 22.
    Linos A, Worthington JW, O’Fallon WM, Kurland LT. The epidemiology of rheumatoid arthritis in Rochester, Minnesota: a study of incidence, prevalence, and mortality. Am J Epidemiol 1980; 111 (1): 87–98PubMedGoogle Scholar
  23. 23.
    Jacobsson LT, Hanson RL, Knowler WC, et al. Decreasing incidence and prevalence of rheumatoid arthritis in Pima Indians over a twenty-five-year period. Arthritis Rheum 1994; 37 (8): 1158–65PubMedCrossRefGoogle Scholar
  24. 24.
    Wiles N, Symmons DP, Harrison B, et al. Estimating the incidence of rheumatoid arthritis: trying to hit a moving target? Arthritis Rheum 1999; 42 (7): 1339–46PubMedCrossRefGoogle Scholar
  25. 25.
    Kvien TK, Glennas A, Knudsrod OG, Smedstad LM, Mowinckel P, Forre O. The prevalence and severity of rheumatoid arthritis in Oslo. Results from a county register and a population survey. Scand J Rheumatol 1997; 26 (6): 412–8PubMedCrossRefGoogle Scholar
  26. 26.
    Wiles NJ, Lunt M, Barrett EM, et al. Reduced disability at five years with early treatment of inflammatory polyarthritis: results from a large observational cohort, using propensity models to adjust for disease severity. Arthritis Rheum 2001; 44 (5): 1033–42PubMedCrossRefGoogle Scholar
  27. 27.
    Bukhari MA, Wiles NJ, Lunt M, et al. Influence of diseasemodifying therapy on radiographic outcome in inflammatory polyarthritis at five years: results from a large observational inception study. Arthritis Rheum 2003; 48 (1): 46–53PubMedCrossRefGoogle Scholar
  28. 28.
    Mottonen T, Hannonen P, Korpela M, et al. Delay to institution of therapy and induction of remission using singledrug or combination-disease-modifying antirheumatic drug therapy in early rheumatoid arthritis. Arthritis Rheum 2002; 46 (4): 894–8PubMedCrossRefGoogle Scholar
  29. 29.
    Lard LR, Visser H, Speyer I, et al. Early versus delayed treatment in patients with recent-onset rheumatoid arthritis: comparison of two cohorts who received different treatment strategies. Am J Med 2001; 111 (6): 446–51PubMedCrossRefGoogle Scholar
  30. 30.
    Stenger AA, Van Leeuwen MA, Houtman PM, et al. Early effective suppression of inflammation in rheumatoid arthritis reduces radiographic progression. Br J Rheumatol 1998; 37 (11): 1157–63PubMedCrossRefGoogle Scholar
  31. 31.
    Egsmose C, Lund B, Borg G, et al. Patients with rheumatoid arthritis benefit from early 2nd line therapy: 5 year followup of a prospective double blind placebo controlled study. J Rheumatol 1995; 22 (12): 2208–13PubMedGoogle Scholar
  32. 32.
    van der Heide A, Jacobs JW, Bijlsma JW, et al. The effectiveness of early treatment with “second-line” antirheumatic drugs. A randomized, controlled trial. Ann Intern Med 1996; 124 (8): 699–707PubMedGoogle Scholar
  33. 33.
    Buckwalter JA and Lappin DR. The disproportionate impact of chronic arthralgia and arthritis among women. Clin Orthop 2000 (372): 159–68Google Scholar
  34. 34.
    James WH. Rheumatoid arthritis, the contraceptive pill, and androgens. Ann Rheum Dis 1993; 52 (6): 470–4PubMedCrossRefGoogle Scholar
  35. 35.
    Hall GM, Perry LA, Spector TD. Depressed levels of dehydroepiandrosterone sulphate in postmenopausal women with rheumatoid arthritis but no relation with axial bone density. Ann Rheum Dis 1993; 52 (3): 211–4PubMedCrossRefGoogle Scholar
  36. 36.
    Valentino R, Savastano S, Tommaselli AP, et al. Hormonal pattern in women affected by rheumatoid arthritis. J Endocrinol Invest 1993; 16 (8): 619–24PubMedGoogle Scholar
  37. 37.
    Brennan P and Silman A. Breast-feeding and the onset of rheumatoid arthritis. Arthritis Rheum 1994; 37 (6): 808–13PubMedCrossRefGoogle Scholar
  38. 38.
    Katz PP and Criswell LA. Differences in symptom reports between men and women with rheumatoid arthritis. Arthritis Care Res 1996; 9 (6): 441–8PubMedCrossRefGoogle Scholar
  39. 39.
    Hochberg MC. Changes in the incidence and prevalence of rheumatoid arthritis in England and Wales, 1970–1982. Semin Arthritis Rheum 1990; 19 (5): 294–302PubMedCrossRefGoogle Scholar
  40. 40.
    Kaipiainen-Seppänen O, Aho K, Isomäki HA, Laakso M. Incidence of rheumatoid arthritis in Finland during 1980–1990. Ann Rheum Dis 1996; 55 (9): 608–11PubMedCrossRefGoogle Scholar
  41. 41.
    Shichikawa K, Inoue K, Hirota S, et al. Changes in the incidence and prevalence of rheumatoid arthritis in Kamitonda, Wakayama, Japan, 1965–1996. Ann Rheum Dis 1999; 58 (12): 751–6PubMedCrossRefGoogle Scholar
  42. 42.
    Hazes JM, Dijkmans BC, Vandenbroucke JP, de Vries RR, Cats A. Reduction of the risk of rheumatoid arthritis among women who take oral contraceptives. Arthritis Rheum 1990; 33 (2): 173–9PubMedCrossRefGoogle Scholar
  43. 43.
    Riise T, Jacobsen BK, Gran JT. Incidence and prevalence of rheumatoid arthritis in the county of Troms, northern Norway. J Rheumatol 2000; 27 (6): 1386–9PubMedGoogle Scholar
  44. 44.
    Imanaka T, Shichikawa K, Inoue K, Shimaoka Y, Takenaka Y, Wakitani S. Increase in age at onset of rheumatoid arthritis in Japan over a 30 year period. Ann Rheum Dis 1997; 56 (5): 313–6PubMedCrossRefGoogle Scholar
  45. 45.
    Kaipiainen-Seppanen O, Aho K, Isomaki H, Laakso M. Shift in the incidence of rheumatoid arthritis toward elderly patients in Finland during 1975–1990. Clin Exp Rheumatol 1996; 14 (5): 537–42PubMedGoogle Scholar
  46. 46.
    Heiberg T, Kvien TK. Preferences for improved health examined in 1,024 patients with rheumatoid arthritis: pain has highest priority. Arthritis Rheum 2002; 47 (4): 391–7PubMedCrossRefGoogle Scholar
  47. 47.
    Smedstad LM, Moum T, Guillemin F, et al. Correlates of functional disability in early rheumatoid arthritis: a crosssectional study of 706 patients in four European countries. Br J Rheumatol 1996; 35 (8): 746–51PubMedCrossRefGoogle Scholar
  48. 48.
    Smedstad LM, Moum T, Vaglum P, Kvien TK. The impact of early rheumatoid arthritis on psychological distress. A comparison between 238 patients with RA and 116 matched controls. Scand J Rheumatol 1996; 25 (6): 377–82PubMedCrossRefGoogle Scholar
  49. 49.
    Smedstad LM, Vaglum P, Moum T, Kvien TK. The relationship between psychological distress and traditional clinical variables: a 2 year prospective study of 216 patients with early rheumatoid arthritis. Br J Rheumatol 1997; 36 (12): 1304–11PubMedCrossRefGoogle Scholar
  50. 50.
    Sharpe L, Sensky T, Allard S. The course of depression in recent onset rheumatoid arthritis: the predictive role of disability, illness perceptions, pain and coping. J Psychosom Res 2001; 51 (6): 713–9PubMedCrossRefGoogle Scholar
  51. 51.
    Wright GE, Parker JC, Smarr KL, et al. Risk factors for depression in rheumatoid arthritis. Arthritis Care Res 1996; 9 (4): 264–72PubMedCrossRefGoogle Scholar
  52. 52.
    Belza BL, Henke CJ, Yelin EH, Epstein WV, Gillis CL. Correlates of fatigue in older adults with rheumatoid arthritis. Nurs Rsch 1993; 2 (2): 93–9Google Scholar
  53. 53.
    Riemsma RP, Rasker JJ, Taal E, Griep EN, Wouters JM, Wiegman O. Fatigue in rheumatoid arthritis: the role of self-efficacy and problematic social support. Br J Rheumatol 1998; 37 (10): 1042–6PubMedCrossRefGoogle Scholar
  54. 54.
    Fifield J, McQuillan J, Tennen H, et al. History of affective disorder and the temporal trajectory of fatigue in rheumatoid arthritis. Ann Behav Med 2001; 23 (1): 34–41PubMedCrossRefGoogle Scholar
  55. 55.
    Wolfe F, Hawley DJ, Wilson K. The prevalence and meaning of fatigue in rheumatic disease. J Rheumatol 1996; 23 (8): 1407–17PubMedGoogle Scholar
  56. 56.
    Belza BL. Comparison of self-reported fatigue in rheumatoid arthritis and controls. J Rheumatol 1995; 22 (4): 639–43PubMedGoogle Scholar
  57. 57.
    Dadoniene J, Uhlig T, Stropuviene S, Venalis A, Boonen A, Kvien TK. Disease activity and health status in rheumatoid arthritis: a case-control comparison between Norway and Lithuania. Ann Rheum Dis 2003; 62 (3): 231–5PubMedCrossRefGoogle Scholar
  58. 58.
    Kvien TK, Uhlig T, Kristiansen IS. Patients with rheumatoid arthritis (RA) are gaining quality adjusted life years (QALYs) with access to new therapies. Arthritis Rheum 2002; 46 Suppl. 342Google Scholar
  59. 59.
    Pincus T, Swearingen C, Gibson M, Sokka T. Is rheumatoid arthritis becoming a (slightly) milder disease? Improvement in hematologic status of patients with rheumatoid arthritis between 1982 and 2001. Arthritis Rheum 2002; 46 Suppl.: 833Google Scholar
  60. 60.
    Wolfe F, Mitchell DM, Sibley JT, et al. The mortality of rheumatoid arthritis. Arthritis Rheum 1994; 37 (4): 481–94PubMedCrossRefGoogle Scholar
  61. 61.
    Yelin E, Trupin L, Wong B, Rush S. The impact of functional status and change in functional status on mortality over 18 years among persons with rheumatoid arthritis. J Rheumatol 2002; 29: 1851–7PubMedGoogle Scholar
  62. 62.
    Mitchell DM, Spitz PW, Young DY, Bloch DA, McShane DJ, Fries JF. Survival, prognosis, and causes of death in rheumatoid arthritis. Arthritis Rheum 1986; 29 (6): 706–14PubMedCrossRefGoogle Scholar
  63. 63.
    Symmons DP, Jones MA, Scott DL, Prior P. Longterm mortality outcome in patients with rheumatoid arthritis: early presenters continue to do well. J Rheumatol 1998; 25 (6): 1072–7PubMedGoogle Scholar
  64. 64.
    Wållberg-Jonsson S, Öhman ML, Dahlqvist SR. Cardiovascular morbidity and mortality in patients with seropositive rheumatoid arthritis in Northern Sweden. J Rheumatol 1997; 24 (3): 445–51PubMedGoogle Scholar
  65. 65.
    Riise T, Jacobsen BK, Gran JT, Haga HJ, Arnesen E. Total mortality is increased in rheumatoid arthritis. A 17-year prospective study. Clin Rheumatol 2001; 20 (2): 123–7PubMedCrossRefGoogle Scholar
  66. 66.
    Gabriel SE, Crowson CS, O’Fallon WM. Mortality in rheumatoid arthritis: have we made an impact in 4 decades? J Rheumatol 1999; 26 (12): 2529–33PubMedGoogle Scholar
  67. 67.
    Chehata JC, Hassell AB, Clarke SA, et al. Mortality in rheumatoid arthritis: relationship to single and composite measures of disease activity. Rheumatology 2001; 40: 447–52PubMedCrossRefGoogle Scholar
  68. 68.
    Myllykangas-Luosujarvi R, Aho K, Kautiainen H, Isomäki HA. Shortening of life span and causes of excess mortality in a population-based series of subjects with rheumatoid arthritis. Clin Exp Rheumatol 1995; 13 (2): 149–53PubMedGoogle Scholar
  69. 69.
    Cooper NJ. Economic burden of rheumatoid arthritis: a systematic review. Rheumatology 2000; 39: 28–33PubMedCrossRefGoogle Scholar
  70. 70.
    Allaire SH, Prashker MJ, Meenan RF. The costs of rheumatoid arthritis. Pharmacoeconomics 1994; 6 (6): 513–22PubMedCrossRefGoogle Scholar
  71. 71.
    Jonsson B, Rehnberg C, Borgquist L, Larsson SE. Locomotion status and costs in destructive rheumatoid arthritis. A comprehensive study of 82 patients from a population of 13,000. Acta Orthopaedica Scandinavica 1992; 63 (2): 207–12PubMedCrossRefGoogle Scholar
  72. 72.
    Meenan RF, Yelin EH, Henke CJ, Curtis DL, Epstein WV. The costs of rheumatoid arthritis. A patient-oriented study of chronic disease costs. Arthritis Rheum 1978; 21 (7): 827–33PubMedCrossRefGoogle Scholar
  73. 73.
    Doyle JJ. Economic and quality-of-life impact of rheumatoid arthritis. Managed Care 2001; 10 Suppl. 7: 15–8PubMedGoogle Scholar
  74. 74.
    Gabriel SE, Crowson CS, Campion ME, O’Fallon WM. Direct medical costs unique to people with arthritis. J Rheumatol 1997; 24 (1): 719–25PubMedGoogle Scholar
  75. 75.
    Lubeck DP, Spitz PW, Fries JF, Wolfe F, Mitchell DM, Roth SH. A multicenter study of annual health service utilization and costs in rheumatoid arthritis. Arthritis Rheum 1986; 29 (4): 488–93PubMedCrossRefGoogle Scholar
  76. 76.
    Meenan RF, Yelin EH, Nevitt M, Epstein WV. The impact of chronic disease: a sociomedical profile of rheumatoid arthritis. Arthritis Rheum 1981; 24 (3): 544–9PubMedCrossRefGoogle Scholar
  77. 77.
    Lanes SF, Lanza LL, Radensky PW, et al. Resource utilization and cost of care for rheumatoid arthritis and osteoarthritis in a managed care setting: the importance of drug and surgery costs. Arthritis Rheum 1997; 40 (8): 1475–81PubMedCrossRefGoogle Scholar
  78. 78.
    Yelin E and Wanke LA. An assessment of the annual and long-term direct costs of rheumatoid arthritis: the impact of poor function and functional decline. Arthritis Rheum 1999; 42 (6): 1209–18PubMedCrossRefGoogle Scholar
  79. 79.
    Clarke AE, Zowall H, Levinton C, et al. Direct and indirect medical costs incurred by Canadian patients with rheumatoid arthritis: a 12 year study. J Rheumatol 1997; 24 (6): 1051–60PubMedGoogle Scholar
  80. 80.
    Yelin E. The costs of rheumatoid arthritis: absolute, incremental, and marginal estimates. J Rheumatol 1996; 44 Suppl.: 47–51Google Scholar
  81. 81.
    Wolfe F, Kleinheksel SM, Spitz PW, et al. A multicenter study of hospitalization in rheumatoid arthritis: effect of health care system, severity, and regional difference. J Rheumatol 1986; 13 (2): 277–84PubMedGoogle Scholar
  82. 82.
    McIntosh E. The cost of rheumatoid arthritis. Br J Rheumatol 1996; 35 (8): 781–90PubMedCrossRefGoogle Scholar
  83. 83.
    van Jaarsveld CH, Jacobs JW, Schrijvers AJ, Heurkens AH, Haanen HC, Bijlsma JW. Direct cost of rheumatoid arthritis during the first six years: a cost-of-illness study. Br J Rheumatol 1998; 37 (8): 837–47PubMedCrossRefGoogle Scholar
  84. 84.
    Kobelt G, Eberhardt K, Jonsson L, Jonsson B. Economic consequences of the progression of rheumatoid arthritis in Sweden. Arthritis Rheum 1999; 42 (2): 347–56PubMedCrossRefGoogle Scholar
  85. 85.
    van Jaarsveld CH, Jacobs JW, Schrijvers AJ, Van Albada-Kuipers GA, Hofman DM, Bijlsma JW. Effects of rheumatoid arthritis on employment and social participation during the first years of disease in the Netherlands. Br J Rheumatol 1998; 37 (8): 848–53PubMedCrossRefGoogle Scholar
  86. 86.
    Sokka T, Kautiainen H, Mottonen T, Hannonen P. Work disability in rheumatoid arthritis 10 years after the diagnosis. J Rheumatol 1999; 26 (8): 1681–5PubMedGoogle Scholar
  87. 87.
    Merkesdal S, Ruof J, Schoffski O, Bernitt K, Zeidler H, Mau W. Indirect medical costs in early rheumatoid arthritis: composition of and changes in indirect costs within the first three years of disease. Arthritis Rheum 2001; 44 (3): 528–34PubMedCrossRefGoogle Scholar
  88. 88.
    Newhall-Perry K, Law NJ, Ramos B, Sterz M, Wong WK. Direct and indirect costs associated with the onset of seropositive rheumatoid arthritis. J Rheumatol 2000; 27: 1156–63PubMedGoogle Scholar
  89. 89.
    Kobelt G, Jonsson L, Lindgren P, Young A, Eberhardt K. Modeling the progression of rheumatoid arthritis: a twocountry model to estimate costs and consequences of rheumatoid arthritis. Arthritis Rheum 2002; 46 (9): 2310–9PubMedCrossRefGoogle Scholar
  90. 90.
    Gabriel SE, Crowson CS, Campion ME, O’Fallon WM. Indirect and nonmedical costs among people with rheumatoid arthritis and osteoarthritis compared with nonarthritic controls. J Rheumatol 1997; 24 (1): 43–8PubMedGoogle Scholar
  91. 91.
    Birnbaum HG, Barton M, Greenberg PE, et al. Direct and indirect costs of rheumatoid arthritis to an employer. J Occup Environ Med 2000; 42 (6): 588–96PubMedCrossRefGoogle Scholar
  92. 92.
    Young A, Dixey J, Kulinskaya E, et al. Which patients stop working because of rheumatoid arthritis? Results of five years’ follow up in 732 patients from the Early RA Study (ERAS). Ann Rheum Dis 2002; 61 (4): 335–40PubMedCrossRefGoogle Scholar
  93. 93.
    The burden of rheumatoid arthritis. Based on a presentation by Frederick Wolfe, MD. Am J Manag Care 1999; 5 Suppl. 14: S852–9; discussion S866-9Google Scholar
  94. 94.
    Gabriel SE, Crowson CS, Luthra HS, Wagner JL, O’Fallon WM. Modeling the lifetime costs of rheumatoid arthritis. J Rheumatol 1999; 26: 1269–74PubMedGoogle Scholar
  95. 95.
    Aho K, Heliovaara M, Sievers K, Maatela J, Isomäki H. Clinical arthritis associated with positive radiological and serological findings in Finnish adults. Rheumatol Int 1989; 9 (1): 7–11PubMedCrossRefGoogle Scholar
  96. 96.
    Aho K, Kaipiainen-Seppänen O, Heliövaara M, Klaukka T. Epidemiology of rheumatoid arthritis in Finland. Semin Arthritis Rheum 1998; 27 (5): 325–34PubMedCrossRefGoogle Scholar

Copyright information

© Adis Data Information BV 2004

Authors and Affiliations

  1. 1.Oslo City Department of RheumatologyDiakonhjemmet HospitalOsloNorway

Personalised recommendations