J Rheum Dis.  2021 Apr;28(2):60-67. 10.4078/jrd.2021.28.2.60.

Epidemiology of Rheumatoid Arthritis in Korea

• Kim H
• Sung YK

• KMID: 2514116
• DOI: http://doi.org/10.4078/jrd.2021.28.2.60

Abstract

Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease characterised by symmetrical involvement of the joints, associated extra-articular manifestations and functional disability. In Korea, several epidemiologic studies reporting prevalence and incidence rates of RA have been conducted using large databases such as claims databases, national surveys, prospective cohort databases or electronic health records; according to these data sources, the estimated prevalence ranged from 0.27% to 1.85%. The prevalence of extra-articular manifestations such as interstitial lung disease (ILD) and Sjögren’s syndrome (SS) were also reported, but an issue of external validity of the study results persisted. In this review, we detail the epidemiology of Korean RA patients, focusing on the prevalence of RA and the frequency of systemic extra-articular manifestations including ILD and SS reported in previous studies. In addition, we discuss the current methodological issues which are inherent in Korean epidemiologic studies for patients with RA with understanding of the characteristics of each database.

Keyword

Rheumatoid arthritis; Epidemiology; Comorbidity; Data sources

Reference

1. Brown KK. 2007; Rheumatoid lung disease. Proc Am Thorac Soc. 4:443–8. DOI: 10.1513/pats.200703-045MS. PMID: 17684286. PMCID: PMC2647595.

2. Ajeganova S, Huizinga TW. 2015; Rheumatoid arthritis: seronegative and seropositive RA: alike but different? Nat Rev Rheumatol. 11:8–9. DOI: 10.1038/nrrheum.2014.194. PMID: 25403158.

3. Myasoedova E, Crowson CS, Turesson C, Gabriel SE, Matteson EL. 2011; Incidence of extraarticular rheumatoid arthritis in Olmsted County, Minnesota, in 1995-2007 versus 1985-1994: a population-based study. J Rheumatol. 38:983–9. DOI: 10.3899/jrheum.101133. PMID: 21459933. PMCID: PMC3193155.

4. Cojocaru M, Cojocaru IM, Silosi I, Vrabie CD, Tanasescu R. 2010; Extra-articular manifestations in rheumatoid arthritis. Maedica (Bucur). 5:286–91. PMID: 21977172. PMCID: PMC3152850.

5. Hur NW, Choi CB, Uhm WS, Bae SC. 2008; The prevalence and trend of arthritis in Korea: results from Korea National Health and Nutrition Examination Surveys. J Korean Rheum Assoc. 15:11–26. DOI: 10.4078/jkra.2008.15.1.11.

6. Park NG, Kim WK, Shin DH, Choi YM, Lee YJ, Lee EB, et al. 2003; Prevalence of osteoarthritis and rheumatoid arthritis in two communities in Korea. J Korean Rheum Assoc. 10:151–7.

7. Won S, Cho SK, Kim D, Han M, Lee J, Jang EJ, et al. 2018; Update on the prevalence and incidence of rheumatoid arthritis in Korea and an analysis of medical care and drug utilization. Rheumatol Int. 38:649–56. DOI: 10.1007/s00296-017-3925-9. PMID: 29302803.

8. Sung YK, Cho SK, Choi CB, Bae SC. 2013; Prevalence and incidence of rheumatoid arthritis in South Korea. Rheumatol Int. 33:1525–32. DOI: 10.1007/s00296-012-2590-2. PMID: 23255140.

9. Kwon JM, Rhee J, Ku H, Lee EK. 2012; Socioeconomic and employment status of patients with rheumatoid arthritis in Korea. Epidemiol Health. 34:e2012003. DOI: 10.4178/epih/e2012003. PMID: 22611518. PMCID: PMC3350820.

10. Kim H, Cho SK, Kim JW, Jung SY, Jang EJ, Bae SC, et al. 2020; An increased disease burden of autoimmune inflammatory rheumatic diseases in Korea. Semin Arthritis Rheum. 50:526–33. DOI: 10.1016/j.semarthrit.2019.11.007. PMID: 31852583.

11. Jeong H, Baek SY, Kim SW, Eun YH, Kim IY, Kim H, et al. 2017; Comorbidities of rheumatoid arthritis: results from the Korean National Health and Nutrition Examination Survey. PLoS One. 12:e0176260. DOI: 10.1371/journal.pone.0176260. PMID: 28423031. PMCID: PMC5397042.

12. Choi IA, Lee JS, Song YW, Lee EY. 2019; Mortality, disability, and healthcare expenditure of patients with seropositive rheumatoid arthritis in Korea: a nationwide population-based study. PLoS One. 14:e0210471. DOI: 10.1371/journal.pone.0210471. PMID: 30620765. PMCID: PMC6324802.

13. Kato E, Sawada T, Tahara K, Hayashi H, Tago M, Mori H, et al. 2017; The age at onset of rheumatoid arthritis is increasing in Japan: a nationwide database study. Int J Rheum Dis. 20:839–45. DOI: 10.1111/1756-185X.12998. PMID: 28205423.

14. Lai CH, Lai MS, Lai KL, Chen HH, Chiu YM. 2012; Nationwide population-based epidemiologic study of rheumatoid arthritis in Taiwan. Clin Exp Rheumatol. 30:358–63. PMID: 22513120.

15. Kuo CF, Luo SF, See LC, Chou IJ, Chang HC, Yu KH. 2013; Rheumatoid arthritis prevalence, incidence, and mortality rates: a nationwide population study in Taiwan. Rheumatol Int. 33:355–60. DOI: 10.1007/s00296-012-2411-7. PMID: 22451027.

16. See LC, Kuo CF, Chou IJ, Chiou MJ, Yu KH. 2013; Sex- and age-specific incidence of autoimmune rheumatic diseases in the Chinese population: a Taiwan population-based study. Semin Arthritis Rheum. 43:381–6. DOI: 10.1016/j.semarthrit.2013.06.001. PMID: 23916348.

17. Yang DH, Huang JY, Chiou JY, Wei JC. 2018; Analysis of socioeconomic status in the patients with rheumatoid arthritis. Int J Environ Res Public Health. 15:1194. DOI: 10.3390/ijerph15061194. PMID: 29875338. PMCID: PMC6024906.

18. Chiu YM, Lu YP, Lan JL, Chen DY, Wang JD. 2020; Dec. 8. Lifetime risks, life expectancy, and health care expenditures for rheumatoid arthritis: a nationwide cohort followed up from 2003 to 2016. Arthritis Rheumatol. [Epub]. DOI: 10.1002/art.41597. DOI: 10.1002/art.41597. PMID: 33295139.

19. Losina E, Barrett J, Baron JA, Katz JN. 2003; Accuracy of Medicare claims data for rheumatologic diagnoses in total hip replacement recipients. J Clin Epidemiol. 56:515–9. DOI: 10.1016/S0895-4356(03)00056-8. PMID: 12873645.

20. 2019 National Health Insurance Statistical Yearbook. National Health Insurance Statistics [Internet]. National Health Insurance Service;Wonju: Available from: https://www.nhis.or.kr/nhis/together/wbhaec06300m01.do?mode=view&articleNo=10802543&article.offset=0&articleLimit=10. cited 2021 Mar 9.

21. Kim JY KH, Im JH. 2007. Development of risk adjustment and prediction methods for care episodes using National Health Insurance Database [Internet]. Health Insurance Review & Assessment Service;Seoul: Available from: https://scholar.google.com/scholar_lookup?title=Development%20of%20risk%20adjustment%20and%20prediction%20methods%20for%20care%20episodes%20using%20National%20Health%20Insurance%20Database&publication_year=2007&author=Kim%2CJY&author=Kim%2CHY&author=Im%2CJH. cited 2021 Mar 9.

22. Ko MJ, Han JT, Lee AK, Kim MK, Park SH. 2008. Health checkup examinees cohort establishment: the development of assessment [Internet]. National Health Insurance Corporation;Seoul: Available from: https://www.nhis.or.kr/nhis/together/wbhaec07800m01.do?mode=view&articleNo=106556. cited 2021 Mar 9.

23. Park BJ, Sung JH, Park KD, Seo SW, Kim SW. 2003. Improving the validity of health insurance Disease code and the utilization of health insurance claim data. Seoul National University College of Medicine;Seoul: p. 223.

24. Cho SK, Sung YK, Choi CB, Kwon JM, Lee EK, Bae SC. 2013; Development of an algorithm for identifying rheumatoid arthritis in the Korean National Health Insurance claims database. Rheumatol Int. 33:2985–92. DOI: 10.1007/s00296-013-2833-x. PMID: 23918169.

25. Ahn GY, Cho SK, Kim D, Choi CB, Lee EB, Bae SC, et al. 2016; Agreement of major diagnosis and comorbidity between self-reported questionnaire and medical record review in patients with rheumatic disease. J Rheum Dis. 23:348–55. DOI: 10.4078/jrd.2016.23.6.348.

26. Corser W, Sikorskii A, Olomu A, Stommel M, Proden C, Holmes-Rovner M. 2008; Concordance between comorbidity data from patient self-report interviews and medical record documentation. BMC Health Serv Res. 8:85. DOI: 10.1186/1472-6963-8-85. PMID: 18416841. PMCID: PMC2346463.

27. Tisnado DM, Adams JL, Liu H, Damberg CL, Chen WP, Hu FA, et al. 2006; What is the concordance between the medical record and patient self-report as data sources for ambulatory care? Med Care. 44:132–40. DOI: 10.1097/01.mlr.0000196952.15921.bf. PMID: 16434912.

28. Byles JE, D'Este C, Parkinson L, O'Connell R, Treloar C. 2005; Single index of multimorbidity did not predict multiple outcomes. J Clin Epidemiol. 58:997–1005. DOI: 10.1016/j.jclinepi.2005.02.025. PMID: 16168345.

29. Kvien TK, Glennås A, Knudsrød OG, Smedstad LM. 1996; The validity of self-reported diagnosis of rheumatoid arthritis: results from a population survey followed by clinical examin-ations. J Rheumatol. 23:1866–71. PMID: 8923358.

30. Klungel OH, de Boer A, Paes AH, Seidell JC, Bakker A. 1999; Cardiovascular diseases and risk factors in a population- based study in The Netherlands: agreement between questionnaire information and medical records. Neth J Med. 55:177–83. DOI: 10.1016/S0300-2977(99)00045-5. PMID: 10555434.

31. Simpson CF, Boyd CM, Carlson MC, Griswold ME, Guralnik JM, Fried LP. 2004; Agreement between self-report of disease diagnoses and medical record validation in disabled older women: factors that modify agreement. J Am Geriatr Soc. 52:123–7. DOI: 10.1111/j.1532-5415.2004.52021.x. PMID: 14687326.

32. Klareskog L, Catrina AI, Paget S. 2009; Rheumatoid arthritis. Lancet. 373:659–72. DOI: 10.1016/S0140-6736(09)60008-8. PMID: 28612748.

33. Syversen SW, Goll GL, van der Heijde D, Landewé R, Lie BA, Odegård S, et al. 2010; Prediction of radiographic progression in rheumatoid arthritis and the role of antibodies against mutated citrullinated vimentin: results from a 10-year prospective study. Ann Rheum Dis. 69:345–51. DOI: 10.1136/ard.2009.113092. PMID: 19648126.

34. Han B, Diogo D, Eyre S, Kallberg H, Zhernakova A, Bowes J, et al. 2014; Fine mapping seronegative and seropositive rheumatoid arthritis to shared and distinct HLA alleles by adjusting for the effects of heterogeneity. Am J Hum Genet. 94:522–32. DOI: 10.1016/j.ajhg.2014.02.013. PMID: 24656864. PMCID: PMC3980428.

35. Daha NA, Toes RE. 2011; Rheumatoid arthritis: are ACPA-positive and ACPA-negative RA the same disease? Nat Rev Rheumatol. 7:202–3. DOI: 10.1038/nrrheum.2011.28. PMID: 21455249.

36. Sung YK, Cho SK, Choi CB, Park SY, Shim J, Ahn JK, et al. 2012; Korean Observational Study Network for Arthritis (KORONA): establishment of a prospective multicenter cohort for rheumatoid arthritis in South Korea. Semin Arthritis Rheum. 41:745–51. DOI: 10.1016/j.semarthrit.2011.09.007. PMID: 22154221.

37. Min HK, Kim HR, Lee SH, Shin K, Kim HA, Park SH, et al. 2021; Feb. 12. Four-year follow-up of atherogenicity in rheumatoid arthritis patients: from the nationwide Korean College of Rheumatology Biologics Registry. Clin Rheumatol. [Epub]. DOI:10.1007/s10067-021-05613-x. DOI: 10.1007/s10067-021-05613-x. PMID: 33576925.

38. Nordberg LB, Lillegraven S, Lie E, Aga AB, Olsen IC, Hammer HB, et al. 2017; Patients with seronegative RA have more inflammatory activity compared with patients with seropositive RA in an inception cohort of DMARD-naïve patients classified according to the 2010 ACR/EULAR criteria. Ann Rheum Dis. 76:341–5. DOI: 10.1136/annrheumdis-2015-208873. PMID: 27094444.

39. Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO 3rd, et al. 2010; 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum. 62:2569–81. DOI: 10.1002/art.27584. PMID: 20872595.

40. Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS, et al. 1988; The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. 31:315–24. DOI: 10.1002/art.1780310302. PMID: 3358796.

41. Choi S, Lee KH. 2018; Clinical management of seronegative and seropositive rheumatoid arthritis: a comparative study. PLoS One. 13:e0195550. DOI: 10.1371/journal.pone.0195550. PMID: 29624625. PMCID: PMC5889180.

42. Kim D, Cho SK, Choi CB, Choe JY, Chung WT, Hong SJ, et al. 2017; Impact of interstitial lung disease on mortality of patients with rheumatoid arthritis. Rheumatol Int. 37:1735–45. DOI: 10.1007/s00296-017-3781-7. PMID: 28748423.

43. Yang JA, Lee JS, Park JK, Lee EB, Song YW, Lee EY. 2019; Clinical characteristics associated with occurrence and poor prognosis of interstitial lung disease in rheumatoid arthritis. Korean J Intern Med. 34:434–41. DOI: 10.3904/kjim.2016.349. PMID: 28352064. PMCID: PMC6406107.

44. Kim HC, Choi KH, Jacob J, Song JW. 2020; Prognostic role of blood KL-6 in rheumatoid arthritis-associated interstitial lung disease. PLoS One. 15:e0229997. DOI: 10.1371/journal.pone.0229997. PMID: 32163457. PMCID: PMC7067443.

45. Kim JW, Lee H, Hwang JH, Park SH, Lee HS, Kim SK, et al. 2016; Factors associated with airway disease and interstitial lung disease in rheumatoid arthritis. J Rheum Dis. 23:101–8. DOI: 10.4078/jrd.2016.23.2.101.

46. Cho SK, Doyle TJ, Lee H, Jin Y, Tong AY, Ortiz AJS, et al. 2020; Validation of claims-based algorithms to identify interstitial lung disease in patients with rheumatoid arthritis. Semin Arthritis Rheum. 50:592–7. DOI: 10.1016/j.semarthrit.2020.04.006. PMID: 32480097.

47. Sparks JA, Jin Y, Cho SK, Vine S, Desai R, Doyle TJ, et al. 2021; Jan. 18. Prevalence, incidence and cause-specific mortality of rheumatoid arthritis-associated interstitial lung disease among older rheumatoid arthritis patients. Rheumatology (Oxford). [Epub]. DOI:10.1093/rheumatology/keaa836. DOI: 10.1093/rheumatology/keaa836. PMID: 33462611.

48. Kim H, Cho SK, Kim HW, Han J, Kim Y, Hwang KG, et al. 2020; The prevalence of Sjögren's syndrome in rheumatoid arthritis patients and their clinical features. J Korean Med Sci. 35:e369. DOI: 10.3346/jkms.2020.35.e369. PMID: 33230982. PMCID: PMC7683240.

49. Brown LE, Frits ML, Iannaccone CK, Weinblatt ME, Shadick NA, Liao KP. 2015; Clinical characteristics of RA patients with secondary SS and association with joint damage. Rheumatology (Oxford). 54:816–20. DOI: 10.1093/rheumatology/keu400. PMID: 25313147. PMCID: PMC4416083.

50. He J, Ding Y, Feng M, Guo J, Sun X, Zhao J, et al. 2013; Characteristics of Sjögren's syndrome in rheumatoid arthritis. Rheumatology (Oxford). 52:1084–9. DOI: 10.1093/rheumatology/kes374. PMID: 23382356.

51. Haga HJ, Naderi Y, Moreno AM, Peen E. 2012; A study of the prevalence of sicca symptoms and secondary Sjögren's syndrome in patients with rheumatoid arthritis, and its association to disease activity and treatment profile. Int J Rheum Dis. 15:284–8. DOI: 10.1111/j.1756-185X.2012.01717.x. PMID: 22709490.

52. Calgüneri M, Ureten K, Akif Oztürk M, Onat AM, Ertenli I, Kiraz S, et al. 2006; Extra-articular manifestations of rheumatoid arthritis: results of a university hospital of 526 patients in Turkey. Clin Exp Rheumatol. 24:305–8. PMID: 16870099.

53. Cimmino MA, Salvarani C, Macchioni P, Montecucco C, Fossaluzza V, Mascia MT, et al. 2000; Extra-articular manifestations in 587 Italian patients with rheumatoid arthritis. Rheumatol Int. 19:213–7. DOI: 10.1007/PL00006853. PMID: 11063290.

54. Kim SK, Park SH, Shin IH, Choe JY. 2008; Anti-cyclic citrullinated peptide antibody, smoking, alcohol consumption, and disease duration as risk factors for extraarticular manifestations in Korean patients with rheumatoid arthritis. J Rheumatol. 35:995–1001. PMID: 18464311.