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What is rheumatoid arthritis?

Rheumatoid arthritis is a chronic autoimmune condition that causes inflammation, pain, swelling, stiffness and loss of function in joints, commonly in the hands.

How common is rheumatoid arthritis?

Around 514,000 (2.0%) people in Australia were estimated to be living with rheumatoid arthritis in 2022.

Impact of rheumatoid arthritis

  • Rheumatoid arthritis accounted for 2.0% of total disease burden and 16% of the total burden of disease for all musculoskeletal conditions in 2023.
  • In 2020–21, an estimated $966.1 million was spent on the treatment and management of rheumatoid arthritis, representing 0.6% of total health system expenditure and 6.6% of expenditure for all musculoskeletal conditions.
  • Rheumatoid arthritis contributed to 1,322 deaths or 5.1 deaths per 100,000 population in 2022, representing 0.7% of all deaths.

Treatment and management of rheumatoid arthritis

In 2021–22, there were 10,000 hospitalisations with a principal diagnosis of rheumatoid arthritis (39 hospitalisations per 100,000 population).

What is rheumatoid arthritis?

Rheumatoid arthritis is a chronic autoimmune condition characterised by inflammation of the joints, pain, swelling, stiffness and loss of function in the joints. It commonly affects the hand joints and both sides of the body at the same time (CDC 2019).

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 people with rheumatoid arthritis, the immune system attacks the synovial membrane which 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).

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

This figure shows the differences between the synovial membrane in a healthy joint and one with rheumatoid arthritis.

How common is rheumatoid arthritis?

Around 514,000 (2.0%) people in Australia were estimated to be living with rheumatoid arthritis, according to self-reported data in the 2022 Australian Bureau of Statistics (ABS) National Health Survey (NHS) (ABS 2023). This represented 14% of people living with any form of arthritis (excluding gout). 

For more information about other forms of arthritis, see All arthritis, Osteoarthritis, Gout, and Juvenile arthritis.

Note: Unless otherwise stated, crude rates are presented for prevalence in this report and as such, these rates have not been adjusted to account for differences in the age structures of different populations. Care should therefore be taken before making comparisons between populations using these data.

According to the NHS, in 2022, rheumatoid arthritis was:

  • most common in people aged 75 years and over (8.9%) (ABS 2023), although the onset of rheumatoid arthritis most frequently occurred in those aged 35–64 (AIHW 2023; Duarte-Garcia 2019)
  • slightly more common in females compared with males (2.5% and 1.6%, respectively) (Figure 2) (ABS 2023).

Figure 2: Prevalence of rheumatoid arthritis, by age and sex, 2022

This figure shows that the prevalence of rheumatoid arthritis is lowest for people aged 44 and under and increases with increasing age.

Impact of rheumatoid arthritis

Many of the symptoms of rheumatoid arthritis, such as physical limitations, pain, fatigue and mental health issues can impact a person’s ability to engage in work, hobbies and social and daily activities (Arthritis Australia 2017; Primdahl et al. 2019). Functional limitations can become evident soon after the onset of the disease and can 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 (Seixas et al. 2022).

Measures of impact presented in this section include burden of disease, health expenditure and mortality data.

Burden of disease

In 2023, rheumatoid arthritis accounted for 2.0% of total disease burden (also known as disability-adjusted life years or DALY), 3.6% of non-fatal burden (also known as years lived with disability or YLD) and 0.1% of fatal burden (also known as years of life lost or YLL). 

Within the musculoskeletal conditions disease group, rheumatoid arthritis accounted for: 

  • 15.7% of total burden (DALY)
  • 15.7% of non-fatal burden (YLD)
  • 15.5% of fatal burden (YLL) (AIHW 2023a).

Variation by age and sex

In 2023, the rate of burden from rheumatoid arthritis:

  • was 1.6 times as high for females compared with males (5.3 and 3.3 DALY per 1,000 population, respectively)
  • increased steeply from about 30–34 years to a high at 75–79 years and 95–99 years (13.3 DALY and 13.4 DALY per 1,000 population, respectively) (Figure 3).

Trends over time

After adjusting for different population age structures over time, the rate of rheumatoid arthritis burden decreased by 35% (from 5.6 to 3.6 DALY per 1,000 population, respectively) – or 2.2% per year on average between 2003 and 2023. Rheumatoid arthritis burden was largely non-fatal in 2023 (97.3% YLD) (Figure 3).

For more information, see the Australian Burden of Disease Study 2023.

Figure 3: Burden of disease due to rheumatoid arthritis by age and sex, 2003, 2011, 2015, 2018 and 2023

This figure shows the rate of total burden of disease for rheumatoid arthritis was highest for people aged 60–64 in 2023.

Variation between population groups

In 2018, after adjusting for age differences, the rate of rheumatoid arthritis burden was highest for people living in:

  • Inner regional areas (5.4 DALY per 1,000 population) and lowest for people living in Major cities and Outer regional areas (both 3.4 DALY per 1,000 population)
  • areas of most disadvantage (lowest socioeconomic areas) and lowest for people living in the moderately disadvantaged areas (the third socioeconomic area) (5.8 and 2.6 DALY per 1,000 population, respectively) (Figure 4) (AIHW 2021).

For more information, see Australian Burden of Disease Study 2018: Interactive data on disease burden.

Figure 4: Burden of disease due to rheumatoid arthritis for remoteness area and socioeconomic area by sex, 2011, 2015 and 2018

This figure shows that the rate of total burden of disease for rheumatoid arthritis was highest for females living in the lowest socioeconomic areas in 2018.

Health system expenditure

In 2020–21, an estimated $966.1 million of expenditure in the Australian health system was for rheumatoid arthritis, representing 0.6% of total health system expenditure and 6.6% of expenditure for all musculoskeletal conditions (AIHW 2023b).

Where is the money spent?

In 2020–21:

  • the Pharmaceutical Benefits Scheme (PBS) accounted for 78% of rheumatoid arthritis spending, which was 6.9 times the proportion for all disease groups (11%)
  • the dominance of PBS led to primary care accounting for 86% of rheumatoid arthritis spending
  • spending for rheumatoid arthritis in all other areas of the health system were proportionately much lower than spending for all disease groups (Figure 5).

Figure 5: Rheumatoid arthritis expenditure attributed to each area of the health system, with comparison to all disease groups, 2020–21

This figure shows that the primary care proportion of rheumatoid arthritis expenditure was $828 million (86%) in 2020-21.

In 2020–21, rheumatoid arthritis accounted for 4.4% ($665.1 million) of PBS expenditure – ranking fourth across all diseases/ conditions (Figure 6).

Figure 6: Proportion of expenditure attributed to rheumatoid arthritis, for each area of the health system, 2020–21

This figure shows that rheumatoid arthritis accounted for 0.6% of pathology expenditure in 2020–21.

Who is the money spent on?

The distribution of health system expenditure on rheumatoid arthritis by age and sex reflects the prevalence distribution, with more spending for older people and females.

In 2020–21:

  • 76% of rheumatoid arthritis expenditure was for people aged over 45
  • twice as much rheumatoid arthritis expenditure was attributed to females compared with males ($561.7 million and $270.9 million, respectively), with a remaining $41.6 million (4.8%) unattributed to any sex.

In 2018–19, it was estimated that rheumatoid arthritis expenditure per case was:

  • 16% higher for females compared with males ($2,000 and $1,700 per case, respectively)
  • 63% higher than expenditure per case for musculoskeletal conditions as a group ($2,000 and $1,200 per case, respectively) (AIHW 2022b).

For more information, see:

How many deaths were associated with rheumatoid arthritis?

Rheumatoid arthritis was recorded as an underlying and/or associated cause for 1,322 deaths or 5.1 deaths per 100,000 population in Australia in 2022. This represented 0.7% of all deaths and 13% of all musculoskeletal deaths in 2022.

Rheumatoid arthritis was the underlying cause for 246 deaths (19% of rheumatoid arthritis deaths) and an associated cause only, for 1,076 deaths (81% of rheumatoid arthritis deaths).

Variation by age and sex

In 2022, rheumatoid arthritis mortality (as the underlying and/or associated cause), in comparison to all deaths, was more common among:

  • older people (76% of rheumatoid arthritis deaths were among people aged 75 and over, compared with 68% for total deaths)
  • females (67% of rheumatoid arthritis deaths were among females, compared with 48% of total deaths) (Figure 7).

Figure 7: Age distribution for rheumatoid arthritis mortality, by sex, 2012 to 2022

This figure shows that in 2022, the death rate due to rheumatoid arthritis was highest for people aged 85 and over (89 deaths per 100,000 population).

Trends over time

After adjusting for different population age structures over time, mortality rates for rheumatoid arthritis (as the underlying and/or associated cause) between 2012 and 2022:

  • changed little, averaging 3.4 per 100,000 population over the period
  • were 1.6 to 1.8 times as high for females compared with males (Figure 8). 

Figure 8: Trends over time for rheumatoid arthritis mortality, 2012 to 2022

This figure shows that between 2012 and 2022, deaths rates due to rheumatoid arthritis increased from 3.8 to 5.1 deaths per 100,000 population.

Variation between population groups

In 2022, after adjusting for age differences, there was little difference by remoteness area or level of disadvantage (or socioeconomic area) for mortality rates for rheumatoid arthritis (as the underlying and/or associated cause).

Treatment and management of rheumatoid arthritis

At present there is no cure for rheumatoid arthritis. The Rheumatoid Arthritis Clinical Care Standard for the management of the disease focuses on early diagnosis, early management, and coordination of multidisciplinary care needs (ARA 2023). 

Medications are primarily used to treat rheumatoid arthritis, however physical therapy and joint replacement surgery can also be used. Based on the patient’s needs, doctors may prescribe 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).

What role do GPs play in managing rheumatoid arthritis?

GPs have an important role to play in the treatment and management of rheumatoid arthritis. The RACGP recommend that GPs complete diagnosis of rheumatoid arthritis as soon as possible and refer patients to a rheumatologist if joint swelling persists beyond 6 weeks (Chaplin 2020; RACGP 2009). Minimising time between diagnosis and referral to a specialist reduces the chances of joint damage occurring and improves long-term outcomes for people with rheumatoid arthritis (Albuquerque et al. 2023).

It is worth noting that there is currently no nationally consistent primary health care data collection to monitor provision of care by GPs. For more information, see General practice, allied health and other primary care services.

What role do hospitals play in treating rheumatoid arthritis?

People with rheumatoid arthritis may require admission to hospital when they experience sudden attacks (flares) of severe pain, swelling and joint pain. 

Data from the National Hospital Morbidity Database (NHMD) show that in 2021–22, there were 15,600 hospitalisations with a principal or additional diagnosis (any diagnosis) of rheumatoid arthritis, representing 0.1% of all hospitalisations.

The rest of this section discusses hospitalisations with a principal diagnosis of rheumatoid arthritis, unless otherwise stated. However, charts and tables also include statistics for any diagnosis of rheumatoid arthritis.

In 2021–22:

  • there were 10,000 hospitalisations for rheumatoid arthritis, representing 0.1% of all hospitalisations, and 39 hospitalisations per 100,000 population
  • rheumatoid arthritis accounted for 20,900 bed days, representing 0.1% of all bed days
  • 21% of rheumatoid arthritis hospitalisations were overnight stays, with an average length of 6.3 days (Figure 9).

Variation by age and sex

In 2021–22, rheumatoid arthritis hospitalisation rates were:

  • highest for people aged 75–79 (140 per 100,000 population) 
  • 2.7 times as high for females compared with males (57 and 21 per 100,000 population, respectively) (Figure 9).

Figure 9: Age distribution for rheumatoid arthritis hospitalisations, by sex, 2011–12 to 2021–22

This figure shows that the hospitalisation rate for rheumatoid arthritis increased with increasing age up to the 75–79 age group, decreasing thereafter.

Trends over time

From 2011–12 to 2021–22, for rheumatoid arthritis hospitalisations:

  • the rate increased to 55 per 100,000 population in 2015–16, before decreasing to 39 per 100,000 population in 2021–22
  • the proportion of overnight stays decreased from 24% to 21% 
  • the average length of overnight stays increased from 5.4 to 6.3 days (Figure 10).

It should be noted that the rate of hospitalisations over the past few years may have been affected by the COVID-19 pandemic. For more information, see the Chronic musculoskeletal conditions COVID-19 impact section.

Figure 10: Trends over time for rheumatoid arthritis hospitalisations, 2011–12 to 2021–22

This figure shows that between 2011–12 and 2021–22, hospitalisation rates for rheumatoid arthritis were consistently higher for females compared with males.

Data