Prevalence of rheumatoid arthritis

D. Zauli, S. Zucchini, E. Manfredini, A. Grassi, G. Ballardini, M. Fusconi and F. B. Bianchi

University of Bologna, Department of Internal Medicine, Cardioangiology and Hepatology, Bologna, Italy

SIR, Symmons et al. [1] have shown that the prevalence of rheumatoid arthritis (RA) in the UK has declined since the 1950s and they have attributed the event to a protective effect of the contraceptive pill or something related to it. As allergo-immunologists, our hypothesis has been that this decline might be related to the well established increase in the prevalence of atopic diseases, conditions thought to be driven by opposite immune mechanisms to RA: the so-called Th1/Th2 paradigm [2].

To test this hypothesis, in the last two years or so we have decided to interview and clinically examine all the subjects referred to our out-patient allergy clinic for autoimmune/rheumatic diseases of any type. To date, we have seen 3671 subjects, of whom 151 were of non-Italian origin and 214 were aged 15 yr or younger. Of the 3306 Italian adults left, 1937 could be classified as atopics on the basis of the clinical history (rhinitis with or without asthma, food allergy, urticaria and other dermatitis) and the results of allergy tests. The 1369 non-atopics, although referred to the clinic for similar complaints as atopics, could not be diagnosed as such on the basis of the results of allergy tests.

In the former group we could identify two female patients with a diagnosis of RA: one, aged 23, with a history of seronegative juvenile RA in complete remission and one, aged 53, who received a diagnosis of RA 5 yr earlier and was in treatment (cyclosporin)-induced partial remission. Thus, the overall prevalence in the atopic group was 0.11%. In the non-atopics we observed only one 26-yr-old male patient who also had a history of seronegative juvenile RA (prevalence rate 0.07%). The global prevalence of RA in the 3306 subjects observed so far is, therefore, 0.09%.

In conclusion, although our hypothesis (of a mutual exclusion between atopy and RA) could not be confirmed by these preliminary data, the prevalence of RA in Italian adults appears to be even lower than that reported by Symmons et al. [1] in the UK. As in their study, however, our prevalence figures might be an underestimate due to failure to attend the clinic by patients with: (i) important RA-related disability, (ii) severe RA and no concern about allergy-related symptoms or (iii) treatment (steroids, in particular)-induced remission of allergy-related symptoms.

Notes

Correspondence to: D. Zauli. E-mail: dzauli{at}almadns.unibo.it Back

References

  1. Symmons D, Turner G, Webb R et al. The prevalence of rheumatoid arthritis in the United Kingdom. Rheumatology 2002;41:793–800.[Abstract/Free Full Text]
  2. Romagnani S. The Th1/Th2 paradigm. Immunol Today 1997;18:263–6.[CrossRef][ISI][Medline]
Accepted 24 September 2002





This Article
Full Text (PDF)
Alert me when this article is cited
Alert me if a correction is posted
Services
Email this article to a friend
Similar articles in this journal
Similar articles in ISI Web of Science
Similar articles in PubMed
Alert me to new issues of the journal
Add to My Personal Archive
Download to citation manager
Disclaimer
Request Permissions
Google Scholar
Articles by Zauli, D.
Articles by Bianchi, F. B.
PubMed
PubMed Citation
Articles by Zauli, D.
Articles by Bianchi, F. B.
Related Collections
Rheumatoid Arthritis