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*It is only for medical professionals to read.
Unexpectedly, it is so difficult for Chinese RA patients! From August 28 to 31, 2021, the 23rd Asia Pacific Association of Rheumatology Association (APLAR) Annual Meeting will be held in Japan in the form of an online conference
.
At the conference, Professor Tian Xinping from the Department of Rheumatology and Immunology of Peking Union Medical College Hospital introduced the epidemiological changes of rheumatoid arthritis (RA) in China
.
Professor Tian Xinping took the harm of RA to the human body as an entry point, compared the international and domestic epidemiology of RA, and summarized the epidemiological characteristics and dynamic changes of RA in China
.
Through CREDIT data, observe the characteristics of Chinese RA patients.
RA is a chronic autoimmune disease with synovitis as the pathological feature.
The clinical manifestations are mainly morning stiffness, joint swelling and pain, and limited joint mobility.
The disability rate is relatively high, which is more common in Female
.
The results of the second national disability sample survey in 2006 (Figure 1) show that arthropathy is one of the two major causes of disability; and among arthropathy, RA is the most important cause of disability
.
One in eight males or four females with RA is disabled by RA
.
Figure 1 Results of the second national disability sample survey 15 years later, what changes have occurred in the epidemiology of RA in my country, such as the prevalence rate, disability rate, and gender difference? What are the local characteristics compared with international data? In order to answer the above questions and improve the long-term prognosis of Chinese RA patients, China established the China Rheumatoid Arthritis Direct Reporting Project (CREDIT; China’s first national multi-center, real-world rheumatoid arthritis registered research project) in 2016, to In 2021, 31 provinces and 417 clinical centers have been covered.
A total of 1,487 rheumatology and immunology experts participated in the project, assisting 69,691 RA patients to complete information entry.
Professor Tian Xinping will summarize and report the relevant statistical results.
Let us continue.
Look
.
Difficulties and challenges: There are more and younger RA patients in China, and the burden is heavier.
Professor Tian Xinping said: Worldwide, the age of onset of RA is 60 to 64 years old, and the average age of onset is 55 years old
.
In China, the general age of onset of RA is 51 years old, and the average age of onset is 45 years (Figure 2), which means that the age of onset of RA patients in China is a full ten years earlier than other RA patients in the world
.
Figure 2 Left: Age of onset of RA in China; Right: Age of onset of International RA In 2010, the global prevalence of RA was 0.
24%
.
However, as early as 1983, the prevalence of RA was reported for the first time in China, which exceeded this figure, at 0.
3%
.
As of 2013, the prevalence of RA has increased to 0.
42%, which is a total of 5 million RA patients (Figure 3)
.
Figure 3 Left: the prevalence of RA in China; right: the prevalence of international RA in recent years.
The increase in the prevalence of RA in China in recent years may be related to medical advances, more accurate examinations and increased diagnosis rates, and may also be related to the occupation of the people.
It is related to changes in life>
.
International data report that 80% of RA patients have incomplete disability, and 16% of RA patients are completely disabled after 12 years of illness
.
In China, disability is defined as joint deformity accompanied by functional disability.
The 5-year disability rate of RA patients is 43.
48%, and the disability rate of patients with a disease course of more than 10 years is as high as 30%-40%
.
It can be seen that not only the age of onset of RA patients in China is younger and the prevalence rate is higher, the disability rate is also much higher than the international level, which has caused a huge medical burden on the patient's family and our society
.
Figure 4 The gap between the domestic RA disability rate and the international RA age of onset, prevalence and disability rate reminds us that medical staff and researchers need to actively search for the etiology and factors of RA to delay the age of onset of RA, the prevalence and The disability rate is reduced, the quality of life of patients is improved, and their social viability is guaranteed
.
Continuous improvement: More patients in China have been diagnosed and their condition is relieved.
The diagnosis of RA is mainly based on medical history, clinical and imaging findings.
However, some patients have atypical early clinical symptoms and imaging features.
At this time, it is necessary to detect rheumatoid factor (RF).
), anti-cyclic citrullinated peptide (CCP) antibody, anti-perinuclear factor antibody (APF), anti-keratin antibody (AKA) and glucose-6-phosphate isomerase (GPI) levels to aid diagnosis
.
However, not all hospitals are equipped with relevant inspection equipment, and not all patients are willing to spend money to do a full set of inspections for "joint discomfort"
.
In China, the diagnosis rate of early RA is low
.
Data from CREDIT before 2019 shows that the average interval from the onset of symptoms to diagnosis is 2.
1 years (Figure 5)
.
Therefore, many patients miss the best treatment window for the disease
.
Nevertheless, the progress in recent years is still worthy of recognition: Based on CREDIT data from 2016 to 2019, the diagnosis rate of RA patients with a course of less than 6 months has gradually increased
.
Figure 5 The diagnosis rate of early RA in my country At the same time, the remission rate of RA patients in China is increasing after treatment
.
CREDIT made an analysis based on the clinical data of 962 patients.
At baseline, patients with high disease activity accounted for 34.
5%, and only 18.
7% of patients achieved remission (Figure 6)
.
After 1 year of treatment, the proportion of patients with high disease activity was reduced to 9.
4%, and 40.
2% of RA patients were relieved
.
However, the condition of most patients still belongs to medium or high disease activity
.
Figure 6 The remission rate of RA patients in China "Local characteristics": ILD is the main complication of RA patients in China.
RA patients have decreased immunity and are more likely to be infected.
Hormonal drugs taken will also have adverse effects on the body, so the types of complications More
.
International statistics report that the most common complications of RA include hypertension (46.
9%), coronary heart disease (CHD) (18.
5%) and interstitial lung disease (ILD) (4.
34%) (Figure 7)
.
In China, ILD is the most important complication of RA.
CREDIT 2017 data shows that 21.
98% of RA patients suffer from ILD.
In 2019, this value decreased to 10.
32%, but it is still the most important complication of RA
.
In addition, complications such as CHD, fragility fractures, and stroke cannot be ignored
.
Figure 7 Left: Domestic RA complications; Right: International RA complications summary: As the systemic rheumatic immune disease with the highest prevalence, the Chinese RA patient population has these four outstanding characteristics: 1.
There are many patients, at least 5 million 2.
The diagnosis is late, the average time from symptom onset to diagnosis is more than 2 years; 3.
The condition is severe, most of the Chinese RA patients have moderate or high disease activity; 4.
There are many complications, including ILD, CHD, fragility fractures, joint replacement, stroke, cancer and so on
.
Finally, Professor Tian Xinping said that the development of rheumatology in my country in recent years is changing the epidemiological characteristics of RA, such as the increase in the diagnosis rate and the remission rate after treatment.
.
However, we still have a long way to go for how to make early diagnosis and improve the prognosis
.
References: [1] Li ZG.
Nal Med J China.
2009:89(27):1873-5.
[2]Zhou Yunshan.
et al.
A national multi-center survey on disability and functional limitation of patients with rheumatoid joints.
Zhonghua Journal of Rheumatology.
Unexpectedly, it is so difficult for Chinese RA patients! From August 28 to 31, 2021, the 23rd Asia Pacific Association of Rheumatology Association (APLAR) Annual Meeting will be held in Japan in the form of an online conference
.
At the conference, Professor Tian Xinping from the Department of Rheumatology and Immunology of Peking Union Medical College Hospital introduced the epidemiological changes of rheumatoid arthritis (RA) in China
.
Professor Tian Xinping took the harm of RA to the human body as an entry point, compared the international and domestic epidemiology of RA, and summarized the epidemiological characteristics and dynamic changes of RA in China
.
Through CREDIT data, observe the characteristics of Chinese RA patients.
RA is a chronic autoimmune disease with synovitis as the pathological feature.
The clinical manifestations are mainly morning stiffness, joint swelling and pain, and limited joint mobility.
The disability rate is relatively high, which is more common in Female
.
The results of the second national disability sample survey in 2006 (Figure 1) show that arthropathy is one of the two major causes of disability; and among arthropathy, RA is the most important cause of disability
.
One in eight males or four females with RA is disabled by RA
.
Figure 1 Results of the second national disability sample survey 15 years later, what changes have occurred in the epidemiology of RA in my country, such as the prevalence rate, disability rate, and gender difference? What are the local characteristics compared with international data? In order to answer the above questions and improve the long-term prognosis of Chinese RA patients, China established the China Rheumatoid Arthritis Direct Reporting Project (CREDIT; China’s first national multi-center, real-world rheumatoid arthritis registered research project) in 2016, to In 2021, 31 provinces and 417 clinical centers have been covered.
A total of 1,487 rheumatology and immunology experts participated in the project, assisting 69,691 RA patients to complete information entry.
Professor Tian Xinping will summarize and report the relevant statistical results.
Let us continue.
Look
.
Difficulties and challenges: There are more and younger RA patients in China, and the burden is heavier.
Professor Tian Xinping said: Worldwide, the age of onset of RA is 60 to 64 years old, and the average age of onset is 55 years old
.
In China, the general age of onset of RA is 51 years old, and the average age of onset is 45 years (Figure 2), which means that the age of onset of RA patients in China is a full ten years earlier than other RA patients in the world
.
Figure 2 Left: Age of onset of RA in China; Right: Age of onset of International RA In 2010, the global prevalence of RA was 0.
24%
.
However, as early as 1983, the prevalence of RA was reported for the first time in China, which exceeded this figure, at 0.
3%
.
As of 2013, the prevalence of RA has increased to 0.
42%, which is a total of 5 million RA patients (Figure 3)
.
Figure 3 Left: the prevalence of RA in China; right: the prevalence of international RA in recent years.
The increase in the prevalence of RA in China in recent years may be related to medical advances, more accurate examinations and increased diagnosis rates, and may also be related to the occupation of the people.
It is related to changes in life>
.
International data report that 80% of RA patients have incomplete disability, and 16% of RA patients are completely disabled after 12 years of illness
.
In China, disability is defined as joint deformity accompanied by functional disability.
The 5-year disability rate of RA patients is 43.
48%, and the disability rate of patients with a disease course of more than 10 years is as high as 30%-40%
.
It can be seen that not only the age of onset of RA patients in China is younger and the prevalence rate is higher, the disability rate is also much higher than the international level, which has caused a huge medical burden on the patient's family and our society
.
Figure 4 The gap between the domestic RA disability rate and the international RA age of onset, prevalence and disability rate reminds us that medical staff and researchers need to actively search for the etiology and factors of RA to delay the age of onset of RA, the prevalence and The disability rate is reduced, the quality of life of patients is improved, and their social viability is guaranteed
.
Continuous improvement: More patients in China have been diagnosed and their condition is relieved.
The diagnosis of RA is mainly based on medical history, clinical and imaging findings.
However, some patients have atypical early clinical symptoms and imaging features.
At this time, it is necessary to detect rheumatoid factor (RF).
), anti-cyclic citrullinated peptide (CCP) antibody, anti-perinuclear factor antibody (APF), anti-keratin antibody (AKA) and glucose-6-phosphate isomerase (GPI) levels to aid diagnosis
.
However, not all hospitals are equipped with relevant inspection equipment, and not all patients are willing to spend money to do a full set of inspections for "joint discomfort"
.
In China, the diagnosis rate of early RA is low
.
Data from CREDIT before 2019 shows that the average interval from the onset of symptoms to diagnosis is 2.
1 years (Figure 5)
.
Therefore, many patients miss the best treatment window for the disease
.
Nevertheless, the progress in recent years is still worthy of recognition: Based on CREDIT data from 2016 to 2019, the diagnosis rate of RA patients with a course of less than 6 months has gradually increased
.
Figure 5 The diagnosis rate of early RA in my country At the same time, the remission rate of RA patients in China is increasing after treatment
.
CREDIT made an analysis based on the clinical data of 962 patients.
At baseline, patients with high disease activity accounted for 34.
5%, and only 18.
7% of patients achieved remission (Figure 6)
.
After 1 year of treatment, the proportion of patients with high disease activity was reduced to 9.
4%, and 40.
2% of RA patients were relieved
.
However, the condition of most patients still belongs to medium or high disease activity
.
Figure 6 The remission rate of RA patients in China "Local characteristics": ILD is the main complication of RA patients in China.
RA patients have decreased immunity and are more likely to be infected.
Hormonal drugs taken will also have adverse effects on the body, so the types of complications More
.
International statistics report that the most common complications of RA include hypertension (46.
9%), coronary heart disease (CHD) (18.
5%) and interstitial lung disease (ILD) (4.
34%) (Figure 7)
.
In China, ILD is the most important complication of RA.
CREDIT 2017 data shows that 21.
98% of RA patients suffer from ILD.
In 2019, this value decreased to 10.
32%, but it is still the most important complication of RA
.
In addition, complications such as CHD, fragility fractures, and stroke cannot be ignored
.
Figure 7 Left: Domestic RA complications; Right: International RA complications summary: As the systemic rheumatic immune disease with the highest prevalence, the Chinese RA patient population has these four outstanding characteristics: 1.
There are many patients, at least 5 million 2.
The diagnosis is late, the average time from symptom onset to diagnosis is more than 2 years; 3.
The condition is severe, most of the Chinese RA patients have moderate or high disease activity; 4.
There are many complications, including ILD, CHD, fragility fractures, joint replacement, stroke, cancer and so on
.
Finally, Professor Tian Xinping said that the development of rheumatology in my country in recent years is changing the epidemiological characteristics of RA, such as the increase in the diagnosis rate and the remission rate after treatment.
.
However, we still have a long way to go for how to make early diagnosis and improve the prognosis
.
References: [1] Li ZG.
Nal Med J China.
2009:89(27):1873-5.
[2]Zhou Yunshan.
et al.
A national multi-center survey on disability and functional limitation of patients with rheumatoid joints.
Zhonghua Journal of Rheumatology.
