Rheumatoid arthritis worldwide: inequalities in epidemiology and care

Abstract

Introduction. Rheumatoid arthritis (RA) is a chronic autoimmune disease affecting approximately 0.5% of the global population. It represents a major cause of disability, reduced quality of life, and healthcare burden. The prevalence of RA is rising, especially in older populations and in low-income regions. Materials and methods. A systematic literature search was performed in PubMed, ScienceDirect and Google Scholar for articles published between 2000 and 2025. Search terms included “rheumatoid arthritis”, “epidemiology”, “risk factors”, “economic burden”, and “healthcare disparities”. Results. RA prevalence ranges from 0.3% to 1.0%, with the highest values in Northern Europe (0.8–1.0%) and North America (0.7–0.9%), and the lowest in Africa (0.1–0.3%) and rural Asia (0.2–0.4%). Work incapacity has declined in several high-income countries, attributed to earlier diagnosis and the widespread use of disease-modifying antirheumatic drugs. Socio-economic status is a key factor for RA outcomes, with patients in the lowest income groups showing up to 50% higher disability rates. Other risk factors include female sex, HLA-DRB1 alleles, smoking, and environmental exposures. The economic burden is considerable, with direct and indirect costs disproportionately affecting low- and middle-income countries, where RA frequently results in early work disability. Conclusions. RA causes disability and reduces quality of life. Its prevalence is rising worldwide, with higher detection and better outcomes in high-income countries, while low-income countries face underdiagnosis and limited access to modern therapies. Reducing these disparities requires stronger healthcare systems, early diagnosis, and affordable and accessible treatments.