Skip to main content

Advertisement

SpringerLink
Log in

Major trends in the manifestations and treatment of rheumatoid arthritis in a multiethnic cohort in Singapore

  • Original Article
  • Published:
Rheumatology International Aims and scope Submit manuscript

Abstract

We analyzed the epidemiological changes of rheumatoid arthritis (RA) over three decades using patients from a single center in Singapore. All patients who fulfill the 1987 American College of Rheumatology criteria for RA were invited to enroll in a prospective disease registry. We analyzed the patient demographics, disease manifestation, management and patient-reported outcomes, including quality of life (QoL), in the three categories according to the year of disease onset: before 1989 (group I), 1990–1999 (group II) and after 2000 (group III). There were 1,153 patients with 231, 532 and 390 in groups I, II and III, respectively. The mean disease durations were 25, 12 and 4.8 years, respectively. The majority was female (84.1 %) and Chinese (76.6 %) with no socio-demographic differences across the three periods. The age of onset rises and the prevalence of rheumatoid factor falls with the proximity of disease onset. Patients with most recent disease onset had the earliest access to the rheumatologist. They also had the highest tender and swollen joint counts, lowest deformed joint count and highest remission rate. Patients in group I report better mental and emotional QoL though many developed marked disability. We have documented changes of the manifestations of RA that are dependent and independent of improved treatment. Significant differences in accessibility to the rheumatologist, RA activity, functional capacity, quality of life and comorbidities were seen in subsequent cohorts due to treatment evolution and more efficient healthcare delivery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Uhlig T, Heiberg T, Mowinckel P, Kvien TK (2008) Rheumatoid arthritis is milder in the new millennium: health status in patients with rheumatoid arthritis 1994–2004. Ann Rheum Dis 67:1710–1715

    Article  PubMed  CAS  Google Scholar 

  2. Welsing PM, Fransen J, van Riel PL (2005) Is the disease course of rheumatoid arthritis becoming milder? Time trends since 1985 in an inception cohort of early rheumatoid arthritis. Arthritis Rheum 52:2616–2624

    Article  PubMed  Google Scholar 

  3. Sokka T, Kautiainen H, Häkkinen A, Hannonen P (2004) Radiographic progression is getting milder in patients with early rheumatoid arthritis. Results of 3 cohorts over 5 years. J Rheumatol 31:1073–1082

    PubMed  Google Scholar 

  4. Enzer I, Dunn G, Jacobsson L, Bennett PH, Knowler WC, Silman A (2002) An epidemiologic study of trends in prevalence of rheumatoid factor seropositivity in Pima Indians: evidence of a decline due to both secular and birth-cohort influences. Arthritis Rheum 46:1729–1734

    Article  PubMed  Google Scholar 

  5. Finckh A, Choi HK, Wolfe F (2006) Progression of radiographic joint damage in different eras: trends towards milder disease in rheumatoid arthritis are attributable to improved treatment. Ann Rheum Dis 65:1192–1197

    Article  PubMed  CAS  Google Scholar 

  6. Kaipiainen-Seppanen O, Kautiainen H (2006) Declining trend in the incidence of rheumatoid factor-positive rheumatoid arthritis in Finland 1980–2000. J Rheumatol 33:2132–2138

    PubMed  Google Scholar 

  7. Leandro MJ (2010) Specificity versus sensitivity: how rheumatoid arthritis diagnosis has changed over the last 10 years. Int J Clin Rheumatol 5:269–271

    Article  Google Scholar 

  8. Gabriel SE, Crowson CS, O’Fallon WM (1999) The epidemiology of rheumatoid arthritis in Rochester, Minnesota, 1955–1985. Arthritis Rheum 42:415–420

    Article  PubMed  CAS  Google Scholar 

  9. Kaipiainen-Seppänen O, Aho K, Isomäki H et al (1996) Shift in the incidence of rheumatoid arthritis toward elderly patients in Finland during 1975–1990. Clin Exp Rheumatol 14:537–542

    PubMed  Google Scholar 

  10. Imanaka T, Shichikawa K, Inoue K et al (1997) Increase in age at onset of rheumatoid arthritis in Japan over a 30 year period. Ann Rheum Dis 56:313–316

    Article  PubMed  CAS  Google Scholar 

  11. Hochberg MC (1990) Changes in the incidence and prevalence of rheumatoid arthritis in England and Wales, 1970–1982. Semin Arthritis Rheum 19:294–302

    Article  PubMed  CAS  Google Scholar 

  12. Doran MF, Pond GR, Crowson CS, O’Fallon WM, Gabriel SE (2002) Trends in incidence and mortality in rheumatoid arthritis in Rochester, Minnesota, over a forty-year period. Arthritis Rheum 46:625–631

    Article  PubMed  Google Scholar 

  13. Myasoedova E, Crowson CS, Kremers HM, Therneau TM, Gabriel SE (2010) Is the incidence of rheumatoid arthritis rising?: results from Olmsted County, Minnesota, 1955–2007. Arthritis Rheum 62:1576–1582

    Article  PubMed  Google Scholar 

  14. Sany J, Bourgeois P, Saraux A et al (2004) Characteristics of patients with rheumatoid arthritis in France: a study of 1109 patients managed by hospital based rheumatologists. Ann Rheum Dis 63:1235–1240

    Article  PubMed  CAS  Google Scholar 

  15. Zink A, Lisitng J, Klindworth C et al (2006) The national database of the German Collaborative Arthritis Centres: I. Structure, aims, and patients. Ann Rheum Dis 60:199–206

    Article  Google Scholar 

  16. Zeng QY, Chen R, Darmawan J et al (2008) Rheumatic diseases in China. Arthritis Res Ther 10:R17

    Article  PubMed  Google Scholar 

  17. Xiang YJ, Dai SM (2009) Prevalence of rheumatic diseases and disability in China. Rheumatol Int 29:481–490

    Article  PubMed  Google Scholar 

  18. Hoe J, Koh DR (1992) Rheumatoid arthritis in Singapore: carpal predominance and lower incidence of erosive changes. Ann Acad Med Singapore 21:741–746

    PubMed  CAS  Google Scholar 

  19. Veerapen K, Mangat G, Watt I et al (1993) The expression of rheumatoid arthritis in Malaysian and British patients: a comparative study. Br J Rheumatol 32:541–545

    Article  PubMed  CAS  Google Scholar 

  20. Rupp I, Boshuizen HC, Roorda LD et al (2006) Course of patient-reported health outcomes in rheumatoid arthritis: comparison of longitudinal and cross-sectional approaches. J Rheumatol 33:228–233

    PubMed  Google Scholar 

  21. Arnett FC, Edworthy SM, Bloch DA et al (1988) The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 31:315–324

    Article  PubMed  CAS  Google Scholar 

  22. Prevoo ML, van‘t Hof MA, Kuper HH et al (1995) Modified disease activity scores that include twenty-eight-joint counts. Development and validation in a prospective longitudinal study of patients with rheumatoid arthritis. Arthritis Rheum 38:44–48

    Article  PubMed  CAS  Google Scholar 

  23. Hochberg MC, Chang RW, Dwosh I et al (1992) The American College of Rheumatology 1991 revised criteria for the classification of global functional status in rheumatoid arthritis. Arthritis Rheum 35:498–502

    Article  PubMed  CAS  Google Scholar 

  24. Koh ET, Seow A, Pong LY et al (1998) Cross cultural adaptation and validation of the Chinese Health Assessment Questionnaire for use in rheumatoid arthritis. J Rheumatol 25:1705–1708

    PubMed  CAS  Google Scholar 

  25. Lam CL, Gandek B, Ren XS et al (1998) Tests of scaling assumptions and construct validity of the Chinese (HK) version of the SF-36 Health Survey. J Clin Epidemiol 51:1139–1147

    Article  PubMed  CAS  Google Scholar 

  26. Koh ET, Leong KP, Tsou IY et al (2006) The reliability, validity and sensitivity to change of the Chinese version of SF-36 in oriental patients with rheumatoid arthritis. Rheumatology (Oxford) 45:1023–1028

    Article  CAS  Google Scholar 

  27. van Tuyl LH, Felson DT, Wells G, American College of Rheumatology, European League against Rheumatism Committee to Define Remission for Clinical Trials et al (2010) Evidence for predictive validity of remission on long-term outcome in rheumatoid arthritis: a systematic review. Arthritis Care Res (Hoboken) 62:108–117

    Article  Google Scholar 

  28. Michaud K, Wolfe F (2007) Comorbidities in rheumatoid arthritis. Best Pract Res Clin Rheumatol 21:885–906

    Article  PubMed  Google Scholar 

  29. Malaviya AN, Kapoor SK, Singh RR et al (1993) Prevalence of rheumatoid arthritis in the adult Indian population. Rheumatol Int 13:131–134

    Article  PubMed  CAS  Google Scholar 

  30. Yamanaka H, Inoue E, Singh G, Tanaka E, Nakajima A et al (2007) Improvement of disease activity of rheumatoid arthritis patients from 2000 to 2006 in a large observational cohort study IORRA in Japan. Mod Rheumatol 17:283–289

    Article  PubMed  Google Scholar 

  31. Singapore Department of Statistics. Census of population (2010) Available from http://www.singstat.gov.sg/pubn/popn/c2010acr.pdf. Accessed 26 October 2011

  32. Taylor KE, Remmers EF, Lee AT, Ortmann WA, Plenge RM, Tian C, Chung SA, Nititham J, Hom G, Kao AH, Demirci FY, Kamboh MI, Petri M, Manzi S, Kastner DL, Seldin MF, Gregersen PK, Behrens TW, Criswell LA (2008) Specificity of the STAT4 genetic association for severe disease manifestations of systemic lupus erythematosus. PLoS Genet 4:e1000084

    Article  PubMed  Google Scholar 

  33. Chibnik LB, Keenan BT, Cui J, Liao KP, Costenbader KH, Plenge RM, Karlson EW. Genetic risk score predicting risk of rheumatoid arthritis phenotypes and age of symptom onset. PLoS One. 2011;6(9):e24380 (Epub 2011 Sep 12)

  34. Ziegler S, Huscher D, Karberg K, Krause A, Wassenberg S, Zink A (2010) Trends in treatment and outcomes of rheumatoid arthritis in Germany 1997–2007: results from the National Database of the German Collaborative Arthritis Centres. Ann Rheum Dis 69:1803–1808

    Article  PubMed  Google Scholar 

  35. Gonzalez-Alvaro I, Descalzo MA, The EMECAR Study Group (2008) Trends towards an improved disease state in rheumatoid arthritis over time: influence of new therapies and changes in management approach: analysis of the EMECAR cohort. Arthritis Res Ther 10:R138

    Article  PubMed  Google Scholar 

  36. Jamal S, Alibhai SM, Badley EM, Bombardier C (2011) Time to treatment for new patients with rheumatoid arthritis in a major metropolitan city. J Rheumatol 38:1282–1288

    Article  PubMed  Google Scholar 

  37. Leardini G, Salaffi F, Montanelli R et al (2002) A multicenter cost-of-illness study on rheumatoid arthritis in Italy. Clin Exp Rheumatol 20:505–515

    PubMed  CAS  Google Scholar 

  38. Carmona L, González-Alvaro I, Balsa A et al (2003) EMECAR study group. Rheumatoid arthritis in Spain: occurrence of extra-articular manifestations and estimates of disease severity. Ann Rheum Dis 62:897–900

    Article  PubMed  CAS  Google Scholar 

  39. Sokka T, Kautiainen H, Toloza S et al (2007) Quantitative clinical assessment of patients with rheumatoid arthritis seen in standard rheumatology care in 15 countries. Ann Rheum Dis 66:1491–1496

    Article  PubMed  Google Scholar 

  40. van der Heijde DM, van Leeuwen MA, van Riel PL et al (1992) Biannual radiographic assessments of hands and feet in a three-year prospective followup of patients with early rheumatoid arthritis. Arthritis Rheum 35:26–34

    Article  PubMed  Google Scholar 

  41. Sanmarti R, Gomez A, Ercilla G, Gratacos J, Larrosa M et al (2003) Radiological progression in early rheumatoid arthritis after DMARDS: a one-year follow-up study in a clinical setting. Rheumatology (Oxford) 42:1044–1049

    Article  CAS  Google Scholar 

  42. Lindqvist E, Jonsson K, Saxne T, Eberhardt K (2003) Course of radiographic damage over 10 years in a cohort with early rheumatoid arthritis. Ann Rheum Dis 62:611–616

    Article  PubMed  CAS  Google Scholar 

  43. Calquneri M, Ureten K, Akif Ozturk M, Onat AM, Ertenli I, Kiraz S, Akdogan A (2006) Extra-articular manifestations of rheumatoid arthritis: results of a university hospital of 526 patients in Turkey. Clin Exp Rheumatol 24:305–308

    Google Scholar 

  44. Cimmino MA, Salvarani C, Macchioni P, Montecucco C, Fossaluzza V et al (2000) Extra-articular manifestations in 587 Italian patients with rheumatoid arthritis. Rheumatol Int 19:213–217

    Article  PubMed  CAS  Google Scholar 

  45. Carmona L, González-Alvaro I, Balsa A, Angel Belmonte M, Tena C, Sanmartí R (2003) Rheumatoid arthritis in Spain: occurrence of extra-articular manifestations and estimates of disease severity. Ann Rheum Dis 62:897–900

    Article  PubMed  CAS  Google Scholar 

  46. Turesson C, O’Fallon WM, Crowson CS, Gabriel SE, Matteson EL (2003) Extra-articular disease manifestations in rheumatoid arthritis: incidence trends and risk factors over 46 years. Ann Rheum Dis 62:727

    Article  Google Scholar 

  47. Alam SM, Kidwai AA, Jafri SR, Oureshi BM, Sami A et al (2011) Epidemiology of rheumatoid arthritis in a tertiary care unit, Karachi, Pakistan. J Pak Med Assoc 61:123–126

    PubMed  Google Scholar 

  48. Mohd Noor N, Mohd Shahrir MS, Shahid MS, Abdul Manap R, Shahizon Azura AM, Azhar Shah S (2009) Clinical and high resolution computed tomography characteristics of patients with rheumatoid arthritis lung disease. Int J Rheum Dis 12:136–144

    Article  PubMed  Google Scholar 

  49. Cohen MG, Li EK, Ng PY, Chan KL (1993) Extra-articular manifestations are uncommon in southern Chinese with rheumatoid arthritis. Br J Rheumatol 32:209–211

    Article  PubMed  CAS  Google Scholar 

  50. Giles JT, Post W, Blumenthal RS, Bathon JM (2006) Therapy insight: managing cardiovascular risk in patients with rheumatoid arthritis. Nat Clin Pract Rheumatol 2:320–329

    Article  PubMed  CAS  Google Scholar 

  51. Bartels CM, Bell CL, Shinki K, Rosenthal A, Bridges AJ (2010) Changing trends in serious extra-articular manifestations of rheumatoid arthritis among United State veterans over 20 years. Rheumatology (Oxford) 49:1670–1675

    Article  Google Scholar 

  52. Sokka T, Toloza S, Cutolo M, Kautiainen H, Makinen H et al (2009) Women, men, and rheumatoid arthritis: analyses of disease activity, disease characteristics, and treatments in the QUEST-RA Study. Arthritis Res Ther 11:R7

    PubMed  Google Scholar 

Download references

Acknowledgments

We acknowledge the contribution of the following in the TTSH RA study group: Li Ching Chew, Eleen Yun Yin Chong, Humeira Badsha, Grace Yin Lai Chan, Gervais Wansaicheong, Julio Chacko. This project was funded by a research grant from the National Healthcare Group (NHG), Singapore.

Conflict of interest

None.

Author information

Author notes

  1. Arul Earnest

    Present address: Centre for Quantitative Medicine, Duke-NUS Graduate Medical School Singapore, 8 College Road, Singapore, 169857, Singapore

Authors and Affiliations

  1. Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore, Singapore

    Ee Tzun Koh, Justina Wei Lynn Tan, Bernard Yu-Hor Thong, Cheng Lay Teh, Tsui Yee Lian, Weng Giap Law, Kok Ooi Kong, Tang Ching Lau, Yew Kuang Cheng, Hwee Siew Howe, Wern Hui Yong, Faith Li-Ann Chia, Hiok Hee Chng & Khai Pang Leong

  2. Clinical Research Unit, Tan Tock Seng Hospital, Singapore, Singapore

    Arul Earnest

Authors
  1. Ee Tzun Koh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Justina Wei Lynn Tan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bernard Yu-Hor Thong
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Cheng Lay Teh
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tsui Yee Lian
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Weng Giap Law
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Arul Earnest
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Kok Ooi Kong
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Tang Ching Lau
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Yew Kuang Cheng
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Hwee Siew Howe
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Wern Hui Yong
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Faith Li-Ann Chia
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Hiok Hee Chng
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Khai Pang Leong
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

TTSH RA Study Group

Corresponding author

Correspondence to Justina Wei Lynn Tan.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Koh, E.T., Tan, J.W.L., Thong, B.YH. et al. Major trends in the manifestations and treatment of rheumatoid arthritis in a multiethnic cohort in Singapore. Rheumatol Int 33, 1693–1703 (2013). https://doi.org/10.1007/s00296-012-2602-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00296-012-2602-2

Keywords

Search

Navigation