Abstract
The age of onset of rheumatoid arthritis (RA) is an important outcome predictor. Northern countries report an age of RA onset of around 50 years, but apparently, variability exists across different geographical regions. The objective of the present study is to assess whether the age of onset of RA varies across latitudes worldwide. In a proof-of-concept cross-sectional worldwide survey, rheumatologists from preselected cities interviewed 20 consecutive RA patients regarding the date of RA onset (RAO, when the patient first noted a swollen joint). Other studied variables included location of each city, rheumatologist settings, latitudes (10° increments, south to north), longitudes (three regions), intracountry consistency, and countries’ Inequality-adjusted Human Development Index (IHDI). Data from 2481 patients (82% females) were obtained from 126 rheumatologists in 77 cities of 41 countries. Worldwide mean age of RAO was 44 ± 14 years (95% CI 44–45). In 28% of patients, RA began before age 36 years and before age 46 years in 50% of patients. RAO was 8 years earlier around the Tropic of Cancer when compared with northern latitudes (p < 0.001, 95% CI 3.5–13). Multivariate analysis showed that females, western cities, and latitudes around the Tropic of Cancer are associated with younger age of RAO (R 2 0.045, p < 0.001). A positive correlation was found between the age of RAO and IHDI (r = 0.7, p < 0.01, R 2 0.5). RA often begins at an early age and onset varies across latitudes worldwide. We postulate that countries’ developmental status and their geographical and geomagnetic location influence the age of RAO.
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Acknowledgements
We thank Graciela S. Alarcon, M.P.H., for assistance with the preparation of an earlier version of the manuscript. We thank Maarten Boers, Ph.D., for providing data. We thank Leopoldo Mendoza-Garcia for artworks.
The members of the GEO-RA Group are as follows:
Universidad Autonoma de Guadalajara, Guadalajara, Mexico
Cesar Ramos-Remus
Unidad de Investigacion en Enfermedades Cronico-Degenerativas, Guadalajara, Mexico
Aldo Barajas-Ochoa
Andrea Ramirez-Gomez
Jose D. Castillo-Ortiz
Victor Brambila-Barba
Faculty of Medicine, Dentistry and Health University of Sheffield, Sheffield, UK
Adewale O. Adebajo
LSU Health Sciences Center, New Orleans, USA
Luis R. Espinoza
Hospital General Regional 46, Instituto Mexicano del Seguro Social, Guadalajara, Mexico
Francisco J. Aceves-Avila
Secretaria de Salud Jalisco, Guadalajara, Mexico
Jorge M. Sánchez-González
Dr. Benbadis University Hospital, Constantine, Algeria
Nadia Boudersa
University of Batna 2, Batna, Algeria
Samy Slimani
Ben Aknoun Hospital, University of Algiers, Algiers, Algeria
Aicha Ladjouze-Rezig
Centro Traumatológico Bariloche, Bariloche, Argentina
Mónica P. Diaz
Sanatorio San Carlos, Bariloche, Argentina
Karin I. Kirmayr
Hospital Alemán, Buenos Aires, Argentina
Cecilia A. Asnal
Hospital Italiano de Buenos Aires, Instituto Universitario, Escuela de Medicina Hospital Italiano de Buenos Aires y Fundación Dr. Pedro M. Catoggio para el Progreso de la Reumatología, Buenos Aires, Argentina
Luis J. Catoggio
Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina
Gustavo Citera
Hospital Militar Central, Buenos Aires, Argentina
Gustavo C. Casado
Hospital Penna, Buenos Aires, Argentina
Analia P. Alvarez
Departamento de Medicina Interna, CEMIC, Buenos Aires, Argentina
Cecilia N. Pisoni
Hospital Distrito Sanitario N 8: Eva Perón, Formosa, Argentina
Emilio Benavente
Centro Fleboestético del Sur, General Roca, Argentina
Adriana Lopez-Cabanillas
Hospital Zonal General Roca, General Roca, Argentina
Roberto M. Baez
Instituto Cardiovascular de Rosario, Rosario, Argentina
Bernardo A. Pons-Estel
Hospital Provincial de Rosario, Rosario, Argentina
Mónica P. Sacnún
Sección de Reumatologia y Enfermedades Autoimmunes, Hospital JB Iturraspe, Santa Fe, Argentina
Javier A. Cavallasca
Centro Privado de Rehabilitación, Santa Rosa, Argentina
Raúl H. Paniego
Royal Adelaide Hospital and Discipline of Medicine, University of Adelaide, Adelaide, Australia
Susanna M. Proudman
The University of Queensland Diamantina Institute, Princess Alexandra Hospital, Brisbane, Australia
Ranjeny Thomas
Bone & Joint Institute Royal New Castle Centre and University of Newcastle, Newcastle, Australia
Gabor Major
Georgetown Arthritis, Newcastle, Australia
David M. Mathers
Department of Rheumatology, Royal North Shore Hospital, Institute of Bone and Joint Research, Kolling Institute, Sydney, Australia
Leslie Schrieber
Department of Rheumatology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
Nazrul Islam
Syed A. Haq
Rheumatology Division, University Hospital Brussels and Free University Brussels, Brussels, Belgium
Patrick H. Dessein
Rheuma Clinic and Brazilian Society of Autoimmunity, Porto Alegre, Brazil
Carlos A. von Muhlen
Postgraduate School-Pontifica Universidade Católica, and Rheumatology Department at Santa Casa da Misericórdia do Rio de Janeiro General Hospital, Rio de Janeiro, Brazil
Washington A. Bianchi
Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
Geraldo da R. Castelar-Pinheiro
Escola Paulista de Medicina, Universidade Federal De Sao Paulo, Sao Paulo, Brazil
Daniel Feldman-Pollak
Rheumatology Division, School of Medicine of Jundiai, Sao Paulo, Brazil
Waldenise Cossermelli
Hospital das Clinicas-Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
Karina R. Bonfiglioli
Serviço de Reumatologia, Hospital do Servidor Público Estadual FranciscoMorato de Oliveira (HSPE-FMO), São Paulo, Brasil
Rina D. Giorgi
Centre Hospitalier Universitaire Yalgado Ouedraogo, University of Ouagadougou, Ouagadougou, Burkina Faso
Wendlassida J. Zabsonre-Tiendrebeogo
University of Alberta, Edmonton, Canada
Anthony S. Russell
Lilia Olaru
Ottawa Hospital, Ottawa, Canada
Jacob Karsh
University of Concepción, Concepción, Chile
Irene H. Castro-Esparza
Hospital Clínico San Borja Arriarán, Santiago, Chile
Carlos Fuentealba
Clínica Indisa, Universidad de Chile, Santiago, Chile
Sergio Aguilera
Pontificia Universidad Católica de Chile, Santiago, Chile
Paula I. Burgos
Hospital del Salvador, Facultad de Medicina Universidad de Chile, and Clínica Alemana, Facultad de Medicina Clínica Alemana-UDD, Santiago, Chile
Oscar Neira
Department of Rheumatology and Immunology, Beijing University Medical School People’s Hospital, Beijing, China
Zhan-guo Li
Department of Medicine & Therapeutics, the Chinese University of Hong Kong, Hong Kong, China
Lai-Shan Tam
Department of Biomedical Sciences, the City University of Hong Kong, Hong Kong, China
Mo Y. Mok
Universidad Nacional de Colombia, Bogotá, Colombia
Yimy F. Medina
Hospital Luis Vernaza, Guayaquil, Ecuador
Andrés E. Zúñiga-Vera
Mario J. Moreno-Alvarez
Universidad Católica de Guayaquil, Guayaquil, Ecuador
Claudia Vera
Hospital de Especialidades Eugenio Espejo, Quito, Ecuador
Ivonne Quezada
Clínica Santa Lucia, Quito, Ecuador
Iván M. Moreno
Centro de Atención Ambulatoria El Batán (IESS), Quito, Ecuador
Wendy Calapaqui
Rheumatology Unit, Cairo University Hospitals, Cairo, Egypt
Ghada El-Mardenly
Department of Medicine, Ain Shams University, Cairo, Egypt
M. Salah Salama
Rheumatology and Immunology Unit, Department of Internal Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
Gaafar Ragab
Kamel Gado
Rheumatology Center, Cairo, Egypt
Tahsin Hadidi
Department of Rheumatology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
Marjatta Leirisalo-Repo
Riitta Tuompo
Kanta-Häme Hospital, Riihimäki, Finland
Riitta Koivuniemi
INSERM UMR-S938, Faculty of Medicine Pierre & Marie Curie Paris VI, Paris, France, and Department of Rheumatology, Saint-Antoine Hospital, AP-HP, Paris, France
Francis Berenbaum
Rheumatology A Department, Cochin Hospital, Paris Descartes University, Paris, France
Yannick Allanore
Centre de Rhumatologie, Hôpital Purpan, and Université Paul Sabatier Toulouse III, Toulouse, France
Arnaud Constantin
Department of Rheumatology and Clinical Immunology, Charité University Medicine Berlin (CCM), Berlin, Germany
Frank Buttgereit
Division of Rheumatology and Clinical Immunology, Medizinische Klinik und Poliklinik IV, Ludwig Maximilians University, Munich, Germany
Hendrik Schulze-Koops
Myriam Liz
School of Medicine and Dentistry, University of Ghana, Accra, Ghana
Dzifa Dey
Instituto Hondureño de Seguridad Social, Tegucigalpa, Honduras
Carlos B. Santiago-Pastelín
Hugo D. Alonzo-Borjas
Víctor Cuéllar-Cruz
Institute of Rheumatology and Autoimmune Disorders, Sakra World Hospital, Bangalore, India
Balebail G. Dharmanand
P.D. Hinduja Hospital and Medical Research Centre, Mumbai, India
G.C. Yathish
Mumbai Arthritis Clinic, Mumbai, India
Shashank M. Akerkar
Department of Rheumatology, ISIC Superspeciality Hospital and ‘A&R Clinic for Arthritis & Rheumatism’, New Delhi, India
Anand N. Malaviya
Shahid Beheshti University of Medical Sciences, Tehran, Iran
Arman Ahmadzadeh
Central Clinic, Tokyo, Japan
Tomoko Hasunuma
Kenyatta National Hospital, Nairobi, Kenya
Benard O. Owino
Facultad de Medicina, Universidad Autónoma de Chihuahua, Chihuahua, Mexico
César Pacheco-Tena
Departamento de Medicina, Clínica Hospital ISSSTE, Gómez Palacio, Mexico
Aaron Frausto-Arenas
Universidad de Colima, Colima, Mexico
Adrián A. De la Madrid-Cernas
Centro Reumatológico de Querétaro, Querétaro, Mexico
Román Cardona-Cabrera
Instituto Mexicano del Seguro Social, Hermosillo, Mexico
Juan D. Centeno-Valadez
Unidad de Enfermedades Reumáticas y Crónico Degenerativas, Torreón, Mexico
Isaura M. Rodríguez-Torres
National Center for Rheumatic Diseases, Kathmandu, Nepal
Binit Vaidya
Kathmandu, Nepal
Arun K. Gupta
Department of Medicine, University of Otago Wellington, Wellington, New Zealand
Andrew A. Harrison
Department of Medicine and Department of Pathology and Molecular Medicine, University of Otago Wellington, Wellington, New Zealand
Rebecca Grainger
Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
Henry M. Nwankwo
Department of Rheumatology, Hospital for Rheumatic Diseases, Haugesund, Haugesund, Norway
Andreas P. Diamantopoulos
Elisabeth Mæland
UiT the Arctic University of Norway and Finnmarkssykehuset i Kirkenes, Kirkenes, Norway
Emilio Besada
Hospital Santo Tomas, Panama, Panama
Luis Gorriz
Hospital de Clínicas, Universidad Nacional de Asunción, Asunción, Paraguay
Margarita Duarte
Sonia Cabrera-Villalba
Sanatorio Santa Clara, Asunción, Paraguay
Maria T. Romero-de Albrecht
Hospital Carlos Alcántara B, Lima, Peru
Augusto García-Poma
Hospital Nacional Edgardo Rebagliati Martins, EsSalud, Lima Peru, and Universidad Nacional Mayor de San Marcos, Lima, Peru
María I. Segami
Hospital Nacional Edgardo Rebagliati Martins, EsSalud, Lima, Peru
María P. Ramos
Wilkerson Pérez-Medina
Dr. Pablo O. Torre Memorial Hospital, Manila, Philippines
Maria L. Dianongco
St Luke’s Medical Center, Manila, Philippines
Juan J. Lichauco
St. Luke’s Medical Center BGC; Manila Doctors Hospital; University of the Philippines-Philippine General Hospital, Manila, Philippines
Geraldine Z. Racaza
University of Santo Tomas Hospital, Manila, Philippines
Sandra V. Navarra
Tito P. Torralba
University of the Philippines-Philippine General Hospital, Manila, Philippines
Bernadette H. Manapat-Reyes
Ester G. Penserga
Hamad Medical Corporation, Doha, Qatar
Mohammed Hammoudeh
Samar Al-Emadi
Privat out-patients’ clinic “Agat”, Egorievsk, Russia
Anna G. Botchkova
Department of Medicine, Rheumatology Unit, King Fahd Hospital, Jeddah, Saudi Arabia
Sabri H. AlSaeedi
Alzaidi Chair of Research in Rheumatic Diseases-Umm Alqura University, Makkah, Saudi Arabia, and Department of Medicine, Dr. Soliman Fakeeh Hospital, Jeddah, Saudi Arabia
Hani Almoallim
King Saud University, Riyadh, Saudi Arabia
Hussein F. Al-Arfaj
Koh Wei Howe Arthritis & Rheumatism Medical Clinic, Singapore, Singapore
Wei H. Koh
Department of Rheumatology & Immunology, Singapore General Hospital, and Duke-NUS Graduate Medical School, Singapore, Singapore
Ying Y. Leung
Tygerberg Hospital and Stellenbosch University, Bellville, South Africa
David A. Whitelaw
Department of Medicine, Division of Rheumatology, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
Bridget Hodkinson
Hospital Universitari Sagrat Cor, Barcelona, Spain
Javier García-Miguel
Rheumatology Unit. IDC-Salud, Clínica del Pilar, Barcelona, Spain
Juan C. Duro
Department of Rheumatology, Hospital Universitario La Paz, Madrid, Spain
Emilio Martin-Mola
Hospital Central de la Defensa Gómez Ulla, Madrid, Spain
María Ahijón-Lana
Hospital Universitario Puerta de Hierro, Majadahonda, Spain
José L. Andreu
University Hospitals of Geneva, Geneva, Switzerland
Axel Finckh
Deshiré Alpízar-Rodríguez
Division of Rheumatology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
Manathip Osiri
Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Nuntana Kasitanon
Worawit Louthrenoo
Amsterdam Rheumatology and Immunology Center (ARC), Amsterdam, The Netherlands
Ronald F. van Vollenhoven
Amsterdam Rheumatology and Immunology Center (ARC), Department of Clinical Immunology & Rheumatology, Academic Medical Center, Amsterdam, The Netherlands
Niek de Vries
Amsterdam Rheumatology and Immunology Center (ARC), Reade Institute, Amsterdam, The Netherlands
Christiaan van Denderen
Martjin Gerritsen
VieCuri Medical Centre, Venlo, and Scientific Institute for Quality of Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
Tim L. Jansen
Department of Rheumatology, Bernhoven, Uden, The Netherlands
Piet van Riel
Universidad Centroccidental Lisandro Alvarado, Clínica Razetti de Barquisimeto, Barquisimeto, Venezuela
Concepción M. Núñez-Sotelo
Servicio de Reumatología, Hospital Vargas, Caracas, Venezuela
Sol Villegas-Morales
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GEO-RA Group. Latitude gradient influences the age of onset of rheumatoid arthritis: a worldwide survey. Clin Rheumatol 36, 485–497 (2017). https://doi.org/10.1007/s10067-016-3481-9
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DOI: https://doi.org/10.1007/s10067-016-3481-9