The epidemiology of rheumatoid arthritis in Indonesia

The prevalence of RA was investigated as part of a house-to-house survey of musculoskeletal pain in a total population of 4683 rural and 1071 urban subjects 15 years of age and over in Central Java. Those identified as having peripheral joint pain of more than 6 weeks duration (82 men and 129 women) were examined by a rheumatologist (JD) and serology tests and X-rays arranged. The prevalence of definite RA by ARA criteria was 0.2% in rural and 0.3% in urban subjects. The severity of diagnosed cases was indicated by Steinbrocker's functional classification of grades 2 and 3 and erosive arthritis on hand X-rays of grades 2-4. The low prevalence rate of RA compared with that found in developed countries is due partly to the different age structure of the population and lower life expectancy. There is also evidence of high mortality from the disease. This is thought to be due to the deprived socio-economic circumstances, the intermittent use of high dose corticosteroids and the frequent presence of severe infections in these communities. These factors should be considered when assessing the low prevalence of RA in surveys in other developing countries.