Rheumatoid arthritis, psoriatic arthritis, and axial spondyloarthritis epidemiology in England from 2004 to 2020: An observational study using primary care electronic health record data

Background Contemporary data on rheumatoid arthritis (RA), psoriatic arthritis (PsA) and axial spondyloarthritis (SpA) epidemiology in England are lacking. This knowledge is crucial to planning healthcare services. We updated algorithms defining patients with diagnoses of RA, PsA, and axial SpA in primary care and applied them to describe their incidence and prevalence in the Clinical Practice Research Datalink Aurum, an electronic health record (EHR) database covering similar to 20% of England. Methods Algorithms for ascertaining patients with RA, axial SpA, and PsA diagnoses validated in primary care EHR databases using Read codes were updated (to account for the English NHS change to SNOMED CT diagnosis coding) and applied. Updated diagnosis and synthetic disease-modifying anti-rheumatic drug code lists were devised by rheumatologists and general practitioners. Annual incidence/point-prevalence of RA, PsA, and axial SpA diagnoses were calculated from 2004 to 2020 and stratified by age/sex. Findings Point-prevalence of RA/PsA diagnoses increased annually, peaking in 2019 (RA 0 cent 779% [95% confidence interval (CI) 0.773, 0.784]; PsA 0.287% [95% CI 0.284, 0.291]) then falling slightly. Point-prevalence of axial SpA diagnoses increased annually (except in 2018/2019), peaking in 2020 (0.113% [95% CI 0.111, 0.115]). RA diagnosis annual incidence was higher between 2013-2019 (after inclusion in the Quality and Outcomes Framework, range 49.1 [95% CI 47. 7, 50.5] to 52. 1 [95% CI 50. 6, 53. 6]/100,000 person-years) than 2004-2012 (range 34. 5 [95% CI 33. 2, 35. 7] to 40. 0 [95% CI 38. 6, 41. 4]/100,000 person-years). Increases in the annual incidence of PsA/axial SpA diagnosis occurred following new classification criteria publication. Annual incidence of RA, PsA and axial SpA diagnoses fell by 40.1%, 67.4%, and 38.1%, respectively between 2019 and 2020, likely reflecting the COVID-19 pandemic's impact on their diagnosis. Interpretation Recorded RA, PsA, and axial SpA diagnoses are increasingly prevalent in England, underlining the importance of organising healthcare services to provide timely, treat-to-target care to optimise the health of > 1% of adults in England.

Automated summary

This study updated algorithms for diagnosing RA, PsA, and axial SpA in primary care and used electronic health record data to describe their incidence and prevalence in England. The findings showed an increasing prevalence of RA and PsA, while the prevalence of axial SpA fluctuated. The annual incidence of these diseases also varied over time, with an increase following the publication of new classification criteria. The COVID-19 pandemic had a significant impact on the diagnosis of these diseases, leading to a decrease in their incidence in 2020.