Epidemiology of rheumatoid arthritis, juvenile idiopathic
arthritis and gout in two regions of the Czech Republic in a
descriptive population-based survey in 2002-2003
P. Hanova1, K. Pavelka1, C. Dostal1, I. Holcatova2, H. Pikhart3
1Institute of Rheumatology and 2Institute of Epidemiology, 1st Medical Faculty, Charles University,
Prague, Czech Republic; 3Department of Epidemiology and Public Health, UCL, London,
To estimate the annual incidence and prevalence of rheumatoid arthritis (RA), juvenile arthritis (JIA) and gout in a
population based study in two regions of the Czech Republic with total population of 186,000 inhabitants.
The study was conducted in the Town of Ceske Budejovice and district of Cheb in the Czech Republic (with a total pop-
ulation of 186,000 inhabitants) in the years 2002 and 2003. Incident cases were registered on condition that the definite
diagnosis was confirmed according to existing classification criteria during the study period. Prevalence was studied
on the basis of identification of established diagnosis from registers of patients of participating rheumatologists and
other specialists. They were asked to report all living patients who had been diagnosed before 1stMarch 2002. Patients
were only included in the study if their permanent address was in the selected study area.
Overall, we found 48 incident and 947 prevalent cases of RA among adults (16+ years), 4 incident and 43 prevalent
cases of JIA among children (less than 16 years old), and 64 incident and 425 prevalent cases of gout among adults
(16+ years). The total annual incidence of RA was 31/100,000 in the adult population aged 16 years and more (95%
CI 20 to 42/100,000). The prevalence of RA was 610/100,000 (95% CI 561 to 658/100,000) in the adult population.
An annual incidence of gout in adults was 41/100,000 (95% CI 28 to 53/100,000). The prevalence of gout was
300/100,000 (95% CI 266 to 334/100,000). The annual incidence of JIA was 13/100,000 in children less than 16 years
old (95%CI 1 to 20/100,000). The prevalence of JIA in children was 140/100,000 (95% CI 117 to 280/100,000).
This study estimates the annual incidence and prevalence rates of RA, gout and JIA in the first population-based survey
in the Czech Republic. The rates of RA and JIA compare well with figures reported from other countries; figures in gout
seem to be lower than reported elsewhere.
Epidemiology, incidence, prevalence, rheumatoid arthritis, juvenile idiopathic arthritis, gout.
Clinical and Experimental Rheumatology 2006; 24: 499-507.
Petra Hanova, MUDr; Karel Pavelka,
Prof. MUDr, DrSc; Ctibor Dostal, Prof.
MUDr, DrSc; Ivana Holcatova, MUDr,
CSc; Hynek Pikhart, MD, PhD..
The study was supported by grant No.
00000023728 from the Czech Ministry of
Please address correspondence and reprint
requests to: MUDr. Petra Hanova, Institute
of Rheumatology, 1st Medical Faculty ,
Charles University, Na Slupi 4, 128 50
Praha 2, Czech Republic.
E-mail address: firstname.lastname@example.org
Received on January 10, 2005; accepted in
revised form on April 11, 2006.
© Copyright CLINICAL AND EXPERIMEN-
TAL RHEUMATOLOGY 2006.
The knowledge of the occurrence of in-
flammatory joint diseases in an exactly
defined population is an important fac-
tor for the planning of rheumatology
health care and it contributes to a better
understanding of the disease process
The estimated annual incidence of
rheumatoid arthritis (RA) in Europe is
between 20-45/100,000 and 24-75/-
100,000 in American Caucasians (1-6).
In southern Sweden, the annual incid-
ence of rheumatoid arthritis (RA) has
been reported to be 24/100,000
(29/100,000 for women and 18/-
100,000 for men) (1). In a British
study, the annual incidence estimate of
RA within the Norwich Health Author-
ity was 30.8/100,000 for women and
12.7/100,000 for men when age-adjust-
ed to the population of England and
Wales (2). Both these studies have used
the 1987 American College of
Rheumatology (ACR) criteria. The
highest incidence of RA has been
reported among American Indians (7-
9). There have also been reports of
decline in the incidence of RA in vari-
ous countries (3, 8, 10), but it has not
been proved by other studies (5,11).
The prevalence of RA has been report-
ed to be 0.4-3% (5, 12-15) It has been
reported to be 0.4-0.5% in northern
Norway in 1989 and 1994 (5), 1.16% in
women and 0.44% in men in 2001 in
the UK (14). Lower prevalence rates
have been reported in southern Europe
and some non-European populations,
for example 0.2% in Yugoslavia (16)
and 0.3% in China (17). The highest
prevalence (ranging between 0.4-8.2%)
has been estimated among American
Indians (9, 18).
The annual incidence of gout in Europe
and the US was found to be 140-
350/100,000 (19-21). In the UK, the
incidence of gout was reported about
250-350/100,000 (19). When restricted
to first-ever episodes beginning during
the study period, the estimates have
decreased to 140/100,000 (210 for
males and 70 for females) (20). Astudy
based on general practice reports in the
UK has reported the prevalence of gout
to be 26% overall in adults (61 in males
and 1% in females) (19). However, the
occurrence varies in different ethnic
groups (22-25). The annual incidence
of gout has been found to be increas-
ing, and the disease tending to start at
an earlier age (26-27).
A wide range in incidence can be seen
for juvenile chronic arthritis (JCA) or
juvenile rheumatoid arthritis (JRA):
1.3-22.6/100,000 in children under
than 16 years old (28-30). Prevalence
of JCAin the Caucasian population in a
retrospective study in Minnesota using
EULAR criteria has been reported to be
In the Czech Republic, medical health
care is accessible for the entire popula-
tion and is overseen by the govern-
ment. The country is divided into 14
regions containing 70 smaller districts.
Typically, there are state hospitals and
private ambulant practices in most of
the districts. Several general practition-
ers represent primary health care in
each district. Patients with specific
symptoms are referred to a private spe-
cialist or, with more severe illness, to a
hospital within the district. General
practitioners should recommend exam-
ination by a specialist but the patient
can also seek the specialist health care
without recommendation. Access to
specialist health care is easily available
to every patient.
Patients with early inflammatory joint
diseases are initially treated by general
practitioners. Gout is basically treated
at the primary care level. All cases of
early arthritis, acute or sub acute poly-
arthritis are referred to rheumatologists
to confirm the diagnosis and to consid-
er appropriate therapy as soon as possi-
ble. In general, patients with ongoing
inflammatory joint symptoms and
patients with a confirmed diagnosis of
inflammatory joint disease stay in the
further care of rheumatologists. Should
the assessment of the definite diagnosis
be complicated or some special labora-
tory investigations are needed, the
patient is referred to the Institute of
Rheumatology in Prague (according to
There have been no known epidemio-
logical data on these diseases in the
Czech Republic until 2002. A project
of Clinical database/national register
of rheumatic diseases started at the
Epidemiology of RA, JIA and gout in the Czech Republic / P. Hanova et al.
Epidemiology of RA, JIA and gout in the Czech Republic / P. Hanova et al.
difficult to estimate the true number of
missed incident and prevalent cases in
the study but we assume that only a
very small proportion of cases was not
identified by the investigators.
A letter of approval was used in inci-
dent cases and did not cause exclusion
of patients from the study. We did not
have any patient who was referred to us
with a definite diagnosis by a cooperat-
ing physician and who refused registra-
tion in the study. Incident patients did
not have to fill in all requested informa-
tion from personal or family history,
however most of the patients answered
all the questions. The extent of the col-
lected data (both questionnaire and
clinical data) could not be exhaustive
but the main focus of this study was to
assess the occurence of selected diag-
noses in the predefined study area.
In summary, this study presents the
first estimates of incidence and preva-
lence of RA, gout, and JIAin the Czech
Republic (and one of the first estimates
in the countries of Central and Eastern
Europe) in a population-based survey.
The occurrence figures in RA and JIA
are consistent with published data; fig-
ures in gout seem to be lower than re-
Thanks for their kind help with data
collection go to: MUDr. Vera Vlasako-
va, MUDr. Jirina Vitova, MUDr. Ivana
Brejchova, MUDr. Sevda Augustinova,
MUDr. Marie Kortusova, MUDr. Alena
Rosaninova, MUDr. Jan Smejkal,
MUDr. Vlastimil Novotny.
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