Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review Article
  • Published:

Geoepidemiology of autoimmune rheumatic diseases

Nature Reviews Rheumatology volume 6, pages 468–476 (2010)Cite this article

Subjects

Abstract

The accumulative global burden of autoimmune and inflammatory rheumatic diseases is substantial. Studying the distribution of these conditions across various global regions and ethnic groups by means of geoepidemiology might readily provide epidemiological data and also advance our understanding of their genetic and environmental underpinnings. In order to depict the geoepidemiology of autoimmune and inflammatory rheumatic diseases, namely rheumatoid arthritis, juvenile rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis, ankylosing spondylitis and Sjögren's syndrome, we present a comprehensive collection of epidemiological reports from various world regions, including the prevalence of each of these conditions. The accumulated data show that the reviewed rheumatic diseases are global phenomena, and, with some variance, seem to be relatively evenly distributed. This finding is in contrast with the obviously uneven distribution of some major nonrheumatic autoimmune conditions. In addition, geoepidemiology demonstrates that ethnogenetic susceptibility interacts with lifestyle and environmental factors, which include socioeconomic status, infectious agents (triggering or protective agents), environmental pollutants, and vitamin D (dependent on sunlight exposure), in determining the risk of developing rheumatic autoimmunity.

Key Points

  • Geoepidemiology provides a comprehensible picture of the burden of autoimmune and inflammatory rheumatic diseases across various regions and ethnicities, and helps to unravel potential causative factors

  • The global distribution of rheumatic autoimmune diseases, with some variance, seems to be ubiquitous, although prominent gradients are present in the distribution of some major nonrheumatic autoimmune conditions

  • Our knowledge of the genetics of rheumatic autoimmunity is supported and advanced by geoepidemiology

  • The risk of developing these illnesses is also affected by environmental factors, such as socioeconomic status and exposure to infectious agents (protective or pathogenic), ultraviolet radiation and pollution

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1: Prevalence of rheumatoid arthritis in the adult population of various world regions.
Figure 2: Prevalence rates of systemic sclerosis per 100,000 people in various European countries.
Figure 3: Prevalence of ankylosing spondylitis in various world regions.

Similar content being viewed by others

References

  1. Shapira, Y., Agmon-Levin, N. & Shoenfeld, Y. Defining and analyzing geoepidemiology and human autoimmunity. J. Autoimmun. 34, J168–J177 (2010).

    Article  CAS  PubMed  Google Scholar 

  2. Shoenfeld, Y., Selmi, C., Zimlichman, E. & Gershwin, M. E. The autoimmunologist: geoepidemiology, a new center of gravity, and prime time for autoimmunity. J. Autoimmun. 31, 325–330 (2008).

    Article  PubMed  Google Scholar 

  3. Cooper, G. S. & Stroehla, B. C. The epidemiology of autoimmune diseases. Autoimmun. Rev. 2, 119–125 (2003).

    Article  PubMed  Google Scholar 

  4. Eaton, W. W., Rose, N. R., Kalaydjian, A., Pedersen, M. G. & Mortensen, P. B. Epidemiology of autoimmune diseases in Denmark. J. Autoimmun. 29, 1–9 (2007).

    Article  PubMed  PubMed Central  Google Scholar 

  5. NIH Autoimmune Diseases Coordinating Committee. Progress in Autoimmune Diseases Research (National Institutes of Health, Bethesda, 2005).

  6. WHO. Atlas—Multiple Sclerosis Resources in the World (WHO, Geneva, 2008).

  7. DIAMOND Project Group. Incidence and trends of childhood type 1 diabetes worldwide 1990–1999. Diabet. Med. 23, 857–866 (2006).

  8. Symmons, D., Mathers, C. & Pfleger, B. Global Burden of Disease 2000: the global burden of rheumatoid arthritis in the year 2000 (WHO, Geneva, 2000).

  9. Jacobson, D. L., Gange, S. J., Rose, N. R. & Graham, N. M. Epidemiology and estimated population burden of selected autoimmune diseases in the United States. Clin. Immunol. Immunopathol. 84, 223–243 (1997).

    Article  CAS  PubMed  Google Scholar 

  10. Gregersen, P. K. & Olsson, L. Recent advances in the genetics of autoimmune disease. Annu. Rev. Immunol. 27, 363–391 (2009).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Rønningen, K. S., Keiding, N. & Green, A. ; EURODIAB ACE Study Group. Correlations between the incidence of childhood-onset type I diabetes in Europe and HLA genotypes. Diabetologia 44, 51–59 (2001).

    Article  Google Scholar 

  12. Mathieu, A. et al. The interplay between the geographic distribution of HLA-B27 alleles and their role in infectious and autoimmune disease: A unifying hypothesis. Autoimmun. Rev. 8, 420–425 (2009).

    Article  CAS  PubMed  Google Scholar 

  13. Kochi, Y., Suzuki, A., Yamada, R. & Yamamoto, K. Genetics of rheumatoid arthritis: underlying evidence of ethnic differences. J. Autoimmun. 32, 158–162 (2009).

    Article  CAS  PubMed  Google Scholar 

  14. Zhou, X. et al. Genome-wide association study for regions of systemic sclerosis susceptibility in a Choctaw Indian population with high disease prevalence. Arthritis Rheum. 48, 2585–2592 (2003).

    Article  CAS  PubMed  Google Scholar 

  15. Balluz, L. et al. Investigation of systemic lupus erythematosus in Nogales, Arizona. Am. J. Epidemiol. 154, 1029–1036 (2001).

    Article  CAS  PubMed  Google Scholar 

  16. Silman, A. J., Howard, Y., Hicklin, A. J. & Black, C. Geographical clustering of scleroderma in south and west London. Br. J. Rheumatol. 29, 93–96 (1990).

    CAS  PubMed  Google Scholar 

  17. Shoenfeld, Y. et al. The mosaic of autoimmunity: genetic factors involved in autoimmune diseases. Isr. Med. Assoc. J. 10, 3–7 (2008).

    PubMed  Google Scholar 

  18. Shoenfeld, Y. et al. The mosaic of autoimmunity: hormonal and environmental factors involved in autoimmune diseases. Isr. Med. Assoc. J. 10, 8–12 (2008).

    PubMed  Google Scholar 

  19. Hewagama, A. & Richardson, B. The genetics and epigenetics of autoimmune diseases. J. Autoimmun. 33, 3–11 (2009).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Hopkinson, N. D., Doherty, M. & Powell, R. J. Clinical features and race specific incidence/prevalence rates of systemic lupus erythematosus in a geographically complete cohort of patients. Ann. Rheum. Dis. 53, 675–680 (1994).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Clark, I. A., Al-Yaman, F. M., Cowden, W. B. & Rockett, K. A. Does malarial tolerance, through nitric oxide, explain the low incidence of autoimmune disease in tropical Africa? Lancet 348, 1492–1494 (1996).

    Article  CAS  PubMed  Google Scholar 

  22. Manners, P. J. & Bower, C. Worldwide prevalence of juvenile arthritis—why does it vary so much? J. Rheumatol. 29, 1520–1530 (2002).

    PubMed  Google Scholar 

  23. Fox, R. I. Epidemiology, pathogenesis, animal models, and treatment of Sjögren's syndrome. Curr. Opin. Rheumatol. 6, 501–508 (1994).

    Article  CAS  PubMed  Google Scholar 

  24. Vinagre, F., Santos, M. J., Prata, A., da Silva, J. C. & Santos, A. I. Assessment of salivary gland function in Sjögren's syndrome: the role of salivary gland scintigraphy. Autoimmun. Rev. 8, 672–676 (2009).

    Article  CAS  PubMed  Google Scholar 

  25. Minaur, N., Sawyers, S., Parker, J. & Darmawan, J. Rheumatic disease in an Australian Aboriginal community in North Queensland, Australia. A WHO-ILAR COPCORD survey. J. Rheumatol. 31, 965–972 (2004).

    PubMed  Google Scholar 

  26. Silman, A. J. et al. Absence of rheumatoid arthritis in a Nigerian population. J. Rheumatol. 20, 618–622 (1993).

    CAS  PubMed  Google Scholar 

  27. Darmawan, J., Muirden, K. D., Valkenburg, H. A. & Wigley, R. D. The epidemiology of rheumatoid arthritis in Indonesia. Br. J. Rheumatol. 32, 537–540 (1993).

    Article  CAS  PubMed  Google Scholar 

  28. Zeng, Q. Y. et al. Rheumatic diseases in China. Arthritis Res. Ther. 10, R17 (2008).

    Article  PubMed  PubMed Central  Google Scholar 

  29. Kalla, A. A. Rheumatoid arthritis in the developing world. Best Pract. Res. Clin. Rheumatol. 17, 863–875 (2003).

    Article  PubMed  Google Scholar 

  30. Al Rawi, Z. S., Alazzawi, A. J., Alajili, F. M. & Alwakil, R. Rheumatoid arthritis in population samples in Iraq. Ann. Rheum. Dis. 37, 73–75 (1978).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Solomon, L., Robin, G. & Valkenburg, H. A. Rheumatoid arthritis in an urban South African Negro population. Ann. Rheum. Dis. 34, 128–135 (1975).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Bang, S. Y. et al. Smoking increases rheumatoid arthritis susceptibility in individuals carrying the HLA-DRB1 shared epitope, regardless of rheumatoid factor or anti-cyclic citrullinated peptide antibody status. Arthritis Rheum. 62, 369–377 (2010).

    CAS  PubMed  Google Scholar 

  33. Doran, M. F., Pond, G. R., Crowson, C. S., O'Fallon, W. M. & Gabriel, S. E. Trends in incidence and mortality in rheumatoid arthritis in Rochester, Minnesota, over a forty-year period. Arthritis Rheum. 46, 625–631 (2002).

    Article  PubMed  Google Scholar 

  34. Kivity, S., Agmon-Levin, N., Blank, M. & Shoenfeld, Y. Infections and autoimmunity—friends or foes? Trends Immunol. 30, 409–414 (2009).

    Article  CAS  PubMed  Google Scholar 

  35. Lidar, M. et al. Infectious serologies and autoantibodies in inflammatory bowel disease: Insinuations at a true pathogenic role. Ann. NY Acad. Sci. 1173, 640–648 (2009).

    Article  CAS  PubMed  Google Scholar 

  36. Ram, M. et al. The putative protective role of hepatitis B virus (HBV) infection from autoimmune disorders. Autoimmun. Rev. 7, 621–625 (2008).

    Article  CAS  PubMed  Google Scholar 

  37. Agmon-Levin, N. et al. Prevalence of hepatitis C serum antibody in autoimmune diseases. J. Autoimmun. 32, 261–266 (2009).

    Article  CAS  PubMed  Google Scholar 

  38. Zandman-Goddard, G. et al. Neuropsychiatric lupus and infectious triggers. Lupus 17, 380–384 (2008).

    Article  CAS  PubMed  Google Scholar 

  39. Saurenmann, R. K. et al. Epidemiology of juvenile idiopathic arthritis in a multiethnic cohort: ethnicity as a risk factor. Arthritis Rheum. 56, 1974–1984 (2007).

    Article  CAS  PubMed  Google Scholar 

  40. McGill, P. E. & Oyoo, G. O. Rheumatic disorders in sub-Saharan Africa. East Afr. Med. J. 79, 214–216 (2002).

    Article  CAS  PubMed  Google Scholar 

  41. Oen, K., Fast, M. & Postl, B. Epidemiology of juvenile rheumatoid arthritis in Manitoba, Canada, 1975–92: cycles in incidence. J. Rheumatol. 22, 745–750 (1995).

    CAS  PubMed  Google Scholar 

  42. Peterson, L. S., Mason, T., Nelson, A. M., O'Fallon, W. M. & Gabriel, S. E. Juvenile rheumatoid arthritis in Rochester, Minnesota 1960–1993. Is the epidemiology changing? Arthritis Rheum. 39, 1385–1390 (1996).

    Article  CAS  PubMed  Google Scholar 

  43. Enzer, I. et al. 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 (2002).

    Article  PubMed  Google Scholar 

  44. Kaipiainen-Seppanen, O. & Savolainen, A. Changes in the incidence of juvenile rheumatoid arthritis in Finland. Rheumatology (Oxford) 40, 928–932 (2001).

    Article  CAS  Google Scholar 

  45. Helmick, C. G. et al. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part I. Arthritis Rheum. 58, 15–25 (2008).

    Article  PubMed  Google Scholar 

  46. Samanta, A., Feehally, J., Roy, S. & Nichol, F. E. High prevalence of systemic disease and mortality in Asian subjects with systemic lupus erythematosus. Ann. Rheum. Dis. 50, 490–492 (1991).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Maskarinec, G. & Katz, A. R. Prevalence of systemic lupus erythematosus in Hawaii: is there a difference between ethnic groups? Hawaii Med. J. 54, 406–409 (1995).

    CAS  PubMed  Google Scholar 

  48. Seagasothy, M. & Phillips, P. A. Systemic lupus erythematosus in Aborigines and Caucasians in central Australia: a comparative study. Lupus 10, 439–444 (2001).

    Article  Google Scholar 

  49. Peschken, C. A. & Esdaile, J. M. Systemic lupus erythematosus in North American Indians: a population based study. J. Rheumatol. 27, 1884–1891 (2000).

    CAS  PubMed  Google Scholar 

  50. Bernstein, L., Teal, C. R., Joslyn, S. & Wilson, J. Ethnicity-related variation in breast cancer risk factors. Cancer 97 (Suppl.), 222–229 (2003).

    Article  PubMed  Google Scholar 

  51. Molokhia, M., McKeigue, P. M., Cuadrado, M. & Hughes, G. Systemic lupus erythematosus in migrants from west Africa compared with Afro-Caribbean people in the UK. Lancet 357, 1414–1415 (2001).

    Article  CAS  PubMed  Google Scholar 

  52. Bae, S., Fraser, P. & Liang, M. H. The epidemiology of systemic lupus erythematosus in populations of African ancestry. Arthritis Rheum. 41, 2091–2099 (1998).

    Article  CAS  PubMed  Google Scholar 

  53. Westlake, S. L. & Edwards, C. J. Anti-malarials and lupus in West Africa use and lupus in Africans. Lupus 18, 193–195 (2009).

    Article  CAS  PubMed  Google Scholar 

  54. Shoenfeld, N., Amital, H. & Shoenfeld, Y. The effect of melanism and vitamin D synthesis on the incidence of autoimmune disease. Nat. Clin. Pract. Rheumatol. 5, 99–105 (2009).

    Article  CAS  PubMed  Google Scholar 

  55. Shapira, Y., Agmon-Levin, N. & Shoenfeld, Y. Mycobacterium tuberculosis, autoimmunity and vitamin D. Clin. Rev. Allergy Immunol. 38, 169–177 (2010).

    Article  CAS  PubMed  Google Scholar 

  56. Ponsonby, A. L., McMichael, A. & van der Mei, I. Ultraviolet radiation and autoimmune disease: insights from epidemiological research. Toxicology 181–182, 71–78 (2002).

    Article  PubMed  Google Scholar 

  57. Kiyohara, C. et al. Cigarette smoking, N-acetyltransferase 2 polymorphisms and systemic lupus erythematosus in a Japanese population. Lupus 18, 630–638 (2009).

    Article  CAS  PubMed  Google Scholar 

  58. Molokhia, M. & McKeigue, P. Systemic lupus erythematosus: genes versus environment in high risk populations. Lupus 15, 827–832 (2006).

    Article  CAS  PubMed  Google Scholar 

  59. Berkun, Y. et al. Infectious antibodies in systemic lupus erythematosus patients. Lupus 18, 1129–1135 (2009).

    Article  CAS  PubMed  Google Scholar 

  60. Kardestuncer, T. & Frumkin, H. Systemic lupus erythematosus in relation to environmental pollution: an investigation in an African-American community in North Georgia. Arch. Environ. Health 52, 85–90 (1997).

    Article  CAS  PubMed  Google Scholar 

  61. Parks, C. G. & Cooper, G. S. Occupational exposures and risk of systemic lupus erythematosus: a review of the evidence and exposure assessment methods in population- and clinic-based studies. Lupus 15, 728–736 (2006).

    Article  CAS  PubMed  Google Scholar 

  62. Chifflot, H., Fautrel, B., Sordet, C., Chatelus, E. & Sibilia, J. Incidence and prevalence of systemic sclerosis: a systematic literature review. Semin. Arthritis Rheum. 37, 223–235 (2008).

    Article  PubMed  Google Scholar 

  63. Shivananda, S. et al. Incidence of inflammatory bowel disease across Europe: is there a difference between north and south? Results of the European Collaborative Study on Inflammatory Bowel Disease (EC-IBD). Gut 39, 690–697 (1996).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  64. Mayes, M. D. et al. Prevalence, incidence, survival, and disease characteristics of systemic sclerosis in a large US population. Arthritis Rheum. 48, 2246–2255 (2003).

    Article  PubMed  Google Scholar 

  65. Laing, T. J. et al. Racial differences in scleroderma among women in Michigan. Arthritis Rheum. 40, 734–742 (1997).

    Article  CAS  PubMed  Google Scholar 

  66. Tan, F. K. et al. HLA haplotypes and microsatellite polymorphisms in and around the major histocompatibility complex region in a Native American population with a high prevalence of scleroderma (systemic sclerosis). Tissue Antigens 53, 74–80 (1999).

    Article  CAS  PubMed  Google Scholar 

  67. Tan, F. K. et al. Association of fibrillin 1 single-nucleotide polymorphism haplotypes with systemic sclerosis in Choctaw and Japanese populations. Arthritis Rheum. 44, 893–901 (2001).

    Article  CAS  PubMed  Google Scholar 

  68. Valesini, G., Litta, A. & Bonavita, M. S. Geographical clustering of scleroderma in a rural area in the province of Rome. Clin. Exp. Rheumatol. 11, 41–47 (1993).

    CAS  PubMed  Google Scholar 

  69. Van der Linden, S. M., Valkenburg, H. A., de Jongh, B. M. & Cats, A. The risk of developing ankylosing spondylitis in HLA-B27 positive individuals: a comparison of relatives of spondylitis patients with the general population. Arthritis Rheum. 27, 241–249 (1984).

    Article  CAS  PubMed  Google Scholar 

  70. Hukuda, S. et al. Spondyloarthropathies in Japan: nationwide questionnaire survey performed by the Japan Ankylosing Spondylitis Society. J. Rheumatol. 28, 554–559 (2001).

    CAS  PubMed  Google Scholar 

  71. Khan, M. A. Spondyloarthropathies in non-Caucasian populations of the world. In Advances in Inflammation Research. Vol. 9: the Spondyloarthropathies (eds Ziff, M. & Cohen, S. B.) 91–99 (Raven Press, New York, (1985).

    Google Scholar 

  72. Gofton, J. P., Bennett, P. H., Smythe, H. A. & Decker, J. L. Sacroilitis and ankylosing spondylitis in North American Indians. Ann. Rheum. Dis. 31, 474–481 (1972).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  73. Boyer, G. S. et al. Prevalence of spondyloarthropathies in Alaskan Eskimos. J. Rheumatol. 21, 2292–2297 (1994).

    CAS  PubMed  Google Scholar 

  74. Braun, J., Bollow, M. & Remlinger, G. Prevalence of spondylarthropathies in HLA-B27 positive and negative blood donors. Arthritis Rheum. 41, 58–67 (1998).

    Article  CAS  PubMed  Google Scholar 

  75. Mijiyawa, M., Oniankitan, O. & Khan, M. A. Spondyloarthropathies in sub-Saharan Africa. Curr. Opin. Rheumatol. 12, 281–286 (2000).

    Article  CAS  PubMed  Google Scholar 

  76. Baum, J. & Ziff, M. The rarity of ankylosing spondylitis in the black race. Arthritis Rheum. 14, 12–18 (1971).

    Article  CAS  PubMed  Google Scholar 

  77. Hill, A. V. et al. HLA class I typing by PCR: HLA-B27 and an African B27 subtype. Lancet 337, 640–642 (1991).

    Article  CAS  PubMed  Google Scholar 

  78. Brown, M. A. et al. Ankylosing spondylitis in West Africans—evidence for a non-HLA-B27 protective effect. Ann. Rheum. Dis. 56, 68–70 (1997).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  79. Khan, M. A. et al. HLA-B27 in ankylosing spondylitis: differences in frequency and relative risk in American blacks and Caucasians. J. Rheumatol. 3 (Suppl.), 39–43 (1977).

    CAS  Google Scholar 

  80. Silman, A. J. & Rooney, B. K. Epidemiology of Sjögren's syndrome. In The 100-year Anniversary of Henrik Sjögren (eds Eriksson, E. & Jonsson, R.) 53–57 (Hygiea, Jönköping, 1999).

    Google Scholar 

  81. Alamanosa, Y. & Drosos, A. A. Epidemiology of adult rheumatoid arthritis. Autoimmun. Rev. 4, 130–136 (2005).

    Article  Google Scholar 

  82. Symmons, D. et al. The prevalence of rheumatoid arthritis in the United Kingdom; new estimates for a new century. Rheumatology (Oxford) 41, 793–800 (2002).

    Article  CAS  Google Scholar 

  83. Stojanovic, R., Vlajinac, H., Palic-Obradovic, D., Janosevic, S. & Adanja, B. Prevalence of rheumatoid arthritis in Belgrade, Yugoslavia. Br. J. Rheumatol. 37, 729–732 (1998).

    Article  CAS  PubMed  Google Scholar 

  84. Shichikawa, K. et al. Changes in the incidence and prevalence of rheumatoid arthritis in Kamitonda, Wakayama, Japan, 1965–1996. Ann. Rheum. Dis. 58, 751–756 (1999).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  85. Spindler, A. et al. Prevalence of rheumatoid arthritis in Tucuman, Argentina. J. Rheumatol. 29, 1166–1170 (2002).

    PubMed  Google Scholar 

  86. Simonsson, M., Bergman, S., Jacobsson, L. T., Petersson, I. F. & Svensson, B. The prevalence of rheumatoid arthritis in Sweden. Scand. J. Rheumatol. 28, 340–343 (1999).

    Article  CAS  PubMed  Google Scholar 

  87. Riise, T., Jacobsen, B. K. & Gran, J. T. Incidence and prevalence of rheumatoid arthritis in the county of Troms, northern Norway. J. Rheumatol. 27, 1386–1389 (2000).

    CAS  PubMed  Google Scholar 

  88. Drosos, A. A. et al. Epidemiology of adult rheumatoid arthritis in northwest Greece 1987–1995. J. Rheumatol. 24, 2129–2133 (1997).

    CAS  PubMed  Google Scholar 

  89. Arguedas, O., Fasth, A., Andersson-Gäre, B. & Porras, O. Juvenile chronic arthritis in urban San José, Costa Rica: a 2 year prospective study. J. Rheumatol. 25, 1844–1850 (1998).

    CAS  PubMed  Google Scholar 

  90. Pruunsild, C. et al. Prevalence and short-term outcome of juvenile idiopathic arthritis: a population-based study in Estonia. Clin. Exp. Rheumatol. 25, 649–653 (2007).

    CAS  PubMed  Google Scholar 

  91. Martínez Mengual, L., Fernández Menéndez, J. M. & Solís Sánchez, G. Epidemiological study of juvenile idiopathic arthtitis in the last sixteen years in Asturias (Spain). An. Pediatr. 66, 24–30 (2007).

    Article  Google Scholar 

  92. Hanova, P., Pavelka, K., Dostal, C., Holcatova, I. & Pikhart, H. 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. Clin. Exp. Rheumatol. 24, 499–507 (2006).

    CAS  PubMed  Google Scholar 

  93. Danner, S. et al. Epidemiology of juvenile idiopathic arthritis in Alsace, France. J. Rheumatol. 33, 1377–1381 (2006).

    PubMed  Google Scholar 

  94. von Koskull, S., Truckenbrodt, H., Holle, R. & Hörmann, A. Incidence and prevalence of juvenile arthritis in an urban population of southern Germany: a prospective study. Ann. Rheum. Dis. 60, 940–945 (2001).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  95. Manners, P. J. & Diepeveen, D. A. Prevalence of juvenile chronic arthritis in a population of 12-year-old children in urban Australia. Pediatrics 98, 84–90 (1996).

    CAS  PubMed  Google Scholar 

  96. Gare, B. A. & Fasth, A. Epidemiology of juvenile chronic arthritis in southwestern Sweden: a 5-year prospective population study. Pediatrics 90, 950–958 (1992).

    CAS  PubMed  Google Scholar 

  97. Oen, K. G. & Cheang, M. Epidemiology of chronic arthritis in childhood. Semin. Arthritis Rheum. 26, 575–591 (1996).

    Article  CAS  PubMed  Google Scholar 

  98. Gudmundsson, S. & Steinsson, K. Systemic lupus erythematosus in Iceland 1975 through 1984. A nationwide epidemiological study in an unselected population. J. Rheumatol. 17, 1162–1167 (1990).

    CAS  PubMed  Google Scholar 

  99. Voss, A., Green, A. & Junker, P. Systemic lupus erythematosus in Denmark: clinical and epidemiological characterization of a county-based cohort. Scand. J. Rheumatol. 27, 98–105 (1998).

    Article  CAS  PubMed  Google Scholar 

  100. Nossent, J. C. Systemic lupus erythematosus on the Caribbean island of Curaçao: an epidemiological investigation. Ann. Rheum. Dis. 51, 1197–1201 (1992).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  101. Nossent, H. C. Systemic lupus erythematosus in the Arctic region of Norway. J. Rheumatol. 28, 539–546 (2001).

    CAS  PubMed  Google Scholar 

  102. Vilar, M. J. & Sato, E. I. Estimating the incidence of systemic lupus erythematosus in a tropical region (Natal, Brazil). Lupus 11, 528–532 (2002).

    Article  PubMed  Google Scholar 

  103. Lopez, P., Mozo, L., Gutierrez, C. & Suarez, A. Epidemiology of systemic lupus erythematosus in a northern Spanish population: gender and age influence on immunological features. Lupus 12, 860–865 (2003).

    Article  CAS  PubMed  Google Scholar 

  104. Deligny, C. et al. Systemic lupus erythematosus in Martinique: an epidemiologic study. Rev. Med. Interne 23, 21–29 (2002).

    Article  CAS  PubMed  Google Scholar 

  105. Somers, E. C., Thomas, S. L., Smeeth, L., Schoonen, W. M. & Hall, A. J. Incidence of systemic lupus erythematosus in the United Kingdom, 1990–1999. Arthritis Rheum. 57, 612–618 (2007).

    Article  PubMed  Google Scholar 

  106. Michelle, P. Epidemiology of systemic lupus erythematosus. Best Pract. Res. Clin. Rheumatol. 16, 847–858 (2002).

    Article  Google Scholar 

  107. Arias-Nuñez, M. C. et al. Systemic sclerosis in northwestern Spain: a 19-year epidemiologic study. Medicine 87, 272–280 (2008).

    Article  PubMed  Google Scholar 

  108. Roberts-Thomson, P. J. et al. Scleroderma in South Australia: epidemiological observations of possible pathogenic significance. Intern. Med. J. 31, 220–229 (2001).

    Article  CAS  PubMed  Google Scholar 

  109. Geirsson, A. J., Steinsson, K., Guthmundsson, S. & Sigurthsson, V. Systemic sclerosis in Iceland. A nationwide epidemiological study. Ann. Rheum. Dis. 53, 502–505 (1994).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  110. Alamanos, Y. et al. Epidemiology of systemic sclerosis in northwest Greece 1981 to 2002. Semin. Arthritis Rheum. 34, 714–720 (2005).

    Article  PubMed  Google Scholar 

  111. Tamaki, T., Mori, S. & Takehara, K. Epidemiological study of patients with systemic sclerosis in Tokyo. Arch. Dermatol. Res. 283, 366–371 (1991).

    Article  CAS  PubMed  Google Scholar 

  112. Le Guern, V. et al. Prevalence of systemic sclerosis in a French multi-ethnic county. Rheumatology (Oxford) 43, 1129–1137 (2004).

    Article  CAS  Google Scholar 

  113. Onen, F. et al. Prevalence of ankylosing spondylitis and related spondyloarthritides in an urban area of Izmir, Turkey. J. Rheumatol. 35, 305–309 (2008).

    PubMed  Google Scholar 

  114. Kaipiainen-Seppanen, O., Aho, K. & Heliovaara, M. Incidence and prevalence of ankylosing spondylitis in Finland. J. Rheumatol. 24, 496–499 (1997).

    CAS  PubMed  Google Scholar 

  115. Alamanos, Y. et al. Epidemiology of ankylosing spondylitis in Northwest Greece, 1983–2002. Rheumatology (Oxford) 43, 615–618 (2004).

    Article  CAS  Google Scholar 

  116. Carbone, L. D. et al. Ankylosing spondylitis in Rochester, Minnesota, 1935–1989: is the epidemiology changing? Arthritis Rheum. 35, 1476–1482 (1992).

    Article  CAS  PubMed  Google Scholar 

  117. Bakland, G., Nossent, H. C. & Gran, J. T. Incidence and prevalence of ankylosing spondylitis in Northern Norway. Arthritis Rheum. 53, 850–855 (2005).

    Article  PubMed  Google Scholar 

  118. Bowman, S. J., Ibrahim, G. H., Holmes, G., Hamburger, J. & Ainsworth, J. R. Estimating the prevalence among Caucasian women of primary Sjögren's syndrome in two general practices in Birmingham, UK. Scand. J. Rheumatol. 33, 39–43 (2004).

    Article  CAS  PubMed  Google Scholar 

  119. Pillemer, S. R. et al. Incidence of physician-diagnosed primary Sjögren's syndrome in residents of Olmsted County, Minnesota. Mayo Clin. Proc. 76, 593–599 (2001).

    Article  CAS  PubMed  Google Scholar 

  120. Thomas, E., Hay, E. M., Hajeer, A. & Silman, A. J. Sjögren's syndrome: a community-based study of prevalence and impact. Br. J. Rheumatol. 37, 1069–1076 (1998).

    Article  CAS  PubMed  Google Scholar 

  121. Bjerrum, K. B. Keratoconjunctivitis sicca and primary Sjögren's syndrome in a Danish population aged 30–60 years. Acta Ophthalmol. Scand. 75, 281–286 (1997).

    Article  CAS  PubMed  Google Scholar 

  122. Wakai, K. et al. Estimated prevalence of Sjögren's syndrome in Japan: findings from a nationwide epidemiological survey. J. Epidemiol. 5, 125–129 (1995).

    Article  Google Scholar 

  123. Alamanos, Y. et al. Epidemiology of primary Sjögren's syndrome in north-west Greece, 1982–2003. Rheumatology (Oxford) 45, 187–191 (2006).

    Article  CAS  Google Scholar 

  124. Plesivcnik Novljan, M. et al. Incidence of primary Sjögren's syndrome in Slovenia. Ann. Rheum. Dis. 63, 874–876 (2004).

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, 52621, Tel-Hashomer, Israel

    Yinon Shapira & Nancy Agmon-Levin

  2. Department of Medicine 'B' & Center for Autoimmune Diseases, Sheba Medical Center, 52621, Tel-Hashomer, Israel

    Yehuda Shoenfeld

Authors
  1. Yinon Shapira
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nancy Agmon-Levin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yehuda Shoenfeld
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yehuda Shoenfeld.

Ethics declarations

Competing interests

The authors declare no competing financial interests.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Shapira, Y., Agmon-Levin, N. & Shoenfeld, Y. Geoepidemiology of autoimmune rheumatic diseases. Nat Rev Rheumatol 6, 468–476 (2010). https://doi.org/10.1038/nrrheum.2010.86

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/nrrheum.2010.86

This article is cited by

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing