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IJPH - Year 8, Volume 7, Number 2, Suppl. 2, 2010 I T A L I A N J O U R N A L O F P U B L I C H E A L T H Tabella 8. Dimissioni per artrite reumatoide, 1999-2005 (ricoveri ordinari). Tabella 9. Dimissioni per artrite reumatoide, 1999-2005 (ricoveri in day hospital). arrivando al 30,1% tra coloro che hanno avuto diagnosi della malattia da più di 10 anni; più del 10,4% di questi è stato costretto a cambiare lavoro. È da sottolineare anche che vi è una considerevole quota di lavoratori che ha riportato episodi di ripetuta assenza dal lavoro a causa della malattia: il dato varia dal 35% tra i soggetti sotto ai 44 anni di età al 43,6% della fascia di età 44-65 anni che hanno segnalato di essersi assentati dal lavoro nell’ultimo mese prima dell’indagine. Conclusioni L’artrite reumatoide è una malattia cronica infiammatoria multifattoriale invalidante. Tra i fattori di rischio di malattia indubbiamente l’età e il genere giocano un ruolo di primo piano: il picco di incidenza della malattia si rileva infatti nella quinta decade con un rapporto F:M di 2:1-3:1. Le manifestazioni cliniche della malattia portano a disabilità nell’80% dei casi e la sopravvivenza è ridotta di 3-18 anni. Si rilevano importanti differenze geografiche nei tassi di incidenza e prevalenza di malattia; la maggior parte degli studi, condotti nell’Europa settentrionale e nell’America del Nord, hanno restituito delle stime di prevalenza e di incidenza media annua di 0,5-1,0% e 0,02- 0,05% rispettivamente. Nell’Europa meridionale, tuttavia, i tassi di prevalenza e incidenza di malattia sembrano inferiori. Basti pensare come in Italia gli studi disponibili rilascino stime di prevalenza comprese tra lo 0,33% e lo 0,46%, con il sesso femminile sempre più colpito rispetto a quello maschile. Anche la mortalità, nella popolazione affetta da AR, sembra superiore, sebbene attribuibile alle stesse cause di decesso registrate nella popolazione generale. Bibliografia 1) Choy EH, Panayi GS. Cytokine pathways and joint inflammation in rheumatoid arthritis. N Engl J Med 2001;344:907-16. 2) Alamanos Y, Drosos AA. Epidemiology of adult rheumatoid arthritis. Autoimmun Rev 2005;4(3):130-6. 3) Gorman JD, Lum RF, Chen JJ, Suarez-Almazor ME, Thomson G, Criswell LA. Impact of shared epitope genotype and ethnicity on erosive disease: a meta-analysis of 3,240 rheumatoid arthritis patients. Arthritis Rheum 2004;50(2):400-12. 4) Ioannidis JP, Tarassi K, Papadopoulos IA, et al. Shared epitopes and rheumatoid arthritis: disease associations in Greece and meta-analysis of Mediterranean European populations. Semin Arhtritis Rheum 2002;31:361-70. 5) Liao KP, Alfredsson L, Karlson EW. Environmental influences on risk for rheumatoid arthritis. Curr Opin Rheumatol 2009;21(3):279-83. S 1 0 C a p i t o l o 2
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Arthritis Rheum 1992;35(5):498-502. 29) Reumatologia online - Artrite Reumatoide. Disponibile online da: http://www.reumatologiaonline.com/main/medici/ artrite_reumatoide.php. [Ultimo accesso maggio 2010]. 30) Klareskog L, Rönnelid J, Lundberg K, Padyukov L, Alfredsson L. Immunity to citrullinated proteins in rheumatoid arthritis. Annu Rev Immunol 2008;26:651-75. 31) American College of Rheumatology Subcommitte on Rheumatoid Arthritis Guidelines. Guidelines for the Management of Rheumatoid Arthritis. 2002 Update. Arthritis Rheum 2002; 46:328-46. 32) Gabriel SE. The epidemiology of rheumatoid arthritis. Rheum Dis Clin North Am 2001;27:269-81. 33) Alamanos Y, Voulgari PV, Drosos AA. Incidence and Prevalence of Rheumatoid Arthritis, Based on the 1987 American College of Rheumatology Criteria: A Systematic Review. Semin Arthritis Rheum 2006;36:182-8. 34) Riise T, Jacobsen BK, Gran JT. Incidence and prevalence of rheumatoid arthritis in the county of Troms, northern Norway. 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Prevalence of rheumatoid arthritis in Tucuman, Argentina. J Rheumatol 2002;29:1166-70. 47) Pountain G. The prevalence of rheumatoid arthritis in the Sultanate of Oman. Br J Rheumatol 1991;30:24-8. 48) Akar S, Birlik M, Gurler O, et al. The prevalence of rheumatoid arthritis in an urban population of Izmir-Turkey. Clin Exp Rheumatol 2004;22:416-20. 49) Darmawan J, Muirden KD, Valkenburg HA, Wigley RD. The epidemiology of rheumatoid arthritis in Indonesia. Br J Rheumatol 1993;32:537-40. 50) Lau E, Symmons D, Bankhead C, MacGregor A, Donnan S, Silman A. Low prevalence of rheumatoid arthritis in the urbanized Chinese of Hong Kong. J Rheumatol 1993;20:1133-7. C a p i t o l o 2 S 1 1
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