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Javaid U, Mahmud TH, Rasheed A, Javaid AUR, Riaz S, Zohaib A. Factors Leading to Diagnostic and Therapeutic Delay of Rheumatoid Arthritis and Their Impact on Disease Outcome. Cureus 2023; 15:e34481. [PMID: 36874695 PMCID: PMC9982193 DOI: 10.7759/cureus.34481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2023] [Indexed: 02/04/2023] Open
Abstract
Objective To identify the factors which lead to delay in diagnosis and initiation of disease-modifying anti-rheumatic drugs (DMARDs) in rheumatoid arthritis (RA) patients and their impact on disease outcome and functional ability. Methodology This cross-sectional study was conducted from June 2021 to May 2022 at the Department of Rheumatology and Immunology, Sheikh Zayed Hospital, Lahore. Inclusion criteria were patients aged >18 years who were diagnosed with RA, based on American College of Rheumatology (ACR) criteria 2010. Delay was defined as any sort of delay which leads to delay in diagnosis or initiation of treatment of more than three months. The factors and impact on disease outcome were measured by using Disease Activity Score-28 (DAS-28) for disease activity and Health Assessment Questionnaire-Disability Index (HAQ-DI) for functional disability. The collected data were analyzed with Statistical Package for Social Sciences (SPSS) version 24 (IBM Corp., Armonk, NY, USA). Results One hundred and twenty patients were included in the study. Mean delay in referral to a rheumatologist was 36.75±61.07 weeks. Fifty-eight (48.3%) patients with RA were misdiagnosed before presentation to a rheumatologist. Sixty-six (55%) patients had the perception that RA is a non-treatable disease. Delay in diagnosis of RA from onset of symptoms (lag 3) and delay in start of DMARDs from onset of symptoms (lag 4) were significantly associated with increased DAS-28 and HAQ-DI scores (p-value 0.001). Conclusion The factors which led to diagnostic and therapeutic delay were delayed consultation with a rheumatologist, old age, low education status and low socioeconomic status. Rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) antibodies had no role in diagnostic and therapeutic delay. Many RA patients were misdiagnosed with gouty arthritis and undifferentiated arthritis before consulting a rheumatologist. This diagnostic and therapeutic delay compromises RA management leading to high DAS-28 and HAQ-DI in RA patients.
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Affiliation(s)
- Umair Javaid
- Rheumatology, Sheikh Zayed Postgraduate Medical Institute, Lahore, PAK
| | - Tafazzul H Mahmud
- Rheumatology, Sheikh Zayed Postgraduate Medical Institute, Lahore, PAK
| | - Aflak Rasheed
- Rheumatology, Sheikh Zayed Postgraduate Medical Institute, Lahore, PAK
| | | | - Saima Riaz
- Rheumatology, Sheikh Zayed Postgraduate Medical Institute, Lahore, PAK
| | - Amer Zohaib
- Rheumatology, Sheikh Zayed Postgraduate Medical Institute, Lahore, PAK
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Mir SA, Noor M, Manzar MD, Alshehri B, Alaidarous M, Dukhyil AAB, Banawas S, Madkhali Y, Jahan S, Kashoo FZ, Iqbal D, Zia Q, Alsagaby SA, ALDosari S. Prevalence of rheumatoid arthritis and diagnostic validity of a prediction score, in patients visiting orthropedic clinics in the Madinah region of Saudi Arabia: a retrospective cross-sectional study. PeerJ 2022; 10:e14362. [PMID: 36405025 PMCID: PMC9673770 DOI: 10.7717/peerj.14362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 10/18/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction In Saudi Arabia, the epidemiology of rheumatoid arthritis (RA) is not well studied and is marked by inconsistencies in clinical diagnosis. Therefore, in this study, we explored the prevalence, clinical characteristics, and diagnostic validity of a prediction score based upon disease markers in orthropedic clinics' patients in the Madinah region of Saudi Arabia. Method The clinical data for this retrospective cross-sectional study were retrieved from the database registry of orthopedic clinics in selected hospitals of the Medinah province of Saudi Arabia. Sociodemographic features, disease markers and the clinical characteristics were collected for a period of 6 months, from December 1, 2020, to May 31, 2021. The prediction score was generated from the sum of disease markers, coded as dichotomous variables. Results The total sample size of our study was 401. The prevalence of RA in the study subjects (n = 401) was 14.46% (n = 58). Among RA patients, the majority were females (60.3%). Painful joints (69%) and swollen joints (51.7%) were the most common clinical complaints among RA patients. RA patients suffered from arthritis (51.7%) and experienced fatigue (46.6%), weight loss (44.8%), and loss of appetite (41.4%). Diabetes (55.2%) was the most common comorbidity in the RA patients. The sensitivity and specificity of the prediction score at the criterion score of 2.5 were 67.3% and 63.0%, respectively. The area under the curve was 0.69 (95% CI [0.62-0.76]). Conclusion There was a moderately high prevalence of RA in patients visiting the orthropedic clinics of the selected hospitals of Madinah region of Saudi Arabia. The diagnostic validity of the prediction score, though promising, was slightly lower than the acceptable range.
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Affiliation(s)
- Shabir Ahmad Mir
- Department of Medical Laboratory Science, College of Applied Medical Science, Majmaah University, Al Majmaah, Riyadh, Saudi Arabia
| | - Mamdooh Noor
- Department of Medical Laboratory Science, College of Applied Medical Science, Majmaah University, Al Majmaah, Riyadh, Saudi Arabia
| | - Md Dilshad Manzar
- Department of Nursing, College of Applied Medical Science, Majmaah University, Al Majmaah, Riyadh, Saudi Arabia
| | - Bader Alshehri
- Department of Medical Laboratory Science, College of Applied Medical Science, Majmaah University, Al Majmaah, Riyadh, Saudi Arabia
| | - Mohammed Alaidarous
- Department of Medical Laboratory Science, College of Applied Medical Science, Majmaah University, Al Majmaah, Riyadh, Saudi Arabia,Health and Basic Sciences Research Center, Majmaah University, Al Majmaah, Riyadh, Saudi Arabia
| | - Abdul Aziz Bin Dukhyil
- Department of Medical Laboratory Science, College of Applied Medical Science, Majmaah University, Al Majmaah, Riyadh, Saudi Arabia
| | - Saeed Banawas
- Department of Medical Laboratory Science, College of Applied Medical Science, Majmaah University, Al Majmaah, Riyadh, Saudi Arabia,Health and Basic Sciences Research Center, Majmaah University, Al Majmaah, Riyadh, Saudi Arabia,Department of Biomedical Sciences, Oregon State University, Corvallis, Oregon, United States
| | - Yahya Madkhali
- Department of Medical Laboratory Science, College of Applied Medical Science, Majmaah University, Al Majmaah, Riyadh, Saudi Arabia
| | - Sadaf Jahan
- Department of Medical Laboratory Science, College of Applied Medical Science, Majmaah University, Al Majmaah, Riyadh, Saudi Arabia
| | - Faizan Z. Kashoo
- Department of Physical Therapy and Rehabilitation, College of Applied Medical Science, Majmaah University, Al Majmaah, Riyadh, Saudi Arabia
| | - Danish Iqbal
- Department of Medical Laboratory Science, College of Applied Medical Science, Majmaah University, Al Majmaah, Riyadh, Saudi Arabia
| | - Qamar Zia
- Department of Medical Laboratory Science, College of Applied Medical Science, Majmaah University, Al Majmaah, Riyadh, Saudi Arabia,Health and Basic Sciences Research Center, Majmaah University, Al Majmaah, Riyadh, Saudi Arabia
| | - Suliman A. Alsagaby
- Department of Medical Laboratory Science, College of Applied Medical Science, Majmaah University, Al Majmaah, Riyadh, Saudi Arabia
| | - Sahar ALDosari
- Department of Medical Laboratory Science, College of Applied Medical Science, Majmaah University, Al Majmaah, Riyadh, Saudi Arabia
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Alqazzaz A, Al_Badran AK, Algabri H, Al Saeedi KH. Incidence of rheumatoid arthritis at Marjan Teaching Hospital in Babylon, Iraq (2014–2019). MEDICAL JOURNAL OF BABYLON 2022. [DOI: 10.4103/mjbl.mjbl_32_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Naeem F, Khan SEA, Saeed MA, Farman S. Diagnostic and therapeutic delay in Rheumatoid Arthritis patients: Impact on disease outcome. Pak J Med Sci 2021; 37:1001-1007. [PMID: 34290773 PMCID: PMC8281185 DOI: 10.12669/pjms.37.4.3471] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/20/2020] [Accepted: 02/25/2021] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To identify factors causing diagnostic and therapeutic delay in patients with rheumatoid arthritis, and to evaluate relationship of diagnostic and therapeutic delay with disease outcome. METHODS This cross-sectional study was conducted in Rheumatology Department, Fatima Memorial Hospital, Lahore, Pakistan, from May 2018 to July 2018. In this study 102 patients fulfilling ACR/EULAR criteria 2010 were enrolled. Lag times were calculated in months: lag-1 (delay in initial medical consultation); lag-2 (delay in consulting rheumatologists); lag-3 (diagnostic delay); lag-4 (therapeutic delay). Disease activity and functional outcome were measured by DAS28, HAQ-DI respectively. Association of lag-3 and lag-4 with HAQ-DI and DAS28 was calculated by Pearson correlation. RESULTS Median (IQR) disease duration of study group was 6(2-10) years. Initial consultations were with; orthopedic surgeon 40(39.2%), general practitioner 27(26.5%), rheumatologist 13(12.7%), medical specialists 14(13.7%). Median (IQR) lag times in months: lag-1 (delayed initial consultation): 2(0-5), lag-2 (delay in consulting rheumatologist): 30(7.7-72), lag-3 (diagnostic delay): 12(3-48), lag-4 (therapeutic delay):18(5.7-72). Factors attributed to lag-3 (diagnostic delay) and lag-4 (therapeutic delay) (p<0.05): older Age (r= 0.2), education level(r= - 0.2), initial consultation (non-rheumatologist) (r=0.2), lag-2(r=0.8), >three doctors visited before diagnosis(r=0.6). Positive anti-CCP antibodies(r=0.2) and lag-1 (delayed initial consultation) (r=1) were associated with lag-3 (diagnostic delay) only; no association was found with positive RA factor. Significant correlation (p=<0.05) of lag-3 (diagnostic delay) was found with both DAS28(r=0.2) & HAQ-DI(r=0.2). Similarly lag-4 (therapeutic delay) also correlated with both & DAS28(r=0.2) & HAQ-DI(r=0.3) (p=<0.05). CONCLUSION Diagnostic and therapeutic delay were associated with older age, lower education and delayed consultation with rheumatologist but not with positive RA factor. Positive anti-CCP antibodies were associated with diagnostic delay only. Diagnostic and therapeutic delay led to high disease activity and poor functional outcome in RA patients.
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Affiliation(s)
- Faiza Naeem
- Faiza Naeem, FCPS Internal Medicine, Rheumatology Fellow, Division of Rheumatology, Fatima Memorial Hospital College of Medicine & Dentistry (FMH), Lahore, Pakistan
| | - Saira Elaine Anwer Khan
- Saira E.A Khan, MRCP (UK), SCE Rheumatology (UK) Assistant Professor, Division of Rheumatology, Fatima Memorial Hospital College of Medicine & Dentistry (FMH), Lahore, Pakistan
| | - Muhammad Ahmed Saeed
- Muhammad Ahmed Saeed, FCPS Rheumatology, FACR, FCPS Internal Medicine Associate Professor, Al-Aleem Medical College, Head Department of Rheumatology, Gulab Devi Teaching Hospital, Lahore, Pakistan. Consultant Rheumatologist, National Hospital and Medical Center, Lahore
| | - Sumaira Farman
- Sumaira Farman, FRCP, FACP, FACR, SCE Rheumatology (UK) Graduate Certificate Paediatric Rheumatology (Australia) Professor, Division of Rheumatology, FMH, Consultant Rheumatologist, National Hospital and Medical Center, Lahore, Pakistan
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Almoallim H, Al Saleh J, Badsha H, Ahmed HM, Habjoka S, Menassa JA, El-Garf A. A Review of the Prevalence and Unmet Needs in the Management of Rheumatoid Arthritis in Africa and the Middle East. Rheumatol Ther 2021; 8:1-16. [PMID: 33226566 PMCID: PMC7991016 DOI: 10.1007/s40744-020-00252-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 10/31/2020] [Indexed: 02/07/2023] Open
Abstract
Estimates of the global prevalence of rheumatoid arthritis (RA) range from 0.24 to 1%, but vary considerably around the globe. A variation in RA prevalence is also expected across Africa and the Middle East, due to ethnic, climate, and socioeconomic differences. To assess the prevalence of RA in Africa and the Middle East, we searched Medline (via PubMed) and databases of major rheumatology conferences. Seventeen journal articles and 0 abstracts met the inclusion criteria. Estimated prevalence ranged from 0.06 to 3.4%. Most studies reported values near or below 0.25%. Consistent with data from other regions, RA was more prevalent among urban than rural populations, and among women than men. The women:men prevalence ratio ranged from 1.3:1 to 12.5:1, which suggests notable differences from the global average of 2:1. Relative increases in prevalence were observed in North Africa and the Middle East (13% since 1990) and Western Sub-Saharan Africa (14%), whereas rates in Eastern, Central, and Southern Sub-Saharan Africa show decreases (4-12%). Low disease awareness, delays to visit rheumatologists, and socioeconomic factors appear to hinder early diagnosis and aggressive treatment. Few countries have developed RA-specific treatment guidelines, and many physicians and patients face limited access to even basic treatments. An improved understanding of the epidemiology and management of RA, and the related socioeconomic consequences is necessary, so that targeted attempts can be made to encourage early diagnosis and treatment.
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Affiliation(s)
- Hani Almoallim
- Faculty of Medicine, Umm-Al-Qura University, Makkah, Saudi Arabia.
| | | | - Humeira Badsha
- Dr Humeira Badsha Medical Center, Dubai, United Arab Emirates
| | | | - Sara Habjoka
- Pfizer Biopharmaceutical Group, Emerging Markets, Dubai, United Arab Emirates
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Demographic and Clinical Patterns of Rheumatoid Arthritis in an Emirati Cohort from United Arab Emirates. Int J Rheumatol 2019; 2019:3057578. [PMID: 31662761 PMCID: PMC6778867 DOI: 10.1155/2019/3057578] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/22/2019] [Accepted: 08/01/2019] [Indexed: 01/09/2023] Open
Abstract
This retrospective cohort study aimed to assess the demographic and clinical characteristics of rheumatoid arthritis (RA) in Emirati patients attending Cleveland Clinic Abu Dhabi, a large tertiary center in the Middle East. In this study, 414 Emirati patients with RA were evaluated over a 3-year period from April 2015 to April 2018. All patients fulfilled the 2010 RA ACR/EULAR criteria and were assessed for demographic and clinical characteristics. The estimated RA prevalence rate in our population cohort was 2.72%. Females showed predominance (80%) with a higher body mass index (31.4 ± 6.61, P = 0.0001) compared to males (28.8 ± 6.03, P = 0.0001). The most frequent comorbidity observed was dyslipidemia (43.5%) followed by hypertension (37.9%), diabetes mellitus (34.5%), and gastroesophageal reflux disease (33.1%). Xerophthalmia was the most frequent extra-articular manifestation. Rheumatoid factor and anti-citrullinated peptide were detected in 63.3% and 41.5% patients, respectively, while both were present in 33.3% of patients. Methotrexate, adalimumab, and rituximab were the most frequently prescribed disease modifying agents. In this study, we describe disease features that are unique to United Arab Emirates (UAE) patients and demonstrate that RA has a significant disease burden. Our findings highlight the need for a RA national registry to improve the quality of care of these patients in UAE.
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Alnakhi WK, Segal JB, Frick KD, Hussin A, Ahmed S, Morlock L. Treatment destinations and visit frequencies for patients seeking medical treatment overseas from the United Arab Emirates: results from Dubai Health Authority reporting during 2009-2016. Trop Dis Travel Med Vaccines 2019; 5:10. [PMID: 31308954 PMCID: PMC6604140 DOI: 10.1186/s40794-019-0086-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 06/04/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Each year, the Dubai Health Authority (DHA) spends millions of dollars to cover the costs of United Arab Emirates (UAE) nationals seeking healthcare overseas. Patients may travel overseas to seek an array of treatments. It is important to analyze the number of trips and treatment destinations for patients travelling overseas to provide baseline information for the DHA to improve polices and strategies related to overseas treatment for UAE nationals. METHODS Administrative data were obtained from the DHA for UAE nationals who sought medical treatment overseas during 2009-2016. We examined the number of trips and treatment destinations by medical specialty, age, gender, years of travel and travel seasons. Multinomial logistic and negative binomial regression models were used to assess the relationships of the treatment destinations and number of trips, respectively, with the key variables of interest. RESULTS The study included data from 6557 UAE nationals. The top three treatment destinations were Germany (46%), the UK (19%) and Thailand (14%). The most common medical specialties were orthopedic surgery (13%), oncology (13%) and neurosurgery (10%). Oncology had the highest expected number of trips adjusted for a number of covariates (IRR 1.34, 95% CI: 1.24-1.44). Regarding destination variation, patients had a lower relative risk ratio of seeking healthcare in Germany in the winter (RRR 0.68, 95% CI: 0.57-0.80). Endocrinology was the most common medical specialty sought in the UK (RRR 3.36, 95% CI: 2.01-5.60). CONCLUSIONS This is the first study to systematically examine the current practice of medical treatment overseas among UAE nationals. The results demonstrate that treatment destinations, medical specialties for which treatment was sought, age, gender and travel season are significant factors in understanding overseas travel for medical care. The study can guide the DHA in collecting more data for further research that may lead to policy-relevant information about sending patients to the best-quality treatment choices at an optimal cost.
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Affiliation(s)
- Wafa K. Alnakhi
- Department of Health Policy and Management Bloomberg School of Public Health, Baltimore, USA
| | - Jodi B. Segal
- School of Medicine Johns Hopkins University, Baltimore, USA
| | - Kevin D. Frick
- Carey Business School Johns Hopkins University, Baltimore, USA
| | | | - Saifuddin Ahmed
- Department of Population, Family and Reproductive Health Bloomberg School of Public Health, Baltimore, USA
| | - Laura Morlock
- Department of Health Policy and Management Bloomberg School of Public Health, Baltimore, USA
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Dargham SR, Zahirovic S, Hammoudeh M, Al Emadi S, Masri BK, Halabi H, Badsha H, Uthman I, Mahfoud ZR, Ashour H, Gad El Haq W, Bayoumy K, Kapiri M, Saxena R, Plenge RM, Kazkaz L, Arayssi T. Epidemiology and treatment patterns of rheumatoid arthritis in a large cohort of Arab patients. PLoS One 2018; 13:e0208240. [PMID: 30566451 PMCID: PMC6300286 DOI: 10.1371/journal.pone.0208240] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 11/14/2018] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES There is limited information on the epidemiology and treatment patterns of rheumatoid arthritis (RA) across the Arab region. We aim in this study to describe the demographic characteristics, clinical profile, and treatment patterns of patients of Arab ancestry with RA. METHODS This is a cross sectional study of 895 patients with established rheumatoid arthritis enrolled from five sites (Jordan, Lebanon, Qatar, Kingdom of Saudi Arabia (KSA), and United Arab Emirates). Demographic characteristics, clinical profile, and treatment patterns are compared between the five countries. RESULTS The majority of our patients are women, have an average disease duration of 10 years, are married and non-smokers, with completed secondary education. We report a high (>80%) ever-use of methotrexate (MTX) and steroids among our RA population, while the ever-use of disease modifying anti-rheumatic drugs (DMARDs) and TNF-inhibitors average around 67% and 33%, respectively. There are variations in RA treatment use between the five country sites. Highest utilization of steroids is identified in Jordan and KSA (p-value < 0.001), while the highest ever-use of TNF-inhibitors is reported in KSA (p-value < 0.001). CONCLUSION Disparities in usage of RA treatments among Arab patients are noted across the five countries. National gross domestic product (GDP), as well as some other unique features in each country likely affect these. Developing treatment guidelines specific to this region could contribute in delivering standardized therapies to RA patients.
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Affiliation(s)
| | | | | | | | | | - Hussein Halabi
- King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Humeira Badsha
- Dr. Humeira Badsha Medical Center, Dubai, United Arab Emirates
| | - Imad Uthman
- American University of Beirut, Beirut, Lebanon
| | | | | | | | | | | | - Richa Saxena
- Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Broad Institute, Cambridge, Massachusetts, United States of America
| | - Robert M. Plenge
- Broad Institute, Cambridge, Massachusetts, United States of America
- Merck Research Laboratories, Boston, Massachusetts, United States of America
| | | | - Thurayya Arayssi
- Weill Cornell Medicine-Qatar, Education City, Doha, Qatar
- * E-mail:
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Sakr BR, Elfishawi MM, ElArousy MH, Hatw AK, AbdulKarim AN, Tammam AB, Kotp AN, Hamed ME, Genedy IE, Desouky EDE, Nawito ZO. Rheumatoid arthritis: A single-center Egyptian experience. Immunol Invest 2018; 47:293-302. [DOI: 10.1080/08820139.2018.1425700] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- B. R Sakr
- Rheumatology and Rehabilitation Department, Kasr Al-Ainy Hospital, Cairo University , Cairo, Egypt
| | - M. M Elfishawi
- Rheumatology and Rehabilitation Department, Kasr Al-Ainy Hospital, Cairo University , Cairo, Egypt
| | - M. H ElArousy
- Medical students, faculty of medicine, Cairo University , Cairo, Egypt
| | - A. K Hatw
- Medical students, faculty of medicine, Cairo University , Cairo, Egypt
| | - A. N AbdulKarim
- Medical students, faculty of medicine, Cairo University , Cairo, Egypt
| | - A. B Tammam
- Medical students, faculty of medicine, Cairo University , Cairo, Egypt
| | - A. N Kotp
- Medical students, faculty of medicine, Cairo University , Cairo, Egypt
| | - M. E Hamed
- Medical students, faculty of medicine, Cairo University , Cairo, Egypt
| | - I. E Genedy
- Medical students, faculty of medicine, Cairo University , Cairo, Egypt
| | - E. D. El Desouky
- Epidemiology and Biostatistics Department, National Cancer Institute, Cairo University , Cairo, Egypt
| | - Z. O. Nawito
- Rheumatology and Rehabilitation Department, Kasr Al-Ainy Hospital, Cairo University , Cairo, Egypt
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Barhamain AS, Magliah RF, Shaheen MH, Munassar SF, Falemban AM, Alshareef MM, Almoallim HM. The journey of rheumatoid arthritis patients: a review of reported lag times from the onset of symptoms. Open Access Rheumatol 2017; 9:139-150. [PMID: 28814904 PMCID: PMC5546831 DOI: 10.2147/oarrr.s138830] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Even after achieving tremendous advances in diagnosis and treatment of rheumatoid arthritis (RA), many of the patients undergo delays in diagnosis and initiation of treatment, which leads to worsening of the condition and poor prognosis. OBJECTIVE The objective of this study was to perform a literature review to quantify the lag times in diagnosis and treatment of RA and study the reported factors associated with it. METHODS The authors searched literature published until September 2016 in electronic full-text and abstract databases and hand-searched the suitable articles. RESULTS The weighted average of median lag time from symptom onset to therapy was 11.79 months (12 studies, 5,512 patients, range 3.6-24.0 months). Lag1 was 3.14 months (onset of symptoms to first physician consultant; 12 studies, 6,055 patients, range 0-5.7 months); lag2 was 2.13 months (physician visit to RA specialist referral; 13 studies, 34,767 patients, range 0.5-6.6 months); lag3 was 2.91 months (consultation with rheumatologist to diagnosis; 3 studies, 563 patients, range 0-5 months), lag4 was 2.14 months (diagnosis to initiation of disease-modifying antirheumatic drug therapy; 5 studies, 30,685 patients, range 0-2.2 months). Numerous patient-and physician-related factors like gender, ethnicity, primary care physician knowledge of the condition, availability of diagnostics, and so on were responsible for the delays. CONCLUSION This review estimated the delay times and identified the main factors for delay in RA patients in diagnosis and initiation of treatment. A most plausible solution to this is coordinated effort by the rheumatology and primary care physicians.
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Affiliation(s)
| | | | | | | | | | | | - Hani M Almoallim
- Department of Medicine, Faculty of Medicine
- Alzaidi Chair of Research in Rheumatic Diseases, Umm Alqura University, Makkah
- Department of Medicine, Dr Soleiman Fakeeh Hospital, Jeddah, Saudi Arabia
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Emadi SA, Hammoudeh M, Mounir M, Mueller RB, Wells AF, Sarakbi HA. An assessment of the current treatment landscape for rheumatology patients in Qatar: Recognising unmet needs and moving towards solutions. J Int Med Res 2017; 45:733-743. [PMID: 28415924 PMCID: PMC5536653 DOI: 10.1177/0300060516686872] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 12/08/2016] [Indexed: 12/30/2022] Open
Abstract
Objective This study assessed the mode of application (oral, intravenous or subcutaneous (SC)) currently employed in the treatment of rheumatoid arthritis (RA) in patients from Qatar in comparison with patients' individual preferences for the mode of application of their treatment. Methods This study included 294 RA patients visiting three clinics at the main referral hospital in Qatar who were interviewed using a standard questionnaire to determine their preference of mode of application for their disease-modifying antirheumatic drug (DMARD) treatment in relation to their currently employed mode of application. Results The majority of patients were female (76%), and 93% of male patients and 61% of female patients in the study clinics were of a nationality other than Qatari. The highest patient preference recorded was for an oral therapy (69%), compared with injection (23%) and intravenous (8%) therapy. In total, 85% of patients expressed a preference to remain on oral therapy compared with 63% and 58% of intravenous and SC injection patients indicating a preference to remain on their current method of administration. Conclusions This high preference for oral therapies highlights the considerable need for incorporation of new oral targeted synthetic DMARD therapies into clinical practice within the region.
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Affiliation(s)
- Samar Al Emadi
- Hamad Medical Corporation, Qatar and Weill Cornell Medical College, Qatar
| | - Mohammed Hammoudeh
- Hamad Medical Corporation, Qatar and Weill Cornell Medical College, Qatar
| | | | | | - Alvin F. Wells
- Rheumatology and Immunotherapy Center, Franklin, WI, USA
| | - Housam Aldeen Sarakbi
- Hamad Medical Corporation, Qatar; Weill Cornell Medical College, Qatar; Mercy Health System, Janesville, Wisconsin, USA
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Moradi-Lakeh M, Forouzanfar MH, Vollset SE, El Bcheraoui C, Daoud F, Afshin A, Charara R, Khalil I, Higashi H, Abd El Razek MM, Kiadaliri AA, Alam K, Akseer N, Al-Hamad N, Ali R, AlMazroa MA, Alomari MA, Al-Rabeeah AA, Alsharif U, Altirkawi KA, Atique S, Badawi A, Barrero LH, Basulaiman M, Bazargan-Hejazi S, Bedi N, Bensenor IM, Buchbinder R, Danawi H, Dharmaratne SD, Zannad F, Farvid MS, Fereshtehnejad SM, Farzadfar F, Fischer F, Gupta R, Hamadeh RR, Hamidi S, Horino M, Hoy DG, Hsairi M, Husseini A, Javanbakht M, Jonas JB, Kasaeian A, Khan EA, Khubchandani J, Knudsen AK, Kopec JA, Lunevicius R, Abd El Razek HM, Majeed A, Malekzadeh R, Mate K, Mehari A, Meltzer M, Memish ZA, Mirarefin M, Mohammed S, Naheed A, Obermeyer CM, Oh IH, Park EK, Peprah EK, Pourmalek F, Qorbani M, Rafay A, Rahimi-Movaghar V, Shiri R, Rahman SU, Rai RK, Rana SM, Sepanlou SG, Shaikh MA, Shiue I, Sibai AM, Silva DAS, Singh JA, Skogen JC, Terkawi AS, Ukwaja KN, Westerman R, Yonemoto N, Yoon SJ, Younis MZ, Zaidi Z, Zaki MES, Lim SS, Wang H, Vos T, Naghavi M, Lopez AD, Murray CJL, Mokdad AH. Burden of musculoskeletal disorders in the Eastern Mediterranean Region, 1990-2013: findings from the Global Burden of Disease Study 2013. Ann Rheum Dis 2017; 76:1365-1373. [PMID: 28209629 PMCID: PMC5738600 DOI: 10.1136/annrheumdis-2016-210146] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 09/28/2016] [Accepted: 01/19/2017] [Indexed: 12/22/2022]
Abstract
Objectives We used findings from the Global Burden of Disease Study 2013 to report the burden of musculoskeletal disorders in the Eastern Mediterranean Region (EMR). Methods The burden of musculoskeletal disorders was calculated for the EMR's 22 countries between 1990 and 2013. A systematic analysis was performed on mortality and morbidity data to estimate prevalence, death, years of live lost, years lived with disability and disability-adjusted life years (DALYs). Results For musculoskeletal disorders, the crude DALYs rate per 100 000 increased from 1297.1 (95% uncertainty interval (UI) 924.3–1703.4) in 1990 to 1606.0 (95% UI 1141.2–2130.4) in 2013. During 1990–2013, the total DALYs of musculoskeletal disorders increased by 105.2% in the EMR compared with a 58.0% increase in the rest of the world. The burden of musculoskeletal disorders as a proportion of total DALYs increased from 2.4% (95% UI 1.7–3.0) in 1990 to 4.7% (95% UI 3.6–5.8) in 2013. The range of point prevalence (per 1000) among the EMR countries was 28.2–136.0 for low back pain, 27.3–49.7 for neck pain, 9.7–37.3 for osteoarthritis (OA), 0.6–2.2 for rheumatoid arthritis and 0.1–0.8 for gout. Low back pain and neck pain had the highest burden in EMR countries. Conclusions This study shows a high burden of musculoskeletal disorders, with a faster increase in EMR compared with the rest of the world. The reasons for this faster increase need to be explored. Our findings call for incorporating prevention and control programmes that should include improving health data, addressing risk factors, providing evidence-based care and community programmes to increase awareness.
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Affiliation(s)
- Maziar Moradi-Lakeh
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA.,Department of Community Medicine, Preventive Medicine and Public Health Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad H Forouzanfar
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Stein Emil Vollset
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA.,Norwegian Institute of Public Health, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Charbel El Bcheraoui
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Farah Daoud
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Ashkan Afshin
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Raghid Charara
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Ibrahim Khalil
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | | | | | - Aliasghar Ahmad Kiadaliri
- Clinical Epidemiology Unit, Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden
| | - Khurshid Alam
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,The University of Melbourne, Melbourne, Victoria, Australia.,The University of Sydney, Sydney, New South Wales, Australia
| | - Nadia Akseer
- Hospital for Sick Children, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Nawal Al-Hamad
- Food and Nutrition Administration, Ministry of Health, Safat, Kuwait
| | | | | | - Mahmoud A Alomari
- Division of Physical Therapy, Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | | | | | | | - Suleman Atique
- Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei, Taiwan
| | - Alaa Badawi
- Public Health Agency of Canada, Toronto, Ontario, Canada
| | - Lope H Barrero
- Department of Industrial Engineering, School of Engineering, Pontificia Universidad Javeriana, Bogota, Colombia
| | | | - Shahrzad Bazargan-Hejazi
- Charles R. Drew University of Medicine and Science, Los Angeles, California, USA.,David Geffen School of Medicine, University of California at Los Angeles (UCLA), California, USA
| | - Neeraj Bedi
- College of Public Health and Tropical Medicine, Jazan, Saudi Arabia
| | | | - Rachelle Buchbinder
- Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Hadi Danawi
- Walden University, Minneapolis, Minnesota, USA
| | - Samath D Dharmaratne
- Department of Community Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Faiez Zannad
- Clinical Investigation Centre INSERM (the National Institute for Health and Medical Research), Université de Lorraine, Vandoeuvre les Nancy, France
| | - Maryam S Farvid
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrine and Metabolic Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Rahul Gupta
- West Virginia Bureau for Public Health, Charleston, West Virginia, USA
| | | | - Samer Hamidi
- Hamdan Bin Mohammed Smart University, Dubai, United Arab Emirates
| | - Masako Horino
- Nevada Division of Behavior and Public Health, Carson City, Nevada, USA.,Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, USA
| | - Damian G Hoy
- Public Health Division, Secretariat of the Pacific Community, Noumea, New Caledonia
| | | | - Abdullatif Husseini
- Institute of Community and Public Health, Birzeit University, Birzeit, Palestine
| | - Mehdi Javanbakht
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Jost B Jonas
- Department of Ophthalmology, Medical Faculty Mannheim, Ruprecht-Karls-University Heidelberg, Mannheim, Germany
| | - Amir Kasaeian
- Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Ann Kristin Knudsen
- Department of Health Registries, Norwegian Institute of Public Health, Bergen, Norway
| | - Jacek A Kopec
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Raimundas Lunevicius
- Aintree University Hospital National Health Service Foundation Trust, Liverpool, UK.,School of Medicine, University of Liverpool, Liverpool, UK
| | | | | | - Reza Malekzadeh
- Digestive Disease Research Institute, Tehran Universities of Medical Sciences, Tehran, Iran
| | - Kedar Mate
- McGill University, Montreal, Quebec, Canada
| | - Alem Mehari
- College of Medicine, Howard University, Washington DC, USA
| | - Michele Meltzer
- Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ziad A Memish
- Saudi Ministry of Health, Riyadh, Saudi Arabia.,College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | | | - Shafiu Mohammed
- Health Systems and Policy Research Unit, Ahmadu Bello University, Zaria, Nigeria.,Institute of Public Health, Heidelberg University, Heidelberg, Germany
| | - Aliya Naheed
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Carla Makhlouf Obermeyer
- Faculty of Health Sciences, Center for Research on Population and Health, American University of Beirut, Beirut, Lebanon
| | - In-Hwan Oh
- Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, South Korea
| | - Eun-Kee Park
- Department of Medical Humanities and Social Medicine, College of Medicine, Kosin University, Busan, South Korea
| | | | | | - Mostafa Qorbani
- Noncommunicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Anwar Rafay
- Contech International Health Consultants, Lahore, Pakistan.,Contech School of Public Health, Lahore, Pakistan
| | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Rahman Shiri
- Finnish Institute of Occupational Health, Helsinki, Finland
| | | | | | - Saleem M Rana
- Contech International Health Consultants, Lahore, Pakistan.,Contech School of Public Health, Lahore, Pakistan
| | - Sadaf G Sepanlou
- Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Ivy Shiue
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK.,Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
| | - Abla Mehio Sibai
- Department of Epidemiology & Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | | | - Jasvinder A Singh
- University of Alabama at Birmingham, and Birmingham Veterans Affairs Medical Center, Birmingham, Alabama, USA
| | - Jens Christoffer Skogen
- Norwegian Institute of Public Health, Bergen, Norway.,Alcohol and Drug Research Western Norway, Stavanger University Hospital, Stavanger, Norway
| | - Abdullah Sulieman Terkawi
- Department of Anesthesiology, University of Virginia, Charlottesville, Virginia, USA.,Outcomes Research Consortium, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Anesthesiology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Kingsley N Ukwaja
- Department of Internal Medicine, Federal Teaching Hospital, Abakaliki, Nigeria
| | - Ronny Westerman
- Federal Institute for Population Research, Wiesbaden, Germany.,German National Cohort Consortium, Heidelberg, Germany
| | - Naohiro Yonemoto
- Department of Biostatistics, School of Public Health, Kyoto University, Kyoto, Japan
| | - Seok-Jun Yoon
- Department of Preventive Medicine, College of Medicine, Korea University, Seoul, South Korea
| | | | | | | | - Stephen S Lim
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Haidong Wang
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Theo Vos
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Alan D Lopez
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA.,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Christopher J L Murray
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
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13
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Al-Herz A, Al-Awadhi A, Saleh K, Al-Kandari W, Hasan E, Ghanem A, Abutiban F, Alenizi A, Hussain M, Ali Y, Khadrawy A, Fazal A, Mokaddem K, Zaman A, Mazloum G, Aftab B, Haider N, Bartella Y, Hamed S, Al-Saber A. Low Prevalence of Nodules in Rheumatoid Arthritis Patients in Kuwait: A Description and a Comparison of Patients from the Kuwait Registry for Rheumatic Diseases. Med Princ Pract 2017; 26:152-156. [PMID: 27883999 PMCID: PMC5588366 DOI: 10.1159/000454679] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 11/23/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To describe the prevalence of rheumatoid nodules (RN) in patients with rheumatoid arthritis (RA) and to compare their features with those of patients without RN. SUBJECTS AND METHODS Adult RA patients (n = 952) in the Kuwait Registry for Rheumatic Diseases from February 2013 to December 2015 were evaluated for RN. Demographic and serological features and disease activity and severity were obtained from the registry. RESULTS Of the 952 RA patients, 22 (2.3%) had RN and 930 (97.7%) did not. Age, sex, disease duration, smoking, and family history of an autoimmune rheumatic disease were similar. Obesity was more prevalent in the RN group, i.e. 11 (50%) vs. 326 (35.1%), p = 0.016. There was no difference in rheumatoid factor (RF) or anti-cyclic citrullinated peptide antibody positivity. Patients with RN had more sicca symptoms, i.e. 8 (36.4%) vs. 152 (16.3%), p = 0.025, a higher mean score on the visual analogue scale pain (3 ± 2.9 vs. 2 ± 2.7, p < 0.001), more tender joints (6.4 ± 8.8 vs. 4.2 ± 7.2, p = 0.001), a higher patient global assessment of disease activity (3.3 ± 2.7 vs. 2.3 ± 2.7, p < 0.001), and more deformities, i.e. 3 (13.6%) vs. 74 (8%), p = 0.034. The mean health assessment questionnaire score in RN patients was 1.1 versus 0.9 in patients without RN (p = 0.08). Patients with RN had a low disease activity (means: disease activity score [DAS-28], 3.02; clinical disease activity index, 7.7; and simple disease activity index, 10.4), similar to the other group. While the rates of methotrexate treatment were comparable, biologic therapy was administered more in patients with RN (i.e. 15 [68.2%] vs. 478 [51.4%], p < 0.001). CONCLUSION In Kuwait, the prevalence of RN is low among RA patients. Patients with and without RN are similar in terms of demographics and serologic features, except for more obesity. However, patients with RN have more sicca symptoms, joint deformities, and painful and tender joints. Disease activity scores are low with more frequent biologic therapy.
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Affiliation(s)
- Adeeba Al-Herz
- Rheumatology Unit, Department of Internal Medicine, Al-Amiri Hospital, Abu Halifa, Kuwait
- *Dr. Adeeba Al-Herz, Rheumatology Unit, Department of Internal Medicine, Al-Amiri Hospital, PO Box 4077, Safat, Kuwait City 13041 (Kuwait), E-Mail
| | - Adel Al-Awadhi
- Department of Medicine, Faculty of Medicine, Kuwait University, Abu Halifa, Kuwait
| | - Khulood Saleh
- Rheumatology Department, Al-Farwania Hospital, Kuwait City, Abu Halifa, Kuwait
| | - Waleed Al-Kandari
- Rheumatology Department, Al-Farwania Hospital, Kuwait City, Abu Halifa, Kuwait
| | - Eman Hasan
- Rheumatology Unit, Department of Internal Medicine, Al-Amiri Hospital, Abu Halifa, Kuwait
| | - Aqeel Ghanem
- Rheumatology Department, Mubarak Al-Kabeer Hospital, Jabriya, Abu Halifa, Kuwait
| | - Fatemah Abutiban
- Rheumatology Department, Al-Jahra Hospital, Al Jahra, Abu Halifa, Kuwait
| | - Ahmad Alenizi
- Rheumatology Department, Al-Jahra Hospital, Al Jahra, Abu Halifa, Kuwait
| | - Mohammed Hussain
- Rheumatology Unit, Department of Internal Medicine, Al-Amiri Hospital, Abu Halifa, Kuwait
| | - Yaser Ali
- Rheumatology Department, Mubarak Al-Kabeer Hospital, Jabriya, Abu Halifa, Kuwait
| | - Ahmad Khadrawy
- Rheumatology Department, Al-Farwania Hospital, Kuwait City, Abu Halifa, Kuwait
| | - Ammad Fazal
- Rheumatology Department, Al-Farwania Hospital, Kuwait City, Abu Halifa, Kuwait
| | - Khaled Mokaddem
- Rheumatology Unit, Department of Internal Medicine, Al-Amiri Hospital, Abu Halifa, Kuwait
| | - Ajaz Zaman
- Rheumatology Department, Mubarak Al-Kabeer Hospital, Jabriya, Abu Halifa, Kuwait
| | - Ghada Mazloum
- Rheumatology Department, Mubarak Al-Kabeer Hospital, Jabriya, Abu Halifa, Kuwait
| | - Beena Aftab
- Rheumatology Department, Al-Jahra Hospital, Al Jahra, Abu Halifa, Kuwait
| | - Najaf Haider
- Rheumatology Department, Al-Jahra Hospital, Al Jahra, Abu Halifa, Kuwait
| | - Youssef Bartella
- Rheumatology Unit, Department of Internal Medicine, Al-Amiri Hospital, Abu Halifa, Kuwait
| | - Sally Hamed
- Rheumatology Unit, Department of Internal Medicine, Al-Amiri Hospital, Abu Halifa, Kuwait
| | - Ahmed Al-Saber
- Department of Mathematics, Kuwait Technical College, Abu Halifa, Kuwait
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14
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Latitude gradient influences the age of onset of rheumatoid arthritis: a worldwide survey. Clin Rheumatol 2016; 36:485-497. [PMID: 27995382 DOI: 10.1007/s10067-016-3481-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 11/07/2016] [Indexed: 02/04/2023]
Abstract
The age of onset of rheumatoid arthritis (RA) is an important outcome predictor. Northern countries report an age of RA onset of around 50 years, but apparently, variability exists across different geographical regions. The objective of the present study is to assess whether the age of onset of RA varies across latitudes worldwide. In a proof-of-concept cross-sectional worldwide survey, rheumatologists from preselected cities interviewed 20 consecutive RA patients regarding the date of RA onset (RAO, when the patient first noted a swollen joint). Other studied variables included location of each city, rheumatologist settings, latitudes (10° increments, south to north), longitudes (three regions), intracountry consistency, and countries' Inequality-adjusted Human Development Index (IHDI). Data from 2481 patients (82% females) were obtained from 126 rheumatologists in 77 cities of 41 countries. Worldwide mean age of RAO was 44 ± 14 years (95% CI 44-45). In 28% of patients, RA began before age 36 years and before age 46 years in 50% of patients. RAO was 8 years earlier around the Tropic of Cancer when compared with northern latitudes (p < 0.001, 95% CI 3.5-13). Multivariate analysis showed that females, western cities, and latitudes around the Tropic of Cancer are associated with younger age of RAO (R 2 0.045, p < 0.001). A positive correlation was found between the age of RAO and IHDI (r = 0.7, p < 0.01, R 2 0.5). RA often begins at an early age and onset varies across latitudes worldwide. We postulate that countries' developmental status and their geographical and geomagnetic location influence the age of RAO.
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Hussain W, Noorwali A, Janoudi N, Baamer M, Kebbi L, Mansafi H, Ibrahim A, Gohary S, Minguet J, Almoallim H. From Symptoms to Diagnosis: An Observational Study of the Journey of Rheumatoid Arthritis Patients in Saudi Arabia. Oman Med J 2016; 31:29-34. [PMID: 26816566 DOI: 10.5001/omj.2016.06] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Rheumatoid arthritis (RA) is often not diagnosed or treated quickly enough to alter outcomes. We aimed to evaluate the lag times from disease onset to first clinical consultation and diagnosis and to identify factors contributing to delayed diagnosis in Saudi Arabia. METHODS This retrospective, multicenter study collected data on 250 patients, from six hospitals in Saudi Arabia, who met the 2010 American College of Rheumatology criteria for RA. RESULTS The patients mean age was 43.3±12.0 years (mean disease duration: 6.6±5.8 years). The majority were female (84.8%) and presented with joint pain during RA onset (83.6%). On average, they consulted 4.3±2.5 physicians from the first symptoms to the final diagnosis. The mean time from onset to first physician visit (lag 1) was 6.2±5.5 months, whereas the mean time was 30.2±16.0 months between the initial visit and final RA diagnosis (lag 2). Only 3.2% of patients initially sought consultation from a rheumatologist, while 67.2%, 23.6%, and 6.0% first met with orthopedic surgeons, general practitioners, and non-rheumatologists, respectively. Non-rheumatologists offered diagnoses in 24.4% of cases while rheumatologists diagnosed 75.6%. The absence of early hand/wrist involvement and fatigue were associated with delayed RA diagnosis (long lag 2; p<0.010). Moreover, geographic distribution influenced RA diagnosis, with rural patients experiencing a greater delay than urban patients (p<0.0001). CONCLUSIONS Failure of patients to be seen by rheumatologists at RA onset delayed diagnosis and treatment. Thus, RA diagnosis can be accelerated by encouraging early referral to rheumatologists.
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Affiliation(s)
- Waleed Hussain
- Department of Medicine, Heraa General Hospital, Makkah, Saudi Arabia
| | - Abdulsalam Noorwali
- Department of Medicine, Umm Alqura University, Makkah, Saudi Arabia; Department of Medicine, Alnoor General Hospital, Makkah, Saudi Arabia
| | - Nahid Janoudi
- Department of Medicine, Dr. Soleiman Fakeeh Hospital, Jeddah, Saudi Arabia
| | - Maatouqa Baamer
- Department of Medicine, King Abdulaziz Hospital and Oncology Center, Jeddah, Saudi Arabia
| | - Lina Kebbi
- Department of Medicine, Specialized Medical Center, Riyadh, Saudi Arabia
| | - Hanady Mansafi
- Department of Medicine, Specialized Medical Center, Riyadh, Saudi Arabia
| | - Ashraf Ibrahim
- Alzaidi Chair of Research in Rheumatic Diseases, Umm Alqura University, Makkah, Saudi Arabia
| | - Shereen Gohary
- Alzaidi Chair of Research in Rheumatic Diseases, Umm Alqura University, Makkah, Saudi Arabia
| | - Joan Minguet
- Alzaidi Chair of Research in Rheumatic Diseases, Umm Alqura University, Makkah, Saudi Arabia
| | - Hani Almoallim
- Department of Medicine, Umm Alqura University, Makkah, Saudi Arabia; Department of Medicine, Dr. Soleiman Fakeeh Hospital, Jeddah, Saudi Arabia; Alzaidi Chair of Research in Rheumatic Diseases, Umm Alqura University, Makkah, Saudi Arabia
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16
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Enhancing the care of women with rheumatic diseases during pregnancy: challenges and unmet needs in the Middle East. Clin Rheumatol 2015; 35:25-31. [PMID: 26304021 PMCID: PMC4710648 DOI: 10.1007/s10067-015-3052-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 05/21/2015] [Accepted: 07/26/2015] [Indexed: 12/16/2022]
Abstract
Pregnancy in women with rheumatic disorders is known to be associated with risks for both the mother and fetus; however, these risks can be minimized with proper planning and careful management of the disease. In the Middle East, there are specific cultural challenges that may have a negative impact on the care that women with rheumatic disorders receive. There is a need for cross-collaboration between specialist physicians, improved awareness of rheumatic disorders among the general public and more open discussion with patients about the potential complications of pregnancy. Women in the region are often unwilling to discuss their disease with their partner and are even less likely to seek advice regarding family planning from their physician. The objective of this review is to highlight the specific challenges of pregnancy management and to discuss why establishing specialist pregnancy clinics for women with rheumatic disorders could be an effective solution. Such clinics can provide high quality care before, during and after pregnancy as shown in several European and US centers. Additionally, such clinics could be useful for the collection of pregnancy outcomes data from the Middle East, which may currently be lacking in the region, in order to highlight where further improvements can be made. With specialist care and analysis of pregnancy outcomes, the standard of care for women with rheumatic disorders in this area could be significantly improved.
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17
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Safety, Tolerability, and Efficacy of Tocilizumab in Rheumatoid Arthritis: An Open-Label Phase 4 Study in Patients from the Middle East. Int J Rheumatol 2015; 2015:975028. [PMID: 26089907 PMCID: PMC4452319 DOI: 10.1155/2015/975028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 04/21/2015] [Accepted: 04/30/2015] [Indexed: 11/19/2022] Open
Abstract
This open-label study investigated the safety and efficacy of tocilizumab in Middle Eastern patients with rheumatoid arthritis (RA). Patients whose Disease Activity Score based on 28 joints (DAS28) was >3.2 received tocilizumab 8 mg/kg intravenously every 4 weeks for 24 weeks. Patients receiving aTNF ± nonbiologic disease-modifying antirheumatic drug(s) (DMARD(s)) switched to tocilizumab; patients receiving nonbiologic DMARD monotherapy added tocilizumab. Primary end points were adverse events (AEs), serious AEs (SAEs), and laboratory parameters; secondary end points were DAS28, Health Assessment Questionnaire-Disability Index, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR). Eighty-eight of 95 patients completed 24 weeks. Overall, 125 AEs were reported in 43 (45%) patients; the most common were increased hepatic enzymes (16%) and cholesterol (11%). Eight patients experienced SAEs. Significant changes from baseline to week 24 occurred for hemoglobin, neutrophils, platelets, total cholesterol, and liver enzymes (P < 0.05). DAS28, CRP, and ESR decreased significantly from baseline at each visit (P < 0.0001). At week 24, the proportions of patients reporting DAS28 clinically meaningful improvement (decrease ≥1.2), low disease activity (DAS28 ≥2.6 to ≤3.2), and remission (DAS28 <2.6) were 92%, 23%, and 64%, respectively. Safety and efficacy of tocilizumab were consistent with values reported in Western patients.
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18
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[Demographic and clinical features of patients with rheumatoid arthritis in Piauí, Brazil--evaluation of 98 patients]. REVISTA BRASILEIRA DE REUMATOLOGIA 2014; 54:360-5. [PMID: 25627299 DOI: 10.1016/j.rbr.2014.02.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Revised: 01/29/2014] [Accepted: 02/10/2014] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Brazilian epidemiological studies on rheumatoid arthritis are scarce, mainly in the northeast; thus many data currently available originate from the international literature. OBJECTIVES To describe demographic, clinical and serological characteristics of patients with rheumatoid arthritis (RA) followed-up by the same physician, in state of Piauí, Brazil. PATIENTS AND METHODS Data were collected between August 2010 and March 2013, in three health services of Piauí that provided health care in Rheumatology: a university-affiliated hospital, a public outpatient clinic and a private clinic. RESULTS The numbers represent mean ± SD or percentage: 47.5±11.03 years-old non-Caucasian woman, non-smoker (59.2%), low educational level, mean disease duration of 7.7 years ± 7.6, and major extra-articular manifestations were rheumatoid nodules (19.4%) and sicca syndrome (46.9%). CONCLUSION Features of rheumatoid arthritis obtained in this study are similar to those found in some national and international studies, but we observed higher female preponderance and illiteracy rate, in addition to a moderately severe erosive disease on average, with frequent sicca and other extra-articular manifestations.
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Halabi H, Alarfaj A, Alawneh K, Alballa S, Alsaeid K, Badsha H, Benitha R, Bouajina E, Al Emadi S, El Garf A, El Hadidi K, Laatar A, Makhloufi CD, Masri AF, Menassa J, Al Shaikh A, Swailem RA, Dougados M. Challenges and opportunities in the early diagnosis and optimal management of rheumatoid arthritis in Africa and the Middle East. Int J Rheum Dis 2014; 18:268-75. [PMID: 24620997 DOI: 10.1111/1756-185x.12320] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2014] [Indexed: 02/01/2023]
Abstract
Early diagnosis and early initiation of disease-modifying antirheumatic drug (DMARD) therapy slow the progression of joint damage and decrease the morbidity and mortality associated with rheumatoid arthritis (RA). According to the European League Against Rheumatism (EULAR) guidelines, treatment should be initiated with methotrexate and addition of biological DMARDs such as tumour necrosis factor (TNF) inhibitors should be considered for RA patients who respond insufficiently to methotrexate and/or other synthetic DMARDs and have poor prognostic factors. Africa and the Middle East is a large geographical region with varying treatment practices and standards of care in RA. Existing data show that patients with RA in the region are often diagnosed late, present with active disease and often do not receive DMARDs early in the course of the disease. In this review, we discuss the value of early diagnosis and remission-targeted treatment for limiting joint damage and improving disease outcomes in RA, and the challenges in adopting these strategies in Africa and the Middle East. In addition, we propose an action plan to improve the overall long-term outlook for RA patients in the region.
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Affiliation(s)
- Hussein Halabi
- King Faisal Specialist Hospital & Research Centre, Jeddah, Saudi Arabia
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Lutf A, Poil AR, Hammoudeh M. Characteristics of patients with rheumatoid arthritis in Qatar: a cross-sectional study. Int J Rheum Dis 2013; 17:63-5. [PMID: 24472269 DOI: 10.1111/1756-185x.12135] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To describe the clinical characteristics, serologic, radiological and clinical disease activity, and modality of therapy in patients with rheumatoid arthritis (RA) at tertiary outpatient care in Qatar. METHODS The study design was cross-sectional where 100 consecutive cases who met 1987 American College of Rheumatology criteria for diagnosis of RA were enrolled in this study. Demographic data (sex, nationality and age) numbers of swollen and tender joints, X-rays and current medications were collected during outpatients visits to Hamad General Hospital. Disease Activity Score of 28 joints (DAS28) and Health Assessment Questionnaires (HAQ) scores were calculated. All patients with RA who were seen as rheumatology outpatients were invited to participate in the study. RESULTS One hundred patients were seen and examined during their follow-up at the outpatient clinic; data were collected and analyzed. Females represented 67% of all patients, 6% had more than six swollen joints, 9% had more than six tender joints. DAS28 and erythrocyte sedimentation rate (DAS28) calculation revealed 49% of patients were in remission (DAS28 < 2.6), 15% had low disease activity (DAS28 2.6-3.2) and 36% had DAS28 > 3.2.Mean HAQ score was 1.02. Rheumatoid factor (RF) was positive in 63%, while anti-cyclic citrullinated protein antibody (anti-CCP) was positive in 71%, and 49% were positive for both. Radiography of hands and feet during the previous year was done in 65% of patients: 11% of them had erosions. Sixty-six percent were on one synthetic disease-modifying anti-rheumatic drug (DMARD) and 27% where on more than one synthetic DMARD and 7% where on no DMRD. Glucocorticoids were used in 51% and 29% were on biologics. CONCLUSION Sixty-four percent of rheumatoid arthritis patients in Qatar were in remission or had low disease activity while the remaining 36% had active disease and among these patients 29% were on biologics.
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Affiliation(s)
- Abdo Lutf
- Rheumatology Division, Department of Medicine, Hamad General Hospital, Doha, Qatar
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Rostom S, Mengat M, Lahlou R, Hari A, Bahiri R, Hajjaj-Hassouni N. Metabolic syndrome in rheumatoid arthritis: case control study. BMC Musculoskelet Disord 2013; 14:147. [PMID: 23621997 PMCID: PMC3639853 DOI: 10.1186/1471-2474-14-147] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Accepted: 04/15/2013] [Indexed: 02/06/2023] Open
Abstract
Background Metabolic syndrome, a cluster of classical cardiovascular risk factors, including hypertension, obesity, glucose intolerance, and dyslipidemia is highly prevalent in patients with rheumatoid arthritis (RA). The aim of the study was to assess the frequency of metabolic syndrome (MS) in RA patients, and to evaluate the relationships between metabolic syndrome and RA. Methods The study was conducted on 120 RA patients according to the 1987 revised American College of Rheumatology classification criteria, and 100 age and sex matched apparently healthy controls. The frequency of metabolic syndrome was assessed using six Metabolic Syndrome definitions (Joint Consensus 2009, National Cholesterol Education Programme 2004 and 2001, International Diabetes Federation, World Health Organisation and European Group for Study of Insulin Resistance). Logistic regression was used to identify independent predictors of metabolic Syndrome. Results The frequency of metabolic syndrome varied from 18 to 48.6% in RA according to the definition used and was significantly higher than controls (for all definitions p<0.05). In multivariate analysis, higher ESR was independently associated with the presence of Met S (OR =1.36; CI: 1.18–2.12; p = 0.03). Glucocorticoid use, but not other disease modifying anti-rheumatic drugs (DMARDs), values remained significant independent predictors of the presence of metabolic syndrome in RA patients (OR = 1.45; CI: 1.12–2.14; p = 0.04). Conclusions In summary, the frequency of metabolic syndrome in RA varies according to the definition used and was significantly higher compared to controls (for all definitions p<0.05). Higher systemic inflammatory marker, and glucocorticoids use were independent predictors associated with the presence of metabolic syndrome in patients with RA. These findings suggest that physicians should screen for metabolic syndrome in patients with RA to control its components and therefore reduce the risk of cardiovascular disease in these patients.
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Affiliation(s)
- Samira Rostom
- Department of Rheumatology, University Mohammed V Souissi, Faculty of Medicine and Pharmacy, El Ayachi hospital, University Hospital of Rabat-Sale, PO Box: 10000, Sale, Morocco.
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Suboptimal management of rheumatoid arthritis in the Middle East and Africa: could the EULAR recommendations be the start of a solution? Clin Rheumatol 2012; 32:151-9. [PMID: 23274756 DOI: 10.1007/s10067-012-2153-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Accepted: 12/10/2012] [Indexed: 01/19/2023]
Abstract
Although the prevalence of RA in the Middle East and Africa is comparable with that in other parts of the world, evidence indicates that its management in this region is suboptimal for a variety of reasons, including misconceptions and misunderstandings about the disease's prevalence and severity in the region, compounded by the lack of local epidemiological and health-economic data around the disease; the perception that RA is a low priority compared with other more prevalent conditions; delayed diagnosis, referral and treatment; and a lack of a region-specific, evidence-based management approach. In the absence of such an approach, the EULAR treatment recommendations may provide a useful starting point for the creation of guidelines to suit local circumstances. However, although agreement with the EULAR recommendations is high, many barriers prevent their implementation in clinical practise, including lack of timely referral to rheumatologists; suboptimal use of synthetic DMARDs; poor access to biologics; lack of awareness of the burden of RA among healthcare professionals, patients and payers; and lack of appropriate staffing levels.To optimise the management of RA in the Middle East and Africa, will require a multi-pronged approach from a diverse group of stakeholders-including local, national and regional societies, such as the African League of Associations in Rheumatology and International League of Associations for Rheumatology, and service providers-to collect data on the epidemiology and burden of the disease; to increase awareness of RA and its burden among healthcare professionals, payers and patients through various educational programmes; to encourage early referral and optimise use of DMARDs by promoting the EULAR treatment recommendations; to encourage the development of locally applicable guidelines based on the EULAR treatment recommendations; and to facilitate access to drugs and the healthcare professionals who can prescribe and monitor them.
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Efforts to Increase Public Awareness May Result in More Timely Diagnosis of Rheumatoid Arthritis. J Clin Rheumatol 2012; 18:279-82. [DOI: 10.1097/rhu.0b013e3182676975] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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The effect of neutralizing antibodies on the sustainable efficacy of biologic therapies: what’s in it for African and Middle Eastern rheumatologists. Clin Rheumatol 2012; 31:1281-7. [DOI: 10.1007/s10067-012-2040-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Accepted: 07/11/2012] [Indexed: 10/28/2022]
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The practical value of biologics registries in Africa and Middle East: challenges and opportunities. Clin Rheumatol 2012; 31:407-16. [PMID: 22228237 DOI: 10.1007/s10067-011-1918-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Accepted: 12/15/2011] [Indexed: 12/19/2022]
Abstract
Biologics, including tumor necrosis factor (TNF) inhibitors, are increasingly used for the treatment of inflammatory conditions such as rheumatoid arthritis (RA), psoriatic arthritis, and ankylosing spondylitis. The efficacy of these drugs has been demonstrated in randomized controlled trials (RCTs). However, these studies are conducted in controlled environments, and the results may not necessarily reflect clinical outcomes in daily clinical practice. In Europe and other western countries, numerous biologics registries that enroll and monitor patients receiving biologics have been established. These registries follow patients irrespective of whether they continue with the initial biologic drug. Thus, real-life efficacy data from these registries can be used to assess the long-term safety of biologics through longitudinal studies. In Africa and Middle East (AFME), such registries currently exist only in Morocco and South Africa. In light of the increasing availability of biologics and scarcity of long-term safety data of these agents in the AFME population, there is a need to establish biologics registries in other countries across the region. This review discusses the value of biologics registries versus RCTs as well as safety and efficacy data from observational studies presented as lessons from well-established biologics registries. In addition, the rationale for establishing such registries in the AFME region is also presented.
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