1
|
Ismail M, Khawaja G. Cannabinoid Receptor 2 Gene Polymorphism and the Risk of Developing Rheumatoid Arthritis in Lebanese Patients. Cannabis Cannabinoid Res 2024. [PMID: 38498014 DOI: 10.1089/can.2023.0220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024] Open
Abstract
Objective: Evidence supports a role of cannabinoid receptor 2 (CB2) in regulating the immune response. Some variations in the CB2 receptor gene (CB2) were linked to the susceptibility of developing rheumatoid arthritis (RA). The aim of this study is to assess the relationship between CNR2 rs2501431 and the risk of developing RA in Lebanese patients. Methods: A total of one hundred five Lebanese RA patients and one hundred five controls participated in the study. CNR2 was genotyped and analyzed. Results: Using χ2 test, our results show that the CC genotype was the most common (47.6%, p<0.00001) and that the C allele highly predominated (64%, p<0.00001) in the RA group compared to the control group. The relative odds ratio show that carriers of the CC genotype have more than 13-fold risk of developing RA as compared to TT. Conclusion: Our results suggest that the rs2501431 variant of CNR2 gene can be considered as a risk factor for RA development, and thus implicate the potential targeting of CB2 receptor for the treatment of RA.
Collapse
Affiliation(s)
- Morouj Ismail
- Department of Biological and Chemical Sciences, School of Arts and Sciences, Lebanese International University, Beirut, Lebanon
| | - Ghada Khawaja
- Department of Biological Sciences, Faculty of Science, Beirut Arab University, Beirut, Lebanon
| |
Collapse
|
2
|
Maher CG, Jones CMP, Coombs D, Ferreira G. Considerable Uncertainty About the Burden of Gout in the Middle East and North Africa Region. J Rheumatol 2023; 50:1201-1202. [PMID: 37061231 DOI: 10.3899/jrheum.2022-1306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2023]
Affiliation(s)
- Christopher G Maher
- The University of Sydney, Sydney Musculoskeletal Health, Camperdown, New South Wales, Australia.
| | - Caitlin M P Jones
- The University of Sydney, Sydney Musculoskeletal Health, Camperdown, New South Wales, Australia
| | - Danielle Coombs
- The University of Sydney, Sydney Musculoskeletal Health, Camperdown, New South Wales, Australia
| | - Giovanni Ferreira
- The University of Sydney, Sydney Musculoskeletal Health, Camperdown, New South Wales, Australia
| |
Collapse
|
3
|
Kötter I, Krusche M. [Inflammatory rheumatic diseases in migrants]. INNERE MEDIZIN (HEIDELBERG, GERMANY) 2023; 64:426-434. [PMID: 37099225 DOI: 10.1007/s00108-023-01514-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 04/04/2023] [Indexed: 04/27/2023]
Abstract
The immigration of people from other countries or even from other continents represents new challenges even for rheumatologists. Although all inflammatory rheumatic diseases that occur in this country also exist in the countries of origin of immigrants, the frequencies are different. Diseases such as familial Mediterranean fever (FMF) or Behçet syndrome (BS) are rare in western Europe but are often more frequent than rheumatoid arthritis (RA) and spondylarthritis (SPA) in North Africa and Mediterranean countries. Furthermore, FMF is associated with the occurrence of spondyloarthritis, which is then frequently negative for the human leucocyte antigen B27 (HLA-B27). There is also an association with BS. Rheumatic fever also still occurs relatively frequently especially in African countries, whereas it is almost eradicated in Europe. Possible differential diagnoses such as rheumatic symptoms in genetically determined anemia or infections such as human immunodeficiency virus (HIV) infections, hepatitis, tuberculosis and parasitosis need to be considered as they are all much more frequent in the countries of origin of immigrants than in northwestern Europe. Last but not least, the treatment situation with modern diagnostic and treatment modalities is different in the countries of origin of the migrants, either because these possibilities are unavailable due to limited resources or because the situation has dramatically deteriorated due to acute events, such as the recent war in Ukraine.
Collapse
Affiliation(s)
- Ina Kötter
- III. Medizinische Klinik, Sektion für Rheumatologie und Entzündliche Systemerkrankungen, Universitätsklinikum Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.
- Klinik für Rheumatologie und Immunologie, Klinikum Bad Bramstedt, Oskar-Alexander Str. 26, 24576, Bad Bramstedt, Deutschland.
| | - Martin Krusche
- III. Medizinische Klinik, Sektion für Rheumatologie und Entzündliche Systemerkrankungen, Universitätsklinikum Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| |
Collapse
|
4
|
The burden of rheumatoid arthritis in the Middle East and North Africa region, 1990-2019. Sci Rep 2022; 12:19297. [PMID: 36369238 PMCID: PMC9652423 DOI: 10.1038/s41598-022-22310-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 10/12/2022] [Indexed: 11/13/2022] Open
Abstract
Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease. The present study reported the burden of RA in the Middle East and North Africa (MENA) region from 1990 to 2019 by age, sex, and socio-demographic index (SDI). Publicly available data from the Global Burden of Disease (GBD) 2019 study was used to report the modelled point prevalence, annual incidence, and disability-adjusted life-years (DALYs) of RA, as counts and age-standardised rates with their corresponding 95% uncertainty intervals (UIs). In 2019, RA had an age-standardised point prevalence of 120.6 per 100,000 population (107.0-135.7) and an annual incidence rate of 5.9 (5.2-6.6) in MENA, which have increased 28.3% and 25.2%, respectively, since 1990. In 2019, the number of DALYs due to RA in the region was 103.6 thousand (74.2-136.7), with an age-standardised rate of 19.0 (13.9-24.9) DALYs per 100,000 population, which has increased by 18.6% since 1990 (6.7-28.2). The highest point prevalence was found in females aged 50-54, and in males aged 45-49. The highest number of DALYs was observed in the 50-54 age group. The MENA DALY rate was lower than the global rate (19.0 vs. 39.6 per 100,000), but the rate was higher in all age groups in 2019, when compared with 1990. In addition, from 1990 to 2019 an increased burden from RA was associated with an increase in SDI. In line with global trends, the burden of RA in the MENA region showed a steady increase from 1990 to 2019. This highlights the increasing need for updating the available health data to design more accurate guidelines to enable the early detection and treatment of RA in the MENA countries.
Collapse
|
5
|
Alzabibi MA, Shibani M, Alsuliman T, Ismail H, alasaad S, Torbey A, Altorkmani A, Sawaf B, Ayoub R, khalayli N, Kudsi M. Fibromyalgia: epidemiology and risk factors, a population-based case-control study in Damascus, Syria. BMC Rheumatol 2022; 6:62. [PMID: 36310163 PMCID: PMC9618353 DOI: 10.1186/s41927-022-00294-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 07/19/2022] [Indexed: 11/16/2022] Open
Abstract
Background Fibromyalgia is a chronic disease with a high burden. We aim to be the first to investigate the prevalence of fibromyalgia (FM) in Syria and assess its risk factors. Methods A self-reported questionnaire was distributed to the public to identify fibromyalgia patients using the American College of Rheumatology (ACR) 2010 modified criteria. Identified cases were matched using age with controls free from rheumatic disorders that were randomly sampled from the same population. Results Out of 2966 participants, 350 (11.8%) satisfied the diagnostic criteria. Of these, only 29 (8.2%) were previously diagnosed by a physician, 239 (68.3%) were females, and 69 (19.71%) were diagnosed with depression. Female sex (OR = 1.31), diagnosis of major depressive disorder (OR = 2.62), irritable bowel syndrome (OR = 1.8), and Restless legs syndrome (OR = 1.72) were associated with a higher likelihood of fibromyalgia. Conclusion Our study revealed one of the highest prevalence rates of fibromyalgia ever reported in the general population. Efforts must be intensified to increase awareness about this disease in Syrian society as well as among healthcare providers. Supplementary Information The online version contains supplementary material available at 10.1186/s41927-022-00294-8.
Collapse
|
6
|
Dehghan A, Soleimani Salehabadi H, Jamshidi A, Kamali Z, Mali M, Faezi ST, Baghdadi A, Alesaeidi S, Sahraei F, Azizi N, Zand S, Yasini SS, Namazi M, Daya A, Nazemian R, Shamsi F, Nejadhosseinian M, Davatchi F. Epidemiology of musculoskeletal symptoms, rheumatologic disorders, and disability in the Zoroastrian population in Yazd, Iran: a WHO-ILAR COPCORD study (stage 1). BMC Rheumatol 2021; 5:46. [PMID: 34724982 PMCID: PMC8561944 DOI: 10.1186/s41927-021-00214-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 07/07/2021] [Indexed: 11/22/2022] Open
Abstract
Background The purpose of this study was to determine the prevalence of musculoskeletal complaints, rheumatologic diseases, and disability among the Zoroastrian population in Iran. Methods The city of Yazd, in central Iran was selected for this study, with the highest population of Zoroastrians in Iran. Subjects were selected by cluster sampling of 9 neighborhoods populated with Zoroastrians. Subjects ≥15 years old were interviewed by trained interviewers in their houses. The validated Farsi translation of Community Oriented Program for the Control of Rheumatic Disease (COPCORD) Core Questionnaire (CCQ) was used for this study. Subjects with musculoskeletal complaints (pain, stiffness and/or swelling) were examined by a rheumatologist. Laboratory tests and radiographic exams were performed when deemed necessary. Results Two-thousand subjects were interviewed during a 12-month period, of which 956 were male, and 1044 were female. The mean age was 41.1 ± 18.3 years (95%CI: 40.3–41.9). 36.9% of the subjects had university-level education. In the 7 days prior to the interview, 27.6% of the subjects had musculoskeletal complaints, with the knee, dorsolumbar spine, and shoulder being the most common sites of complaints. The most common rheumatologic diagnoses were osteoarthritis (21.5%) and low back pain (10.3%). Rheumatoid arthritis was diagnosed in 1.2% of the subjects. Conclusions The epidemiology of musculoskeletal complaints and rheumatologic disorders was inconsistent with previous COPCORD studies in Iran, with a lower prevalence of musculoskeletal complaints in general, lower rates of Behçet and lupus, and a higher prevalence of rheumatoid arthritis. The findings of this study can be for development of better prevention, screening, and treatment programs for the vulnerable population of Zoroastrians in Iran.
Collapse
Affiliation(s)
- Ali Dehghan
- Department of Internal Medicine, Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Hossein Soleimani Salehabadi
- Department of Internal Medicine, Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Ahmadreza Jamshidi
- Rheumatology Research Center, Tehran University of Medical Sciences, North Amirabad Street, Tehran, 1411713137, Iran
| | - Zohre Kamali
- Diabetic Care Center, Shahid Sadoughi University, Yazd, Iran
| | - Mojgan Mali
- Ziayee Hospital, Shahid Sadoughi University, Ardakan, Yazd, Iran
| | - Seyedeh Tahereh Faezi
- Rheumatology Research Center, Tehran University of Medical Sciences, North Amirabad Street, Tehran, 1411713137, Iran.
| | - Azarakhsh Baghdadi
- Rheumatology Research Center, Tehran University of Medical Sciences, North Amirabad Street, Tehran, 1411713137, Iran.
| | - Sogol Alesaeidi
- Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Fatemeh Sahraei
- Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | | | - Sanaz Zand
- Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Sara Sadat Yasini
- Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | | | - Atefe Daya
- Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Ryan Nazemian
- Clinical Translational Science PhD Program, Case Western Reserve University, Cleveland, OH, USA
| | - Farimah Shamsi
- Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mohammad Nejadhosseinian
- Rheumatology Research Center, Tehran University of Medical Sciences, North Amirabad Street, Tehran, 1411713137, Iran
| | - Fereydoun Davatchi
- Rheumatology Research Center, Tehran University of Medical Sciences, North Amirabad Street, Tehran, 1411713137, Iran
| |
Collapse
|
7
|
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.
Collapse
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
| | | | | |
Collapse
|
8
|
Zahid-Al-Quadir A, Zaman MM, Ahmed S, Bhuiyan MR, Rahman MM, Patwary I, Das BB, Hossain SA, Paul S, Shahin A, Rahman M, Haq SA. Prevalence of musculoskeletal conditions and related disabilities in Bangladeshi adults: a cross-sectional national survey. BMC Rheumatol 2020; 4:69. [PMID: 33323124 PMCID: PMC7739446 DOI: 10.1186/s41927-020-00169-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 10/05/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Nationally representative data on burden of musculoskeletal conditions (MSK) in Bangladesh are not available. The objective of this study was to determine the prevalence of MSK conditions and related disabilities in the adult population of Bangladesh. METHODS A total of 2000 individuals aged 18 years or older were targeted from 20 primary sampling units (urban and rural) of all former seven divisions of Bangladesh in 2015. Structured interviews were done using the modified Community Oriented Program for Control of Rheumatic Disorders questionnaire to detect positive respondents. Standard criteria were used for diagnosing MSK conditions by rheumatology residents. In case of uncertainty, opinion was taken from senior rheumatologists. A Bangla version of the Health Assessment Questionnaire was used to determine disability. RESULTS A total of 1843 (92.1%) participated. Among them, 892 men and 951 women participated from rural (n = 716) and urban (n = 1127) areas. Their mean age was 40.5 (standard deviation 14.7) years. Almost a third did not have any formal schooling. Overall, 30.4% (95% confidence interval, 28.3-32.5) had MSK conditions. Low back pain (18.6%, 16.9-20.5), knee osteoarthritis (7.3%, 6.1-8.5) and soft tissue rheumatism 3.8% (2.9-4.7) were the three top-ranking MSK conditions. Rheumatoid arthritis (1.6%, 1.0-2.1), spondyloarthritis (1.2%, 7-1.8) and adhesive capsulitis (1.4%, 0.9-1.9) were relatively uncommon. Among those who had MSK conditions, 24.8% (21.3-28.6) had some degree of disability. Of them, 24.4% (21.0-28.1) had history of work loss during last 12 months. CONCLUSIONS The high burden of MSK conditions and related disabilities in Bangladesh warrants greater attention of the health system. Further studies are needed to estimate the impact of this group of conditions particularly addressing related disabilities and loss of work.
Collapse
Affiliation(s)
- Ahmad Zahid-Al-Quadir
- Department of Rheumatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - M. Mostafa Zaman
- WHO Bangladesh, 10 Gulshan Avenue, Road Number 5, Gulshan 1, Dhaka, 1212 Bangladesh
| | - Shamim Ahmed
- Department of Rheumatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | | | | | - Ismail Patwary
- Department of Medicine, Sylhet Women’s Medical College, Sylhet, Bangladesh
| | - Bidhu Bhushan Das
- Department of Medicine, Rangpur Medical College, Rangpur, Bangladesh
| | | | - Sujat Paul
- Department of Medicine, Chittagong Medical College, Chittagong, Bangladesh
| | - Abu Shahin
- Department of Medicine, Rajshahi Medical College, Rajshahi, Bangladesh
| | - Moshiur Rahman
- Department of Medicine, Patuakhali Sadar Hospital, Patuakhali, Bangladesh
| | - Syed Atiqul Haq
- Department of Rheumatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| |
Collapse
|
9
|
Cui A, Li H, Wang D, Zhong J, Chen Y, Lu H. Global, regional prevalence, incidence and risk factors of knee osteoarthritis in population-based studies. EClinicalMedicine 2020; 29-30:100587. [PMID: 34505846 PMCID: PMC7704420 DOI: 10.1016/j.eclinm.2020.100587] [Citation(s) in RCA: 408] [Impact Index Per Article: 102.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/22/2020] [Accepted: 09/23/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Knee osteoarthritis (OA) is a major cause of disability in the elderly, however, there are few studies to estimate the global prevalence, incidence, and risk factors of knee OA. METHODS For this study, we searched PUBMED, EMBASE and SCOPUS from inception to April 4, 2020, without language restriction. We identified eligible studies with information on the prevalence or incidence of knee OA in population-based observational studies and extracted data from published reports. We did random-effects meta-analysis to generate estimates. This study was registered with PROSPERO (CRD42020181035). FINDINGS Out of 9570 records identified, 88 studies with 10,081,952 participants were eligible for this study. The pooled global prevalence of knee OA was 16⋅0% (95% CI, 14⋅3%-17⋅8%) in individuals aged 15 and over and was 22⋅9% (95% CI, 19⋅8%-26⋅1%) in individuals aged 40 and over. Correspondingly, there are around 654⋅1 (95% CI, 565⋅6-745⋅6) million individuals (40 years and older) with knee OA in 2020 worldwide. The pooled global incidence of knee OA was 203 per 10,000 person-years (95% CI, 106-331) in individuals aged 20 and over. Correspondingly, there are around annual 86⋅7 (95% CI, 45⋅3-141⋅3) million individuals (20 years and older) with incident knee OA in 2020 worldwide. The prevalence and incidence varied substantially between individual countries and increased with age. The ratios of prevalence and incidence in females and males were 1⋅69 (95% CI, 1⋅59-1⋅80, p<0⋅00) and 1⋅39 (95% CI, 1⋅24-1⋅56, p<0⋅00), respectively. INTERPRETATION Our study provides the global prevalence (16⋅0% [95% CI, 14⋅3%-17⋅8%]) and incidence (203 per 10,000 person-years [95% CI, 106-331]) of knee OA. These findings can be used to better assess the global health burden of knee OA. Further prospective cohort studies are warranted to identify modifiable risk factors for providing effectively preventive strategies in the early stages of the disease. FUNDING This work was supported by grants from the National Natural Science Foundation of China (nos. 81772384 and 81572174).
Collapse
Affiliation(s)
| | | | - Dawei Wang
- Department of Orthopaedics, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai 519000, Guangdong, China
| | - Junlong Zhong
- Department of Orthopaedics, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai 519000, Guangdong, China
| | - Yufeng Chen
- Department of Orthopaedics, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai 519000, Guangdong, China
| | - Huading Lu
- Department of Orthopaedics, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai 519000, Guangdong, China
| |
Collapse
|
10
|
Aldeen Sarakbi H, Alsaed O, Hammoudeh M, Lutf A, Razzakh Poil A, Ziyada A, Al-emadi S. Epidemiology of musculoskeletal complaints and diseases in Qatar: A cross-sectional study. Qatar Med J 2020; 2020:29. [PMID: 33282713 PMCID: PMC7684551 DOI: 10.5339/qmj.2020.29] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 06/24/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Musculoskeletal (MSK) conditions are considered a significant public health problem on account of their high prevalence in communities worldwide and their pervasive impact. Knowledge of the epidemiology of MSK symptoms and diseases is lacking in Qatar. Obtaining this information will guide local health policymakers in the future strategic planning of the health budget. OBJECTIVE To estimate the prevalence rate of MSK disorders in the Qatari population above 15 years of age using the Community Oriented Program for the Control of Rheumatic Disease (COPCORD) survey. METHODS This cross-sectional study targeted 1000 Qatari participants, including 500 males and 500 females. A door-to-door survey was conducted using the Arabic version of the COPCORD questionnaire with the help of research assistants. Participants with positive surveys were asked to visit Hamad General Hospital Rheumatology outpatient clinics for clinical evaluation by a rheumatologist. When necessary, laboratory testing and X-rays were conducted to confirm any MSK diagnosis. RESULTS A total of 1239 (males, 50.8%) Qatari individuals randomly selected from the different municipalities of Qatar completed the COPCORD survey. Among the participants, 563 (45.4%) screened positive for MSK pain. Knee pain (24.5%) and back pain (23.3%) were the most common sites of pain, and both conditions showed no gender predominance (p = 0.073 and 0.108, respectively). Shoulder, wrist, hand, hip, and neck pain were significantly predominant in females (p < 0.001 for all). A total of 237 MSK disorders were diagnosed in 196 (15.8%) participants, including 181 degenerative joint diseases, 52 soft-tissue rheumatism conditions, and 4 autoimmune inflammatory disorders. Among degenerative joint diseases, knee osteoarthritis (6.4%) was the most common. Among soft-tissue rheumatic conditions, muscular lower back pain (1.9%), myofascial neck pain (0.64%), generalized body pain (0.32%), and shoulder tendinitis (0.7%) were the most common diseases. The autoimmune inflammatory disorders identified included rheumatoid arthritis (n = 2), connective tissue disease (n = 1), and inflammatory bowel disease-associated arthritis (n = 1). CONCLUSION The overall prevalence rate of MSK disorders in this small cross-sectional cohort of Qatari individuals was 15.8%. Knee pain (24.5%) and knee osteoarthritis (6.4%) were the most common MSK complaints and diagnosis in the studied Qatari population. This study guides future efforts directed toward the prevention and management of MSK diseases. Further studies with a larger sample size are needed to verify the findings.
Collapse
Affiliation(s)
| | - Omar Alsaed
- Rheumatology Section, Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | - Mohamed Hammoudeh
- Rheumatology Section, Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | - Abdo Lutf
- Rheumatology Section, Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | - Abdul Razzakh Poil
- Rheumatology Section, Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | - Ayah Ziyada
- Pharmacy Section, Dubai Medical University, UAE
| | - Samar Al-emadi
- Rheumatology Section, Medicine Department, Hamad Medical Corporation, Doha, Qatar
| |
Collapse
|
11
|
Fibromyalgia: an update on clinical characteristics, aetiopathogenesis and treatment. Nat Rev Rheumatol 2020; 16:645-660. [DOI: 10.1038/s41584-020-00506-w] [Citation(s) in RCA: 100] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2020] [Indexed: 12/20/2022]
|
12
|
Nurse-led care for the management of rheumatoid arthritis: a review of the global literature and proposed strategies for implementation in Africa and the Middle East. Rheumatol Int 2020; 41:529-542. [PMID: 32851423 PMCID: PMC7867556 DOI: 10.1007/s00296-020-04682-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 08/09/2020] [Indexed: 11/29/2022]
Abstract
Globally, increasing demand for rheumatology services has led to a greater reliance on non-physician healthcare professionals (HCPs), such as rheumatology nurse specialists, to deliver care as part of a multidisciplinary team. Across Africa and the Middle East (AfME), there remains a shortage of rheumatology HCPs, including rheumatology nurses, which presents a major challenge to the delivery of rheumatology services, and subsequently the treatment and management of conditions such as rheumatoid arthritis (RA). To further explore the importance of nurse-led care (NLC) for patients with RA and create a set of proposed strategies for the implementation of NLC in the AfME region, we used a modified Delphi technique. A review of the global literature was conducted using the PubMed search engine, with the most relevant publications selected. The findings were summarized and presented to the author group, which was composed of representatives from different countries and HCP disciplines. The authors also drew on their knowledge of the wider literature to provide context. Overall, results suggest that NLC is associated with improved patient perceptions of RA care, and equivalent or superior clinical and cost outcomes versus physician-led care in RA disease management. Expert commentary provided by the authors gives insights into the challenges of implementing nurse-led RA care. We further report practical proposed strategies for the development and implementation of NLC for patients with RA, specifically in the AfME region. These proposed strategies aim to act as a foundation for the introduction and development of NLC programs across the AfME region.
Collapse
|
13
|
Abstract
PURPOSE OF REVIEW To discuss the disease incidence and prevalence rates of axial spondyloarthritis (axSpA) and ankylosing spondylitis (AS) relative to those of rheumatoid arthritis (RA). RECENT FINDINGS According to the most recently published systematic reviews, pooled prevalence estimates for RA are 0.38% in North America, and 0.21 to 0.25% in European subregions, while that of AS is 0.20% in North America and 0.25% in Europe. The estimated prevalence of axSpA has been reported to be approximately twice as common as AS in a study from the USA. This finding has also been supported by studies from northern Norway, central Italy, western Turkey, northern and southern regions of China, and rural Taiwan. These data suggest that axSpA, that encompasses AS, may be more prevalent than RA, at least in some countries. In general, higher occurrences of RA relative to AS have been noted worldwide, both in terms of incidence and prevalence. But axSpA, that encompasses AS, may be more prevalent than RA, at least in some countries. There is a need for concurrently run studies in the same population for a reliable comparison to establish occurrence of RA, AS, and axSpA. It is hoped that the implementation of the ICD-11 codes for axSpA will be helpful in determining a more accurate estimate of its incidence and prevalence.
Collapse
|
14
|
Ziade N, El Khoury B, Zoghbi M, Merheb G, Abi Karam G, Mroue' K, Messaykeh J. Prevalence and pattern of comorbidities in chronic rheumatic and musculoskeletal diseases: the COMORD study. Sci Rep 2020; 10:7683. [PMID: 32376850 PMCID: PMC7203228 DOI: 10.1038/s41598-020-64732-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 04/21/2020] [Indexed: 02/08/2023] Open
Abstract
Increased risk of comorbidities has been reported in Rheumatic and Musculoskeletal Diseases (RMD). We aimed to evaluate the prevalence and pattern of comorbidities in RMD patients nationwide, to identify multimorbidity clusters and to evaluate the gap between recommendations and real screening. Cross-sectional, multicentric nationwide study. Prevalence of comorbidities was calculated according to six EULAR axes. Latent Class Analysis identified multimorbidity clusters. Comorbidities' screening was compared to international and local recommendations. In 769 patients (307 RA, 213 OA, 63 SLE, 103 axSpA, and 83 pSA), the most frequent comorbidities were cardiovascular risk factors and diseases (CVRFD) (hypertension 36.5%, hypercholesterolemia 30.7%, obesity 22.7%, smoking 22.1%, diabetes 10.4%, myocardial infarction 6.6%), osteoporosis (20.7%) and depression (18.1%). Three clusters of multimorbidity were identified: OA, RA and axSpA. The most optimal screening was found for CVRF (> = 93%) and osteoporosis (53%). For malignancies, mammograms were the most optimally prescribed (56%) followed by pap smears (32%) and colonoscopy (21%). Optimal influenza and pneumococcus vaccination were found in 22% and 17%, respectively. Comorbidities were prevalent in RMD and followed specific multimorbidity patterns. Optimal screening was adequate for CVRFD but suboptimal for malignant neoplasms, osteoporosis, and vaccination. The current study identified health priorities, serving as a framework for the implementation of future comorbidity management standardized programs, led by the rheumatologist and coordinated by specialized health care professionals.
Collapse
Affiliation(s)
- Nelly Ziade
- Rheumatology department, Hotel-Dieu de France Hospital, Beirut, Lebanon.
- Rheumatology department, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon.
| | - Bernard El Khoury
- Gastro-enterology department, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Marouan Zoghbi
- Family Medicine department, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Georges Merheb
- Notre-Dame des Secours University Hospital, Jbeil, Lebanon
- Holy Spirit University Kaslik, Jounieh, Lebanon
| | - Ghada Abi Karam
- Rheumatology department, Hotel-Dieu de France Hospital, Beirut, Lebanon
- Rheumatology department, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | | | | |
Collapse
|
15
|
Awada S, Ajrouche R, Shoker M, Al-Hajje A, Rachidi S, Zein S, Bawab W. Rheumatoid Arthritis in the Lebanese Adults: Impact on Health-Related Quality of Life. J Epidemiol Glob Health 2019; 9:281-287. [PMID: 31854170 PMCID: PMC7310793 DOI: 10.2991/jegh.k.190820.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 08/19/2019] [Indexed: 11/16/2022] Open
Abstract
Rheumatoid Arthritis (RA) is a chronic inflammatory disabling disease with significant impact on the Quality of Life (QOL) of patients. Information on the effects of RA on Health-related Quality of Life (HRQoL) is lacking in the Lebanese population. The objective of this study was to evaluate QOL of RA patients compared with non-RA subjects and to suggest possible predictors of their QOL in Lebanon. We conducted a case–control observational study among individuals visiting the external clinics at three hospitals and different private clinics; the QOL was measured using the SF-36 questionnaire administered face to face to the study population, applied to RA (N = 90) and non-RA (N = 180) groups. RA presented lower Physical Component Scores (PCS) and Mental Component Scores (MCS) as well as overall QOL scores. Among RA patients, MCS and QOL were significantly decreased with morning stiffness duration (β = −9.211, p = 0.013 and β = −9.190, p = 0.009, respectively). The frequency of practicing sport per week increases PCS and QOL (β = 6.692, p = 0.002 and β = 6.148, p = 0.003, respectively). Workability has a positive effect on PCS (β = 5.546, p = 0.022) and time between blood transfusion and the onset of the disease has a positive impact on MCS (β = 8.415, p = 0.007). To improve QOL of patients with RA, health professionals have to take these results into consideration while treating their patients.
Collapse
Affiliation(s)
- Sanaa Awada
- Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University, Hadath, Lebanon
| | - Roula Ajrouche
- Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University, Hadath, Lebanon
| | - Mariam Shoker
- Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University, Hadath, Lebanon
| | - Amal Al-Hajje
- Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University, Hadath, Lebanon
| | - Samar Rachidi
- Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University, Hadath, Lebanon
| | - Salam Zein
- Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University, Hadath, Lebanon
| | - Wafaa Bawab
- Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University, Hadath, Lebanon
| |
Collapse
|
16
|
Hage S, Hage V, el-Khoury N, Azar H, Chelala D, Ziadé N. Musculoskeletal disorders in hemodialysis patients: different disease clustering according to age and dialysis vintage. Clin Rheumatol 2019; 39:533-539. [DOI: 10.1007/s10067-019-04786-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 09/07/2019] [Accepted: 09/21/2019] [Indexed: 02/07/2023]
|
17
|
Bedaiwi M, Al-Homood IA, El-Garf A, Uthman I, Sunna N, Nassier R, Mohamed H, Al Saleh J. Disease burden and treatment challenges of psoriatic arthritis in Africa and the Middle East. Rheumatol Int 2019; 39:1321-1329. [PMID: 31134289 DOI: 10.1007/s00296-019-04319-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 05/03/2019] [Indexed: 01/17/2023]
Abstract
Psoriatic arthritis (PsA) is a chronic, inflammatory arthropathy occurring in up to 30% of patients with psoriasis, and is characterized by multiple manifestations including peripheral arthritis, enthesitis, dactylitis, spondylitis, and psoriatic skin and nail disease. This complex and heterogeneous disease is poorly understood and its diagnosis and treatment are suboptimal, particularly in Africa and the Middle East, where very few studies into the impact of PsA have been carried out. This article aims to highlight the disease burden of PsA in the region as well as to identify unmet clinical needs. A non-systematic review was carried out in the PubMed database and the most relevant publications were selected. Expert rheumatologists practicing in Africa and the Middle East provide an insight into the challenges of treating PsA in daily practice, along with recommendations for improvements.
Collapse
Affiliation(s)
- Mohamed Bedaiwi
- Division of Rheumatology, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia.
| | - Ibrahim A Al-Homood
- Department of Medical Specialties, Rheumatology Section, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ayman El-Garf
- Rheumatology Department, Cairo University Hospitals, Cairo University, Cairo, Egypt
| | - Imad Uthman
- Division of Rheumatology, American University of Beirut Medical Center, Beirut, Lebanon
| | | | | | | | - Jamal Al Saleh
- Rheumatology Unit, Dubai Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| |
Collapse
|
18
|
Slim ZF, Soares de Moura C, Bernatsky S, Rahme E. Identifying Rheumatoid Arthritis Cases within the Quebec Health Administrative Database. J Rheumatol 2019; 46:1570-1576. [DOI: 10.3899/jrheum.181121] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2019] [Indexed: 11/22/2022]
Abstract
Objective.Our objective was to calculate rheumatoid arthritis (RA) point prevalence estimates in the CARTaGENE cohort, as well as to estimate the sensitivity and specificity of our ascertainment approach, using physician billing data. We investigated the effects of using varying observation windows in the Régie de l’assurance maladie du Québec (RAMQ) health services administrative databases, alone or in combination with self-reported diagnoses and drugs.Methods.We studied subjects enrolled in the CARTaGENE cohort, which recruited 19,995 participants from 4 metropolitan regions in Québec from August 2009 to October 2010. A series of Bayesian latent class models were developed to assess the effects of 3 factors: the number of years of billing data, the addition of self-reported information on RA diagnoses and drugs, and the adjustment for misclassification error.Results.The 3-year 2010 point prevalence estimate among cohort members aged 40–69 years, using physician billing plus self-report, adjusting for misclassification error in each source, was 0.9% [95% credible interval (CrI) 0.7–1.2] with RAMQ sensitivity of 84.0% (95% CrI 74.0–93.7) and a specificity of 99.8% (95% CrI 99.6–100.0). Our results show variations in the prevalence point estimates related to all 3 factors investigated.Conclusion.Our study illustrates that multiple data sources identify more RA cases and thus a higher prevalence estimate. RA point prevalence estimates using billing data are lower if fewer years of data are used.
Collapse
|
19
|
Ziade N, Abi Karam G, Merheb G, Mallak I, Irani L, Alam E, Messaykeh J, Menassa J, Mroue' K, Uthman I, Masri AF, Ghorra P, Witte T, Baraliakos X. HLA-B27 prevalence in axial spondyloarthritis patients and in blood donors in a Lebanese population: Results from a nationwide study. Int J Rheum Dis 2019; 22:708-714. [PMID: 30729696 DOI: 10.1111/1756-185x.13487] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 12/31/2018] [Accepted: 01/03/2019] [Indexed: 12/31/2022]
Abstract
AIM To calculate the prevalence of human leukocyte antigen (HLA)-B27 in axial spondyloarthritis patients (axSpA) compared to blood donors (BD) in Lebanon, to identify the clinical and radiological findings associated with HLA-B27 and to estimate the proportion of patients fulfilling the clinical arm of the Assessment of the Spondyloarthritis International Association (ASAS) criteria. METHOD Consecutive Lebanese adult axSpA patients fulfilling the ASAS classification criteria were included from 12 rheumatology clinics across Lebanon. BD served as controls. A binary logistic regression was used to study the association between HLA-B27 and the disease features. RESULTS A total of 247 individuals were included (141 axSpA patients and 106 BD). The prevalence of HLA-B27 was 3.8% in BD and 41.1% in axSpA. Overall, 39.7% of the axSpA patients fulfilled the clinical arm of the ASAS classification criteria. Sensitivity of HLA-B27 for axSpA was 41.1%, specificity was 96.2%, positive predictive value was 93.6%, and negative predictive value was 55.13%. Positive likelihood ratio (LR) was 10.9 and negative LR was 1.63. We found a positive association of HLA-B27 with family history of SpA and psoriasis. CONCLUSION Our study confirmed a low prevalence of HLA-B27 in axSpA patients and BD in this Lebanese population, However, we found a high specificity and positive LR, as well as the same number of axSpA patients fulfilling the clinical arm of the ASAS criteria as in European studies. HLA-B27 is therefore valuable for identification of axSpA in Lebanese patients despite the overall low prevalence in this population. Our results may guide future evaluations the role of HLA-B27 in planning local referral strategies.
Collapse
Affiliation(s)
- Nelly Ziade
- Rheumatology Department, Saint-Joseph University, Beirut, Lebanon.,Rheumatology Department, Hotel-Dieu de France Hospital, Beirut, Lebanon
| | - Ghada Abi Karam
- Rheumatology Department, Saint-Joseph University, Beirut, Lebanon.,Rheumatology Department, Hotel-Dieu de France Hospital, Beirut, Lebanon
| | - Georges Merheb
- Rheumatology Department, Holy Spirit University, Kaslik, Lebanon.,Rheumatology Department, Notre-Dame des Secours University, Lebanon
| | - Iyad Mallak
- Radiology Department, Hotel-Dieu de France, Beirut, Lebanon
| | - Laure Irani
- Lebanese University Hospital, Beirut, Lebanon.,Rizk University Medical Center, Beirut, Lebanon
| | - Elie Alam
- Levant Hospital, Sin-el-Fil, Lebanon
| | | | - Jeanine Menassa
- Lebanese University Hospital, Beirut, Lebanon.,Geitawi Hospital, Beirut, Lebanon
| | | | - Imad Uthman
- American University of Beirut Medical Center, Beirut, Lebanon
| | | | - Pierre Ghorra
- Blood Transfusion Center, Hotel-Dieu de France, Beirut, Lebanon
| | | | - Xenofon Baraliakos
- Rheumazentrum Ruhrgebiet, Herne, Germany.,Ruhr-Universität Bochum, Bochum, Germany
| |
Collapse
|
20
|
Ziade N, Khoury B, Zoghbi M, Merheb G, Abi Karam G, Mroue’ K, Messayke J. Prevalence and pattern of COMOrbidities in chronic Rheumatic and musculoskeletal Diseases: results of the COMORD study. BMC Rheumatol 2018. [DOI: 10.1186/s41927-018-0025-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
21
|
Vega-Hinojosa O, Cardiel MH, Ochoa-Miranda P. Prevalencia de manifestaciones musculoesqueléticas y discapacidad asociada en una población peruana urbana habitante a gran altura. Estudio COPCORD. Estadio I. ACTA ACUST UNITED AC 2018; 14:278-284. [DOI: 10.1016/j.reuma.2017.01.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 12/09/2016] [Accepted: 01/26/2017] [Indexed: 11/27/2022]
|
22
|
Fayad F, Ziade NR, Merheb G, Attoui S, Aiko A, Mroue K, Masri AF. Patient preferences for rheumatoid arthritis treatments: results from the national cross-sectional LERACS study. Patient Prefer Adherence 2018; 12:1619-1625. [PMID: 30214164 PMCID: PMC6124803 DOI: 10.2147/ppa.s168738] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION To investigate the treatment preferences of patients with rheumatoid arthritis (RA) and determine whether these preferences are related to specific disease characteristics. METHOD A national survey was designed to collect demographic, disease, treatment, and preference data on RA patients enrolled in 7 private and university hospital clinics in Lebanon. Associations between patient factors and treatment preferences for RA were analyzed by χ2 or Mann-Whitney U test. RESULTS A total of 693 patients (83% female; 67% aged 41-70 years) consulting 7 trained rheumatologists completed the survey. Most patients (80%) had established RA >24 months, and approximately one-third (34%) were in remission according to the disease activity score in 28 joints (DAS28). Most (87%) were receiving oral agents (60% oral only). Almost two-thirds of patients (64%) expressed a preference for oral treatments, and more than half (53%) ranked doctor's advice as the most influential factor when choosing treatment. In univariable analysis, health coverage, radiographic damage, disease duration, current therapy, and previous side effects were significantly associated with treatment preference. In multivariable analyses, only radiographic damage and current route of administration were independently associated with preference (both P<0.001), with patients with no radiographic damage and those on oral-only therapy being more likely to prefer oral agents. CONCLUSION RA patients expressed a preference for oral rather than subcutaneous/intravenous-administered drugs. Understanding patients' preferences may help to inform policymaker decisions.
Collapse
Affiliation(s)
- Fouad Fayad
- Rheumatology Department, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon,
| | - Nelly R Ziade
- Rheumatology Department, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon,
| | - Georges Merheb
- Department of Rheumatology, Notre Dame des Secours University Hospital, Jbeil, Lebanon, Holy Spirit University, Kaslik, Lebanon
| | - Said Attoui
- Rheumatology Department, Hammoud University Medical Center, Saida, Lebanon
| | - Alla Aiko
- Department of Medicine (Rheumatology), Saint George Hospital, Beirut, Lebanon
| | - Kamel Mroue
- Rheumatology Department, Hammoud University Medical Center, Saida, Lebanon
| | - Abdel Fattah Masri
- Department of Internal Medicine (Rheumatology), American University of Beirut Medical Center, Beirut, Lebanon
| |
Collapse
|
23
|
A prevalência de fibromialgia: atualização da revisão de literatura. REVISTA BRASILEIRA DE REUMATOLOGIA 2017. [DOI: 10.1016/j.rbr.2016.10.004] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
|
24
|
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.
Collapse
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
| |
Collapse
|
25
|
Maldini C, Druce K, Basu N, LaValley MP, Mahr A. Exploring the variability in Behçet’s disease prevalence: a meta-analytical approach. Rheumatology (Oxford) 2017; 57:185-195. [DOI: 10.1093/rheumatology/kew486] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Indexed: 01/01/2023] Open
|
26
|
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: 73] [Impact Index Per Article: 10.4] [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.
Collapse
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
| |
Collapse
|
27
|
Marques AP, Santo ADSDE, Berssaneti AA, Matsutani LA, Yuan SLK. Prevalence of fibromyalgia: literature review update. REVISTA BRASILEIRA DE REUMATOLOGIA 2017; 57:356-363. [PMID: 28743363 DOI: 10.1016/j.rbre.2017.01.005] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 10/25/2016] [Indexed: 11/30/2022] Open
Abstract
The present study aimed to update the literature review on the prevalence of fibromyalgia published in 2006. A bibliographical survey was carried out from 2005 to 2014 in the MEDLINE, Web of Science, Embase, LILACS and SciELO databases and 3274 records were identified. Five researchers selected the studies, following the inclusion criteria: studies that obtained the prevalence of fibromyalgia. Fibromyalgia studies in associated diseases were excluded. When screening by title and abstract, 2073 irrelevant articles were excluded. The full texts of 210 articles were evaluated for eligibility and this review included 39 studies, described in 41 articles. The selected studies were grouped into four categories: (A) prevalence of fibromyalgia in the general population; (B) prevalence of fibromyalgia in women; (C) prevalence of fibromyalgia in rural and urban areas; (D) prevalence of fibromyalgia in special populations. The literature shows values of fibromyalgia prevalence in the general population between 0.2 and 6.6%, in women between 2.4 and 6.8%, in urban areas between 0.7 and 11.4%, in rural areas between 0.1 and 5.2%, and in special populations values between 0.6 and 15%. This literature review update shows a significant increase in fibromyalgia prevalence studies in the world. The new 2010 American College of Rheumatology criteria have not been widely used yet and the COPCORD (Community-oriented program for control of Rheumatic Diseases) methodology has increased the quality of studies on the prevalence of rheumatic diseases in general.
Collapse
Affiliation(s)
- Amelia Pasqual Marques
- Universidade de São Paulo (USP), Faculdade de Medicina, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, São Paulo, SP, Brazil
| | - Adriana de Sousa do Espírito Santo
- Universidade de São Paulo (USP), Faculdade de Medicina, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, São Paulo, SP, Brazil
| | - Ana Assumpção Berssaneti
- Universidade de São Paulo (USP), Faculdade de Medicina, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, São Paulo, SP, Brazil
| | - Luciana Akemi Matsutani
- Universidade de São Paulo (USP), Faculdade de Medicina, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, São Paulo, SP, Brazil
| | - Susan Lee King Yuan
- Universidade de São Paulo (USP), Faculdade de Medicina, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, São Paulo, SP, Brazil.
| |
Collapse
|
28
|
Prevalence of musculoskeletal disorders in Azar cohort population in Northwest of Iran. Rheumatol Int 2017; 37:495-502. [DOI: 10.1007/s00296-017-3661-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 01/16/2017] [Indexed: 10/20/2022]
|
29
|
Al Saleh J, Sayed ME, Monsef N, Darwish E. The Prevalence and the Determinants of Musculoskeletal Diseases in Emiratis Attending Primary Health Care Clinics in Dubai. Oman Med J 2016; 31:117-23. [PMID: 27168922 DOI: 10.5001/omj.2016.23] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To estimate the prevalence of rheumatic diseases in the Emiratis attending primary health care (PHC) clinics in Dubai. The secondary objective was to study the relationship between age, gender, and body mass index (BMI) and rheumatic diseases in the general population. . METHODS The Prevalence of Rheumatic Diseases and Osteoporosis (PRO) in Dubai study was a cross-sectional study, which randomly enrolled Emiratis' aged between 18-85 years old who attended one of 13 PHC clinics between 2 January 2009 and 31 December 2009. Demographic and health data for all participants was obtained via a questionnaire. Participants that indicated positive answers had their responses validated by a rheumatologist and underwent a thorough locomotor examination. . RESULTS The study included 3,985 participants with a mean age of 42.1±15.8 years. The majority (77.4%) were female. Lower back pain was the most prevalent problem in our study population (32.9%). Knee osteoarthritis (OA) was the most common form of arthritis seen in our cohort (25.8%). Overall, the prevalence of inflammatory arthritis was 3.1%. Age and BMI were associated with increased risk of knee OA and lower back pain. . CONCLUSIONS Rheumatic diseases are quite common in Emirati patients attending PHC clinics. Lower back pain and knee OA were the most common musculoskeletal diseases seen in our cohort. There is a need for more population-based studies in the Middle East to have a better understanding of the epidemiology of rheumatic diseases in this region.
Collapse
Affiliation(s)
| | - Manal El Sayed
- Hatta Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | - Nahed Monsef
- Primary Health Care, Dubai Health Authority, Dubai, United Arab Emirates
| | - Ebtihal Darwish
- Primary Health Care, Dubai Health Authority, Dubai, United Arab Emirates
| |
Collapse
|
30
|
Guevara-Pacheco S, Feicán-Alvarado A, Sanín LH, Vintimilla-Ugalde J, Vintimilla-Moscoso F, Delgado-Pauta J, Lliguisaca-Segarra A, Dután-Erráez H, Guevara-Mosquera D, Ochoa-Robles V, Cardiel MH, Peláez-Ballestas I. Prevalence of musculoskeletal disorders and rheumatic diseases in Cuenca, Ecuador: a WHO-ILAR COPCORD study. Rheumatol Int 2016; 36:1195-204. [PMID: 27023004 DOI: 10.1007/s00296-016-3446-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 02/18/2016] [Indexed: 11/25/2022]
Abstract
The aim of this study was to determine the prevalence of musculoskeletal pain and rheumatic diseases in subjects over 18 years of age from the canton of Cuenca, Ecuador. Cross-sectional analytical community-based study was conducted in subjects over 18 years of age using the validated Community-Oriented Program for the Control of Rheumatic Diseases (COPCORD) questionnaire. Random sampling was used. The questionnaire was administered by standardized health workers. Subjects were visited house by house. Subjects positive for musculoskeletal (MSK) pain in the last 7 days and at some point in life were assessed by rheumatologists to confirm the diagnosis. A total of 4877 subjects participated, with an average age of 42.8 (SD 18.8) years of age; 59.7 % were women; 69.7 % lived in urban areas. 32.5 % reported MSK pain in the last 7 days and 45.7 % at some point in life. The prevalence of knee osteoarthritis was 7.4 %, hand osteoarthritis 5.3 %, low back pain 9.3 %, rheumatoid arthritis 0.8 %, fibromyalgia 2 %, gout 0.4 %, and lupus 0.06 %. Subjects from rural areas reported experiencing more MSK pain in the last 7 days and at some point in life, lower income, poorer health-care coverage, and increased physical activity involving repetitive tasks such as lifting weights or cooking with firewood. MSK pain prevalence was high. Osteoarthritis and low back pain were the most common diseases. Age, sex, physical activity, repetitive tasks, living in a rural area, and lack of health-care coverage were found to be associated with MSK pain.
Collapse
Affiliation(s)
- Sergio Guevara-Pacheco
- Dirección de Investigación de la, Universidad de Cuenca-DIUC, Av. 12 de Abril y Agustín Cueva, Cuenca, Ecuador.
- Universidad de Barcelona, Barcelona, Spain.
| | - Astrid Feicán-Alvarado
- Dirección de Investigación de la, Universidad de Cuenca-DIUC, Av. 12 de Abril y Agustín Cueva, Cuenca, Ecuador
- Universidad de Barcelona, Barcelona, Spain
| | | | - Jaime Vintimilla-Ugalde
- Dirección de Investigación de la, Universidad de Cuenca-DIUC, Av. 12 de Abril y Agustín Cueva, Cuenca, Ecuador
| | - Fernando Vintimilla-Moscoso
- Dirección de Investigación de la, Universidad de Cuenca-DIUC, Av. 12 de Abril y Agustín Cueva, Cuenca, Ecuador
| | - Jorge Delgado-Pauta
- Dirección de Investigación de la, Universidad de Cuenca-DIUC, Av. 12 de Abril y Agustín Cueva, Cuenca, Ecuador
| | - Angelita Lliguisaca-Segarra
- Dirección de Investigación de la, Universidad de Cuenca-DIUC, Av. 12 de Abril y Agustín Cueva, Cuenca, Ecuador
| | - Holger Dután-Erráez
- Dirección de Investigación de la, Universidad de Cuenca-DIUC, Av. 12 de Abril y Agustín Cueva, Cuenca, Ecuador
| | - Daniel Guevara-Mosquera
- Dirección de Investigación de la, Universidad de Cuenca-DIUC, Av. 12 de Abril y Agustín Cueva, Cuenca, Ecuador
| | - Verónica Ochoa-Robles
- Dirección de Investigación de la, Universidad de Cuenca-DIUC, Av. 12 de Abril y Agustín Cueva, Cuenca, Ecuador
| | | | - Ingris Peláez-Ballestas
- Department of Rheumatology, Hospital General de México "Eduardo Liceaga", Mexico City, Mexico
| |
Collapse
|
31
|
Alvarez-Nemegyei J, Peláez-Ballestas I, Goñi M, Julián-Santiago F, García-García C, Quintana R, Silvestre AMR, García-Olivera I, Mathern NA, Loyola-Sanchez A, Conti S, Sanabria AJ, Pons-Estel BA. Prevalence of rheumatic regional pain syndromes in Latin-American indigenous groups: a census study based on COPCORD methodology and syndrome-specific diagnostic criteria. Clin Rheumatol 2016; 35 Suppl 1:63-70. [PMID: 26833395 PMCID: PMC4954835 DOI: 10.1007/s10067-016-3188-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 12/22/2015] [Accepted: 01/14/2016] [Indexed: 01/31/2023]
Abstract
This study assessed the overall and specific prevalence of the main rheumatic regional pain syndromes (RRPS) in four Latin-American indigenous groups. A Community Oriented Program for Control of Rheumatic Diseases (COPCORD) methodology-based census study was performed in 4240 adults (participation rate: 78.88 %) in four indigenous groups: Chontal (Oaxaca, Mexico, n = 124), Mixteco (Oaxaca, Mexico; n = 937), Maya-Yucateco (Yucatán, Mexico; n = 1523), and Qom (Rosario, Argentina; n = 1656). Subjects with musculoskeletal pain were identified using a cross-cultural, validated COPCORD questionnaire administered by bilingual personnel, and reviewed by general practitioners or rheumatologists using standardized case definitions for the 12 most frequent RRPS. The overall prevalence of RRPS was confirmed in 239 cases (5.64 %, 95 % CI: 4.98–6.37). The prevalence in each group was Chontal n = 19 (15.32 %, 95 % CI: 10.03–22.69); Maya-Yucateco n = 165 (10.83 %, 95 % CI: 9.37–12.49); Qom n = 48 (2.90 %, 95 % CI: 2.19–3.82); and Mixteco n = 7 (0.75 %, 95 % CI: 0.36–1.53). In the whole sample, the syndrome-specific prevalence was rotator cuff tendinopathy: 1.98 % (95 % CI: 1.60–2.45); lateral epicondylalgia: 0.83 % (95 % CI: 0.59–1.15); medial epicondylalgia: 0.73 % (95 % CI: 0.52–1.04); biceps tendinopathy: 0.71 % (95 % CI: 0.50–1.01); anserine syndrome: 0.64 % (95 % CI: 0.44–0.92); inferior heel pain: 0.61 % (95 % CI: 0.42–0.90); trochanteric syndrome: 0.49 % (95 % CI: 0.25–0.64); de Quervain’s tendinopathy: 0.45 % (95 % CI: 0.29–0.70); trigger finger: 0.42 % (95 % CI: 0.27–0.67); carpal tunnel syndrome: 0.28 % (95 % CI: 0.16–0.49); Achilles tendinopathy (insertional): 0.12 % (95 % CI: 0.05–0.28); and Achilles tendinopathy (non-insertional): 0.07 % (95 % CI: 0.02–0.21). Leaving aside the comparison between Maya-Yucateco and Chontal groups (p = 0.18), we found significant differences (p < 0.001) in overall RRPS prevalence between the remaining pairs of indigenous groups. Syndrome-specific prevalences were also different between groups. Our findings support the hypothesis that overall RRPS prevalence and syndrome-specific prevalences are modulated by population-specific factors.
Collapse
Affiliation(s)
- José Alvarez-Nemegyei
- Unidad de Investigación, Hospital Regional de Alta Especialidad de la Península de Yucatán, Secretaría de Salud, Calle 7 No. 433 por 20 y 22, Fracc, Altabrisa, C.P. 97130, Mérida, Yucatán, Mexico.
| | - Ingris Peláez-Ballestas
- Rheumatology Unit, Hospital General de México "Eduardo Liceaga", Secretaría de Salud, México, D.F., Mexico
| | - Mario Goñi
- Centro de Especialidades Médicas Ambulatorias de Rosario (CEMAR), Secretaría de Salud Pública, Municipalidad de Rosario, Santa Fe, Argentina
| | | | - Conrado García-García
- Rheumatology Unit, Hospital General de México "Eduardo Liceaga", Secretaría de Salud, México, D.F., Mexico
| | | | | | | | | | | | - Silvana Conti
- Ministerio de Salud de la Provincia de Santa Fe, Rosario, Santa Fe, Argentina
| | - Alvaro J Sanabria
- Ministerio de Salud de la Provincia de Santa Fe, Rosario, Santa Fe, Argentina
| | | |
Collapse
|
32
|
Davatchi F, Sandoughi M, Moghimi N, Jamshidi AR, Tehrani Banihashemi A, Zakeri Z, Sadeghi Abdollahi B. Epidemiology of rheumatic diseases in Iran from analysis of four COPCORD studies. Int J Rheum Dis 2015; 19:1056-1062. [PMID: 26620687 DOI: 10.1111/1756-185x.12809] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
AIM To calculate the epidemiology of Rheumatic Diseases in Iran. MATERIALS AND METHODS The data of Tehran, Zahedan, Sanandaj (urban) and Tuyserkan (rural) stage Community Oriented Program for the Control of Rheumatic Diseases (COPCORD) studies were gathered. The data were adjusted to the population number of the studied areas to represent Iran. RESULTS The population of Iran is 75 149 669 (71.5% urban areas, males 50.4%) and of the mentioned area were respectively 10 000 000, 580 071, 311 444 and 109 262. The interviewed subjects were 10 291, 1565, 2100 and 5830. Male/female ratio was 0.9/1, 0.8/1, 08/1 and 0.8/1. Musculoskeletal complaints during the past 7 days (people aged ≥ 15 years) were detected in 44.7% of subjects. They were: shoulder 15.6%, wrist 10.4%, hands and fingers 10.2%, hip 8.3%, knee 27.4%, ankle 12.3%, toes 6.2%, cervical spine 14.2% and dorsolumbar spine 23.7%. Osteoarthritis (OA) was detected in 16.9%: knee 15.5%, hands 2.9% and hip 0.32%. Low back pain was found in 15.7%, sciatica in 0.94%, and soft tissue rheumatism in 4.6% (shoulder tenosynovitis 2.5%, frozen shoulder 0.56%, tennis elbow 1.2%, golf elbow 0.48%, de Quervain tenosynovitis 0.24%, trigger finger 0.2%, carpal tunnel syndrome 1.3%). Rheumatoid arthritis was detected in 0.37%, seronegative spondyloarthropathy in 0.24%, ankylosing spondylitis in 0.12%, systemic lupus erythematosus in 0.06%, Behcet's disease in 0.08%, fibromyalgia in 0.79% and gout in 0.13%. CONCLUSION Compared to other COPCORD reports (17 countries), Iran gets the following rank: musculoskeletal complaints second, low back pain fourth, osteoarthritis second, knee osteoarthritis third, soft tissue rheumatism sixth, rheumatoid arthritis tenth, seronegative spondyloarthropathies fifth, gout eleventh and fibromyalgia fifth.
Collapse
Affiliation(s)
- Fereydoun Davatchi
- Rheumatology Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahnaz Sandoughi
- Rheumatology Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Nasrin Moghimi
- Rheumatology Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad-Reza Jamshidi
- Rheumatology Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Tehrani Banihashemi
- Rheumatology Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Zakeri
- Rheumatology Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Bahar Sadeghi Abdollahi
- Rheumatology Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
33
|
Safety and Efficacy of Autologous Intra-articular Platelet Lysates in Early and Intermediate Knee Osteoarthrosis in Humans: A Prospective Open-Label Study. Clin J Sport Med 2015; 25:524-8. [PMID: 25387167 DOI: 10.1097/jsm.0000000000000166] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To explore the safety and benefit from intra-articular autologous platelet lysate (PL) injection in early and intermediate knee osteoarthritis. DESIGN Open-label prospective study. SETTING Laboratory. PATIENTS Adult patients, aged 35 to 70 years, with a history of chronic pain or swelling on one or both knees and imaging findings (radiograph or magnetic resonance imaging) of degenerative changes in the joint of grade I or II on the Kellgren scale were included. INTERVENTIONS Autologous PL was given in the knee joint by percutaneous intra-articular route every 3 weeks for a total of 3 injections. MAIN OUTCOME MEASURES Response was evaluated by nonnormalized Knee Osteoarthritis and Disability Outcome Score (KOOS). RESULTS There was a significant improvement in the 5 aspects evaluated at weeks 32 and 52 compared with baseline. Symptoms score significantly improved at weeks 32 and 52 from a mean of 11.1 at baseline to 9.0 (P < 0.0001) and 8.7 (P < 0.0001). Stiffness score significantly improved at weeks 32 and 52 from 2.2 at baseline to 1.7 (P < 0.022) and 1.6 (P < 0.016). Pain score improved at 32 weeks and at 52 weeks from a baseline of 14.2 to 9.8 (P < 0.0001) and 9.2 (P < 0.0001). Daily Living score improved from 25.0 to 18.7 at 32 weeks (P < 0.0001) and to 15.6 at 52 weeks (P < 0.0001). Sport score improved from 10.7 to 8.4 at 32 weeks (P < 0.0001) and to 8.1 at 52 weeks (P < 0.0001). CONCLUSIONS Intra-articular PL significantly improved score of all aspects evaluated by KOOS. Platelet lysate seems to be a safe product. CLINICAL RELEVANCE To the best of our knowledge, this is the first clinical study addressing the use of autologous PL as a treatment measure for knee osteoarthrosis (KOA). There are no studies published regarding the treatment of KOA by intra-articular injections of PL. The previous studies were on the use of platelet-rich plasma (PRP) treatment for KOA. Platelet-rich plasma use has been in place for several years, however, a standardized protocol has not yet been established. Platelet lysate represents a safe, economical, easy to prepare, and easy to apply source of growth factors in the treatment of KOA. A head-to-head study is needed to compare PRP with PL in KOA.
Collapse
|
34
|
Moukaddem A, Chaaya M, Slim ZFN, Jaffa M, Sibai AM, Uthman I. Fibromyalgia: epidemiology and risk factors, a population-based case-control study in Lebanon. Int J Rheum Dis 2015; 20:169-176. [PMID: 26172074 DOI: 10.1111/1756-185x.12701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIM To investigate the epidemiology of fibromyalgia (FM) and assess its risk factors. METHODS Using data from the 2009 Community Oriented Program for Control of Rheumatic Diseases (COPCORD) study conducted in Lebanon, a population-based case control study was performed. The sample included 34 FM patients, frequency matched with 136 controls free from any musculoskeletal complaints and randomly sampled from the population. The controls were frequency matched with cases by age and gender. RESULTS The 34 female FM cases were prevalent cases which existed for a long period of time and all those who consulted a doctor were previously misdiagnosed. Family history of joint problems (OR = 4.93, 95% CI: 1.56-15.58) and working status (OR = 2.69, 95% CI: 1.04-6.93) were significant risk factors for FM, after adjusting for body mass index, distress level, smoking status and residence location. CONCLUSION This was the first study to address the epidemiology of FM in Lebanon and the region. The chronic nature of FM that is characterized by frequent bouts of intense disabling pain and symptoms constitutes a significant health and economic burden. Clustering of cases in coastal areas was partially explained by other factors such as body mass index, distress level, smoking and work status. The high burden of FM found in our study calls for further investigation of potential risk factors of this condition.
Collapse
Affiliation(s)
- Afaf Moukaddem
- Department of Epidemiology & Population Health, American University of Beirut, Beirut, Lebanon
| | - Monique Chaaya
- Department of Epidemiology & Population Health, American University of Beirut, Beirut, Lebanon
| | - Zeinab F N Slim
- Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Miran Jaffa
- Department of Epidemiology & Population Health, American University of Beirut, Beirut, Lebanon
| | - Abla Mehio Sibai
- Department of Epidemiology & Population Health, American University of Beirut, Beirut, Lebanon
| | - Imad Uthman
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| |
Collapse
|
35
|
Evaluation of functional capacity in individuals with signs and symptoms of musculoskeletal disease: results of the BRAZCO population study (Brazilian COPCORD Study). Rheumatol Int 2015; 35:1873-9. [DOI: 10.1007/s00296-015-3299-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 05/26/2015] [Indexed: 11/30/2022]
|
36
|
Abstract
STUDY DESIGN Validity study. OBJECTIVE To determine the validity of the shortened version of the Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH) in comparison to the full DASH in patients undergoing total shoulder arthroplasty (TSA) and rotator cuff repair (RCR). BACKGROUND The QuickDASH is a shorter version of the DASH that may reduce respondent burden while retaining similar measurement properties. METHODS One hundred thirty-two patients undergoing TSA or RCR were assessed at baseline and at 3 and 6 months postoperatively. The patients completed the DASH, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form self-report section, and the Western Ontario Rotator Cuff index, and were tested to determine their shoulder range of motion and isometric strength. The differences between scores on the DASH and QuickDASH across the scale range were evaluated using the Bland-Altman technique. Item difficulty, correlations with other patient-reported outcome measures, and physical impairments were used to assess validity. Known group validity was assessed by examining differentiation of work status. Responsiveness was assessed through standardized response means. RESULTS QuickDASH scores were slightly higher than DASH scores, with a mean difference of 1 to 1.3 points for the TSA group and 1 to 3 points for the RCR group tested preoperatively, and at 3 months and 6 months postoperatively, although limits of agreement were wide (ranging from -10 to 13 across all estimates). The QuickDASH items were distributed across the full DASH, when ranked by item difficulty, for both patient groups. The correlation between the QuickDASH and DASH was almost perfect (r>0.92). Correlations between the DASH/QuickDASH and other patient-reported outcome measures ranged from moderate to very large (American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form self-report section, r=0.47-0.85; Western Ontario Rotator Cuff index, r=0.83-0.91), whereas correlations to impairments were small to moderate. Correlation estimates varied by less than 0.07, depending on whether the DASH or QuickDASH was used, suggesting equivalent construct validity. Both the DASH and QuickDASH discriminated between working and nonworking patients, with similar group differences and statistical significance (P<.01). The QuickDASH and DASH showed similar responsiveness between presurgery and 6-month follow-up (standardized response mean, 1.1 following TSA and 0.8 following RCR). CONCLUSION When substituting the QuickDASH for the full DASH, similar score estimates, discrimination of clinically relevant subgroups, and responsiveness can be expected across patients following TSA and RCR.
Collapse
|
37
|
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.
Collapse
Affiliation(s)
- Hussein Halabi
- King Faisal Specialist Hospital & Research Centre, Jeddah, Saudi Arabia
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Sandoughi M, Zakeri Z, Tehrani Banihashemi A, Davatchi F, Narouie B, Shikhzadeh A, Mohammadi M, Jahantigh M, Shakiba M, Moulaei NA, Yousefi S, Rezazehi B, Shirzaei Sani E, Emamdadi A, Hoseynian M, Masoodian S, Shahbakhsh S. Prevalence of musculoskeletal disorders in southeastern Iran: a WHO-ILAR COPCORD study (stage 1, urban study). Int J Rheum Dis 2013; 16:509-17. [PMID: 24164837 DOI: 10.1111/1756-185x.12110] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the prevalence of musculoskeletal complaints and rheumatic diseases in southeast of Iran. METHODS Subjects were selected based on a cluster sampling from 20 districts of urban areas in Zahedan, Iran. Subjects 15 years old and over were randomly selected and interviewed by trained interviewers in their houses. The Community Oriented Program for the Control of Rheumatic Disease (COPCORD) and Core Questionnaire (CCQ) were used in this study. The people with musculoskeletal complaints (pain, stiffness and swelling) were examined by the rheumatologist. Laboratory tests and radiographic exams were carried out when necessary to further categorize diagnoses. RESULTS Data were collected from October 10, 2008 to September 15, 2009. Two thousand and one hundred subjects including 921 (43.9%) males and 1179 (56.1%) females were interviewed. The average age of the population was 33.1 ± 14.7 years. The prevalence of complaints within the past 7 days prior to the interview was 54.13%. The most common sites of complaint were as follows: knee (30.59%), dorsolumbar (28.83%), shoulder (22.26%) and neck (17.07%). The most common rheumatic diseases were osteoarthritis and low back pain with the prevalence of 18.66% and 17.71%, respectively. Finally, the prevalence of rheumatoid arthritis was 0.98%. CONCLUSION Musculoskeletal complaints are highly common in southeast Iran. Knee and low back pain were the most common sites of complaints. The most frequent diagnosed diseases were osteoarthritis of knee followed by low back pain and soft tissue rheumatism. Rheumatoid arthritis was the most prevalent inflammatory disease.
Collapse
Affiliation(s)
- Mahnaz Sandoughi
- Department of Internal Medicine, Ali Ebne Abitaleb Hospital, Zahedan University of Medical Sciences, Zahedan, Iran
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
El Ayoubi N, Chaaya M, Mahfoud Z, Habib RR, Uthman I, Slim ZN. Risk factors for incident symptomatic knee osteoarthritis: A population-based case control study in Lebanon. Int J Rheum Dis 2013; 16:211-8. [DOI: 10.1111/1756-185x.12047] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Nabil El Ayoubi
- Department of Internal Medicine; American University of Beirut; Beirut; Lebanon
| | - Monique Chaaya
- Department of Epidemiology & Population Health; American University of Beirut; Beirut; Lebanon
| | - Ziyad Mahfoud
- Department of Public Health; Weill Cornell Medical College-Doha; Doha; Qatar
| | - Rima R. Habib
- Department of Environmental Health; American University of Beirut; Beirut; Lebanon
| | - Imad Uthman
- Department of Internal Medicine; American University of Beirut; Beirut; Lebanon
| | - Zeinab N. Slim
- Department of Epidemiology & Population Health; American University of Beirut; Beirut; Lebanon
| |
Collapse
|
40
|
Slim ZFN, Uthman I. The state of rheumatic diseases in Lebanon. A call for research and education. Rheumatology (Oxford) 2012; 51:1929-30. [PMID: 22886339 DOI: 10.1093/rheumatology/kes208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
|