Rheumatoid Arthritis in the UAE

Humeira Badsha1 , Kok Ooi Kong2 and Paul P. Tak1, 3
(1)
Dubai Bone & Joint Center LLC, Level 50, Emirates Towers, P.O. Box 118855, Dubai, United Arab Emirates
(2)
Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore, Singapore
(3)
Division of Clinical Immunology & Rheumatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
Received: 12 September 2007 Revised: 10 October 2007 Accepted: 14 October 2007 Published online: 1 November 2007
Abstract Studies have shown that patients with rheumatoid arthritis (RA) in the Middle East have delayed diagnosis and low disease-modifying anti-rheumatic drug (DMARD) utilization. We describe the characteristics and treatments of consecutive RA patients presenting to a new musculoskeletal clinic in Dubai, United Arab Emirates (UAE). Demographic and clinical data were collected over a 10-month period at the first visit to our clinic for patients meeting the American College of Rheumatology (ACR) criteria for RA. A total of 100 patients were seen: (average ± SD) age 42.2 ± 12.3 years; female 87%; Arabs 38%, Indian 36%, Caucasian and others 26%; 73% rheumatoid-factor positive; years since diagnosis: 3.9 ± 5.7; lag time between symptom onset to diagnosis 1.2 ± 1.3 years and lag time to first DMARD was 1.6 ± 2.0 years. Mean tender joint count was 8.9 ± 7.9, mean swollen joint count 9.0 ± 7.6, mean patient’s global assessment of disease activity 57.4 ± 25.0 mm, mean ESR 33 ± 25 mm/h, mean DAS28 5.2 ± 1.6, physician global assessment 55.0 ± 23.8. Only 43% were on DMARDs (25% MTX, 5% TNF blockers). Among the patients who were not on DMARD, only 28.1% had disease duration less than 1 year (p = <0.01). Erosions were present in 55.2% of patients with available X-rays, and deformities in 26% of patients. There were no racial differences in disease characteristics. The UAE has a unique population with many races residing in the country. Among the first 100 consecutive patients seen at our clinic, there were no significant differences in disease characteristics with the majority of the patients having very active disease, delayed diagnosis, and not being treated with DMARDs.
Keywords Arab - Disease activity - Gulf - Indian - Middle East - Rheumatoid arthritis - Treatment
Footline: RA in the United Arab Emirates

Humeira BadshaEmail: humeira.badsha@dbaj.ae
References
1.
Al-Rawi ZS, Alazzawi AJ, Alajili FM, Alwakil R (1978) Rheumatoid arthritis in population samples in Iraq. Ann Rheum Dis 37(1):73–75, Feb 1978

2.
Al-Salem IH, Al-Awadhi AM (2004) The expression of rheumatoid arthritis in Kuwaiti patients in an outpatient hospital-based practice. Med Princ Pract 13(1):47–50, Jan 2004

3.
Al Attia HM, Gatee OB, George S, Masri MM (1993) Rheumatoid arthritis in a population sample in the Gulf: clinical observations. Clin Rheumatol 12(4):506–510, Dec 1993

4.
Alballa SR (1995) The expression of rheumatoid arthritis in Saudi Arabia. Clin Rheumatol 14(6):641–645, Nov 1995

5.
Badsha H, Kong KO, Tak PP (2007) Rheumatoid arthritis in Dubai-delayed diagnosis and low usage of disease modifying antirheumatic drugs. Ann Rheum Dis 66(6):835, Jun 2007

6.
Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS et al (1988) The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 31(3):315–324, Mar 1988

7.
Smolen JS, Breedveld FC, Schiff MH, Kalden JR, Emery P, Eberl G et al (2003) A simplified disease activity index for rheumatoid arthritis for use in clinical practice. Rheumatology (Oxford) 42(2):244–257, Feb 2003

8.
Prevoo ML, van ’t Hof MA, Kuper HH, van Leeuwen MA, van de Putte LB, van Riel PL (1995) Modified disease activity scores that include twenty-eight-joint counts. Development and validation in a prospective longitudinal study of patients with rheumatoid arthritis. Arthritis Rheum 38(1):44–48, 1995 Jan

9.
Sokka T, Kautiainen H, Toloza S, Makinen H, Verstappen SM, Hetland ML et al (2007) QUEST-RA: Quantitative clinical assessment of patients with rheumatoid arthritis seen in standard rheumatology care in 15 countries. Ann Rheum Dis 66:1491–1496, Apr 2007

10.
Michaud K, Wolfe F (2006) Trends in mEdication Use by 10,982 Rheumatoid Arthritis patients in the United States from 1998–2005: Biological Use now at 40%. Ann Rheum Dis 65(Suppl II):311

11.
Nurmohamed MT, Dijkmans BA (2005) Efficacy, tolerability and cost effectiveness of disease-modifying antirheumatic drugs and biologic agents in rheumatoid arthritis. Drug 65(5):661–694

12.
Verstappen SM, Jacobs JW, Bijlsma JW, Heurkens AH, van Booma-Frankfort C, Borg EJ et al (2003) Five-year followup of rheumatoid arthritis patients after early treatment with disease-modifying antirheumatic drugs versus treatment according to the pyramid approach in the first year. Arthritis Rheum 48(7):1797–1807, Jul 2003

13.
Breedveld FC, Weisman MH, Kavanaugh AF, Cohen SB, Pavelka K, van Vollenhoven R et al (2006) The PREMIER study: A multicenter, randomized, double-blind clinical trial of combination therapy with adalimumab plus methotrexate versus methotrexate alone or adalimumab alone in patients with early, aggressive rheumatoid arthritis who had not had previous methotrexate treatment. Arthritis Rheum 54(1):26–37, Jan 2006

14.
Michaud K, Wolfe F (2005) Reduced Mortality among RA Patients Treated with Anti-TNF Therapy and Methotrexate. Ann Rheum Dis 64(Suppl III):87, 2006

15.
St Clair EW, Van der Heijde DM, Smolen JS, Maini RN, Bathon JM, Emery P et al (2004) Combination of infliximab and methotrexate therapy for early rheumatoid arthritis: a randomized, controlled trial. Arthritis Rheum 50(11):3432–3443, Nov 2004

16.
Anderson JJ, Wells G, Verhoeven AC, Felson DT (2000) Factors predicting response to treatment in rheumatoid arthritis: the importance of disease duration. Arthritis Rheum 43(1):22–29, Jan 2000

17.
Pountain G (1991) The prevalence of rheumatoid arthritis in the Sultanate of Oman. Br J Rheumatol 30(1):24–28, Feb 1991

18.
Malaviya AN, Kapoor SK, Singh RR, Kumar A, Pande I (1993) Prevalence of rheumatoid arthritis in the adult Indian population. Rheumatol Int 13(4):131–134

19.
Lacaille D, Anis AH, Guh DP, Esdaile JM (2005) Gaps in care for rheumatoid arthritis: a population study. Arthritis Rheum 3(2):241–248, Apr 15, 2005

20.
Stucki G (1997) Specialist management: needs and benefits. Baillieres Clin Rheumatol 11(1):97–107, Feb 1997

21.
Chandrashekara S, Anilkumar T, Jamuna S (2002) Complementary and alternative drug therapy in arthritis. J Assoc Physicians India 50:225–227, Feb 2002

22.
Abdel-Nasser AM, Rasker JJ, Valkenburg HA (1997) Epidemiological and clinical aspects relating to the variability of rheumatoid arthritis. Semin Arthritis Rheum 27(2):123–140, Oct 1997

Arthritis Walk Dubai a big success

Osteoporosis screening

Dubai Bone and Joint Center screened the employees of the Ministry of Health on November 20th 2007

Arthritis Dubai

Walk this wayNirmala Natarajan (CONTRIBUTOR)22 November 2007
A 'STEPS for Arthritis’ Walkathon will be held tomorrow (November 23) under the patronage of Princess Haya Bint Al Hussein, wife of His Highness Shaikh Mohammed bin Rashid Al Maktoum, Vice-President and Prime Minister of the UAE and Ruler of Dubai.
The Walkathon is aimed to benefit the Emirates Arthritis Foundation (EAF), an establishment which increases awareness about arthritis in the region and works towards improving the quality of life of patients.
The EAF was launched in April 2006 in an effort to make a tangible difference to the lives of arthritis sufferers in the UAE.
The Walkathon, sponsored by Dubai Festival City, is also supported by Rivoli, Arwa, Anlene and Roche. The scenic route of the Walkathon, through the Al Badia residential community overlooking the golf course, will begin and end at the Dubai Festival City.
School children, EAF volunteers, journalists, a few arthritis patients with their families as well as Dubai Festival City management are expected to participate in the walk. The registration fee is Dhs50 and proceeds will go to the EAF Endowment Fund that supports arthritis patients.
Speaking at a Press conference to launch the Walkathon, Martina Boor, Assistant Marketing Manager, Retail, Dubai Festival City said: "There will be a jazz band and live entertainment afterwards at the Dubai Festival City so families can have a fun day. We look forward to a huge turnout as this will afford a lot of enjoyment to the public and also support a very noble cause. We are hoping to make this an annual event."
"We can really make a difference in the lives of patients who need help to obtain vital treatment," commented Suzanne Al Houby, Vice-Chairperson of the EAF Board of Directors, on behalf of all Board members and the CEO of the Dubai Bone and Joint Center, the umbrella organisation of the EAF.
"So far, the EAF has supported 10 patients at a cost of Dh70,000 each, per year and through this Walkathon, we hope to increase that figure and support more patients who undergo intense pain through this often debilitating condition," she said.
EAF director of operations, Mrs. Cathy Leibman, is extremely enthusiastic about the Walkathon. Being involved so closely with the cause, her passion and longing to help arthritis patients both in terms of the right treatment and funding is amazing. "It is very comforting to see patients who can barely walk begin to lead a much better quality of life" she said.
Participants can register for the Walkathon between 8 and 9am tomorrow at the VIP entrance of the Dubai Festival Centre. The walk begins at 9am and is expected to last 45 minutes. Upon return to the starting point, there will be a morning of fun and entertainment for one and all.
Whilst holding focus on the cause of arthritic patients, the Dubai Festival City also wants to ensure an enjoyable experience for families this Friday.
For further information on the Walkathon, please contact Irina Ionascu of Dubai Festival City on 050 5592184
'There is a general misconception that arthritis only affects old people'
To find out more about the types of arthritis, causes, prevention and medication, City Times spoke to Dr Humeira Badsha, Specialist Rheumatologist and vice-chairperson of the Emirates Arthritis Foundation
DR BADSHA, who came to Dubai two years ago after working in India, SIngapore, Los Angeles and Boston has been with the EAF since then, treating arthritis patients for the past 12 years.
She says: "There is a general misconception that arthritis only affects old people. Older people usually suffer from osteo-arthritis when the cartilage between the bones wears off. However there are over 100 types of inflammatory arthritis which can affect the old and the young (even babies) alike. This happens both due to genetic predisposition and a trigger which causes the immune system to attack the body. Treatment involves regular medications including methotrexate and the newer biological drugs which suppress the over-active immune system and prevents further joint damage."
Asked about the causes of arthritis, Dr Badsha says it is not due to cold weather or diet. However, obesity, lack of exercise and lack of a balanced diet can contribute to it. There is evidence that certain types of arthritic conditions can benefit from the consumption of oily fish, ginger, turmeric, avocado and pineapple. In patients suffering from gout, avoiding red meat and alcohol could help. Stress can trigger the immune system so patients should lead a healthy lifestyle with the right balance of diet and exercise to help prevent as well as reduce the effects of arthritic pain, she explains.
Dr Badsha says that at the Emirates Arthritis Foundation, aqua exercises, yoga and patient support groups complement the administration of drugs to bring greater quality of life. Early diagnosis through awareness, education and screening and the right treatment are extremely important to effectively treat this painful condition
EAF to the rescue
It’s all in one’s attitude, says courageous Katrina Oakeley, Operations Manager Phototechnics/Secretary, Emirates Arthritis Foundation
Katrina was diagnosed with juvenile chronic arthritis at the tender age of one. She was crawling on elbows and then stopped trying to walk. She went through intolerable pain, both physically and emotionally as the disease invaded her feet, wrists, fingers and jaw and challenged her day to day activities.
Determined to make the most of life, she bravely carried on to complete school and college and is now running her business.
She is currently being treated through the EAF with two injections a week and is able to lead a good quality of life. Her tale of physical pain is no match for her extremely positive attitude. "It is important to keep one’s spirits up and to meet life head on. I live an active life and am looking forward to taking my first proper skiing holiday next year!"
"Besides the support of family and friends, the most important thing is not to let arthritis control you. You only have one chance to live your life, so please make the most of it. Don’t let it beat you!"
Katrina is passionate about her work with the EAF and would love to make a difference to this compassionate establishment.
Nael Hammad, 32 years, another arthritis patient says her nightmare started at the age of 28 with pain in the hips, joints and shoulders and it soon invaded his entire body.
There was a time he could barely put on his clothes or even get out of bed. He lost his job and lived through despair. Initially, he suffered with the wrong diagnosis and was given some pain killers and, later, he was advised to replace his hips.
Fortunately, he did not go in for the surgery. He thanks God for the day he was referred to the EAF by a friend. Here, he received not just medical treatment (which involved twice monthly injections) but understanding, care and concern.
Says Nael: "I could never have afforded this expensive treatment and I am deeply grateful to the Emirates Arthritis Foundation for coming to my rescue. Here I received the right kind of knowledge, caring and financial support. Before I came here I was semi-disabled. I now lead a normal family life and have a job again!"
What you need to know about arthritis:

Arthritis Dubai Walk

Walkathon a triumph for arthritis victimsBy Zoe Sinclair (Our staff reporter)24 November 2007
DUBAI — Young and old alike, arthritis sufferers of every age and description along with fellow walkers took part in “Steps for Arthritis”, the first Emirates Arthritis Foundation (EAF) walkathon yesterday.
For arthritis patients like Nael Hammad, 32, his completion of the walkathon of about 4km at Dubai Festival City yesterday was a sign of how far his treatment had come in the three years since he first developed the condition.
It took one-and-a-half years for the doctors to diagnose the type of arthritis he had as psoriatic arthritis, and another year before he received the correct treatment.
In that time, his condition caused him so much pain and was debilitating that he was unable to go about his daily life including work and family life. He eventually lost his job.
After getting in touch with the EAF, his condition has improved so much that he was proud to finish the walkathon with his family by his side.
“I’m very very happy,” he said.
“It gives me such pleasure that I’m here and I can support others and we can increase awareness.”
EAF director and organiser of yesterday’s walkathon Dr Cathy Liebman said Hammad’s experience of misdiagnosis and difficulty in finding the best treatment was not unusual.
Liebman said there were more than 100 forms of arthritis and it was important to realise the condition affected 20 per cent of the community, as high a rate as diabetes, but arthritis also led to disability.
“If you think you might have arthritis, go and see a rheumatologist,” she urged.
“Don’t be scared to get a second opinion and the foundation can answer any questions.”
She said raising awareness of the condition, the main aim of the walkathon, was crucial as many people did not realise the extent of the population, including young people, that were affected by the condition.
Katrina Oakeley, 25, a sufferer of juvenile chronic arthritis and EAF secretary, is testament to the range of people touched by arthritis.
Oakeley developed the disease when she was one-year-old and has been trying to manage it ever since.
She is on medication for the pain and treatment of the condition and has also had operations to have her wrists fused to help her function better.
“There are good days and bad days,” Oakeley said.
“There are days when you feel fine. But there are days when you don’t want to get out of bed because the pain is so bad.
“It’s a state of mind. If you let it beat you then that’s when you’ve lost.”
Many of the patients urged fellow sufferers to keep positive and join support groups.
But the most important message was to be aware of the disease because early diagnosis and the correct treatment was the best chance for managing it as a definitive cure is yet to be found.
Liebman said Dh192,500 was raised through corporate sponsors and the 250 people who registered for the walkathon.Held under the patronage of Princess Haya bint Hussein, wife of His Highness Shaikh Mohammed bin Rashid Al Maktoum, Vice-President and Prime Minister of the UAE and Ruler of Dubai, the walkathon will become an annual event for the next three years

EULAR 2006 Amsterdam

Inflammatory arthritis in Dubai UAE: Abstract presented by Dr. Badsha

APLAR 2006 KL, Malaysia

Dr. Badsha abstract: Inflammatory arthritis in the UAE

Pan Arab Conference Cairo Egypt 2006

Case Presenation by Dr. Badsha: Catastrophic antiphosphlipid syndrome

Pan Arab Conference Doha Qatar January 2008

Abstracts to be presented:

1) Rheuamatoid arthritis in the UAE: an unmet need for increased rheumatological care
2) Rheumatoid arthritis in the UAE and ability to pay
3) Rheumatoid Arthritis in the UAE and delay to start DMARD

Rheumatoid Arthritis in UAE

Clin Rheumatol. 2007 Nov 1; [Epub ahead of print]
Links
Rheumatoid arthritis in the United Arab Emirates.
Badsha H, Kong KO, Tak PP.
Dubai Bone & Joint Center LLC, Level 50, Emirates Towers, P.O. Box 118855, Dubai, United Arab Emirates, humeira.badsha@dbaj.ae.
Studies have shown that patients with rheumatoid arthritis (RA) in the Middle East have delayed diagnosis and low disease-modifying anti-rheumatic drug (DMARD) utilization. We describe the characteristics and treatments of consecutive RA patients presenting to a new musculoskeletal clinic in Dubai, United Arab Emirates (UAE). Demographic and clinical data were collected over a 10-month period at the first visit to our clinic for patients meeting the American College of Rheumatology (ACR) criteria for RA. A total of 100 patients were seen: (average +/- SD) age 42.2 +/- 12.3 years; female 87%; Arabs 38%, Indian 36%, Caucasian and others 26%; 73% rheumatoid-factor positive; years since diagnosis: 3.9 +/- 5.7; lag time between symptom onset to diagnosis 1.2 +/- 1.3 years and lag time to first DMARD was 1.6 +/- 2.0 years. Mean tender joint count was 8.9 +/- 7.9, mean swollen joint count 9.0 +/- 7.6, mean patient's global assessment of disease activity 57.4 +/- 25.0 mm, mean ESR 33 +/- 25 mm/h, mean DAS28 5.2 +/- 1.6, physician global assessment 55.0 +/- 23.8. Only 43% were on DMARDs (25% MTX, 5% TNF blockers). Among the patients who were not on DMARD, only 28.1% had disease duration less than 1 year (p = <0.01). Erosions were present in 55.2% of patients with available X-rays, and deformities in 26% of patients. There were no racial differences in disease characteristics. The UAE has a unique population with many races residing in the country. Among the first 100 consecutive patients seen at our clinic, there were no significant differences in disease characteristics with the majority of the patients having very active disease, delayed diagnosis, and not being treated with DMARDs.