Arab Arthritis

More Than One Year Delay In Diagnosis For Rheumatoid Arthritis Patients In The UAE, According To New StudyWednesday, January 16 - 2008
Dr.Humeira Badsha, Specialist Rheumatologist at DBAJ

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In a recent study published in the Annals of Rheumatic Diseases, a leading European journal, as well as Clinical Rheumatology, doctors from the Dubai Bone & Joint Center (DBAJ) showed that patients in the UAE had a lag time of nearly one year in detection of Rheumatoid Arthritis (RA) and another 9 months before they were started on the correct treatment.

“There are many reasons for rheumatoid arthritis delay in diagnosis in the UAE, and all of them need to be addressed to deliver better quality of life for sufferers in the Emirates,” stated Dr. Humeira Badsha, Specialist Rheumatologist at DBAJ and lead author of the study.

“A key factor is an insufficient numbers of rheumatologists practicing in the UAE. The World Health Organization recommends 1 rheumatologist for every 100,000 members of the population. Here in the UAE, there is a definite shortage of trained rheumatologists.”

The report also discovered that UAE-based patients suffering with the ailment had very active disease levels. Disease activity is measured by DAS28 scores, which are a composite, validated rheumatoid arthritis scoring system including a record of tender and swollen joints on a 28 joint count, along with Erythrocyte Sedimentation Rate (ESR) and patient global activity testing. A score of <3.2 is considered low disease activity. In the UAE, patients had DAS28 scores of 5.2, compared to 3.2 in the USA, and 3.0 in the Netherlands. The study also found that only 50% of patients were taking medications called disease modifying drugs, whereas these numbers in western populations are close to 90%. These drugs are essential to prevent joint damage.

There are typically seven features of Rheumatoid Arthritis. These features include pain in more that one joint, usually affecting the fingers, wrist, elbows, toes, knees, shoulders and ankles. Swelling of joints may also occur; this generally makes joints feel like small balloons filled with water. Patients may also suffer from joint stiffness which is normally at its worst first thing in the morning or after extended periods of inactivity. Characteristically, the disease will affect both sides of the body equally and nodules or lumps may develop under the skin in different areas. Blood tests for Rheumatoid Arthritis are positive in 75% of patients and X-rays can show “erosions” or joint damage only in later stages of the disease. Individuals will normally have at least four of these features in order to be diagnosed with RA.

“Several steps can be urgently taken to improve the care of rheumatoid arthritis in the UAE,’ said Dr. Badsha, “including increasing patient awareness of the necessity to seek early specialist opinion and obtain the right treatment.”

The study was conducted on 100 patients with an average age of 42.2 (+/- 12.3 years). The UAE’s diverse background was evident when studying the racial background of each patient. Of those examined, 38% were of Arab descent, 36% were of Indian descent and 26% percent were of Caucasian or other nationality. With the wide range of ethnic backgrounds taken into consideration, the study showed that there are no racial differences in disease characteristics with a majority of patients having very active disease, delayed diagnosis and not appropriately treated with disease modifying drugs.
As Rheumatoid Arthritis is a systematic disease which affects the entire body, early diagnosis can provide the steps required to keep the ailment under control, aside from the joints. Early treatment can prevent joint damage and deformity. With early identification, sufferers can learn the steps to manage the disease through medication, rest, exercise and understanding how to protect their joints.