Rheumatoid Arthritis treatment in Dubai UAE, Emirates

In a recent study published in the Annals of Rheumatic Diseases it was found that care of Rheumatoid Arthritis in the uAE has improved and is now comparable to other High GDP countries. The only disparity is low access and use of the newer Biological agents due to their expense and lack of coverage.

Disparities in rheumatoid arthritis disease activity according to gross domestic product in 25 countries in the QUEST–RA database

T Sokka,1 H Kautiainen,2 T Pincus,3 S Toloza,4 G da Rocha Castelar Pinheiro,5
J Lazovskis,6 M L Hetland,7 T Peets,8 K Immonen,9 J F Maillefert,10 A A Drosos,11
R Alten,12 C Pohl,12 B Rojkovich,13 B Bresnihan,14 P Minnock,15 M Cazzato,16
S Bombardieri,16 S Rexhepi,17 M Rexhepi,17 D Andersone,18 S Stropuviene,19
M Huisman,20 S Sierakowski,21 D Karateev,22 V Skakic,23 A Naranjo,24 E Baecklund,25
D Henrohn,25 F Gogus,26 H Badsha,27 A Mofti,28 P Taylor,29 C McClinton,29 Y Yazici3
For numbered affiliations see
end of article
Correspondence to:
Dr T Sokka, Arkisto/Tutkijat,
Jyva¨skyla¨ Central Hospital,
40620 Jyva¨skyla¨, Finland;
tuulikki.sokka@ksshp.fi
Accepted 19 May 2009
Published Online First
This paper is freely available
online under the BMJ Journals
unlocked scheme, see http://
ard.bmj.com/info/unlocked.dtl
ABSTRACT
Objective: To analyse associations between the clinical
status of patients with rheumatoid arthritis (RA) and the
gross domestic product (GDP) of their resident country.
Methods: The Quantitative Standard Monitoring of
Patients with Rheumatoid Arthritis (QUEST–RA) cohort
includes clinical and questionnaire data from 6004
patients who were seen in usual care at 70 rheumatology
clinics in 25 countries as of April 2008, including 18
European countries. Demographic variables, clinical
characteristics, RA disease activity measures, including
the disease activity score in 28 joints (DAS28), and
treatment-related variables were analysed according to
GDP per capita, including 14 ‘‘high GDP’’ countries with
GDP per capita greater than US$24 000 and 11 ‘‘low
GDP’’ countries with GDP per capita less than US$11 000.
Results: Disease activity DAS28 ranged between 3.1 and
6.0 among the 25 countries and was significantly
associated with GDP (r = 20.78, 95% CI 20.56 to
20.90, r2 = 61%). Disease activity levels differed
substantially between ‘‘high GDP’’ and ‘‘low GDP’’
countries at much greater levels than according to
whether patients were currently taking or not taking
methotrexate, prednisone and/or biological agents.
Conclusions: The clinical status of patients with RA was
correlated significantly with GDP among 25 mostly
European countries according to all disease measures,
associated only modestly with the current use of
antirheumatic medications. The burden of arthritis
appears substantially greater in ‘‘low GDP’’ than in ‘‘high
GDP’’ countries. These findings may alert healthcare
professionals and designers of health policy towards
improving the clinical status of patients with RA in all
countries.
Health disparities, including high mortality rates,
are associated with low socioeconomic status in
many specific diseases in many countries.1–6
Furthermore, differences in gross domestic product
(GDP) in different countries are associated significantly
with differences in mortality rates among
countries.7–9 Most reports of these observations are
based on surveys and national databases, with
relatively limited information from clinical settings
based on physical examination, laboratory tests,
medications and patient self-report information
concerning functional status, pain, psychosocial
distress, etc, to understand further the basis for
these disparities. Furthermore, little is known
concerning associations of GDP and clinical outcomes
of chronic disabling musculoskeletal conditions
such as rheumatoid arthritis (RA).
A multinational database Quantitative Standard
Monitoring of Patients with Rheumatoid Arthritis
(QUEST–RA)10 11 was established to assess 100
unselected consecutive patients with RA per clinic
and included 25 countries by April 2008.
Considerable variation was observed in clinical
status in different countries according to most
clinical measures, whether derived from the physician,
patient or laboratory, as well as the
composite RA disease activity score in 28 joints
(DAS28) index.12 In this report, we compare
demographic characteristics, RA disease activity
measures and treatment-related variables between
‘‘high GDP’’ and ‘‘low GDP’’ countries, and analyse
associations between DAS28 and GDP.

New treatment for Rheumatoid Arthritis soon in Dubai, United Arab Emirates

Starting September 2009, we will beable to offer a new treatment for Rheumatoid Arthritis,Actemra.

Patients with rheumatoid arthritis treated with ACTEMRA™ (tocilizumab) experienced a rapid and significant reduction in the signs and symptoms of their disease, according to a study published in this week's issue of The Lancet.

Results from the OPTION (TOcilizumab Pivotal Trial in Methotrexate Inadequate respONders) trial
a major Phase III international study - demonstrated that rheumatoid arthritis (RA) patients not only achieved greater improvement of symptoms but also a higher quality-of-life with ACTEMRA, an innovative interleukin-6 (IL-6) receptor inhibitor, compared with methotrexate, a commonly used RA treatment.

"Results of this pivotal study convincingly demonstrate that tocilizumab can effectively and rapidly diminish the painful and debilitating effects of rheumatoid arthritis," said Josef Smolen, M.D., lead investigator of the OPTION trial and Professor of Medicine at the Department of Internal Medicine at the Medical University of Vienna, Austria. "These trial findings are significant because we know that many rheumatoid arthritis patients continue to experience symptoms of joint pain and stiffness, physical disability and fatigue despite treatment with existing therapies."

Rheumatoid arthritis is a progressive autoimmune disease characterized by inflammation of the membrane lining in the joints throughout the body. This inflammation causes distortion of the joint and impaired function accompanied by pain, stiffness and swelling and ultimately leading to irreversible joint destruction and disability. In addition, the systemic symptoms of RA include fatigue, anaemia, osteoporosis and may contribute to shortening life expectancy by affecting major organ systems. Sadly after 10 years, less than 50% of patients can continue to work or function normally on a daily basis.

ACTEMRA is the first humanized interleukin-6 (IL-6) receptor-inhibiting monoclonal antibody and it represents a novel mechanism of action to treat RA. Research has shown that reducing the activity of IL-6, one of several key cytokines involved in the inflammatory process, reduces inflammation of the joints and relieves certain systemic effects of RA.

About the OPTION Study

In the OPTION trial, a three-arm, double-blind, controlled Phase III study, 623 patients were randomized to receive ACTEMRA intravenously (either 4mg/kg or 8mg/kg) every four weeks plus methotrexate weekly or placebo infusions plus methotrexate weekly. The study was conducted in 73 trial sites in 17 countries outside the United States.

At 24 weeks, 58.5% of ACTEMRA patients (8mg/kg) achieved a 20% reduction in RA symptoms (ACR20)1, compared with 26.5% of patients in placebo plus metrotrexate patients. In the study, 43.9% of patients treated with ACTEMRA (8 mg/kg) plus methotrexate achieved at least a 50% (ACR50) reduction in symptoms compared to 10.8% of patients receiving placebo and methotrexate; ACR70 was achieved in 22% of the treatment group versus 2% in the control group. A rapid decrease in disease activity (DAS28)2 was seen as early as two weeks in a greater proportion of patients treated with ACTEMRA plus methotrexate, with 27.5% achieving clinical remission (DAS28≤ 2.6) by 24 weeks.

Additionally, results showed that 80% of patients in the ACTEMRA (8mg/kg) plus methotrexate group responded with moderate to good improvements in RA symptoms, according to the EULAR response criteria3, compared with 35% for those treated with placebo and methotrexate at 24 weeks.

The OPTION trial also assessed physical function and quality-of-life at baseline and every four weeks thereafter. Patients receiving ACTEMRA achieved significantly greater improvement in areas of fatigue and mental function at 24 weeks, and achieved normal levels of hemoglobin and C-reactive protein (CRP), a marker of inflammation due to RA, compared with patients receiving placebo plus methotrexate.

About ACTEMRA

ACTEMRA is the result of research collaboration by Chugai and is being co-developed globally with Chugai. ACTEMRA is the first humanized interleukin-6 (IL-6) receptor-inhibiting monoclonal antibody. An extensive clinical development program of five Phase III trials was designed to evaluate clinical findings of ACTEMRA. Three other studies are completed and have reported meeting their primary endpoints. A fifth trial, a two-year study called LITHE (TociLIzumab safety and THE prevention of structural joint damage), is currently underway and is expected to report preliminary first-year data in 2008. ACTEMRA is awaiting approval in the United States and Europe. In Japan, ACTEMRA was launched by Chugai in June 2005 as a therapy for Castleman's disease; in April 2006, additional indications for rheumatoid arthritis and systemic-onset juvenile idiopathic arthritis were also filed in Japan.

ACTEMRA is generally well tolerated. The overall safety profile of ACTEMRA is consistent across all global clinical studies. The most common, non-serious, adverse events reported are upper respiratory tract infection, nasopharyngitis, headache and hypertension. As with other biological disease modifying anti-rheumatic drugs (DMARDs), serious infections and hypersensitivity reactions including a few cases of anaphylaxis, have been reported in some patients treated with ACTEMRA. Increases in liver transaminases (ALT and AST) were seen in some patients; these increases were generally mild and reversible, with no hepatic injuries or any observed impact on liver function.

Rheumatoid Arthritis in Arab Patients

Dr. Humeira Badsha presented her findings as part of findings from the QUEST RA database. Seen here at the EULAR conference in Copenhagen (June 2009)with collaborators. Data from Morocco and Egypt was presented and compared to that from other developed countries. patients from North Africa had higher disease activity and more disability.

Higher weight increased risk for arthritis

the Los Angeles Times (7/14) Booster Shots blog, Jeannine Stein observed that, according to a study published in the August issue of the journal Radiology, being overweight "can be bad for the cartilage in your knees." Researchers from Boston University examined "data from the Multicenter Osteoarthritis Study of 3,026 people 50 to 79 who were at risk for osteoarthritis or had early evidence of the disease," focusing on "347 knees in 336 patients with an average BMI of 29.5." At study start, "most knees did not show evidence of tibiofemoral osteoarthritis," but after 30 months, "20 percent showed slow cartilage loss, and almost six percent showed rapid cartilage loss." Notably, "the only demographic feature that predicted rapid cartilage loss was having a high BMI at the start of the study."

"In fact, for every one-unit increase in body mass index, the chances of rapid cartilage loss increased 11 percent," HealthDay (7/14, Reinberg) reported. Moreover, the "association between obesity and rapid cartilage loss remained even after taking into account age, gender, and ethnic background." Study author Frank W. Roemer, MD, concluded, "We know that weight loss is probably the most important factor to slow disease progression." He added, "Osteoarthritis is the most common musculoskeletal disorder with major health and socioeconomic impact in our aging society."