Demographic and Clinical Characteristics of
Rheumatoid Arthritis patients in some Arab
States: Preliminary analysis
Mohammed Hammoudeh
Division of Rheumatology, Department of Medicine,
Hamad Medical Corporation, Doha, Qatar
Member of Middle East Rheumatoid Arthritis
Consortium (MERAC)
Saskia Mandey, Mohammed Hammoudeh, Ziyad Mahfoud, Wessam G. Elhaq, Marjonneke J
Mook-Kanamori , Rawan Shayboub, Samar Al Emadi, Humeira Badsha, Imad Uthman, Hussein
Halabi, Basel Masri, Layla Kazkaz, Robert M. Plenge, Cindy McKeon, Thurayya Arayssi
1
Disclaimer
Introduction
As faculty of Weill Cornell Medical College in Qatar
we are committed to providing transparency for any
and all external relationships prior to giving an
academic presentation.
Mohammed Hammoudeh M.D.FACP
I DO NOT have a financial interest in commercial
products or service.
RA in the Middle East
Introduction
• There are few systemic large studies of RA in the ME
• 15 studies, largest 160 patients, single center
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RA is more common in females
High proportion of RF positivity
Association with SE
Conflicting results of severity
Delay in initiation of therapy 1,2
Low use of DMARDS 1,2
Current study: Genetic studies of Rheumatoid Arthritis in
some Arab States (GRAAS)
1.
2.
Badsha H et al. Ann Rheum Dis 66, 835 (2007)
Badsha H et al. Clin Rheumatol 27, 739-42 (2008)
Genetic studies of Rheumatoid Arthritis
in some Arab States
Introduction
Goal:
• Investigate the genetic basis of RA in the
Middle East by collecting at least 2000 RA and
2000 controls from 5 Rheumatology Centers
across 5 Arab States.
Genetic studies of Rheumatoid Arthritis
in some Arab States
Introduction
Goal:
– Genome Wide Association Study (GWAS) that will
test for >30 identified risk alleles identified in
European and North American populations
Objective of this Presentation
Introduction
-So far 500 patients are recruited (350 RA and
150 Control )
Objective of this Presentation
Introduction
Describe the demographic and clinical
characteristics of the first 150 Rheumatoid
Arthritis patients from 5 countries in the Middle
East recruited to date ( OCTOBER 2012FEBRUARY 2013).
Inclusion Criteria
Introduction
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•
•
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Self reported Arab ancestry
Age > 18
RA diagnosed per the ACR criteria
Ability to provide informed consent
Data Collection
Introduction
• Two sets of data were collected:
– Demographic and clinical data
– Ancestry data, based on self-reported ancestry
• All data entry is web-based and centralized at
WCMC-Q
Introduction
Results
Nationality
Introduction Nationality (%)
30
Nationality (regions)
North
0%
Africa
14%
25
0%
percentage (%)
20
Gulf
49%
Levant
37%
15
10
5
0
Gulf
Levant
North Africa
Analysis done on 150 patients in February 2013
Demographics/ Clinical
Introduction
Demographic/ clinical characteristics
Mean (SD)
Age in years
49.9 (12.2)
Age at diagnosis in years
38.9 (12.7)
Disease Duration in years
11.1 (9.5)
Demographics/Clinical characteristics
Gender
Female
Male
Number
Percentage
135
15
90
10
38
12
25.3
8
4
2.7
68
82
45.3
54.7
77
73
51.3
48.7
93
62.1
Family member with RA
Yes
I don't know
Extra-articular manifestation
Yes
Result of Anti CCP
Positive
Negative
Result of Rheumatoid Factor
Positive
Negative
Anti-CCP and/or RF positive
Analysis done on 150 patients in February 2013
Clinical history
Introduction
Clinical history characteristics
History of Autoimmune Disease
Yes
No
History of vascular disease
Yes
No
Diabetes
Yes type 1
Yes type 2
No
Number
Percentage
10
140
6.7
93.3
9
141
6
94
2
16
132
1.3
10.7
88
Analysis done on 150 patients in February 2013
Demographics
Introduction
Demographic characteristics
Number
Percentage
Married
120
80
Single
16
10.7
Divorced/ Separated/ Widowed
14
9.3
No formal education/ primary school
51
34
Middle/ Secondary School
49
32.7
University
50
33.3
Marital Status
Education
Analysis done on 150 patients in February 2013
Lifestyle
Introduction
Clinical characteristics
Cigarette smoking
Current
Past
never
Number of years smoking cigarettes
Mean (SD)
[range]
Shisha smoking
Current
Past
never
Number of years smoking shisha (in
years)
Mean (SD)
[range]
Number
Percentage
24
8
118
16
5.3
78.7
17.6 (13.1)
[1-45]
10.7
2
87.3
16
3
131
7.8 (10.1)
[1-38]
Analysis done on 150 patients in February 2013
Medications
Introduction
% (percentage)
Medication Use (in percentage)
100
90
80
70
60
50
40
30
20
10
0
Yes
Never
86% of the patients are using Methotrexate;
Analysis done on 150 patients in February 2013
Current Users
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•
•
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Introduction
Methotrexate
Oral steroids
HCQ
SSZ
Leflunamide
Etanrcep
Infliximab
Adalimumab
Rituximab
Total on Biologics
60%
35%
22%
5%
4.5%
11%
4%
10%
12%
37%
Conclusions
Introduction
• The patient population of this study is relatively
young in comparison to mean age (56.2 years) in the
other large databases
Conclusions
Introduction
• The patient population of this study is relatively
young in comparison to mean age (56.2 years) in the
other large databases
• RF positivity and CCP positivity are low
• .
Conclusions
Introduction
• The patient population of this study is relatively
young in comparison to mean age (56.2 years) in the
other large databases
• RF positivity and CCP positivity are low
• 1/3 of patients are illiterate, which may impact
compliance and disease outcome
Conclusions
Introduction
• The patient population of this study is relatively
young in comparison to mean age (56.2 years) in the
other large databases
• RF positivity and CCP positivity are low
• 1/3 of patients are illiterate, which may impact
compliance and disease outcome
• Compared to the study done by Badsha et al, there is
an increase in the use of Methotrexate (36% vs. 86%)
Conclusions
Introduction
• The patient population of this study is relatively
young in comparison to mean age (56.2 years) in the
other large databases
• RF positivity and CCP positivity are low
• 1/3 of patients are illiterate, which may impact
compliance and disease outcome
• Compared to the study done by Badsha et al, there is
an increase in the use of Methotrexate (36% vs. 86%)
• 37% of our RA patients are on biologics
( in Europe 10-30% , in USA 40% )
Future Plans
Introduction
• Analyze the demographic and clinical data on
a regular basis
• Encourage more centers to join MERAC
Acknowledgements
Introduction
Weill Cornell Medical College-Qatar
Saskia Mandey
Ziyad Mahfoud
Wessam G. Elhaq
Marjonneke Mook-Kanamori
Cindy McKeon
Rawan Shayboub
Thurayya Arayssi
Hamad Medical Corporation, Doha, Qatar
Mohammed Hammoudeh
Samar Al Emadi
Al Biraa Arthritis and Bone Clinic, Dubai, UAE
Humeirah Badsha
American University of Beirut, Lebanon
Imad Uthman
King Faisal Specialist Hospital &
Research center, Jeddah, Kingdom of
Saudi Arabia
Hussein Halabi
Jordan Hospital, Amman, Jordan
Basel Masri
Tishreen Hospital, Damascus, Syria
Layla Kazkaz
Broad Institute, Cambridge, MA, USA
Robert Plenge
Introduction
• THANK YOU