Mohammed Hammoudeh , M.D
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Demographic and Clinical Characteristics of Rheumatoid Arthritis patients in some Arab States: Preliminary analysis
Mohammed Hammoudeh,M.DDivision 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
IntroductionAs 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.
I DO NOT have a financial interest in commercial products or service.
Disclaimer
IntroductionRA in the Middle East
• There are few systemic large studies of RA in the ME
• 15 studies, largest 160 patients, single center– 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. Badsha H et al. Ann Rheum Dis 66, 835 (2007) 2. Badsha H et al. Clin Rheumatol 27, 739-42 (2008)
Introduction
Genetic studies of Rheumatoid Arthritis in some Arab States
Goal:• Investigate the genetic basis of RA in the
Middle East by collecting at least 2000 RA controls and 2000 RA controls from 5 Rheumatology Centers across 5 Arab States.– Genome Wide Association Study (GWAS) that will
test for >30 identified risk alleles identified in European and North American populations
IntroductionObjective of this Presentation
Describe the demographic and clinical characteristics of the first 150 Rheumatoid Arthritis patients from 5 countries in the Middle East recruited to date
Introduction Inclusion Criteria
• Self reported Arab ancestry• Age > 18• RA diagnosed per the ACR criteria• Ability to provide informed consent
IntroductionData Collection
• 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
IntroductionNationality
Bahrai
nQata
r
Saudi-A
rabia
United Arab
Emira
tesYem
en Iraq
Jordan
Leban
on
Palestine
Syria
Egypt
Somalia
Sudan
Algeria
Tunesi
a
Mauret
ania
0
5
10
15
20
25
30
Nationality (%)
Analysis done on 150 patients in February 2013
Gulf Levant North Africa
perc
enta
ge (%
)
Gulf 48%
Levant37%
North Africa14%
Nationality (regions)
IntroductionDemographics/ Clinical
Demographics/Clinical characteristics Number Percentage
Gender
FemaleMale
13515
9010
Family member with RA Yes 38 25.3No 100 66.7I don't know 12 8Extra-articular manifestationYes 4 2.7no 146 97.3Result of Anti CCPPositive 68 45.3Negative 82 54.7Result of Rheumatoid FactorPositive 77 51.3Negative 73 48.7Anti-CCP and/or RF positive 93 62.1
Analysis done on 150 patients in February 2013
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)
IntroductionClinical history
Clinical history characteristics Number Percentage
History of Autoimmune Disease
Yes 10 6.7No 140 93.3History of vascular disease
Yes 9 6No 141 94Diabetes
Yes type 1 2 1.3Yes type 2 16 10.7No 132 88
Analysis done on 150 patients in February 2013
IntroductionDemographics
Analysis done on 150 patients in February 2013
Demographic characteristics Number Percentage
Marital Status
Married 120 80
Single 16 10.7
Divorced/ Separated/ Widowed 14 9.3
Education
No formal education/ primary school 51 34
Middle/ Secondary School 49 32.7
University 50 33.3
IntroductionLifestyle
Clinical characteristics Number Percentage
Cigarette smoking
Current 24 16
Past 8 5.3
never 118 78.7
Number of years smoking cigarettes
Mean (SD) 17.6 (13.1)
[range] [1-45]
Shisha smoking
Current 16 10.7
Past 3 2
never 131 87.3
Number of years smoking shisha (in years)
Mean (SD) 7.8 (10.1)
[range] [1-38]
Analysis done on 150 patients in February 2013
IntroductionMedications
Place of Birth (regions)
Analysis done on 150 patients in February 2013
% (p
erce
ntag
e)
Methotrexa
te
Oral/IM Corti
coste
roids
Antimalarials
Sulfa
salazine
Leflunomidec
Etanercept
Infliximab
Adalimumab
Rituxim
ab0
102030405060708090
100
Medication Use (in percentage)
YesNever
86% of the patients are using Methotrexate; the use of biologics is low
IntroductionConclusions
• 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• Large percentage 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%) but use of Biologics is still limited.
IntroductionFuture Plans
• Analyze the demographic and clinical data on a regular basis
• Encourage more centers to join MERAC
IntroductionAcknowledgements
Weill Cornell Medical College-QatarSaskia MandeyZiyad MahfoudWessam G. ElhaqMarjonneke Mook-KanamoriCindy McKeonRawan ShayboubThurayya Arayssi
Hamad Medical Corporation, Doha, QatarSamar Al Emadi
Al Biraa Arthritis and Bone Clinic, Dubai, UAEHumeirah 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, USARobert Plenge
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