1

Demographic and Clinical Characteristics of Rheumatoid Arthritis patients in some Arab States: Preliminary analysis

Mohammed HammoudehDivision 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.FACP

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 and 2000 controls from 5 Rheumatology Centers across 5 Arab States.

Introduction

Genetic studies of Rheumatoid Arthritis in some Arab States

Goal:

– Genome Wide Association Study (GWAS) that will test for >30 identified risk alleles identified in European and North American populations

IntroductionObjective of this Presentation

-So far 500 patients are recruited (350 RA and 150 Control )

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 ( OCTOBER 2012-FEBRUARY 2013).

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

GenderFemaleMale

13515

9010

Family member with RA Yes 38 25.3I don't know 12 8Extra-articular manifestationYes 4 2.7

Result 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 DiseaseYes 10 6.7No 140 93.3History of vascular diseaseYes 9 6No 141 94DiabetesYes 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 smokingCurrent 24 16Past 8 5.3never 118 78.7Number of years smoking cigarettesMean (SD) 17.6 (13.1)[range] [1-45]Shisha smokingCurrent 16 10.7Past 3 2never 131 87.3Number 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;

IntroductionCurrent Users

• Methotrexate 60%• Oral steroids 35%• HCQ 22%• SSZ 5%• Leflunamide 4.5%• Etanrcep 11%• Infliximab 4%• Adalimumab 10%• Rituximab 12%• Total on Biologics 37%

IntroductionConclusions

• The patient population of this study is relatively young in comparison to mean age (56.2 years) in the other large databases

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• .

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• 1/3 of patients are illiterate, which may impact

compliance and disease outcome

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• 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%)

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• 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% )

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, QatarMohammed HammoudehSamar Al EmadiAl 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

Introduction

• THANK YOU