Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.


Increased Awareness of Arthritis May Result in Earlier Diagnosis of Rheumatoid Arthritis.

Zafar1,  Sara, Badsha2,  Humeira M., Mofti2,  Ayman, Delosantos2,  Arlene, Altares2,  Janice, Matudio2,  Gerald, Kong3,  Kok Ooi

University of Edinburgh, Edinburgh, United Kingdom
Al Biraa Arthritis Center, Dubai, United Arab Emirates
Tan Tong Seck Hospital, Singapre, Singapore

Background/Purpose:

Patients with Rheumatoid Arthritis (RA) in the United Arab Emirates (UAE) have been found to have a long delay in diagnosis, in addition to a low utilization of DMARD therapy (1, 2). Over the past 5 years, in addition to the establishment of support groups such as the Emirates Arthritis Foundation, a number of awareness programs and PR campaigns have also been instituted in the UAE. The aim of our study is to assess whether initiatives to increase awareness of arthritis among the general public have resulted in a shorter lag time to diagnosis.

Methods:

We collected demographic, disease and treatment data on the first 100 patients who met ACR criteria for RA, and who were presenting to our practice for the first time. This data was compared with similarly collected data, on the first 100 patients presenting to our musculoskeletal clinic, 5 years previously.

Results:

A total of 100 patients were seen with an average age of 40.2 ± 11.0 years (42.2 ± 12.3 years in previous data set, not statistically significant by Student's t-test); female 87% (as before); Arabs 28% and Indians 48% (Arabs 38% and Indians 36% previously). 62% were rheumatoid-factor positive, whereas 73% were titre positive in the previous study (not statistically significant, chi-square test). There was a mean reduction in lag time between symptom onset to diagnosis by 45.8%, from 14.4 ± 15.6 months to 7.8 ± 12.1 months (Student's t-test p=0.001). Furthermore, the lag to the first DMARD was also reduced by a mean of 34.9%, from 19.2 ± 24 months to 12.5 ± 21.7 months (Student's t-test p=0.04). There was no statistically significant difference between the mean DAS 28, ESR and patient global assessment of disease activity (VAS) score amongst the two groups (current data: ESR 36 ±28 mm/h, DAS 28 5.0 ± 1.4, VAS 58.0 ± 26.7 mm; 5 years prior: ESR 33 ±25 mm/h, DAS 28 5.2 ± 1.6, VAS 57.4 ± 25.0 mm).

Conclusion:

These data suggest that there has been a reduction in both the lag to diagnosis and the initiation of DMARD therapy among patients in the UAE, as compared with 5 years prior. This may be attributed to the inception of patient support groups and a general drive towards increasing public awareness about RA. Studies of larger cohorts may be needed to substantiate our findings. In addition subsequent studies must address if the shorter lag time to diagnosis and first DMARD can result in higher levels of disease remission and improved quality of life for our patients with RA.

Table 1.

 2006 Data2010 Datap-values
100 patients seen (average ± SD)
Age:42.2 ± 12.340.2 ± 11.0 
Gender: Female87%87% 
Arab38%28% 
Indian36%48% 
Caucasian and other26%24% 
RF positive73%62% 
Years since diagnosis3.9 ± 5.73.5 ± 5.6 
Lag time between symptom onset and diagnosis (months)14.4 ± 15.67.8 ± 12.9p = 0.001
Lag to first DMARD (months)19.2 ± 2412.5 ± 21.7p = 0.04
Mean Tender joint count8.9 ± 7.97.0 ± 4.8 
Mean Swollen joint count9.0 ± 7.66.7 ± 5.0 
Mean patients Global Assessment of Disease activity (mm)57.4 ± 25.058.0 ± 26.7 
Mean ESR (mm/h)33 ± 2536 ± 28 
Mean DAS5.2 ± 1.65.0 ± 1.4 
Physician global assessment55.0 ± 23.8 

References:

1.Rheumatoid arthritis in Dubai – delayed diagnosis and low DMARD utilization. Badsha, H, Kong, KO & Tak, PP. Ann Rheum Dis 2007 Jun;66(6):835

2.Rheumatoid Arthritis in the UAE. Badsha, H, Kong, KO & Tak, PP. Clinical Rheumatology Nov 2007

To cite this abstract, please use the following information:
Zafar, Sara, Badsha, Humeira M., Mofti, Ayman, Delosantos, Arlene, Altares, Janice, Matudio, Gerald, et al; Increased Awareness of Arthritis May Result in Earlier Diagnosis of Rheumatoid Arthritis. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :1581
DOI:

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