title: Suboptimal management of rheumatoid arthritis in the Middle East and Africa: could the EULAR recommendations be the start of a solution?
abstract: Although the prevalence of RA in the Middle East and Africa is comparable with that in other parts of the world, evidence indicates that its management in this region is suboptimal for a variety of reasons, including misconceptions and misunderstandings about the disease's prevalence and severity in the region, compounded by the lack of local epidemiological and health-economic data around the disease; the perception that RA is a low priority compared with other more prevalent conditions; delayed diagnosis, referral and treatment; and a lack of a region-specific, evidence-based management approach. In the absence of such an approach, the EULAR treatment recommendations may provide a useful starting point for the creation of guidelines to suit local circumstances. However, although agreement with the EULAR recommendations is high, many barriers prevent their implementation in clinical practise, including lack of timely referral to rheumatologists; suboptimal use of synthetic DMARDs; poor access to biologics; lack of awareness of the burden of RA among healthcare professionals, patients and payers; and lack of appropriate staffing levels.To optimise the management of RA in the Middle East and Africa, will require a multi-pronged approach from a diverse group of stakeholders-including local, national and regional societies, such as the African League of Associations in Rheumatology and International League of Associations for Rheumatology, and service providers-to collect data on the epidemiology and burden of the disease; to increase awareness of RA and its burden among healthcare professionals, payers and patients through various educational programmes; to encourage early referral and optimise use of DMARDs by promoting the EULAR treatment recommendations; to encourage the development of locally applicable guidelines based on the EULAR treatment recommendations; and to facilitate access to drugs and the healthcare professionals who can prescribe and monitor them.
authors.forename: Bassel
authors.initials: B
authors.lastname: El Zorkany
authors.forename: Humaid A
authors.initials: HA
authors.lastname: Alwahshi
authors.forename: Mohamed
authors.initials: M
authors.lastname: Hammoudeh
authors.forename: Samar
authors.initials: S
authors.lastname: Al Emadi
authors.forename: Romela
authors.initials: R
authors.lastname: Benitha
authors.forename: Adel
authors.initials: A
authors.lastname: Al Awadhi
authors.forename: Elyes
authors.initials: E
authors.lastname: Bouajina
authors.forename: Ahmed
authors.initials: A
authors.lastname: Laatar
authors.forename: Samir
authors.initials: S
authors.lastname: El Badawy
authors.forename: Marzooq
authors.initials: M
authors.lastname: Al Badi
authors.forename: Mustafa
authors.initials: M
authors.lastname: Al-Maini
authors.forename: Jamal
authors.initials: J
authors.lastname: Al Saleh
authors.forename: Ramiz
authors.initials: R
authors.lastname: Alswailem
authors.forename: Mahmood Moosa Tar Mahomed
authors.initials: MM
authors.lastname: Ally
authors.forename: Wafaa
authors.initials: W
authors.lastname: Batha
authors.forename: Hachemi
authors.initials: H
authors.lastname: Djoudi
authors.forename: Ayman
authors.initials: A
authors.lastname: El Garf
authors.forename: Khaled
authors.initials: K
authors.lastname: El Hadidi
authors.forename: Mohamed
authors.initials: M
authors.lastname: El Marzouqi
authors.forename: Musa
authors.initials: M
authors.lastname: Hadidi
authors.forename: Ajesh Basantharan
authors.initials: AB
authors.lastname: Maharaj
authors.forename: Abdel Fattah
authors.initials: AF
authors.lastname: Masri
authors.forename: Ayman
authors.initials: A
authors.lastname: Mofti
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Nahar
authors.forename: Clive Allan
authors.initials: CA
authors.lastname: Pettipher
authors.forename: Catherine Elizabeth
authors.initials: CE
authors.lastname: Spargo
authors.forename: Paul
authors.initials: P
authors.lastname: Emery
mesh_terms: D000349:Africa; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D003906:Developing Countries; D006801:Humans; D008877:Middle East; D017410:Practice Guidelines as Topic; D015995:Prevalence; D012219:Rheumatology / Q000592:standards*