title: Challenges and opportunities in the early diagnosis and optimal management of rheumatoid arthritis in Africa and the Middle East.
abstract: Early diagnosis and early initiation of disease-modifying antirheumatic drug (DMARD) therapy slow the progression of joint damage and decrease the morbidity and mortality associated with rheumatoid arthritis (RA). According to the European League Against Rheumatism (EULAR) guidelines, treatment should be initiated with methotrexate and addition of biological DMARDs such as tumour necrosis factor (TNF) inhibitors should be considered for RA patients who respond insufficiently to methotrexate and/or other synthetic DMARDs and have poor prognostic factors. Africa and the Middle East is a large geographical region with varying treatment practices and standards of care in RA. Existing data show that patients with RA in the region are often diagnosed late, present with active disease and often do not receive DMARDs early in the course of the disease. In this review, we discuss the value of early diagnosis and remission-targeted treatment for limiting joint damage and improving disease outcomes in RA, and the challenges in adopting these strategies in Africa and the Middle East. In addition, we propose an action plan to improve the overall long-term outlook for RA patients in the region.
authors.affiliation: King Faisal Specialist Hospital & Research Centre, Jeddah, Saudi Arabia.
authors.forename: Hussein
authors.initials: H
authors.lastname: Halabi
authors.forename: Abdurhman
authors.initials: A
authors.lastname: Alarfaj
authors.forename: Khaldoon
authors.initials: K
authors.lastname: Alawneh
authors.forename: Soliman
authors.initials: S
authors.lastname: Alballa
authors.forename: Khalid
authors.initials: K
authors.lastname: Alsaeid
authors.forename: Humeira
authors.initials: H
authors.lastname: Badsha
authors.forename: Romela
authors.initials: R
authors.lastname: Benitha
authors.forename: Elyes
authors.initials: E
authors.lastname: Bouajina
authors.forename: Samar
authors.initials: S
authors.lastname: Al Emadi
authors.forename: Ayman
authors.initials: A
authors.lastname: El Garf
authors.forename: Khaled
authors.initials: K
authors.lastname: El Hadidi
authors.forename: Ahmed
authors.initials: A
authors.lastname: Laatar
authors.forename: Chafia D
authors.initials: CD
authors.lastname: Makhloufi
authors.forename: Abdel F
authors.initials: AF
authors.lastname: Masri
authors.forename: Jeanine
authors.initials: J
authors.lastname: Menassa
authors.forename: Ahmed
authors.initials: A
authors.lastname: Al Shaikh
authors.forename: Ramiz Al
authors.initials: RA
authors.lastname: Swailem
authors.forename: Maxime
authors.initials: M
authors.lastname: Dougados
mesh_terms: D000349:Africa / Q000453:epidemiology; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D042241:Early Diagnosis; D006801:Humans; D008877:Middle East / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D012074:Remission Induction; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents
keywords: Africa and Middle East; early diagnosis; low disease activity; remission; rheumatoid arthritis