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Al-Ajlouni YA, Al Ta'ani O, Mushasha R, Lee JL, Capoor J, Kapadia MR, Alejandro R. The burden of musculoskeletal disorders in the Middle East and North Africa (MENA) region: a longitudinal analysis from the global burden of disease dataset 1990-2019. BMC Musculoskelet Disord 2023; 24:439. [PMID: 37259119 DOI: 10.1186/s12891-023-06556-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 05/19/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Musculoskeletal (MSK) disorders are one of the main causes of disability among adults globally. The burden of MSK disorders varies greatly between different regions and is the highest in low- and middle income- countries. This study sought to investigate trends in the burden of MSK disorders across the MENA region, utilizing the GBD 2019 dataset. METHODS This ecological study utilized data from the Global Burden of Disease (GBD) to report on the burden of musculoskeletal (MSK) disorders in The Middle East and North Africa (MENA) region between 1990 and 2019. Our analysis involved descriptive statistics and sociodemographic trends and did not employ any specific statistical analyses. Using age-standardized rates of prevalence and disability-adjusted life-years (DALYs), we reported trends in the burden of MSK disorders, as well as national variation between different countries. Furthermore, we analyzed trends in risk factors contributing to MSK disorders by age and gender. RESULTS The longitudinal analysis from 1990 to 2019 showed an increase in the age-standardized rate for prevalence and DALYs of MSK disorders by 5% and 4.80%, respectively. Low back pain continued to be the most prevalent MSK condition, while RA and other MSK disorders had the largest percentage increase for DALYs between 1990 and 2019. The study found that Afghanistan had the lowest age standardized DALYs rate attributed to MSK disorders, while Iran, Turkey, and Jordan had the highest. Further, Syria showed the most dramatic decrease while Saudi Arabia had the most notable increase in age standardized DALY rates from 1990 to 2019. In 2019, occupational risks, high body mass index, and tobacco smoking were the main risk factors for MSK disorders, with occupational risks being the largest contributor, and between 1990 and 2019, there was a decrease in the contribution of occupational risks but an increase in the contribution of high body mass index as a risk factor. CONCLUSION This study highlights the significant burden of MSK disorders in the MENA region, with various risk factors contributing to its increasing prevalence in recent decades. Further research is needed to better understand the underlying factors and potential interventions that could improve health outcomes. Addressing MSK disorders should be a public health priority in the region, and efforts should be made to develop effective strategies to prevent and manage this debilitating condition.
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Affiliation(s)
| | - Omar Al Ta'ani
- University of Pittsburgh Medical Center, Pittsburgh, PA, 15260, USA
| | - Rand Mushasha
- Charité - Universitätsmedizin Berlin Charitéplatz 1, 10117, Berlin, Germany
| | - Justin Lin Lee
- New York Medical College School of Medicine, Valhalla, NY, 10595, USA
| | | | - Mitul R Kapadia
- Department of Pediatrics and Orthopedics, University of California, San Francisco, USA
| | - Ruth Alejandro
- New York Medical College School of Medicine, Valhalla, NY, 10595, USA
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Archer R, Hock E, Hamilton J, Stevens J, Essat M, Poku E, Clowes M, Pandor A, Stevenson M. Assessing prognosis and prediction of treatment response in early rheumatoid arthritis: systematic reviews. Health Technol Assess 2019; 22:1-294. [PMID: 30501821 DOI: 10.3310/hta22660] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Rheumatoid arthritis (RA) is a chronic, debilitating disease associated with reduced quality of life and substantial costs. It is unclear which tests and assessment tools allow the best assessment of prognosis in people with early RA and whether or not variables predict the response of patients to different drug treatments. OBJECTIVE To systematically review evidence on the use of selected tests and assessment tools in patients with early RA (1) in the evaluation of a prognosis (review 1) and (2) as predictive markers of treatment response (review 2). DATA SOURCES Electronic databases (e.g. MEDLINE, EMBASE, The Cochrane Library, Web of Science Conference Proceedings; searched to September 2016), registers, key websites, hand-searching of reference lists of included studies and key systematic reviews and contact with experts. STUDY SELECTION Review 1 - primary studies on the development, external validation and impact of clinical prediction models for selected outcomes in adult early RA patients. Review 2 - primary studies on the interaction between selected baseline covariates and treatment (conventional and biological disease-modifying antirheumatic drugs) on salient outcomes in adult early RA patients. RESULTS Review 1 - 22 model development studies and one combined model development/external validation study reporting 39 clinical prediction models were included. Five external validation studies evaluating eight clinical prediction models for radiographic joint damage were also included. c-statistics from internal validation ranged from 0.63 to 0.87 for radiographic progression (different definitions, six studies) and 0.78 to 0.82 for the Health Assessment Questionnaire (HAQ). Predictive performance in external validations varied considerably. Three models [(1) Active controlled Study of Patients receiving Infliximab for the treatment of Rheumatoid arthritis of Early onset (ASPIRE) C-reactive protein (ASPIRE CRP), (2) ASPIRE erythrocyte sedimentation rate (ASPIRE ESR) and (3) Behandelings Strategie (BeSt)] were externally validated using the same outcome definition in more than one population. Results of the random-effects meta-analysis suggested substantial uncertainty in the expected predictive performance of models in a new sample of patients. Review 2 - 12 studies were identified. Covariates examined included anti-citrullinated protein/peptide anti-body (ACPA) status, smoking status, erosions, rheumatoid factor status, C-reactive protein level, erythrocyte sedimentation rate, swollen joint count (SJC), body mass index and vascularity of synovium on power Doppler ultrasound (PDUS). Outcomes examined included erosions/radiographic progression, disease activity, physical function and Disease Activity Score-28 remission. There was statistical evidence to suggest that ACPA status, SJC and PDUS status at baseline may be treatment effect modifiers, but not necessarily that they are prognostic of response for all treatments. Most of the results were subject to considerable uncertainty and were not statistically significant. LIMITATIONS The meta-analysis in review 1 was limited by the availability of only a small number of external validation studies. Studies rarely investigated the interaction between predictors and treatment. SUGGESTED RESEARCH PRIORITIES Collaborative research (including the use of individual participant data) is needed to further develop and externally validate the clinical prediction models. The clinical prediction models should be validated with respect to individual treatments. Future assessments of treatment by covariate interactions should follow good statistical practice. CONCLUSIONS Review 1 - uncertainty remains over the optimal prediction model(s) for use in clinical practice. Review 2 - in general, there was insufficient evidence that the effect of treatment depended on baseline characteristics. STUDY REGISTRATION This study is registered as PROSPERO CRD42016042402. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Rachel Archer
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Emma Hock
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Jean Hamilton
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - John Stevens
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Munira Essat
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Edith Poku
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Mark Clowes
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Abdullah Pandor
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Matt Stevenson
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
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Norton S, Fu B, Scott DL, Deighton C, Symmons DPM, Wailoo AJ, Tosh J, Lunt M, Davies R, Young A, Verstappen SMM. Health Assessment Questionnaire disability progression in early rheumatoid arthritis: systematic review and analysis of two inception cohorts. Semin Arthritis Rheum 2014; 44:131-44. [PMID: 24925692 PMCID: PMC4282305 DOI: 10.1016/j.semarthrit.2014.05.003] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 03/26/2014] [Accepted: 05/02/2014] [Indexed: 11/29/2022]
Abstract
Objective The Health Assessment Questionnaire is widely used for patients with inflammatory polyarthritis (IP) and its subset, rheumatoid arthritis (RA). In this study, we evaluated the progression of HAQ scores in RA (i) by systematically reviewing the published literature on the methods used to assess changes in functional disability over time and (ii) to study in detail HAQ progression in two large prospective observational studies from the UK. Methods Data from two large inception cohorts, ERAS and NOAR, were studied to determine trajectories of HAQ progression over time by applying latent class growth models (LCGMs) to each dataset separately. Age, sex, baseline DAS28, symptom duration, rheumatoid factor, fulfilment of the 1987 ACR criteria and socio-economic status (SES) were included as potential predictors of HAQ trajectory subgroup membership. Results The literature search identified 49 studies showing that HAQ progression has mainly been based on average changes in the total study population. In the HAQ progression study, a LCGM with four HAQ trajectory subgroups was selected as providing the best fit in both cohorts. In both the cohorts, older age, female sex, longer symptom duration, fulfilment of the 1987 ACR criteria, higher DAS28 and lower SES were associated with increased likelihood of membership of subgroups with worse HAQ progression. Conclusion Four distinct HAQ trajectory subgroups were derived from the ERAS and NOAR cohorts. The fact that the subgroups identified were nearly identical supports their validity. Identifying distinct groups of patients who are at risk of poor functional outcome may help to target therapy to those who are most likely to benefit.
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Affiliation(s)
- Sam Norton
- Psychology Department, Institute of Psychiatry, King׳s College London, London, UK
| | - Bo Fu
- Centre for Biostatistics, Institute of Population Health, The University of Manchester, Manchester, UK
| | - David L Scott
- Department of Rheumatology, Kings College Hospital, London, UK
| | - Chris Deighton
- Department of Rheumatology, Medical Specialities Out-Patients, Rehabilitation Block, Royal Derby Hospital, Derby, UK
| | - Deborah P M Symmons
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, The University of Manchester, Manchester Academic Health Science Centre, Stopford Building, Oxford Rd, Manchester M13 9PT, UK; NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust and University of Manchester Partnership, Manchester, UK
| | - Allan J Wailoo
- School of Health and Related Research, University of Sheffield, UK
| | - Jonathan Tosh
- School of Health and Related Research, University of Sheffield, UK
| | - Mark Lunt
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, The University of Manchester, Manchester Academic Health Science Centre, Stopford Building, Oxford Rd, Manchester M13 9PT, UK
| | - Rebecca Davies
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, The University of Manchester, Manchester Academic Health Science Centre, Stopford Building, Oxford Rd, Manchester M13 9PT, UK
| | - Adam Young
- Early Rheumatoid Arthritis Study, City Hospital, St Albans, UK
| | - Suzanne M M Verstappen
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, The University of Manchester, Manchester Academic Health Science Centre, Stopford Building, Oxford Rd, Manchester M13 9PT, UK.
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Halabi H, Alarfaj A, Alawneh K, Alballa S, Alsaeid K, Badsha H, Benitha R, Bouajina E, Al Emadi S, El Garf A, El Hadidi K, Laatar A, Makhloufi CD, Masri AF, Menassa J, Al Shaikh A, Swailem RA, Dougados M. Challenges and opportunities in the early diagnosis and optimal management of rheumatoid arthritis in Africa and the Middle East. Int J Rheum Dis 2014; 18:268-75. [PMID: 24620997 DOI: 10.1111/1756-185x.12320] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2014] [Indexed: 02/01/2023]
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.
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Affiliation(s)
- Hussein Halabi
- King Faisal Specialist Hospital & Research Centre, Jeddah, Saudi Arabia
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Cross M, Smith E, Hoy D, Carmona L, Wolfe F, Vos T, Williams B, Gabriel S, Lassere M, Johns N, Buchbinder R, Woolf A, March L. The global burden of rheumatoid arthritis: estimates from the global burden of disease 2010 study. Ann Rheum Dis 2014; 73:1316-22. [PMID: 24550173 DOI: 10.1136/annrheumdis-2013-204627] [Citation(s) in RCA: 703] [Impact Index Per Article: 70.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To estimate the global burden of rheumatoid arthritis (RA), as part of the Global Burden of Disease 2010 study of 291 conditions and how the burden of RA compares with other conditions. METHODS The optimum case definition of RA for the study was the American College of Rheumatology 1987 criteria. A series of systematic reviews were conducted to gather age-sex-specific epidemiological data for RA prevalence, incidence and mortality. Cause-specific mortality data were also included. Data were entered into DisMod-MR, a tool to pool available data, making use of study-level covariates to adjust for country, region and super-region random effects to estimate prevalence for every country and over time. The epidemiological data, in addition to disability weights, were used to calculate years of life lived with disability (YLDs). YLDs were added to the years of life lost due to premature mortality to estimate the overall burden (disability-adjusted life years (DALYs)) for RA for the years 1990, 2005 and 2010. RESULTS The global prevalence of RA was 0.24% (95% CI 0.23% to 0.25%), with no discernible change from 1990 to 2010. DALYs increased from 3.3 million (M) (95% CI 2.6 M to 4.1 M) in 1990 to 4.8 M (95% CI 3.7 M to 6.1 M) in 2010. This increase was due to a growth in population and increase in aging. Globally, of the 291 conditions studied, RA was ranked as the 42nd highest contributor to global disability, just below malaria and just above iodine deficiency (measured in YLDs). CONCLUSIONS RA continues to cause modest global disability, with severe consequences in the individuals affected.
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Affiliation(s)
- Marita Cross
- Institute of Bone & Joint Research, University of Sydney, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Emma Smith
- Institute of Bone & Joint Research, University of Sydney, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Damian Hoy
- School of Population Health, University of Queensland, Herston, Queensland, Australia
| | - Loreto Carmona
- Instituto de Salud Musculoesquelética (InMusc), Calle Hilarión Eslava, Madrid, Spain
| | - Frederick Wolfe
- National Data Bank for Rheumatic Diseases, Wichita, Kansas, USA
| | - Theo Vos
- School of Population Health, University of Queensland, Herston, Queensland, Australia Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Benjamin Williams
- Faculty of Medicine, University of New South Wales, St George Clinical School, Kogarah, New South Wales, Australia
| | - Sherine Gabriel
- Department of Health Sciences Research, Mayo Foundation, Rochester, Minnesota, USA
| | - Marissa Lassere
- Faculty of Medicine, University of NSW, Sydney, New South Wales, Australia Department of Rheumatology, St George Hospital, Sydney, New South Wales, Australia
| | - Nicole Johns
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Rachelle Buchbinder
- Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Victoria, Australia Department of Epidemiology & Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Anthony Woolf
- Department of Rheumatology, Royal Cornwall Hospital, Truro, UK
| | - Lyn March
- Institute of Bone & Joint Research, University of Sydney, Royal North Shore Hospital, St Leonards, New South Wales, Australia
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CHAAYA M, SLIM ZN, HABIB RR, ARAYSSI T, DANA R, HAMDAN O, ASSI M, ISSA Z, UTHMAN I. High burden of rheumatic diseases in Lebanon: a COPCORD study. Int J Rheum Dis 2011; 15:136-43. [DOI: 10.1111/j.1756-185x.2011.01682.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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