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• W49309093 abstract "Original ArticlesThe Prevalence of Rheumatoid Arthritis in the Qassim Region of Saudi Arabia Abdullah Al-Dalaan, ABIM FACR Suliman Al Ballaa, FRCP, FACR Sultan Bahabri, FRCPC T. Biyari, MD M. Al Sukait, and MD M. MousaMDMRCP Abdullah Al-Dalaan Address reprint requests and correspondence to Dr. Al-Dalaan: Deputy Director, Academic Affairs & Postgraduate Education, MBC-36, King Faisal Specialist Hospital and Research Centre, P.O. Box 3354, Riyadh 11211, Saudi Arabia. From the Departments of Medicine. King Saud University, Riyadh Search for more papers by this author , Suliman Al Ballaa King Faisal Specialist Hospital and Research Centre, the College of Medicine. King Saud University, Riyadh Search for more papers by this author , Sultan Bahabri From the Departments of Pediatrics. King Saud University, Riyadh Search for more papers by this author , T. Biyari From the King Saud University, the Ministry of Health, Riyadh Search for more papers by this author , M. Al Sukait King Faisal Specialist Hospital and Research Centre, the College of Medicine. King Saud University, Riyadh Search for more papers by this author , and M. Mousa From the Department of Medicine, King Fahad Specialist Hospital, Al Qassim, Saudi Arabia. Search for more papers by this author Published Online:1 Sep 1998https://doi.org/10.5144/0256-4947.1998.396SectionsPDF ToolsAdd to favoritesDownload citationTrack citations ShareShare onFacebookTwitterLinked InRedditEmail AboutAbstractBACKGROUND:Although rheumatoid arthritis (RA) of varying degrees of severity has been seen in our clinics, there is no statistical evidence of the magnitude of the problem in Saudi nationals. We conducted this study to determine the prevalence of RA in the Al Qassim Region of Saudi Arabia.PATIENTS AND METHODS:Five thousand eight hundred and ninety-one Saudi adults, aged 16 years and over, were studied in a house-to-house survey in the Al Qassim Region.RESULTS:Of the 5891 adults studied, 13 cases of RA were identified, using the criteria set for the diagnosis of RA by the American College of Rheumatology. Thirty-five percent of our patients showed positive rheumatoid factor.CONCLUSION:The prevalence of RA in A1 Qassim was estimated at 2.2 per thousand people. It was also noted that the prevalence of the disease increased with age, and that it was more common in females.IntroductionRheumatoid arthritis (RA) is a common chronic inflammatory disease in developed countries. The prevalence of RA varies from country to country, from 0.7%1 to 3%,2 with an average of 1% in the adult population.3,4 In the Gulf region, two studies estimated the prevalence of RA to be 1% in the Iraqi population,5 and 0.36% in the Omani population.6It is important to know the magnitude of the problem in Saudi Arabia, because the disease has been shown to put an enormous economic burden on the health services in particular, and on the society in general. The disease has been described as the most common inflammatory arthritis in a hospital-based population study in Saudi Arabia, and appears to be less severe than those encountered in developed countries,7 but the magnitude of the problem in the general population is not fully known.MATERIALS AND METHODSBecause of the logistic and practical problems in population surveys for RA, which require detailed clinical examinations, personal histories and radiological and serological investigations of the subjects involved, the study was limited to the Al Qassim region in the Central part of Saudi Arabia. Based on the 1992 census figures, Qassim region has a population of 660,000, with a national growth rate of 5%, as estimated by the Ministry of Finance.We divided the region into three strata, according to the population density, as follows: large (>20,000 population), medium (5,000-20,000 population), and small (<5,000 population). Random samples were selected from each of the two large and medium-sized populations, while the third stratum of five villages was selected with probability proportionate to their size. Each village was treated as a cluster, and the number of households in each cluster or village was noted.The work was divided into three phases. During phase 1, a general practitioner and two nurses administered personal interviews to all inhabitants of the selected households. The main purpose of this was to identify individuals with symptoms of RA. In phase 2, trained nurses and paramedics administered a detailed questionnaire to all individuals identified in phase 1, with symptoms suggestive of RA. During phase 3, we interviewed and examined the cases identified in phase 2, followed by radiological investigations of the hands, knees and chest. Quantitative and semi-quantitative determination of rheumatoid factor (RF) in serum samples was determined by latex agglutination slide test, using Humatex RF test kits (Human Gesellschaft für Biochemica und Diagnostica mbh, Taunusstein, Germany), according to the manufacturer’s instructions. All individuals at this stage were examined by a rheumatologist at King Fahad Hospital in Qassim.RESULTSOf the 5891 adults studied, 2674 were male and 3197 were female. Thirteen cases of RA were diagnosed according to ACR (American College of Rheumatology) criteria proposed in 1987 for RA diagnosis. 8 The prevalence in the adult general population was 0.22%. The prevalence according to sex was 0.18% in adult males and 0.25% in adult females. The results also showed that the prevalence of the disease increased with age. Figure 1 summarizes our findings.The RF was tested in all the serum samples collected. Of the 3977 serum samples collected, 113 were positive for RF (a prevalence of 2.8% in the general population). We found that nine patients out of 13 (65%) were RF-negative and four were RF-positive (35%). A titer equal to or greater than 1:80 was considered positive. Radiological examination showed evidence of erosion in only two patients, and both had positive RF in high titer. Other patients showed evidence of juxta-articular osteoporosis, with soft tissue swelling and no evidence of erosion.DISCUSSIONThere is a widespread view that connective tissue diseases, in particular RA, are not common in Saudi Arabia. Another belief is that RA in Saudi Arabia is a less aggressive disease, in comparison to that in Western patients. The population survey of 5891 adults suggests a prevalence of RA in Qassim of 0.22% for adults aged 16 and above. The prevalence of RA in Al Qassim (which represents a homogenous Arab population) is lower than in Western countries. 1–2 On the other hand, the prevalence is almost similar to that in rural black South Africans (0.12%) 9 and in the Chinese (0.3%). 10 Two similar studies conducted in Iraq and Oman showed RA prevalence of 1% and 0.36%, respectively. 5,6 The Iraq study showed a high prevalence because they used the 1958 ACR criteria, which are less specific. One of the probable reasons for the lower RA prevalence rate in developing countries is the predominance of a younger population. For example, of the over 10,000 people surveyed in our study, just over 40% were less than 16 years of age.Genetic factors may play a role in this geographical variation, in view of the association between HLA-type and RA in various races.11,12 Our study also showed that RA prevalence is more common in adult females (0.25%) in comparison to adult males (0.18%), where the literature survey showed a prevalence varying between 0.5%-3.8% in women and from 0.15%-1.37% in men, with peak incidence in the fourth decade of life.4,13Table 1. Summary of prevalence of RA in general population according to age and sex.Table 1. Summary of prevalence of RA in general population according to age and sex.Of the 13 patients with RA in our study, only two showed radiological evidence of erosive changes (15%).Rheumatic disorder has often been given low priority in developing countries, but our experience shows that inflammatory polyarthritis and collagen vascular diseases are not uncommon. This indicates the need for a nationwide study to look at the prevalence of connective tissue diseases in the Kingdom of Saudi Arabia. We are hoping to implement this study in the near future.ARTICLE REFERENCES:1. Cobb S, Warren JE, Merchant WR, Thompson DJ. An estimate of the prevalence of rheumatoid arthritis . J Chron Dis. 1957; 5:636–43. Google Scholar2. Laine VAI. Rheumatic complaints in an urban population in Finland . Acta Rheum Scand. 1962; 8:81–8. Google Scholar3. Wood PHN, Badley EM. Epidemiology of individual rheumatic disorders. In: Scott JT, editor. Copeman's Textbook of Rheumatic Diseases. 6.th edition. Edinburgh: Churchill Livingstone, 1986:63–7. Google Scholar4. Lawrence JS. Rheumatoid arthritis. In: Rheumatism in Populations. London: Heinemann Medical, 1977:202–7. Google Scholar5. Al Kawi ZS, Alzzawi AJ, Al Ajili FM, Al Wakili R. Rheumatoid arthritis in population samples in Iraq . Ann Rheum Dis. 1978; 37:73–5. Google Scholar6. Pountain G. The prevalence of rheumatoid arthritis in the Sultanate of Oman . Br J Rheumatol. 1991; 30:24–8. Google Scholar7. Rajapakse CNA. The spectrum of rheumatic diseases in Saudi Arabia . Br J Rheumatol. 1987; 26:22–3. Google Scholar8. Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS, et al. The American Rheumatism Association 1987 Revised Criteria for the Classification of Rheumatoid Arthritis . Arthritis Rheum. 1988; 31:315–23. Google Scholar9. Beighton P, Solomon L, Valkenburg HA. Rheumatoid arthritis in a rural South African Negro population . Ann Rheum Dis. 1975; 34:136–41. Google Scholar10. Beasley RP, Bennett PH, Lin CC. Low prevalence of rheumatoid arthritis in Chinese: prevalence survey in a rural community . J Rheumatol. 1983;(Suppl 10): 11–5. Google Scholar11. Roitt IM, Corbett M, Festenstein H, Jaraquemada D, Papasteriadis C, Hay FC, et al. HLA DRW4 and prognosis in rheumatoid arthritis . Lancet (letter). 1978; I:990. Google Scholar12. Woodrow JC, Nichol FE, Zaphiropoulos G. DR antigens and rheumatoid arthritis: a study of two populations . BMJ. 1981; 283:1287–8. Google Scholar13. Wolfe AM. The epidemiology of rheumatoid arthritis: a review . Bull Rheum Dis. 1968; 19:518–21. Google Scholar Previous article Next article FiguresReferencesRelatedDetailsCited byAl-Ghamdi A and Attar S (2019) Extra-articular manifestations of rheumatoid arthritis: a hospital-based study, Annals of Saudi Medicine , 29:3, (189-193), Online publication date: 1-May-2009. Volume 18, Issue 5September 1998 Metrics History Received28 December 1997Accepted7 June 1998Published online1 September 1998 KeywordsprevalenceRheumatoid arthritisACKNOWLEDGEMENTSWe are sincerely grateful to Dr. Anwar Al Jabarti, Chief Executive Director of King Faisal Specialist Hospital and Research Centre, for sponsoring this study. Appreciation is also due to the support staff of KFSH&RC, and to Ms. Dolly Raiz for secretarial assistance.InformationCopyright © 1998, Annals of Saudi MedicinePDF download" @default.
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