1. 1 Demographic and Clinical Characteristics of Rheumatoid Arthritis patients in some Arab States: Preliminary analysis Mohammed Hammoudeh Division of Rheumatology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar Member of Middle East Rheumatoid Arthritis Consortium (MERAC) Saskia Mandey, Mohammed Hammoudeh, Ziyad Mahfoud, Wessam G. Elhaq, Marjonneke J Mook-Kanamori, Rawan Shayboub, Samar Al Emadi, Humeira Badsha, Imad Uthman, Hussein Halabi, Basel Masri, Layla Kazkaz, Robert M. Plenge, Cindy McKeon, Thurayya Arayssi

2. Introduction As faculty of Weill Cornell Medical College in Qatar we are committed to providing transparency for any and all external relationships prior to giving an academic presentation. Mohammed Hammoudeh M.D.FACP I DO NOT have a financial interest in commercial products or service. Disclaimer

3. Introduction RA in the Middle East There are few systemic large studies of RA in the ME 15 studies, largest 160 patients, single center – RA is more common in females – High proportion of RF positivity – Association with SE – Conflicting results of severity – Delay in initiation of therapy 1,2 – Low use of DMARDS 1,2 Current study: Genetic studies of Rheumatoid Arthritis in some Arab States (GRAAS) 1.Badsha H et al. Ann Rheum Dis 66, 835 (2007) 2.Badsha H et al. Clin Rheumatol 27, 739-42 (2008)

4. Introduction Genetic studies of Rheumatoid Arthritis in some Arab States Goal: Investigate the genetic basis of RA in the Middle East by collecting at least 2000 RA and 2000 controls from 5 Rheumatology Centers across 5 Arab States.

5. Introduction Genetic studies of Rheumatoid Arthritis in some Arab States Goal: – Genome Wide Association Study (GWAS) that will test for >30 identified risk alleles identified in European and North American populations

6. Introduction Objective of this Presentation -So far 500 patients are recruited (350 RA and 150 Control )

7. Introduction Objective of this Presentation Describe the demographic and clinical characteristics of the first 150 Rheumatoid Arthritis patients from 5 countries in the Middle East recruited to date ( OCTOBER 2012- FEBRUARY 2013).

8. Introduction Inclusion Criteria Self reported Arab ancestry Age > 18 RA diagnosed per the ACR criteria Ability to provide informed consent

9. Introduction Data Collection Two sets of data were collected: – Demographic and clinical data – Ancestry data, based on self-reported ancestry All data entry is web-based and centralized at WCMC-Q

10. Introduction Results

11. Introduction Nationality Analysis done on 150 patients in February 2013 GulfLevant North Africa percentage (%)

12. Introduction Demographics/ Clinical Demographics/Clinical characteristicsNumberPercentage Gender Female Male 135 15 90 10 Family member with RA Yes3825.3 I don't know128 Extra-articular manifestation Yes42.7 Result of Anti CCP Positive6845.3 Negative8254.7 Result of Rheumatoid Factor Positive7751.3 Negative7348.7 Anti-CCP and/or RF positive9362.1 Analysis done on 150 patients in February 2013 Demographic/ clinical characteristicsMean (SD) Age in years49.9 (12.2) Age at diagnosis in years38.9 (12.7) Disease Duration in years11.1 (9.5)

13. Introduction Clinical history Clinical history characteristicsNumberPercentage History of Autoimmune Disease Yes10 6.7 No140 93.3 History of vascular disease Yes9 6 No141 94 Diabetes Yes type 12 1.3 Yes type 216 10.7 No132 88 Analysis done on 150 patients in February 2013

14. Introduction Demographics Analysis done on 150 patients in February 2013 Demographic characteristicsNumberPercentage Marital Status Married12080 Single1610.7 Divorced/ Separated/ Widowed149.3 Education No formal education/ primary school5134 Middle/ Secondary School4932.7 University5033.3

15. Introduction Lifestyle Clinical characteristicsNumberPercentage Cigarette smoking Current2416 Past85.3 never11878.7 Number of years smoking cigarettes Mean (SD)17.6 (13.1) [range][1-45] Shisha smoking Current1610.7 Past32 never13187.3 Number of years smoking shisha (in years) Mean (SD)7.8 (10.1) [range][1-38] Analysis done on 150 patients in February 2013

16. Introduction Medications Analysis done on 150 patients in February 2013 % (percentage) 86% of the patients are using Methotrexate;

17. Introduction Current Users Methotrexate 60% Oral steroids 35% HCQ 22% SSZ 5% Leflunamide 4.5% Etanrcep 11% Infliximab 4% Adalimumab 10% Rituximab 12% Total on Biologics 37%

18. Introduction Conclusions The patient population of this study is relatively young in comparison to mean age (56.2 years) in the other large databases

19. Introduction Conclusions The patient population of this study is relatively young in comparison to mean age (56.2 years) in the other large databases RF positivity and CCP positivity are low.

20. Introduction Conclusions The patient population of this study is relatively young in comparison to mean age (56.2 years) in the other large databases RF positivity and CCP positivity are low 1/3 of patients are illiterate, which may impact compliance and disease outcome

21. Introduction Conclusions The patient population of this study is relatively young in comparison to mean age (56.2 years) in the other large databases RF positivity and CCP positivity are low 1/3 of patients are illiterate, which may impact compliance and disease outcome Compared to the study done by Badsha et al, there is an increase in the use of Methotrexate (36% vs. 86%)

22. Introduction Conclusions The patient population of this study is relatively young in comparison to mean age (56.2 years) in the other large databases RF positivity and CCP positivity are low 1/3 of patients are illiterate, which may impact compliance and disease outcome Compared to the study done by Badsha et al, there is an increase in the use of Methotrexate (36% vs. 86%) 37% of our RA patients are on biologics ( in Europe 10-30%, in USA 40% )

23. Introduction Future Plans Analyze the demographic and clinical data on a regular basis Encourage more centers to join MERAC

24. Introduction Acknowledgements Weill Cornell Medical College-Qatar Saskia Mandey Ziyad Mahfoud Wessam G. Elhaq Marjonneke Mook-Kanamori Cindy McKeon Rawan Shayboub Thurayya Arayssi Hamad Medical Corporation, Doha, Qatar Mohammed Hammoudeh Samar Al Emadi Al Biraa Arthritis and Bone Clinic, Dubai, UAE Humeirah Badsha American University of Beirut, Lebanon Imad Uthman King Faisal Specialist Hospital & Research center, Jeddah, Kingdom of Saudi Arabia Hussein Halabi Jordan Hospital, Amman, Jordan Basel Masri Tishreen Hospital, Damascus, Syria Layla Kazkaz Broad Institute, Cambridge, MA, USA Robert Plenge

25. Introduction THANK YOU

26. Introduction Medications

27. Introduction Lifestyle