October 12 marked World Arthritis Day. Arthritis is a general term for inflammation, which manifests itself in a number of diseases such as rheumatoid arthritis, gout and osteoarthritis. If left untreated, it can be painful and debilitating, effecting your ability to work. Dr Jamal Al Saleh, Head of Rheumatology at Dubai Hospital, says the key to tackling the condition is early detection. “If inflammation continues, it will result in sub-chemical damage inside the joint,” he says. “This will eventually result in deformity. Therefore, the European League Against Rheumatism has recommended that patients with symptoms should be seen and assessed by a rheumatologist within 40 days of the onset of the symptoms.
“In Dubai Health Authority, when GPs, primary healthcare centres and other specialities have a doubt about whether a patient is suffering from arthritis, they refer the patient to our clinic. The problem we have is the time the patient takes between experiencing symptoms and seeing a doctor. This is an international problem.
“In countries such as Saudi Arabia, the journey from experiencing symptoms to seeing a dermatologist is about three years. In the UAE, it’s around three months. Around 35 per cent of our patients refer themselves on time, which is comparable to countries such as the UK.”
Another reason for early detection is that arthritis can be particular damaging in its initial stages. “Studies have shown that the greatest damage from arthritis occurs early in the disease rather than later,” says Dr Saleh. “Early diagnosis and early treatment will prevent a lot of deformities, especially in chronic cases. If you have a joint pain that is worse in the morning, this could be a symptom of rheumatoid arthritis.
“There are two types of arthritis: chronic and acute. For example, if you have an infection, you might have arthritis for a couple of days and then it will go away. In less than 20 per cent of cases, the symptoms remain for six months.”
There are a number of misapprehensions surrounding arthritis, particularly over who the condition effects. “There is a misconception that chronic arthritis affects the elderly population and that it affects more females than males,” says Dr Saleh. “People also think that its mostly affects Caucasians and that Arabs are largely unaffected. We conducted a study on 5,000 Emiratis in Dubai and we found that the prevalence of rheumatoid arthritis was around 1 per cent, about the same as Caucasian populations, and the median age for people with the condition was 28.
“For treatments of arthritis, we group them as either mechanical or inflammatory. Osteoarthritis is more common in the elderly. From the age of 60, you have a one in two chance of developing the condition and between 40 and 60 you have a one in five chance of suffering from the problem.”
When someone is diagnosed with arthritis, a blood test will reveal if the patient is seropositive or seronegative. This refers to the presence of an antibody in the blood that’s known as the rheumatoid factor. Around 70 per cent of people with rheumatoid arthritis are seropositive. If a person is seronegative, one marker for rheumatoid arthritis is HLA-B27, a protein found in white blood cells that contributes to immune function disruption. For seronegative people, conditions such as psoriatic arthritis and reactive arthritis are more common.
“In terms of treatments, it’s not only a case of try to prevent inflammation but it’s also about trying to stop the damage,” says Dr Saleh. “We try to achieve remission rather than symptom control.
“For rheumatoid arthritis treatment, we usually start with a disease-modifying antirheumatic drug, based on the patient’s individual circumstances. It depends on the gender of the patient, their preference for taking medication daily or weekly as well as their lifestyle preferences, such as whether they are trying to conceive.
“If in three months the patient hasn’t reached the clinical targets we’re aiming for, we either combine the medication with something else or start biologics.”
For a significant amount of patients, if you achieve remission, then you can taper and reduce the medication and if you’re lucky, you may not need to take any medication.
The good news is that for the majority of patients who achieve remission or their clinical target, where there is no clinical damage happening inside the joints, they can continue to live on minimum medication with no symptoms.
Nevertheless, Dr Saleh emphasises the benefits of early detection. “If you have joint pain or symptoms such as tennis elbow and pain in the heel, I would advise that you go to the doctor straight away and don’t wait.”