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 Table of Contents  
REVIEW & CASE REPORT
Year : 2022  |  Volume : 2  |  Issue : 1  |  Page : 1-5

Demographic similarity and variability between patients with juvenile idiopathic arthritis in the gulf cooperation council countries


1 Pediatric Rheumatology, King Faisal Specialist Hospital and Research, Riyadh, Saudi Arabia
2 Pediatric Rheumatology, AlSabah Hospital, Kuwait
3 Pediatric Rheumatology, King Faisal Specialist Hospital and Research; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia

Date of Submission30-Jan-2022
Date of Decision08-Mar-2022
Date of Acceptance14-Mar-2022
Date of Web Publication25-May-2022

Correspondence Address:
Prof. Sulaiman M Al-Mayouf
Professor, Consultant of Pediatric Rheumatology, Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Alfaisal University, Riyadh 11211
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ara.ara_4_22

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  Abstract 


To highlight the similarities and variability between patients with juvenile idiopathic arthritis (JIA) in the Gulf Cooperation Council (GCC) countries. We comprehensively conducted electronic searches through PubMed and Google Scholar for relevant studies using the appropriate MeSH terms related to demographic and clinical features of JIA. The search was limited to articles from January 1988 to October 2021. Authors independently reviewed the searched literature to identify eligible studies. Citations from selected articles were also checked for additional eligible studies. Data were retrieved from seven eligible studies. A total of 757 JIA patients with a mean age of 10.7 ± 4.6 years were identified from four different countries (Saudi Arabia, UAE, Kuwait, and Oman); there were no published reports from Bahrain or Qatar. Two studies identified the estimated prevalence rate of nearly 20 per 100,000. There was a female predominance (62.1%). The mean age at the onset of JIA manifestations was 6.3 ± 3.9 years. Thirty-two out of 377 (8.5%) patients had a positive family history of JIA. Interestingly, Omani cohort had the highest frequency (9.8%) of affected siblings with JIA. The most frequent JIA subtypes were oligoarticular JIA, followed by polyarticular and systemic JIA. Of note, oligoarticular JIA was more frequent in UAE and Omani cohorts, while systemic JIA was more prevalent in Saudi and Kuwaiti cohorts. Uveitis occurred in 5.0% (n = 38) of patients during their disease course, mostly in oligoarticular category. Detection of positive anti-nuclear antibody was in 37.3% while rheumatoid factor and anti-cyclic citrullinated peptide were 21% and 10.5% respectively. Our findings estimated the number of children affected by JIA, and showed demographic similarities between patients. However, more studies are needed to address the incidence and prevalence, and the true burden of this disease in the GCC countries.

Keywords: Arabian Gulf countries, familial arthritis, Gulf Cooperation Council, juvenile idiopathic arthritis


How to cite this article:
AlKhars F, Almutairi N, Al-Mayouf SM. Demographic similarity and variability between patients with juvenile idiopathic arthritis in the gulf cooperation council countries. Ann Rheumatol Autoimmun 2022;2:1-5

How to cite this URL:
AlKhars F, Almutairi N, Al-Mayouf SM. Demographic similarity and variability between patients with juvenile idiopathic arthritis in the gulf cooperation council countries. Ann Rheumatol Autoimmun [serial online] 2022 [cited 2022 Jun 29];2:1-5. Available from: http://www.ara.ssr.com/text.asp?2022/2/1/1/345951




  Introduction Top


Juvenile idiopathic arthritis (JIA) is the most common chronic childhood rheumatic disease; the incidence and prevalence varied greatly among published data.[1],[2],[3] JIA is heterogeneous in clinical presentation and course, and probably distinct epidemiological presentations, disease pathogenesis, and genetic background.[4],[5],[6],[7] The clinical characteristics of JIA have been well described in different countries. Remarkably, the prevalence and severity of the disease differ among ethnic groups.[6],[7],[8],[9],[10],[11],[12] The available published data over the last 30 years from Arab countries about JIA incidence and prevalence remained limited. It is worth mentioning that several nomenclature and classification have been used to categorize patients with juvenile arthritis. The terms juvenile chronic arthritis (JCA) and juvenile rheumatoid arthritis (JRA) have been replaced by JIA.[5] Most of the clinical studies from Arab countries were retrospective single centered.[13],[14],[15],[16] Interestingly, most of these data originate from the Gulf Cooperation Council (GCC) countries.[14],[17],[18],[19],[20],[21] Of note, these countries are Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and UAE, which constitute the GCC. A systematic review of all published studies from these countries can determine the phenotypic features and treatment approach to JIA. Our study aimed to highlight the similarities and variability between patients with JIA throughout the GCC countries.


  Methods Top


Search strategy

We conducted comprehensive electronic searches using PubMed and Google Scholar from January 1988 to October 2021 using the following MeSH terms: Juvenile idiopathic arthritis, JIA, juvenile rheumatoid arthritis, JRA, juvenile chronic arthritis, JCA, or childhood arthritis. Geographic filters for Arabian Gulf, Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and United Arab Emirates (UAE) were applied. All English medical literatures were reviewed to identify the relevant articles. The listed references in the included studies were screened for additional eligible studies. Authors independently screened the retrieved publications for the eligibility. We resolved disagreements by verification.

Inclusion and exclusion criteria

The included children should meet the following criteria: Diagnosis of JIA based on the International League of Association for Rheumatology (ILAR) criteria or American College of Rheumatology (ACR) criteria for JIA and JRA, respectively.[4],[7] Articles describing different types of arthritis or arthropathy were excluded. Furthermore, single case report, editorial, letter to the Editor, or articles with insufficient data were excluded. Full-text articles were then retrieved for further review. To avoid any duplication, reports of similar data from the same center were not included. All included patients must be citizens of the GCC countries or residing in those countries.

Data extraction

The extracted data comprised age, gender, age at diagnosis, JIA category, history of uveitis through the disease course. Furthermore, we gathered data of familial JIA. Relevant laboratory data, including anti-nuclear antibody (ANA), rheumatoid factor (RF), and anti-cyclic citrullinated peptide antibody (anti-CCP), and human leukocyte antigen B-27 (HLA B-27) were collected.

Due to the nature of this work, all data were extracted from the published articles. Thus, no ethical clearance was required.

Statistical analysis

Statistical analyses were performed using the SAS software package version 9.4 (Statistical Analysis System, SAS Institute, Inc., Cary, NC, USA). Descriptive statistics for continuous variables were reported as mean ± standard deviation and categorical variables were summarized as frequencies and percentages.


  Results Top


The articles selection process is shown in a flow chart [Figure 1]. Electronic search returned 53 articles. After discarded 19 articles with irrelevant content, 34 articles remained. We excluded 27 articles because either only case reports, or duplicates or insufficient data. We remained with seven retrospective studies. A total of 757 patients (fulfilled either the ACR criteria for JRA or ILAR criteria for JIA) with a mean age of 10.7 ± 4.6 (range 9.9–11.2) years were reported from four different GCC countries (Saudi Arabia, UAE, Kuwait, and Oman). Two studies, one hospital-based study from Kuwait, and another population-based, multicenter study from Oman, identified the estimated prevalence rate of nearly 20 per 100,000.[14],[17] There was a female predominance (62.1%); the highest female: Male ratio was from Oman (3.6: 1). The mean age at the onset of JIA manifestations was 6.3 ± 3.9 years, whereas the mean disease duration was 4.3 ± 4.4 years. Thirty-two (8.5%) out of 377 patients (there was no available data for 380 patients) had a positive family history of JIA. Interestingly, Omani cohort showed that the highest frequency (9.8%) of affected siblings with JIA. [Table 1] summarizes the demographics of patients with JIA from four GCC countries. The time to diagnose the patients was ranging from 1 to 6 months. The most frequent JIA subtypes were oligoarticular JIA (35.1%), followed by polyarticular (31.9%) with marginal RF negative polyarticular JIA preponderance (17.6%).
Figure 1: Flow chart of the article selection

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Table 1: Comparison of demographic data of patients with juvenile idiopathic arthritis in Gulf Cooperation Council countries

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A comparison of the frequency of JIA subtypes and relevant autoantibodies presented in [Table 2]. According to disease distribution, oligoarticular JIA was more prevalent in UAE and Omani cohorts. In contrast, systemic JIA was more prevalent in Saudi and Kuwaiti cohorts. Interestingly, systemic JIA represents only 10.4% of the UAE patients. furthermore, one study from Kuwait reported a predominance of RF positive polyarticular JIA (29.5%) as compared to other cohorts. Psoriatic arthritis, enthesitis-related arthritis, and undifferentiated JIA were the least reported JIA subtypes throughout the cohorts. [Figure 2] represents the spectrum and frequency of JIA subtypes in GCC countries. Thirty-eight patients (5.0%) had uveitis during their disease course, mostly in oligoarticular category. One hundred and forty-nine (37.3%) patients had a positive ANA test. In contrast, RF and anti-CCP were detected in 9.8% and 10.5% respectively, while HLA B-27 was positive in 5.3% of the tested JIA patients. In general, patients from Saudi Arabia had the highest frequency of autoantibodies (ANA, RF, and anti-CCP), while patients from UAE showed the lowest frequency of these autoantibodies.
Table 2: The spectrum and frequency of juvenile idiopathic arthritis subtypes in Gulf Cooperation Council countries

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Figure 2: Spectrum and frequency of juvenile idiopathic arthritis subtypes in the Gulf Cooperation Council countries

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  Discussion Top


JIA is a heterogeneous condition that primarily affects the musculoskeletal system but may impact growth and vision. The prevalence and outcome of JIA differ among ethnic groups.[2],[22],[23] Compared to worldwide, the published data about the epidemiology and demographic of JIA from Arab world, including GCC countries, are scarce and limited to case reports and small cohorts from single tertiary centers. It is worth mentioning that the GCC countries share common features of ethnic background and high consanguinity rate. Also, the infrastructure of health services, including the availability of diagnostic and therapeutic resources, are comparable.

In this study, we highlighted the demographic similarities and variability between patients with JIA across the GCC countries. Our systematic search found only seven studies of different designs from Saudi Arabia, UAE, Kuwait, and Oman. Unfortunately, we could not find published data from Bahrain or Qatar. It is essential to note that the data accessed made precise comparisons and interpretation between the different cohorts challenging. We estimated the total number of children with JIA to be 757 patients, and demographic similarity has been demonstrated among JIA patients. Although a couple of studies identified the prevalence in two GCC countries, the precise incidence and prevalence of JIA across the GCC countries are not well defined yet.[14],[17] Thus, the current epidemiological data should be interpreted carefully because of the paucity of adequate studies and the heterogeneity of the available data. Our findings showed that JIA is more predominant in female patients. However, there was some variability in gender distribution across the JIA subtypes. In general, patients with oligoarticular and polyarticular subtype had the highest female to male ratio compared to other subtypes. However, a predominance of the female gender was observed in Omani children with RF positive polyarticular JIA. Interestingly, clustering of juvenile arthritis cases like other familial autoimmune diseases is prevalent in Arabs, which might be linked to the high consanguinity rate.[24],[25] Remarkably, previous study suggested that the frequency of familial cases of juvenile arthritis was high.[21] The current study confirmed similar findings. However, the observed frequency of familial cases in the current study was lower than the previously reported; this variance is probably related to the methodology and nature of these studies. The variability in the disease subtypes and laboratory variables among JIA patients from GCC countries was not major. Like other published data, the most frequent JIA subtypes were oligoarticular JIA followed by polyarticular. However, this study showed a relatively low prevalence of systemic JIA among UAE patients. On the other hand, although there is a disparity, the frequencies of other JIA subtypes were comparable. Similar observation on the relevant autoantibody profile; UAE cohort showed the lowest frequency of these autoantibodies. The exact rationalization for the clinical and laboratory divergence among JIA patients from the GCC countries remains blurred. However, referral bias cannot be excluded.

This study has limitations and results should be interpreted carefully due to the nature of the available data. The collected data were retrieved from different studies designed for various purposes and the time span of studies varied. Some of these studies were conducted a long time ago.[17],[18] An important aspect, this study did not address medications use, disease course, and long-term outcome.

In summary, this study from the GCC countries presents the first data on demographic similarity and variability in patients with JIA. However, more studies are needed to address the incidence and prevalence, and the true burden of this disease in the GCC countries.

Ethics statement

All procedures described in this manuscript were performed in accordance with the ethical standards.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Figures

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