Clin Rheumatol. 2013 Feb;32(2):151-9. doi: 10.1007/s10067-012-2153-7. Epub 2012 Dec 30.
Although the prevalence of RA in the Middle East and Africa is comparable with that in other parts of the world, evidence indicates that its management in this region is suboptimal for a variety of reasons, including misconceptions and misunderstandings about the disease's prevalence and severity in the region, compounded by the lack of local epidemiological and health-economic data around the disease; the perception that RA is a low priority compared with other more prevalent conditions; delayed diagnosis, referral and treatment; and a lack of a region-specific, evidence-based management approach. In the absence of such an approach, the EULAR treatment recommendations may provide a useful starting point for the creation of guidelines to suit local circumstances. However, although agreement with the EULAR recommendations is high, many barriers prevent their implementation in clinical practise, including lack of timely referral to rheumatologists; suboptimal use of synthetic DMARDs; poor access to biologics; lack of awareness of the burden of RA among healthcare professionals, patients and payers; and lack of appropriate staffing levels.To optimise the management of RA in the Middle East and Africa, will require a multi-pronged approach from a diverse group of stakeholders-including local, national and regional societies, such as the African League of Associations in Rheumatology and International League of Associations for Rheumatology, and service providers-to collect data on the epidemiology and burden of the disease; to increase awareness of RA and its burden among healthcare professionals, payers and patients through various educational programmes; to encourage early referral and optimise use of DMARDs by promoting the EULAR treatment recommendations; to encourage the development of locally applicable guidelines based on the EULAR treatment recommendations; and to facilitate access to drugs and the healthcare professionals who can prescribe and monitor them.
虽然中东和非洲的 RA 患病率与世界其他地区相当，但有证据表明，由于该地区对疾病的流行和严重程度存在误解和误解，加上缺乏有关该疾病的当地流行病学和健康经济学数据；与其他更为普遍的疾病相比，人们认为 RA 优先级较低；诊断、转诊和治疗的延迟；以及缺乏针对该地区的、基于证据的管理方法等各种原因，该地区的 RA 管理并不理想。在缺乏这种方法的情况下，EULAR 的治疗建议可能为制定适合当地情况的指南提供有用的起点。然而，尽管与 EULAR 建议的一致性很高，但许多障碍阻止了它们在临床实践中的实施，包括未能及时转诊给风湿病学家；合成 DMARDs 的使用不理想；生物制剂的获取途径不佳；医疗保健专业人员、患者和付款人对 RA 负担的认识不足；以及缺乏适当的人员配备水平。为了优化中东和非洲的 RA 管理，需要包括当地、国家和地区协会（如非洲风湿病学协会联盟和国际风湿病学协会联盟）在内的利益相关者采取多管齐下的方法，以及服务提供商，以收集有关疾病的流行病学和负担的数据；通过各种教育计划提高医疗保健专业人员、付款人和患者对 RA 及其负担的认识；通过推广 EULAR 治疗建议，鼓励及早转诊并优化 DMARD 的使用；鼓励根据 EULAR 治疗建议制定适用于当地的指南；并为药物和能够开处方和监测药物的医疗保健专业人员提供便利。
