Epidemiology and demographics of juvenile idiopathic arthritis in Africa and Middle East

Affiliations

02 December 2021

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doi: 10.1186/s12969-021-00650-x


Abstract

Juvenile Idiopathic Arthritis (JIA) is a group of chronic heterogenous disorders that manifests as joint inflammation in patients aged <16 years. Globally, approximately 3 million children and young adults are suffering from JIA with prevalence rates consistently higher in girls. The region of Africa and Middle East constitute a diverse group of ethnicities, socioeconomic conditions, and climates which influence the prevalence of JIA. There are only a few studies published on epidemiology of JIA in the region. There is an evident paucity of adequate and latest data from the region. This review summarizes the available data on the prevalence of JIA and its subtypes in Africa and Middle East and discusses unmet needs for patients in this region. A total of 8 journal publications were identified concerning epidemiology and 42 articles describing JIA subtypes from Africa and Middle East were included. The prevalence of JIA in Africa and Middle East was observed to be towards the lower range of the global estimate. We observed that the most prevalent subtype in the region was oligoarticular arthritis. The incidence of uveitis and anti-nuclear antibody (ANA) positivity were found to be lower as compared to the incidence from other regions. There is a huge unmet medical need in the region for reliable epidemiological data, disease awareness, having regional and local treatment guidelines and timely diagnosis. Paucity of the pediatric rheumatologists and economic disparities also contribute to the challenges regarding the management of JIA.

Conflict of interest statement

Sara Habjoka and Nouran Tahoun are employees of Pfizer Ltd. All other authors report no potential conflicts of interest.


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References

  1.  
    1. Giancane G, Consolaro A, Lanni S, Davi S, Schiappapietra B, Ravelli A. Juvenile Idiopathic Arthritis: Diagnosis and Treatment. Rheumatol Ther. 2016;3:187–207. - PMC - PubMed
  2.  
    1. Ravelli A, Martini A. Juvenile idiopathic arthritis. Lancet. 2007;369(9563):767–778. - PubMed
  3.  
    1. Jacobson JL, Pham JT. Juvenile Idiopathic Arthritis: A Focus on Pharmacologic Management. J Pediatr Health Care. 2018;32(5):515–528. - PubMed
  4.  
    1. Saad N, Onel K. Overview of Juvenile Idiopathic Arthritis. The Open Orthopaedics Journal. 2020;14:101–109.
  5.  
    1. Verstappen SM, Cobb J, Foster HE, Fu B, Baildam vhE, Wedderburn LR, et al. The association between low socioeconomic status with high physical limitations and low illness self-perception in patients with juvenile idiopathic arthritis: results from the Childhood Arthritis Prospective Study. Arthritis Care Res (Hoboken). 2015;67(3):382–9. - PMC - PubMed
  6.  
    1. Dave M, Rankin J, Pearce M, Foster HE. Global prevalence estimates of three chronic musculoskeletal conditions: club foot, juvenile idiopathic arthritis and juvenile systemic lupus erythematosus. Pediatr Rheumatol. 2020;18:49. - PMC - PubMed
  7.  
    1. McHugh J. Global prevalence of JIA, JSLE and club foot. Nat Rev Rheumatol. 2020;16(8):408. - PubMed
  8.  
    1. Thierry S, Fautrel B, Lemelle I, Guillemin F. Prevalence and incidence of juvenile idiopathic arthritis: a systematic review. Joint Bone Spine. 2014;81(2):112–117. - PubMed
  9.  
    1. Hoy D, Brooks P, Woolf A, Blyth F, March L, Bain C, et al. Assessing risk of bias in prevalence studies: modification of an existing tool and evidence of interrater agreement. J Clin Epidemiol. 2012;65(9):934–939. - PubMed
  10.  
    1. Usenbo A, Kramer V, Young T, Musekiwa A. Prevalence of Arthritis in Africa: A Systematic Review and Meta-Analysis. PLoS ONE. 2015;10(8):e0133858. - PMC - PubMed
  11.  
    1. Abdwani R, Abdalla E, Al Abrawi S, Al-Zakwani I. Epidemiology of juvenile idiopathic arthritis in Oman. Pediatr Rheumatol Online J. 2015;13:33. - PMC - PubMed
  12.  
    1. Abou El-Soud AM, El-Najjar AR, El-Shahawy EE, Amar HA, Hassan TH, Abd-Allaha SH, et al. Prevalence of juvenile idiopathic arthritis in Sharkia Governorate, Egypt: epidemiological study. Rheumatol Int. 2013;33(9):2315–2322. - PubMed
  13.  
    1. Khuffash FA, Majeed HA. Juvenile rheumatoid arthritis among Arab children. Scand J Rheumatol. 1988;17(5):393–395. - PubMed
  14.  
    1. Khuffash FA, Majeed HA, Lubani MM, Najdi KN, Gunawardana SS, Bushnaq R. Epidemiology of juvenile chronic arthritis and other connective tissue diseases among children in Kuwait. Ann Trop Paediatr. 1990;10(3):255–259. - PubMed
  15.  
    1. Ozen S, Karaaslan Y, Ozdemir O, Saatci U, Bakkaloglu A, Koroglu E, et al. Prevalence of juvenile chronic arthritis and familial Mediterranean fever in Turkey: a field study. J Rheumatol. 1998;25(12):2445–2449. - PubMed
  16.  
    1. Singwe-Ngandeu M, Mfegue Mengue AL, Ondoa Mekongo M, Ibrahima F, Mbassi Awa HD. Rheumatic diseases in African children: A hospital based study inYaounde, Cameroon. Clinical Rheumatology. 7th Congress of the African League of Associations for Rheumatology, AFLAR and 23rd Congress of the South African Rheumatism and Arthritis Association, SARAA Durban South Africa: Springer; 2013.
  17.  
    1. Tayel MY, Tayel KY. Prevalence of juvenile chronic arthritis in school children aged 10 to 15 years in Alexandria. J Egypt Public Health Assoc. 1999;74(5-6):529–546. - PubMed
  18.  
    1. Singwe-Ngandeu M, Meli J, Ntsiba H, Nouedoui C, Yollo AV, Sida MB, et al. Rheumatic Diseases in Patients Attending a Clinic at a Referral Hospital in Yaounde. Cameroon East Afr Med J. 2007;84(9):404–409. - PubMed
  19.  
    1. Brewer EJ, Jr, Bass J, Baum J, Cassidy JT, Fink C, Jacobs J, et al. Current proposed revision of JRA Criteria. JRA Criteria Subcommittee of the Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Section of The Arthritis Foundation. Arthritis Rheum. 1977;20(2 Suppl):195–199. - PubMed
  20.  
    1. Wood PH. Special meeting on: nomenclature and classification of arthritis in children. In: Munthe E, ed. The care of rheumatic children, EULAR; Basel 1978. p. 47–50.
  21.  
    1. Manners PJ, Bower C. Worldwide prevalence of juvenile arthritis why does it vary so much. J Rheumatol. 2002;29(7):1520–1530. - PubMed
  22.  
    1. Consolaro A, Giancane G, Alongi A, van Dijkhuizen EHP, Aggarwal A, Al-Mayouf SM, et al. Phenotypic variability and disparities in treatment and outcomes of childhood arthritis throughout the world: an observational cohort study. Lancet Child Adolesc Health. 2019;3(4):255–263. - PubMed
  23.  
    1. Al Maini M, Adelowo F, Al Saleh J, Al Weshahi Y, Burmester GR, Cutolo M, et al. The global challenges and opportunities in the practice of rheumatology: white paper by the World Forum on Rheumatic and Musculoskeletal Diseases. Clin Rheumatol. 2015;34(5):819–829. - PMC - PubMed
  24.  
    1. Harper BD, Nganga W, Armstrong R, Forsyth KD, Ham HP, Keenan WJ, et al. Where are the paediatricians? An international survey to understand the global paediatric workforce. BMJ Paediatr Open. 2019;3(1):bmjpo-2018-000397. 10.1136/bmjpo-2018-000397. - PMC - PubMed
  25.  
    1. Abdillahi HS, Finnie JF, Van Staden J. Anti-inflammatory, antioxidant, anti-tyrosinase and phenolic contents of four Podocarpus species used in traditional medicine in South Africa. J Ethnopharmacol. 2011;136(3):496–503. - PubMed
  26.  
    1. Oberle EJ, Harris JG, Verbsky JW. Polyarticular juvenile idiopathic arthritis - epidemiology and management approaches. Clin Epidemiol. 2014;6:379–393. - PMC - PubMed
  27.  
    1. Briggs A, Slater H, Jordan J, Huckel Schneider C, Kopansky-Giles D, Sharma S, et al. Towards a global strategy to improve musculoskeletal health. Australia: Global Alliance for Musculoskeletal Health; 2021. Available at: https://gmusc.com/wp-content/uploads/2021/07/Final-report-with-metadata.pdf.
  28.  
    1. Al-Mayouf SM, Hashad S, Khawaja K, Alrasheedi A, Abdwani R, Abushhaiwia A, et al. Cumulative Damage in Juvenile Idiopathic Arthritis: A Multicenter Study From the Pediatric Rheumatology Arab Group. Arthritis Care Res (Hoboken) 2021;73(4):586–592. - PubMed
  29.  
    1. Abdul-Sattar A, Magd SA, Negm MG. Associates of school impairment in Egyptian patients with juvenile idiopathic arthritis: Sharkia Governorate. Rheumatol Int. 2014;34(1):35–42. - PubMed
  30.  
    1. Abdul-Sattar AB, Elewa EA, El-Shahawy Eel D, Waly EH. Determinants of health-related quality of life impairment in Egyptian children and adolescents with juvenile idiopathic arthritis: Sharkia Governorate. Rheumatol Int. 2014;34(8):1095–1101. - PubMed
  31.  
    1. Aiche MF, Djoudi H, Al-Mayouf S, Consolaro A, Bovis F, Ruperto N, et al. The Algerian Arabic version of the Juvenile Arthritis Multidimensional Assessment Report (JAMAR) Rheumatol Int. 2018;38(Suppl 1):27–33. - PMC - PubMed
  32.  
    1. Al Marri M, Qari A, Al-Mayouf SM. Juvenile idiopathic arthritis in multiplex families: longitudinal follow-up. Int J Rheum Dis. 2017;20(7):898–902. - PubMed
  33.  
    1. Al-Abrawi S, Al-Mayouf SM, Abdwani R, Abdalla E, Consolaro A, Bovis F, et al. The Omani Arabic version of the Juvenile Arthritis Multidimensional Assessment Report (JAMAR) Rheumatol Int. 2018;38(Suppl 1):299–306. - PMC - PubMed
  34.  
    1. Al-Hemairi MH, Albokhari SM, Muzaffer MA. The Pattern of Juvenile Idiopathic Arthritis in a Single Tertiary Center in Saudi Arabia. Int J Inflam. 2016;2016:7802957. - PMC - PubMed
  35.  
    1. Al-Mayouf SM, AlE'ed A, Muzaffer M, Consolaro A, Bovis F, Ruperto N, et al. The Arabic version of the Juvenile Arthritis Multidimensional Assessment Report (JAMAR) Rheumatol Int. 2018;38(Suppl 1):43–49. - PMC - PubMed
  36.  
    1. Albokhari SM, Muzaffer MA. Health-Related Quality of Life of Children and Adolescents with Juvenile Idiopathic Arthritis in Western Saudi Arabia. Open J Rheumatol Autoimmune Dis. 2019;9:69–83.
  37.  
    1. Alzyoud R, Alsuweiti MO, Almaaitah HQ, Aladaileh BN, Alnoubani MK, Alwahadneh AM. Juvenile Idiopathic Arthritis in Jordan: Single-Center Experience. Res Square. 2020:1–17.
  38.  
    1. Amine B, Rostom S, Benbouazza K, Abouqal R, Hajjaj-Hassouni N. Health related quality of life survey about children and adolescents with juvenile idiopathic arthritis. Rheumatol Int. 2009;29(3):275–279. - PubMed
  39.  
    1. Bahabri S, Al-Sewairi W, Al-Mazyad A, Karrar A, Al-Ballaa S, El-Ramahai K, et al. Juvenile rheumatoid arthritis: The Saudi Experience. Ann Saudi Med. 1997;17(4):413–418. - PubMed
  40.  
    1. Bouaddi I, Rostom S, El Badri D, Hassani A, Chkirate B, Amine B, et al. Impact of juvenile idiopathic arthritis on schooling. BMC Pediatr. 2013;13:2. - PMC - PubMed
  41.  
    1. Cakan M, Aktay-Ayaz N, Keskindemirci G, Ekinci DY, Karadag SG. Subtype frequencies, demographic features, and remission rates in juvenile idiopathic arthritis - 265 cases from a Turkish center. Turk J Pediatr. 2017;59(5):548–554. - PubMed
  42.  
    1. Chipeta J, Njobvu P, Wa-Somwe S, Chintu C, McGill PE, Bucala R. Clinical patterns of juvenile idiopathic arthritis in Zambia. Pediatr Rheumatol Online J. 2013;11(1):33. - PMC - PubMed
  43.  
    1. Dagher R, Assi S. Juvenile idiopathic arthritis: a single center Lebanese study. Pediatr Rheumatol. 2014;12:179.
  44.  
    1. Demirkaya E, Ozen S, Bilginer Y, Ayaz NA, Makay BB, Unsal E, et al. The distribution of juvenile idiopathic arthritis in the eastern Mediterranean: results from the registry of the Turkish Paediatric Rheumatology Association. Clin Exp Rheumatol. 2011;29(1):111–116. - PubMed
  45.  
    1. Demirkaya E, Ozen S, Sozeri B, Ayaz NA, Kasapcopur O, Unsal E, et al. The Turkish version of the Juvenile Arthritis Multidimensional Assessment Report (JAMAR) Rheumatol Int. 2018;38(Suppl 1):395–402. - PMC - PubMed
  46.  
    1. El Miedany Y, El Mikkawy DME, Youssef SS, El Gaafary M, Nassar N, Consolaro A, et al. The Egyptian Arabic version of the Juvenile Arthritis Multidimensional Assessment Report (JAMAR) Rheumatol Int. 2018;38(Suppl 1):155–161. - PMC - PubMed
  47.  
    1. Furia FF, Godfrey E, Mwamanenge N, Swai P. Spectrum of paediatric rheumatic disorders at a tertiary hospital in Tanzania. Pediatr Rheumatol Online J. 2020;18(1):30. - PMC - PubMed
  48.  
    1. Hashad S, Zletni MA, Al-Mayouf SM, Etayari H, Ibrahim E, Etfil M, et al. The Libyan Arabic version of the Juvenile Arthritis Multidimensional Assessment Report (JAMAR) Rheumatol Int. 2018;38(Suppl 1):267–274. - PMC - PubMed
  49.  
    1. Hussein ZM, Wagdy R, Shawki M, Zohni S, Shehawy I. The pattern of juvenile idiopathic arthritis; a retrospective Egyptian study. Egypt J Pediatr Allergy Immunol. 2018;16(1):7–14.
  50.  
    1. Karadag SG, Sonmez HE, Tanatar A, Cakmak F, Cakan M, Ayaz NA. Profile of new referrals to a single pediatric rheumatology center in Turkey. Rheumatol Int. 2020;40(2):313–321. - PubMed
  51.  
    1. Kasapcopur O, Yologlu N, Ozyazgan Y, Ercan G, Caliskan S, Sever L, et al. Uveitis and anti nuclear antibody positivity in children with juvenile idiopathic arthritis. Indian Pediatr. 2004;41(10):1035–1039. - PubMed
  52.  
    1. Khawaja K, Al-Maini M. Access to pediatric rheumatology care for Juvenile Idiopathic Arthritis in the United Arab Emirates. Pediatr Rheumatol Online J. 2017;15(1):41. - PMC - PubMed
  53.  
    1. Mostafa WE, Abdul-Sattar AB, Dawa GAE. Prevalence and Factors of Functional Disability in Patients with Juvenile Idiopathic Arthritis. Zagazig Univ Med J. 2019;25(3):456–463.
  54.  
    1. Olaosebikan BH, Adelowo OO, Animashaun BA, Akintayo RO. Spectrum of paediatric rheumatic diseases in Nigeria. Pediatr Rheumatol Online J. 2017;15(1):7. - PMC - PubMed
  55.  
    1. Oyoo GO, Genga EK, Otieno FO, Omondi EA. Clinical patterns of juvenile idiopathic arthritis: A single tertiary center experience in Kenya. Afr J Rheumatol. 2016;4(2):66–71.
  56.  
    1. Ozdogan H, Kasapcopur O, Dede H, Arisoy N, Beceren T, Yurdakul S, et al. Juvenile chronic arthritis in a Turkish population. Clin Exp Rheumatol. 1991;9(4):431–435. - PubMed
  57.  
    1. Scott C, Okong'o L, Brice N, Murless S, Slamang W, Fadlelmola A, et al. The Afrikaans version of the Juvenile Arthritis Multidimensional Assessment Report (JAMAR) Rheumatol Int. 2018;38(Suppl 1):19–26. - PMC - PubMed
  58.  
    1. Sen V, Ece A, Uluca U, Gunes A, Yel S, Tan I, et al. Evaluation of children with juvenile idiopathic arthritis in southeastern Turkey: a single center experience. Hippokratia. 2015;19(1):63–68. - PMC - PubMed
  59.  
    1. Shafaie N, Ziaee V, Aghighi Y, Raees Karami SR, Moradinejad MH, Consolaro A, et al. The Farsi version of the Juvenile Arthritis Multidimensional Assessment Report (JAMAR) Rheumatol Int. 2018;38(Suppl 1):171–178. - PMC - PubMed
  60.  
    1. Weakley K, Esser M, Scott C. Juvenile idiopathic arthritis in two tertiary centres in the Western Cape. South Africa. Pediatr Rheumatol Online J. 2012;10(1):35. - PMC - PubMed
  61.  
    1. Yener GO, Tekin ZE, Girisgen I, Cetin EN, Akdag B, Yuksel S. Juvenile idiopathic arthritis in a center in the Western Anatolia region in Turkey. Turk Pediatri Ars. 2020;55(2):157–165. - PMC - PubMed
  62.  
    1. Yilmaz M, Kendirli SG, Altintas DU, Karakoc GB, Inal A, Kilic M. Juvenile idiopathic arthritis profile in Turkish children. Pediatr Int. 2008;50(2):154–158. - PubMed
  63.  
    1. Salah S, Hamshary A, Lofty H, Adbdel RH. Juvenile Idiopathic Arthritis, the Egyptian Experience. J Med Sci. 2009;9(2):98–102.
  64.  
    1. Oen K, Tucker L, Huber AM, Miettunen P, Scuccimarri R, Campillo S, et al. Predictors of early inactive disease in a juvenile idiopathic arthritis cohort: results of a Canadian multicenter, prospective inception cohort study. Arthritis Rheum. 2009;61(8):1077–1086. - PubMed
  65.  
    1. Schinzel V, da Silva SGL, Terreri MT, Len CA. Prevalence of juvenile idiopathic arthritis in schoolchildren from the city of Sao Paulo, the largest city in Latin America. Adv Rheumatol. 2019;59(1):32. - PubMed
  66.  
    1. Saurenmann RK, Rose JB, Tyrrell P, Feldman BM, Laxer RM, Schneider R, et al. Epidemiology of juvenile idiopathic arthritis in a multiethnic cohort: ethnicity as a risk factor. Arthritis Rheum. 2007;56(6):1974–1984. - PubMed
  67.  
    1. Haffejee IE, Raga J, Coovadia HM. Juvenile chronic arthritis in black and Indian South African children. S Afr Med J. 1984;65(13):510–514. - PubMed
  68.  
    1. Schwartz MM, Simpson P, Kerr KL, Jarvis JN. Juvenile rheumatoid arthritis in African Americans. J Rheumatol. 1997;24(9):1826–1829. - PubMed
  69.  
    1. Al-Mayouf SM, Madi SM, AlMane K, Al JS. Comparison of clinical and laboratory variables in familial versus sporadic systemic onset juvenile idiopathic arthritis. J Rheumatol. 2006;33(3):597–600. - PubMed
  70.  
    1. Aviel YB, Ofir A, Ben-Izhak O, Vlodavsky E, Karbian N, Brik R, et al. A novel loss-of-function mutation in LACC1 underlies hereditary juvenile arthritis with extended intra-familial phenotypic heterogeneity. Rheumatology (Oxford). 2021. - PubMed
  71.  
    1. Wakil SM, Monies DM, Abouelhoda M, Al-Tassan N, Al-Dusery H, Naim EA, et al. Association of a mutation in LACC1 with a monogenic form of systemic juvenile idiopathic arthritis. Arthritis Rheumatol. 2015;67(1):288–295. - PubMed
  72.  
    1. Kronzer VL, Bridges SL, Jr, Davis JM., 3rd Why women have more autoimmune diseases than men: An evolutionary perspective. Evol Appl. 2021;14(3):629–633. - PMC - PubMed
  73.  
    1. Orstavik KH. Why are autoimmune diseases more prevalent in women. Tidsskr Nor Laegeforen. 2017;137(12-13):866–868. - PubMed
  74.  
    1. Tincani A, Gerardl MC, Fredl M, Andreoll L. Gender differences in rheumatology and the point of view of the Italian Society for Rheumatology (SIR) Ital J Gend Specif Med. 2018;4(4):e79–e88.
  75.  
    1. Henrickson M. Policy challenges for the pediatric rheumatology workforce: Part III. the international situation. Pediatr Rheumatol Online J. 2011;9:26. - PMC - PubMed
  76.  
    1. Foster HE, Minden K, Clemente D, Leon L, McDonagh JE, Kamphuis S, et al. EULAR/PReS standards and recommendations for the transitional care of young people with juvenile-onset rheumatic diseases. Ann Rheum Dis. 2017;76(4):639–646. - PubMed
  77.  
    1. Ringold S, Angeles-Han ST, Beukelman T, Lovell D, Cuello CA, Becker ML, et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Treatment of Juvenile Idiopathic Arthritis: Therapeutic Approaches for Non-Systemic Polyarthritis, Sacroiliitis, and Enthesitis. Arthritis Care Res (Hoboken) 2019;71(6):717–734. - PMC - PubMed
  78.  
    1. Ringold S, Weiss PF, Beukelman T, DeWitt EM, Ilowite NT, Kimura Y, et al. 2013 update of the 2011 American College of Rheumatology recommendations for the treatment of juvenile idiopathic arthritis: recommendations for the medical therapy of children with systemic juvenile idiopathic arthritis and tuberculosis screening among children receiving biologic medications. Arthritis Rheum. 2013;65(10):2499–2512. - PMC - PubMed
  79.  
    1. Guide De L’arthrite Juvenile Idiopathique: Groupe De Rhumatologie Pediatrique; 2020. Published by: SociétéAlgérienne de Pédiatrie, Available at: https://www.sapediatrie-dz.com/site/congres.php.
  80.  
    1. Scott C, Chan M, Slamang W, Okong'o L, Petty R, Laxer RM, et al. Juvenile arthritis management in less resourced countries (JAMLess): consensus recommendations from the Cradle of Humankind. Clin Rheumatol. 2019;38(2):563–575. - PubMed
  81.  
    1. Foster HE, Scott C, Tiderius CJ, Dobbs MB. Members of the Paediatric Global Musculoskeletal Task F. Improving musculoskeletal health for children and young people - A 'call to action'. Best Pract Res Clin Rheumatol. 2020;34(5):101566. - PMC - PubMed
  82.  
    1. Migowa AN, Hadef D, Hamdi W, Mwizerwa O, Ngandeu M, Taha Y, et al. Pediatric rheumatology in Africa: thriving amidst challenges. Pediatr Rheumatol Online J. 2021;19(1):69. - PMC - PubMed