Background Rheumatic diseases are underdiagnosed in the Middle East. Screening and awareness campaigns can be used in conjunction with peripheral ultrasound machines used to screen for low bone mass are a cheaper and more practical option than a whole body dual-energy X-ray absorptiometry.
Objectives We proposed to scan a population of a walk-in bone health clinic to aid in the diagnosis of rheumatic diseases such as osteoporosis, inflammatory arthritis, inflammatory back pain and connective tissue disease. Furthermore, we aimed to ascertain if a peripheral heel ultrasound can be used to identify patients at high risk of bone fracture or in need of treatment.
Methods Data were gathered from a walk in clinic, part of the Healthy Bone and Joints Campaign at the third level, public hospital in the United Arab Emirates. Screening for osteoporosis, inflammatory arthritis, back pain and other inflammatory arthropothies was undertaken. The patient questionnaire was developed by the rheumatology team with the design based on clinical practice as well as recommendations from internationally-recognised societies (FRAX and ASAS) and textbooks (Kelley) in regards to screening questions for the possible diagnosis. Heel scan was performed using the Achilles™ EXPII (General Electric Company) ultrasonometer. Participants were categorised, based on a Swiss study that established quality assurance procedures for quantitative ultrasound, with an upper threshold of 78% on the stiffness index (SI) reading and lower threshold of 57% (SI), so that the rate of false positives and false negatives were 10%, when DXA was used as the gold standard for diagnosis1.
Results The cohort was comprised 232 individuals from 25 different nationalities, with mean age (±SD) of 40.6 (12.2) years, 64.2% were female, and 65.4% were staff members at the hospital. The cohort had a mean number of clinical risk factors (smoking, prior fracture, early menopause, no exercise and oral steroids) of 0.9. Forty four (19%) of the population had two or more of these strong predictors of osteoporosis. There were a total of 156 different referrals to other hospital services with the most common being musculoskeletal ultrasound (n=37), followed by first rheumatology appointment (n=35), physiotherapy (n=25), blood tests (n=24) and central DXA (n=12). Of interest are new diagnoses of osteoarthritis (n=5), osteoporosis (n=2), rheumatoid arthritis (n=1) and ankylosing spondylitis (n=1). Upon categorisation based on the SI thresholds, 184 (84%) were low risk, 29 (13%) intermediate risk and 7 (3%) high risk. Within these groups there were a total of 4 (2.2%), 5 (17%), 3 (43%) of people sent for central DXA from the low, intermediate and high risk groups respectively.
Conclusions This is the first such study undertaken in the UAE. The implementation and delivery of a screening campaign to screen for osteoporosis, inflammatory arthritis, inflammatory back pain and connective tissue disease and to increase the awareness and educate patients about the diseases was well received. This working screening campaign will now be improved and taken away from the hospital setting targeting the general population in areas where specialist healthcare and central DXA is not readily available.
Hans et al. Osteoporos Int 2003
Disclosure of Interest None declared