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 Table of Contents  
Year : 2022  |  Volume : 8  |  Issue : 3  |  Page : 145-150

The level of knowledge about rheumatic diseases in Saudi Arabia: A community-based survey

1 Departments of Clinical Sciences, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
2 King Abdullah Bin Abdulaziz University Hospital, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
3 Dr. Suliman AlHabib Medical Group, Riyadh, Saudi Arabia
4 College of Medicine, Princess Nourah Bint Abdulrahman University, Saudi Arabia

Date of Submission28-Sep-2021
Date of Acceptance24-May-2022
Date of Web Publication28-Sep-2022

Correspondence Address:
Dr. Fahidah Alenzi
Department of Clinical Sciences, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh
Saudi Arabia
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijam.ijam_121_21

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Introduction: Joint inflammation, which causes pain and swelling, is common in rheumatic diseases. In Saudi Arabia, large multicenter studies on the prevalence of rheumatic diseases and the common beliefs about these diseases are lacking. Our study aimed to investigate the false beliefs about rheumatic diseases in Saudi Arabia.
Materials and Methods: A cross-sectional questionnaire-based study was carried out in Riyadh, Saudi Arabia, from December 2019 to January 2020, to assess the understanding and misconceptions of rheumatic disorders in the study population. The statistical analysis was performed using the Fisher's exact test and the Chi-squared test, and binary logistic regression was employed for dichotomous variables.
Results: Five hundred and eleven respondents were recruited in the study, with a mean age of 26.9 years; 76.9% of respondents were female. 89.4% of the respondents were Saudi nationals; 75.2%, 20.3%, and 4.5% of respondents had bachelor's, prebachelor's, and master's degrees, respectively. The most frequently reported rheumatic disease was rheumatoid arthritis (66%), followed by myositis (13.3%). Most of the respondents (77%) in this study were aware of rheumatic diseases.
Conclusion: Most of the respondents were aware of rheumatic diseases. However, a more exhaustive multicentric survey with a wider population-based survey is needed to provide substantial data and help rheumatologists overcome patients' misconceptions and improve outcomes.
The following core competencies are addressed in this article: Medical knowledge, Patient care, Systems-based practice, Practice-based learning and improvement.

Keywords: Misconceptions, questionnaire, rheumatic disease, Riyadh, Saudi Arabia

How to cite this article:
Alenzi F, Al-Sheikh H, Alnasser M, Adwani MA, Aldhuwayhi R, Algenaim E, Abowadaan M. The level of knowledge about rheumatic diseases in Saudi Arabia: A community-based survey. Int J Acad Med 2022;8:145-50

How to cite this URL:
Alenzi F, Al-Sheikh H, Alnasser M, Adwani MA, Aldhuwayhi R, Algenaim E, Abowadaan M. The level of knowledge about rheumatic diseases in Saudi Arabia: A community-based survey. Int J Acad Med [serial online] 2022 [cited 2023 Mar 27];8:145-50. Available from: https://www.ijam-web.org/text.asp?2022/8/3/145/357229

  Introduction Top

Rheumatic diseases are characterized by joint inflammation and can affect extra-articular organs; when an active disease is left untreated, it can lead to loss of function. Because of its high prevalence and association with significant morbidity, arthritis has become a major health issue in Saudi Arabia, with a significant social and economic impact.[1] Rheumatoid arthritis (RA) has a global prevalence rate of approximately 0.5%–1.1% and an incidence rate of about 20–50 reported cases per 100,000 individuals annually in the United States (U.S) and Europe.[2] The age-adjusted prevalence of arthritis was higher in women than in men.[3] The estimated arthritis prevalence is expected to affect 78.4 million (26%) U.S. adults by 2040.[4] In Saudi Arabia, large multicenter studies on the prevalence of rheumatic diseases are lacking. Most studies represented single-center experiences. In Saudi Arabia, in the Qassim region, the prevalence of RA is approximately 2.2 in every 1000 individuals.[1] A previous study showed that 39% of RA patients had radiological changes appearing as erosions in the feet and hands; the erosions in the feet (6%) were less than those in the hands (39%).[5] Aside from RA prevalence, other variations of RA in Saudi Arabia across different socioeconomic categories, ages, and races include disease patterns, knowledge, attitudes, and practices (KAP).[6]

In health care, the importance of patient interaction is emphasized. Patient education regarding the diagnosis and the potential outcomes is important. There should be active participation from both health-care professionals and patients, especially in managing life-threatening or chronic conditions.[7] Having an active role has, over time, resulted in greater patient satisfaction with health services, as this is associated with better outcomes.[8],[9] In rheumatic diseases, educating patients contributes positively to their psychological well-being, adherence to therapy, global assessment, rate of depression, and functional disability.[10] Some articles that have examined the general public's misconceptions regarding rheumatic disease report that their beliefs are often inaccurate,[11] and to the best of our knowledge, there have been no similar studies in our country. Knowledge plays a significant role in shaping behaviors and attitudes; this has a direct impact on getting appropriate information on the health condition, enhances self-management skills, and also improves adherence.[11] Therefore, further research is needed since KAPs are deeply influenced by socioeconomic and demographic conditions and by the pathophysiology of the disease.[12] The current study aimed to identify inaccurate beliefs and information on rheumatic diseases from a sample population and identify target groups needing health education.

  Materials and Methods Top

Study design and setting

The current cross-sectional questionnaire-based study was conducted in Riyadh City, Saudi Arabia, from December 2019 to January 2020. Males and females aged 15–80 years who consented to participate were included in the study.

Study tool

A self-reported questionnaire was designed to assess the misconceptions and general knowledge regarding rheumatic disorders in the study population. Before distributing the questionnaire, a pilot study was conducted with 15 participants from the public. The pilot study participants were asked to complete the questionnaire and afterward were asked whether the questionnaire was acceptable and easy to understand. This questionnaire was handed out in different public areas in Riyadh, such as shopping malls, hospitals, and universities. Participants filled out the questionnaires under the guidance of the researchers [Table 1]. The beginning of each interview was marked by obtaining the participants' consent and with an explanation of the study. The participants were assured confidentiality. The questionnaire included true or false statements regarding career status, social status, nationality, demographics (type of work, residency, education level, age, marital status, and sex), behavior, and clinical features. The details were obtained by trained interviewers.
Table 1: Questionnaire of the level of knowledge about rheumatic diseases

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Statistical analysis

Analysis of the collected data was performed using SPSS 21.0 IBM SPSS Statistics for Windows, Version 21.0 (IBM Corp. Armonk, NY, USA). Categorical variables were presented as percentages and numbers, and the comparison between the groups was performed using the Fisher's exact test and the Chi-squared test. Binary logistic regression was employed in the dichotomous variable, where P < 0.05 was regarded as statistically significant.

  Results Top

[Table 2] shows the demographic features of the 511 respondents included in our sample with a mean age ± standard deviation of 26.9 ± 10.3 (range, 15–82) years [Figure 1]. The majority of our participants were female (76.9%, n = 393). Regarding the level of education, 384 (75.2%) had a bachelor's degree and 23 (4.5%) had a master's degree. Concerning residency, 355 (69.5%) were from Riyadh. About half of them (53.4%, n = 273) had a relative who was a health-care worker and 223 (43.6%) had no health-care worker relatives. Of the participants, 429 (84%) had no rheumatic disorders and 18 (3.5%) had a history of rheumatic disease. Of the patients with a history of rheumatic disease, 10 (66.6%) had RA, 2 (13.3%) had myositis, 1 (6.7%) had fibromyalgia, 1 (6.7%) had gouty arthritis, and 1 (6.7%) had osteoarthritis.
Table 2: Demographics features of participants

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Figure 1: Percentage of participants knowledge awareness

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[Figure 1] shows that 77% of the patients were aware of rheumatic diseases. Furthermore, [Table 3] reveals the association between awareness and how it affects family members. Regarding the understanding of the age spectrum affected by rheumatic disease, 65.8% of the patients were aware that rheumatic diseases can affect all age groups. In addition, 51.6% of the patients were aware that rheumatic diseases can affect children, whereas 48.1% were aware that rheumatic diseases affect women more than men; 41% were aware that rheumatic diseases can affect pregnancy, whereas 25.9% were unaware; 14.2% though that rheumatic diseases only affect the elderly, whereas 4.3% thought that rheumatic diseases affect men more; and 74.4% were aware that rheumatic diseases are chronic condition, whereas 1.5% thought that rheumatic conditions are contagious. Moreover, 58.7% of the patients were aware that genetics play a role in some rheumatic diseases and 32.4% thought that rheumatic diseases only affect joints; 49.6% were aware that rheumatic diseases can affect other organs such as the heart, lung, kidney, and nervous system, 3.5% thought that rheumatic diseases can be treated with herbal medicines, and 15.4% thought that painkillers are the only and main treatment options for rheumatic diseases. We found that the subpopulation <21 years showed a higher regression coefficient of 0.983 in comparison to 0.769 for the age group of 22–26 years with the predicted log odds of awareness = 1, which would be expected by an increase of 1 unit in the predictor, considering all other predictors to be constant.
Table 3: Association between awareness and how affects the family members and treatments for rheumatic disease

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  Discussion Top

Our community-based survey was conducted in Saudi Arabia. In this study, approximately 76.9% of the respondents were female, and 89.4% were Saudi nationals. In our study, men had significantly higher awareness scores regarding rheumatic diseases than women, contrasting with those of a previous study that stated that women's knowledge of rheumatic arthritis was higher than that of males.[13] Our findings revealed that RA was the most commonly reported rheumatic condition among respondents, and that younger people were more aware of the disease than older people. Our findings are consistent with those of a prior study,[14],[15] which found a link between respondents' RA knowledge and their educational level. This implied that people who had received appropriate education were more aware of the causes and consequences of these diseases. In addition, the authors reported that the level of education had a positive correlation with knowledge of rheumatic conditions, where respondents with a higher level of education were more responsive and aware of rheumatic diseases than those with a lower level of education, which is consistent with the results of the current study.[15] Most of the respondents in this study had beliefs and knowledge about rheumatic diseases, whereas only 23% were unaware of rheumatic diseases; this knowledge may be because younger age groups and women received the appropriate education. Our findings are consistent with a previous study where many respondents were aware that even though the onset of these diseases can affect any age group, patients in their forties and fifties were highly affected.[16] Most of them knew the impact of rheumatic diseases on different age groups, their medical conditions or complications, their chronicity, and their dependence on environmental factors and genetic information. A previous study reported that most patients initially consult with a general practitioner, an orthopedic surgeon, or a nonrheumatologist rather than a rheumatologist.[15] These practices delay the diagnosis and lead to an increase in the number of cases. The researchers of the current study recommend more educational programs and campaigns in the community to increase awareness about the natural history of rheumatic diseases, associated symptoms, causes, and availability of management, including pharmacologic interventions that may be made available in Riyadh and in universities.

The current study has some limitations. Our ability to identify causality between study variables was restricted by the cross-sectional survey design of the study. In addition, the study sample had a higher frequency of women than men, which could have led to a selection bias.

  Conclusion Top

Although majority of the respondents in our study were educated, we found some misconceptions and false beliefs regarding rheumatic diseases. A more comprehensive multicentric survey with a larger population, on the other hand, would provide more solid data and help rheumatologists overcome patients' false beliefs, improving disease outcomes.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

Research quality and ethics statement

The authors declare that this scientific work complies with reporting quality, formatting, and reproducibility guidelines following the EQUATOR Network (http://www.equator-network.org/) research reporting guidelines. The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Institutional Review Board committee of Princess Nourah bint Abdulrahman University (Approval number: 19-0248).

  References Top

Carmona L, Ballina, J, Gabriel R, Laffon A; EPISER Study Group. The burden of musculoskeletal diseases in the general population of Spain: Results from a national survey. Ann Rheum Dis 2011;60:1040-5.  Back to cited text no. 1
Almoallim H, Hassan R, Cheikh M, Faruqui H, Alquraa R, Eissa A, et al. Rheumatoid Arthritis Saudi Database (RASD): Disease characteristics and remission rates in a tertiary care center. Open Access Rheumatol 2020;12:139-45.  Back to cited text no. 2
Riemsma RP, Taal E, Kirwan JR, Rasker JJ. Systematic review of rheumatoid arthritis patient education. Arthritis Rheum 2004;51:1045-59.  Back to cited text no. 3
Mjaavatten MD, Bykerk VP. Early rheumatoid arthritis: The performance of the 2010 ACR/EULAR criteria for diagnosing RA. Best Pract Res Clin Rheumatol 2013;27:451-66.  Back to cited text no. 4
Asche C, Coyte PC, Chan B. The economic cost and social and psychological impact of musculoskeletal conditions: Comment on the article by Yelin et al. Arthritis Rheum 1996;39:1931.  Back to cited text no. 5
Usenbo A, Kramer V, Young T, Musekiwa A. Prevalence of arthritis in Africa: A systematic review and meta-analysis. PLoS One 2015;10:e0133858.  Back to cited text no. 6
Barbour KE, Helmick CG, Boring M, Brady TJ. Vital signs: Prevalence of doctor-diagnosed arthritis and arthritis-attributable activity limitation United States, 2013-2015. MMWR Morb Mortal Wkly Rep 2017;66:246.  Back to cited text no. 7
Hootman JM, Helmick CG, Barbour KE, Theis KA, Boring MA. Updated projected prevalence of self-reported doctor-diagnosed arthritis and arthritis-attributable activity limitation among US adults, 2015-2040. Arthritis Rheumatol 2016;68:1582-7.  Back to cited text no. 8
Al-Dalaan A, Al Ballaa S, Bahabri S, Biyari T, Al Sukait M, Mousa M. The prevalence of rheumatoid arthritis in the Qassim region of Saudi Arabia. Ann Saudi Med 1998;18:396-7.  Back to cited text no. 9
Al-Arfaj AS, Al-Boukai AA. Patterns of radiographic changes in hands and feet of rheumatoid arthritis in Saudi Arabia. Saudi Med J 2005;26:1065-7.  Back to cited text no. 10
Severo M, Gaio R, Lucas R, Barros H. Assessment of the general public's knowledge about rheumatic diseases: Evidence from a Portuguese population-based survey. BMC Musculoskelet Disord 2010;11:211.  Back to cited text no. 11
Neame R, Hammond A, Deighton C. Need for information and for involvement in decision making among patients with rheumatoid arthritis: A questionnaire survey. Arthritis Rheum 2005;53:249-55.  Back to cited text no. 12
Pytel A, Wrzosek Z. Estimation of patient knowledge on rheumatoid arthritis in the range of their own disease – Preliminary study. Adv Clin Exp Med 2012;21:343-51.  Back to cited text no. 13
Alballa SR. The expression of rheumatoid arthritis in Saudi Arabia. Clin Rheumatol 1995;14:641-5.  Back to cited text no. 14
Elhussein N, Ahmed R, Alosaimi R, Alshehri H, Altwerqi S, Alotaibi B. Awareness of rheumatoid arthritis among population in Taif, Saudi Arabia. Indian J Appl Res 2018;8:9-12.  Back to cited text no. 15
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  [Figure 1]

  [Table 1], [Table 2], [Table 3]


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