Common Autoimmune Diseases among Yemeni Patients in Sana’a City, Yemen

Abstract

Objective: To determine the most common autoimmune diseases (ADs) among Yemeni patients in Sana’a city. Methods: This cross-sectional study was conducted in six health facilities in Sana’a city from January 2014 to July 2017. It prospectively recruited 131 patients with ADs and retrospectively included 1786 records of patients with ADs, totaling the sample size to 1917. Data about gender and age of prospective patients and as well as the gender, age and the type of AD from patients’ records were collected using a pre-designed data collection sheet. Sera from patients’ sera were investigated for autoantibodies to diagnose ADs using immunological techniques. Data were then analyzed and expressed using descriptive statistics. Results: The majority of approximately two-thirds of patients with ADs attending the health facilities or record-retrieved were females, with a mean age of 32.35 ± 13.72 years (range: 1–89). Approximately half of the patients had a single type of either systemic or organ-specific ADs, while less than 1% had concurrent ADs. Rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS) were the most frequent systemic ADs, being higher among females than males with male:female ratios of 1:4, 1:6 and 1:7, respectively. On the other hand, autoimmune hepatitis (AIH), Graves’ disease, Hashimoto's disease and celiac disease (CD) were the most frequent organ-specific ADs. AIH was higher among males than females with a male:female ratio of 2:1, while Graves’ and Hashimoto's diseases and CD were higher among females with a male:female ratio of 1:2–1:5. The most frequent concurrence between ADs was between SLE and RA (55.6%) as well as AIH and AIG (16.7%), being higher among females than males with male:female ratios of 1:9 and 1:2, respectively. SLE and AIH were equally concurrent between males and females, while the concurrence of other types of ADs was observed among females only. Conclusions: AIH, RA and SLE are the most frequent ADs among Yemeni patients with a steady rise in the frequency of ADs over the period 2014-2017 in Sana'a city. Systemic and organ-specific ADs are comparably equal in distribution and concurrently present among approximately 1.0% of cases, with predominance among females compared to males. Population-based studies for the assessment of incidence/prevalence of ADs and the environmental factors associated with the trending increase in the prevalence of ADs in Yemen are issues for further studies. Keywords: Autoimmune diseases, Autoimmune hepatitis, Rheumatoid arthritis, Systemic lupus erythematosus, Yemen