Department of Rheumatology, Dubai Hospital

UAE Awards

Hamdan Award for an Outstanding Clinical Department in the Public Sector in UAE
2017-2018

Introduction

The first Rheumatology Department in the UAE was established in Dubai Hospital in 1987. Dr. Hamdy Afify established the Rheumatology  as a dual medical unit, looking after patients with rheumatological disorders as well as patients with general diseases. For two years, Dr. Afify was the only rheumatologist in the department of health in the UAE. He was joined by Dr. Vihra Jassim and Dr. Manal El-Sayed in 1989 and 1990 respectively. The triad formed the core team that provided rheumatologic health services in the UAE for many years. Furthermore, they founded the pillars for the current Rheumatology Unit in the Dubai Health Authority (DHA). 
 
The first designated Rheumatology clinic was established in 1989; it was operated once a week by a single doctor. This expanded into three clinic rooms running two days a week in 1992. This expansion was coupled with tremendous efforts to increase awareness of rheumatic diseases among primary health care physicians and colleagues of other specialities, in order to enable early diagnoses and referral of patients with musculoskeletal symptoms who might benefit from the newly founded rheumatology services. 
 
The awareness campaign was done through a series of regularly structured educational meetings. Physicians from the ministry of health and private facilities have attended these regular meetings, which helped in extending awareness beyond the Department of Health and Medical Services.

In early 2003, the unit was the first in the UAE, and in the government and private health sectors to introduce biological therapy. Dr. Jamal Al Saleh opted under the supervision of Dr. Afify to introduce this innovative biological therapy for patients with rheumatoid arthritis. This was accompanied with the introduction of validated clinical tools such as DAS28, BASDAI, and many more. In addition, it produced the first guidelines for 26 common diseases that were treated in the Rheumatology Unit based on the scientific evidence available at the time.

Since the appointment of Dr. Jamal Al-Saleh as the new acting head in 2006 and the head in 2008, the Rheumatology Unit opened the first osteoporosis clinic in the UAE in 2007, which also functioned as the first biologic infusion center in the UAE. This was followed by a prevalence study of rheumatic diseases and osteoporosis in Dubai, the first landmark study performed in the UAE. Since 2012, the Rheumatology Unit further expanded its public health services with the institution of multiple clinics including the early arthritis clinic, combined pregnancy and rheumatic diseases clinic, and the combined rheumatology nephrology clinic. Other clinics in the pipeline include the musculoskeletal ultrasound clinic, the rheumatic comorbidities screening clinic, and many more. 

Over the last ten years, the unit had contributed significantly to producing local data which helped in discerning the epidemiological and clinical features of musculoskeletal diseases in the United Arab Emirates as well as the Middle East. Furthermore, the Rheumatology Unit has participated in many patient education and awareness campaigns.
 
The Rheumatology Department of Dubai Hospital serves as  a referral for second opinion from governmental and nongovernmental institutions, as well as institutions abroad .It is the home for innovations on a national level; it has introduced biologics to the country in 2003, and has inaugurated the first osteoporosis clinic in the Gulf region in 2007, the first Registry on Lupus in 2008, the first Early Arthritis clinic in the Middle East in 2012, the first registry for six diseases in 2014, and the first combined clinics in the middle East in 2015.  
 

Services

The Department is staffed by two consultant rheumatologists for adults, as well as seven specialists and two nurses specialized in Rheumatology. One of the specialists is a certified musculoskeletal USS trainer by EULAR. The services are as follows: 
 

A. Outpatients

The Rheumatology Department runs 17 rheumatology room clinics per week, with over  7000 registered clinic visits per year. The General rheumatology clinic looks after a wider spectrum of musculoskeletal disorders; including mechanical, inflammatory, connective tissue diseases, vasculopathies, crystal induced arthritis, and many more. 
 
Currently, we have four specialized clinics, which are considered the first specialized clinics in the UAE and Middle East; the osteoporosis clinic, early arthritis clinic, combined rheumatology and obstetric clinic, and combined rheumatology and nephrology clinic. The early arthritis clinic was established in June 2012, to close the gap in the care of patients with early arthritis, previously uncovered through the PRO-Dubai study (prevalence of Rheumatic disease and Osteoporosis). Our plan is to expand to another three clinic involving a Lupus clinic, annual arthritis assessment clinic, and spondyloarthritis clinic. 
 
The Dubai Arthritis Registry (DAR) launched in 2014 represents another success story; it was the first in the region to include six rheumatic diseases, and has attracted the attention of rheumatologists throughout many regions including Saudi Arabia, Iraq, Lebanon and South Africa. The Department has also contributed to the Joint Commission International Accreditation in the Dubai Hospital. 

B. Infusion

The Department offers 8 types of biologic infusion therapies. The Day Case ward has expanded from admitting 30 patients per month to admitting 85-90 patients per month at present. 

C. Diagnostics

The Rheumatology Department provides Musculoskeletal Ultrasound (MSUS) diagnostic services, making it distinct from other Rheumatology Departments in the UAE. The MSUS service is a valuable addition to the Department, as it saves the patient’s time from awaiting MRI or other imaging procedures. Additionally, it supports guided needle placement during soft tissue injection/aspiration.

D. Long-stay ward

The department maintained roughly the same number of admissions over the years despite the change in patients’ profiles from those with non-rheumatological disorders to patients with rheumatic diseases. We managed to keep our average length of stay over the years down to less than two days. 

E. Oncall services.

The Rheumatology Unit, since its foundation in 1987, provided full coverage to all DHA hospitals. Along with its transformation in 2012, the rheumatology team is now able to provide rheumatology services 24/7. 

Research and Continuing Medical Education

The head of the Department has played a pivotal role in transforming the Pan Arab Rheumatology Congress into its current iteration, the Arab League Against Rheumatism (ArLAR). His efforts led to the birth of ArLAR in Dubai in 2014. This has resulted in the creation of the “Young Arab Rheumatologists” (YAR) which offered 94 travel grants; this has subsequently led to the collaboration of ArLAR with the British Society of Rheumatology for the provision of training on “Research in Rheumatology”.
 
The Rheumatology Department has members participating in the World Forum of Rheumatic and Musculoskeletal Diseases, the British Society of Rheumatology Task Force, and the European League Against Rheumatism Task Force; the head of the Department is an advisor in the Royal College of Physicians. The Rheumatology Department has three inpatient KPI that are based on the international guidelines that assess disease, activity and degree of disability. Members of the Department have published 54 publications over the last 5 years in reputed journals with high impact factors.
 
The Rheumatology Department in Dubai Hospital is exceptionally proficient in multiple areas including clinical performance, safety, quality, research and innovation that make it one of the leading Department the UAE, a feat that you can rarely find in other clinical Departments.
 
All of the above contributions to healthcare services and medical education highlight the extraordinary role played by the Rheumatology Department in Dubai Hospital, which is being awarded by the Hamdan Award for Outstanding Clinical Department in the Public Sector in the United Arab Emirates for the 2017 – 2018 term.
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