Clinical patterns of juvenile idiopathic arthritis in Zambia

Abstract

BackgroundJuvenile idiopathic arthritis (JIA) is a heterogeneous group of disorders with different disease manifestations among various populations. There are few reports of JIA among indigenous Africans especially sub-Saharan Africa. We present herein the clinical patterns of JIA encountered at a tertiary hospital in Lusaka, Zambia.MethodHospital records of patients with a diagnosis of chronic arthritis with onset at the age of 16 years or less presenting to University Teaching Hospital, Lusaka, Zambia for the periods 1994–98 and 2006–2010 were retrospectively reviewed and reclassified as Juvenile Idiopathic Arthritis (JIA) based on the International League of Associations for Rheumatology (ILA R) JIA diagnostic criteria.ResultsIn total, 126 patients with chronic arthritis of onset at age 16 years or less were evaluated over these periods at the hospital. Of these, 85 could further be analyzed by ILAR JIA criteria but 7 (8.24%) were HIV seropositive and were assessed separately. The average age at disease onset among the 78 JIA patients was 8.70 years (range: 1–15 years) with average age at first visit to hospital being 11.3 years (range: 2 to 25 years) and with a female to male ratio of 1.2:1. Polyarticular rheumatoid factor negative JIA, at 34.62%, was the most frequent type of chronic arthritis encountered. Oligoarthritis was found in 32.05% while 11.54% and 14.10% were polyarticular rheumatoid factor positive and systemic JIA, respectively. Enthesitis-related arthritis was found in 6.41% and only 1.28% were determined to have psoriatic arthritis among this population.ConclusionJIA is predominantly a polyarticular rheumatoid factor negative disease in Zambia. Late presentation is an issue with major implications for educational input and resource acquisition. There is need to elucidate the genetics and environmental factors of JIA in this region.

The Pattern of Juvenile Idiopathic Arthritis in a Single Tertiary Center in Saudi Arabia

“…Among all our JIA children, fever was present in 34/82 (41.46%) patients which is higher than other similar studies [3, 29]. which is probably due to the predominance of SoJIA in our cohort.…”

Epidemiology of juvenile idiopathic arthritis in Oman

“…Systemic onset JIA was the most prevalent subtypes in Asian countries like Japan [5] and Arab origin like Saudi Arabia [6] while oligoarticular JIA subtype was most prevalent in western countries like Canada [7] and France [8]. However, polyarticular JIA, especially RF -, was most common in patients of Arab origin like Kuwait [9], Egypt [10] and Oman (current study) as well as in patients with African origin as in Zambia [11] and Nigeria [12]. …”

“…However, polyarticular JIA, especially RF -, was most common in patients of Arab origin like Kuwait [9], Egypt [10] and Oman (current study) as well as in patients with African origin as in Zambia [11] and Nigeria [12]. …”

Polyarticular juvenile idiopathic arthritis – epidemiology and management approaches

“…RF-positive polyarticular JIA may be misrepresented in these regions as the diagnosis is generally made after checking RF status only once due to the constraints on resources and inability to repeat laboratory testing 40. Many affected individuals in these populations also present late, after several years of arthritis 42. This too could lead to misclassification as several cases likely represented oligoarticular patients with extended disease who would have been diagnosed differently if seen within the first 6 months of disease onset.…”