Socio-demographic and clinical aspects of rheumatoid arthritis

Abstract

Objective: To determine the socio-demographic profiles and some clinical aspects of patients with rheumatoid arthritis (RA). Design: Prospective, cross-sectional study. Setting: Ambulatory outpatient clinics of Kenyatta National Hospital (KNH), a public national and referral hospital. Subjects: Out of 180 patients interviewed and examined, 60 met American College of Rheumatology (ACR) diagnostic criteria of RA. Results: Of the 60 patients recruited 52 (87%) were females with male: female ratio of 1: 6.5. The mean age of patients was 41.38(± 16.8) years. There were two peaks of age of occurrence, 20-29 and 40-49 years. In 75% of the study patients, one or more of metacarpophalangeal joints of the hand were involved in the disease. Other frequently involved sites were-wrists, elbows, knees, ankles and glenohumeral joints of shoulders in a symmetrical manner. Serum rheumatoid factor was positive in 78.9% while rheumatoid nodules were present in 13.3% of the study patients. A large majority of patients (88%) had active disease with 18% having mild disease, 38% moderate activity and 32% having severe disease. Only 12% of patients had disease in remission. Forty six point seven per cent (46.7%) of the study patients were on at least one Disease Modifying anti Rheumatic Drugs (DMARD) from a selection of methotrexate, sulphasalazine, hydroxychloroquine and leflunamide. The most frequent drug combination was methotrexate plus prednisolone at 30% of the study population; while 66.7% were on oral prednisolone with 25% of the study patients taking only Non-Steroidal anti Inflammatory Drugs (NSAIDS). Conclusion: A large majority of ambulatory patients with RA had active disease. Most of' them were sub-optimally treated, especially the use of DMARDS. About two thirds were on oral steroids. Sub-optimal therapy in relatively young patients, peak 20-29 and 40-49 years is likely to impact negatively on their disease control and quality of life.

Prescribing pattern in Rheumatoid Arthritis patients in a tertiary care teaching hospital

“…9 In the present study 378 (86%) of the affected patients were females and the ratio of disease among female:male was 5.25:1 which is similar to the previous study by Bajraktari IH et al 10 In the present study the most commonly affected age group was 31-60 years (61.33%) and the study by Owino et al showed that the peak prevalence of RA was in age groups of 20-29 years and 40-49 years. 11 The lab parameters as RA factor were positive in 70.67%, which is in relation to the study by O'Dell JR et al 12 The anti-ccp was raised in 90.67% of the patients which is similar to the study by Shini VK et al where anti-ccp was raised in 87.29% of the patients. 13 The associated comorbid conditions in present study were Type-2 diabetes mellitus (DM) in 16%, hypertension (HTN) in 10.67%, hypothyroidism in 8% of the patients, which is contrast to previous study where comorbidities like HTN 60%, DM 26.66% and asthma 13.34% respectively.…”

Suboptimal management of rheumatoid arthritis in the Middle East and Africa: could the EULAR recommendations be the start of a solution?

“…Indeed, the prevalence of RA in these parts of the world is reported to be in the same range as in developing countries (Table 1) [1-4, 6, 14-18]. Encouragingly, the number of patients seen by physicians with RA is increasing in some areas, such as Kenya, which may be due to improvements in health awareness among the population, a better referral system, more widespread access to rheumatologists and increasing urbanisation [19].…”

“…The misconception that RA is more uncommon and milder in the Middle East and Africa may result in delays between symptom onset, referral, diagnosis and the introduction of DMARDs-the mainstay of treatment in the developed world-as well as low use of DMARDs and intensive therapy [19,20,22,26]. In Nigeria, for example, the mean time to presentation to a rheumatologist is 63 months from first symptoms due to delays in diagnosis, ignorance on the part of medical and nursing personnel previously consulted by patients and misconceptions about the diagnosis and management of RA [22].…”

“…In Nigeria, for example, the mean time to presentation to a rheumatologist is 63 months from first symptoms due to delays in diagnosis, ignorance on the part of medical and nursing personnel previously consulted by patients and misconceptions about the diagnosis and management of RA [22]. In a study in Kenya, the majority of RA patients attending a particular clinic were found to be young, unemployed women with low levels of education, who are unlikely either to understand their disease and seek competent medical attention during the crucial window of opportunity of the first few months or to be able to afford proper medical care [19]. Lack of affordability is also an issue in Cameroon, for example, where X-rays and tests for rheumatoid factor are too expensive for many patients, which means that the ACR/EULAR classification criteria can be used only rarely [21].…”

Reliable and cost-effective serodiagnosis of rheumatoid arthritis

“…However, estimating the cost of RA disease burden in the South African and continental African setting in general is lacking, with the majority of articles relating to this topic having been published prior to 1990 [18]. Exceptions include a 2009 study originating from Kenya which concluded that the majority of RA patients present at a relatively young age and are sub-optimally treated, which impacts negatively on disease control and quality of life [19], while a 2010 article highlighted the prevalence and functional impact of musculoskeletal conditions, including RA, in a small cohort in Cape Town [20].…”