The specialist physician’s approach to rheumatoid arthritis in South Africa

Bester, Frederik C. J.; Bosch, Fredricka J.; Rensburg, B.J. Jansen Van

doi:10.3904/kjim.2015.134

Cited by 6 publications

(3 citation statements)

References 80 publications

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“…The second group comprises individuals with an established disease who have suffered from symptoms related to inflammation and joint damage. 13 Methotrexate is the first-line treatment as an immunosuppressant therapy. The drug has various mechanisms of action to improve clinical symptoms and control the disease in individuals with RA, including repression of inflammatory cell proliferation, interference with T-cell activity and cytokine secretion, and augmented release of adenosine, which in turn activates receptors on macrophages and neutrophils to decrease the release of pro-inflammatory cytokines.…”

Section: Discussionmentioning

confidence: 99%

Perceptions of primary care physicians about early diagnosis of rheumatoid arthritis and methotrexate monitoring

et al. 2020

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Background: Current guidelines recommend the early recognition and diagnosis of rheumatoid arthritis and treatment with disease-modifying antirheumatic drugs (DMARDs). Methotrexate is the first drug of choice for most patients with rheumatoid arthritis, but this medication has contraindications and side effects that need monitoring. This survey analysis aims to explore the level of knowledge of primary healthcare physicians towards the early detection of rheumatoid arthritis and monitoring treatment with methotrexate.Methods: A self-administered structured questionnaire was distributed to primary healthcare physicians in the region of Riyadh, Saudi Arabia. The survey consists of sections including the demographics of respondents, knowledge about rheumatoid arthritis, and methotrexate. Data were analyzed using SPSS version 22.Results: In total, 249 physicians responded to the survey. Physicians with more years of experience showed a significantly higher level of knowledge about rheumatoid arthritis and methotrexate monitoring (p-value <0.001). The responses of physicians regarding knowledge about the disease were better than their responses about the drug.Conclusions: The knowledge of primary healthcare physicians in Riyadh, Saudi Arabia, is considered satisfactory in regard to rheumatoid arthritis diagnosis, but the level of knowledge about methotrexate requires improvement.

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Section: Discussionmentioning

confidence: 99%

Perceptions of primary care physicians about early diagnosis of rheumatoid arthritis and methotrexate monitoring

et al. 2020

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“…It is very difficult to answer the first question; while the fact that the number of rheumatologists is still very low in sub-Saharan Africa [even South Africa has an estimated ratio of only one rheumatologist for every 820,000 inhabitants (6), and in Ghana two specialists serve the whole country (7)] argues against an improved diagnostic capacity, continuing urbanization (Africa is the fastest urbanizing continent) and consequent proximity to referral hospitals of a higher number of potential patients may explain the increase in diagnoses. Registries and cohorts are needed to better establish the epidemiology of SLE in sub-Saharan Africa; the African Lupus Genetics Network (ALUGEN) registry (8) is an important initiative that will hopefully allow to gather comprehensive, multi-ethnic data on African SLE patients, and to establish whether the frequency of the disease differs between urban and rural areas.…”

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confidence: 99%

Commentary: Systemic Lupus Erythematosus in Native sub-Saharan Africans: A Systematic Review and Meta-Analysis

Vento

Cainelli

2020

Front. Med.

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Low and middle-income countries are thought to have a high frequency of infectious diseases and a low rate of autoimmune and allergic diseases (1); this belief has supported the "hygiene hypothesis, " i.e., the idea that a decreased incidence of infections contributes directly to an increased frequency of autoimmune and allergic diseases worldwide (2). In particular, the incidence of systemic lupus erythematosus (SLE) in black Africans has long been considered negligible (3). A recent systematic review and meta-analysis on SLE in native sub-Saharan Africans (4) challenges this view and changes the perspective. By examining studies published between January 2008 and October 2018 on SLE in native sub-Saharan Black Africans, the pooled prevalence of the disease among 28,575 participants in Internal Medicine and Rheumatology Units was found to be 1.7%. Patients were diagnosed between 1987 and 2014, and the mean age at diagnosis was 28.8-39.2 years (4). Studies from only 11 countries, the majority of which located in West Africa, were included in the analysis, and the pooled mortality rate was 10.3%, with infections, kidney disease, neurological involvement, and SLE flares as the main causes (4). The patients had 89.7% prevalence rate for antinuclear antibodies and 54.6% for anti-DNA antibodies, and a high seroprevalence for anti-ribonucleoprotein (57.9%), anti-Smith (53.5%), anti-Sjogren syndrome antigen A (45.6%) and anti-Sjogren syndrome antigen B (33.7%) autoantibodies (4). The high seroprevalence rates of ENA autoantibodies confirms their higher frequency in Blacks, due to genetic susceptibility (5). The authors outlined that the prevalence from their study contrasted with the low number of SLE cases described by Bae et al. (3) over 20 years before, in spite of comparable data sources and geographical coverage. Importantly, a review of published studies is different from a review of all cases diagnosed with SLE in all hospitals or in referral hospitals of certain countries over a defined period of time, and is likely to underestimate the real number of observed hospital cases. Three questions arise from the results of this review, that estimated a hospital-based prevalence in urban areas: is the rise in diagnoses due to improved diagnostic capacity of sub-Saharan African doctors, or to a real increase in the number of cases? What is the prevalence of SLE in the general population? Are other autoimmune diseases also more frequent than commonly thought?

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“…A second csDMARD can be added in the presence of poor prognostic factors including seropositivity, radiographic erosions within the first two years, extra-articular complications or functional disability. 10,[15][16][17] The following should be kept in mind when prescribing pharmacological therapy for RA:…”

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confidence: 99%

Rheumatoid arthritis : a joint venture

Potgieter

2020

South African General Practitioner

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Rheumatoid arthritis (RA) is a chronic auto-immune inflammatory disorder, usually affecting the joints. Its prevalence is estimated at 0.3–1% in industrialised countries and areas of urban living. RA leads to functional disability, significant pain and joint destruction, and subsequent loss of income: in developed countries half of people diagnosed with RA are unable to sustain full-time employment ten years after diagnosis. It also carries substantial cardiovascular risk if inadequately treated. RA is possibly the largest cause of treatable disability in the Western World. The exact prevalence of RA in South Africa is currently not known, but its significant impact is compounded by frequent late diagnoses and a scarcity of treating specialists.

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The specialist physician’s approach to rheumatoid arthritis in South Africa

Cited by 6 publications

References 80 publications

Perceptions of primary care physicians about early diagnosis of rheumatoid arthritis and methotrexate monitoring

Perceptions of primary care physicians about early diagnosis of rheumatoid arthritis and methotrexate monitoring

Commentary: Systemic Lupus Erythematosus in Native sub-Saharan Africans: A Systematic Review and Meta-Analysis

Rheumatoid arthritis : a joint venture

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