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Anaemia in patients with rheumatoid arthritis at the Kenyatta National Hospital, Nairobi, Kenya
Abstract
Background: Anaemia is the commonest extra articular manifestation of Rheumatoid Arthritis (RA). Anaemia is an independent predictor of morbidity and mortality in the population. When RA is complicated by anaemia it is associated with a more severe disease and significant reduction in the quality of life in the affected patient.
Objectives: To determine the characteristics and the prevalence of anaemia in patients with RA at the Kenyatta National Hospital (KNH) and correlate the anaemia with the disease activity using the Modified Disease Activity Score 28 (MDAS28).
Design: A cross sectional descriptive study.
Methods: Patients presenting to the Rheumatology Outpatients Clinic (ROPC) in Kenyatta National Hospital were screened and those who met the American College of Rheumatology- European League Against Rheumatism (ACR-EULAR) diagnostic criteria for RA were consecutively recruited to the study. The study period was 6 months from September 2011 to March 2012. Consecutive sampling technique was applied until the desired sample size was achieved.
Results: Ninety seven patients were studied in a span of six months (September 2011 –March 2012). Females were 84 (86.6%) while males were 13 (13.4%) with a male to female (M: F) ratio of 1:6.8. The mean age of the study population was 50.7 years with age range of 18-88 years. Seventy nine percent of the patients had the clinical features of RA for more than one year while 69% had the diagnosis made in the last five years. Eighty percent of the patients were on methotrexate while 72% were on Non Steroidal Anti Inflammatory Drugs (NSAIDS). The mean haemoglobin was 12.4 g/dl with a range of 3-15.7g/dl. Thirty three percent of the patients had high disease activity while 57 (58.8%) had moderate disease score. The prevalence of anaemia in the study population was 33% with Anaemia of Chronic Disease (ACD) responsible for 75% of the cases of anaemia while Iron Deficiency Anaemia (IDA) was seen in 25% of the cases. Anaemia was commonly seen among the patients with high and moderate disease activity scores. None of the patients on remission and low disease scores had anaemia. Anaemia was also found to be independently related to the disease activity and the patient’s gender with males being the most affected. The use of Disease Modifying Anti Rheumatic Drugs (DMARDS) was found to confer protection to anaemia. The study did not demonstrate any significant association between the use of NSAIDs and use of steroids and IDA.
Conclusions: There is a high burden of anaemia in RA patients although it is lower compared to studies done elsewhere. Anaemia correlates very well with the disease activity. Anaemia of chronic disease is the commonest type. The use of DMARDs was associated with reduction of anaemia among the patients. Men form a small percentage of patients with RA locally but do present with severe anaemia.
Keywords: Anaemia, Rheumatoid arthritis, Kenyatta National Hospital
Objectives: To determine the characteristics and the prevalence of anaemia in patients with RA at the Kenyatta National Hospital (KNH) and correlate the anaemia with the disease activity using the Modified Disease Activity Score 28 (MDAS28).
Design: A cross sectional descriptive study.
Methods: Patients presenting to the Rheumatology Outpatients Clinic (ROPC) in Kenyatta National Hospital were screened and those who met the American College of Rheumatology- European League Against Rheumatism (ACR-EULAR) diagnostic criteria for RA were consecutively recruited to the study. The study period was 6 months from September 2011 to March 2012. Consecutive sampling technique was applied until the desired sample size was achieved.
Results: Ninety seven patients were studied in a span of six months (September 2011 –March 2012). Females were 84 (86.6%) while males were 13 (13.4%) with a male to female (M: F) ratio of 1:6.8. The mean age of the study population was 50.7 years with age range of 18-88 years. Seventy nine percent of the patients had the clinical features of RA for more than one year while 69% had the diagnosis made in the last five years. Eighty percent of the patients were on methotrexate while 72% were on Non Steroidal Anti Inflammatory Drugs (NSAIDS). The mean haemoglobin was 12.4 g/dl with a range of 3-15.7g/dl. Thirty three percent of the patients had high disease activity while 57 (58.8%) had moderate disease score. The prevalence of anaemia in the study population was 33% with Anaemia of Chronic Disease (ACD) responsible for 75% of the cases of anaemia while Iron Deficiency Anaemia (IDA) was seen in 25% of the cases. Anaemia was commonly seen among the patients with high and moderate disease activity scores. None of the patients on remission and low disease scores had anaemia. Anaemia was also found to be independently related to the disease activity and the patient’s gender with males being the most affected. The use of Disease Modifying Anti Rheumatic Drugs (DMARDS) was found to confer protection to anaemia. The study did not demonstrate any significant association between the use of NSAIDs and use of steroids and IDA.
Conclusions: There is a high burden of anaemia in RA patients although it is lower compared to studies done elsewhere. Anaemia correlates very well with the disease activity. Anaemia of chronic disease is the commonest type. The use of DMARDs was associated with reduction of anaemia among the patients. Men form a small percentage of patients with RA locally but do present with severe anaemia.
Keywords: Anaemia, Rheumatoid arthritis, Kenyatta National Hospital
