Audit on the management of early rheumatoid arthritis in Nairobi

Abstract

Background: Clinical audit for rheumatoid arthritis on patients over  the age of 18 years in Nairobi, Kenya within the first three months of referral
to a specialist.
Objective: The audit gives detailed information on the following; access to care, quality of treatment and care received by patients from their  rheumatology team in these first 3 months and the early impact of arthritis on the patient’s life.
Design: This was a cross-sectional survey.
Results: The audit included 100 patients referred to the Nairobi Arthritis Clinic between January and April 2018. A majority (54%) had symptoms for  more than 6 months before being referred to a rheumatologist. Most of the patients (83%) were seen within 3 weeks of referral. Disease Modifiying
Antirheumatic Drugs (DMARDs) were commenced in 90% within 6 weeks of being seen at the clinic. Treatment to target was done in 98% of the patients with a further 60% able to access the clinic within a day of flare of symptoms.
Conclusion: The audit revealed the need to improve on referral time to the rheumatologist. It was encouraging to note that once they saw the
rheumatologists the patients were commenced on the proper treatment with the treat to target strategy. An area that needs improvement is the time to access the rheumatologist in case of side effect from the treatment or flare of the disease.

Key words: Rheumatoid arthritis, Audit, Management, Nairobi