The severity of rheumatoid arthritis at the first rheumatology consultation and factors associated with initial structural damage in sub Saharan patients

Abstract

Background: The severity of Rheumatoid Arthritis (RA) at diagnosis has not been fully described in sub-Saharan Africa in recent years, nor have been the factors associated with it.
Objective: The aim of this study was to determine the frequency of severe RA at the first rheumatology consultation and assess the factors associated with this early severity.
Design: This was a retrospective study.
Methods: The study was carried out in the rheumatology service of the Yaoundé Central Hospital, Cameroon. Files (one patient = one file) of patients diagnosed with RA during January 2004-May 2018 were included. RA severity was defined by the presence of at least one of these markers: Disease Activity Score-28 with Erythrocyte Sedimentation Rate (DAS28-ESR) > 5.1, initial structural damage on hand X-rays which was defined by a Larsen score ≥ 2 per joint and the presence of Rheumatoid Factor (RF) and/or Anticitrullinated Protein Antibodies (ACPA). Files with no information to assess disease severity at the time of diagnosis were excluded. Data were analyzed with Epi-info version 7.0. Statistical significance was set at p-values less than 0.05.
Results: Forty-nine patients were included. Their mean age was 48 ± 14 years. Eighty percent of them were females. Sixty-seven percent had established RA, 33% had early-stage RA and two patients had ever smoked. None of them had received biological diseasemodifying antirheumatic drugs. RA was severe in 82% of patients, with DAS28- ESR > 5.1 in 71%, positivity of at least one autoantibody found in 63% to 82%, and initial structural damage found in 55% of them. Initial structural damage was only associated with the presence of ≥ 10 swollen joint counts.
Conclusions: RA was severe from the onset in most patients and structural damage was associated with the presence of ≥ 10 swollen joint counts.

Key words: Rheumatoid arthritis, Severity, Initial presentation, Structural damage, Sub-Saharan Africa.