Rheumatoid arthritis in Kenya: disease status

Abstract

Objective: To document the socio-demographic and clinical aspect of patients with rheumatoid arthritis.
Design: Prospective cross-sectional study
Setting: Ambulatory outpatient clinics at Kenyatta National Hospital, Mater Hospital, Mombasa Hospital and Aga Khan Hospital, Kisumu
Subjects: Patients with diagnosis of rheumatoid arthritis (RA) based on American College of Rheumatology (ACR) or European Alliance of Associations for Rheumatology (EULAR) classification criteria (ACR1987 or ACR/EULAR 2010).
Methods: Pre-coded questionnaires were used to capture the data.
Data management: Data analysis was carried out using prism 7 and SPSS version 25. Prevalence (at 95% confidence intervals) was calculated.
Results: A total of 206 patients with a mean age of 51.2 years, mostly females were included. Majority had post primary education; 35.9% had formal professional employment; majority paid for health care out of pocket. Nearly half of the patients had moderate to severe disability. Majority had elevated baseline erythrocyte sedimentation rate and C-reactive protein. Rheumatoid factor test was positive in 90.3% of the patients, while 58.5% had a positive anti-Cyclic Citrullinated Peptide test. Majority had moderate disease activity while only 16% were in remission. Majority of patients were on non-steroidal anti-inflammatory drugs, non-biological disease modifying anti- inflammatory drugs (DMARDS) and systemic corticosteroids.
Conclusion: RA patients are predominantly females with a mean age of 51.2 years. Most have attained post- primary education with two thirds having no formal employment. Almost all pay for healthcare out of pocket; have a high prevalence of moderate to high disability index. While the uptake of DMARDS is high, disease activity is still high. There is need to optimize disease control in this patient population