Establishing Rheumatoid Arthritis care in Zanzibar: a year of clinical outcomes and challenges

Abstract

Background: Chronic Inflammatory Joint Diseases (CIJD) are systematic conditions that primarily affect the joints. If untreated they cause permanent deformity, increased morbidity and mortality. Although treatment options are available in Zanzibar, many patients have delayed presentation.
Objective: This study aims to describe a Rheumatoid Arthritis (RA) patient cohort’s presentation and outcomes after implementation of treat-to-target (T2T) strategy.
Methods: A total of 132 patients with RA were recruited across three hospitals in Zanzibar and followed up for one year. Sociodemographic, clinical, radiological, laboratory, medication adherence and expenditure on health data were collected. Descriptive statistics were used for patient characteristics and clinical parameters. Summary statistics were used to describe demographic variables. Paired-sample t-test was used to determine significance of changes from baseline to one year. A p value of <0.05 was considered significant.
Results: The majority were female (86%) with a mean age of 45±13 years and a mean disease duration of six years. At baseline, mean disease activity based on the Clinical Disease Activity Index (CDAI) was moderate but improved at one year to low disease activity (p  <0.001). Rheumatoid factor positivity was 60% and 64% had evidence of radiological damage at enrollment. Prior steroid and non-steroidal anti-inflammatory drug use was common.
Conclusion: RA can be adequately managed in resource limited settings in the absence of biologic disease-modifying antirheumatic drugs using the T2T approach with good outcomes. Educational measures are needed to increase awareness among communities and health care providers to reduce delays in diagnosis and treatment.