Patterns of knee osteoarthritis in a hospital setting in sub-Saharan Africa

Assessing the Burden of Osteoarthritis in Africa and the Middle East: A Rapid Evidence Assessment

Introduction/Objectives

This rapid evidence assessment (REA) was conducted to assess the burden of weight-bearing joint osteoarthritis in the developing countries of Africa and the Middle East.

Methods

Our REA methodology used a standardized search strategy to identify observational studies, published between January 1, 2010, and April 23, 2020, reporting on outcomes pertaining to the epidemiology and humanistic or economic burden of weight-bearing osteoarthritis. Relevant data from the included studies were used for qualitative analysis.

Results

Among the 20 publications reporting on knee osteoarthritis in 10 countries in Africa and the Middle East, 2 also reported on hip, and 1 on foot osteoarthritis. Prevalence of symptomatic/radiographic knee OA was 9-14% among rheumatology outpatients and 31-34% among those with mixed etiology osteoarthritis. Prevalence of knee OA diagnosed by magnetic resonance imaging was 70% among patients ≥40 years of age attending a hospital in Saudi Arabia. Quality-of-life outcomes were reported in 16 publications and suggested a substantial humanistic burden of osteoarthritis, including worse pain, function, and quality of life, and more depression; comparisons between studies were hampered by the variety of tools and scoring scales used, however. No studies reported on economic outcomes.

Conclusion

This REA indicates a substantial burden of osteoarthritis in weight-bearing joints in Africa and the Middle East, consistent with publications from other regions of the world.

Frequency, pattern, and associations of generalized osteoarthritis among Nigerians with knee osteoarthritis

BACKGROUND

Osteoarthritis (OA) is a common degenerative condition leading to significant pain, functional limitation, and economic loss. Generalized OA (GOA) is associated with greater morbidity and accounts for 5-25% of total OA cases depending on definition used. This paper aims to determine the frequency and pattern of GOA, compare clinical and laboratory parameters of GOA and non-GOA subjects, then identify independent associations of GOA among Nigerians with knee OA.

METHODS

A cross-sectional study of 180 knee OA patients with knee and generalized OA defined using ACR criteria. Questionnaire administration was followed by physical examination and appropriate radiographs. Data was summarized using tables and figures. Multivariate regression was done to identify independent GOA associations with statistical significance p<0.05. Ethical approval was obtained for the study.

RESULTS

There were 180 participants with mean age 59.7±9.1 years. Twenty-eight patients (15.6%) had GOA of which 26 were female. The hip/knee/spine pattern was the commonest while hand OA was rare. Comparisons showed that GOA patients were significantly older with longer pain duration, higher pain score, more Heberden's nodes, and greater fatigue. There were no significant differences between both groups in levels of inflammatory markers and other laboratory parameters. Further analysis identified joint stiffness as the only independent association of GOA (OR 3.34, p=0.01).

CONCLUSION

A 15.6% frequency of GOA was identified among knee OA sufferers with the hip/knee/spine pattern most frequent. Nigerians with GOA are predominantly females with a large joint phenotype. Joint stiffness was the only independent association of GOA observed. Key Points • Generalized osteoarthritis occurs in 15.6% of Nigerian patients with knee osteoarthritis. • Females are predominantly affected with a large joint phenotype involving the hip/knee/spine. • Joint stiffness is an independent association of generalized osteoarthritis.

Perceptions and performance of exercise in people with knee osteoarthritis in the Middle East: are they different to countries in the developed world? A qualitative study in Jordan

Background: Culture and lifestyle could justify the variability in clinical patterns of knee osteoarthritis (OA) and was reported to affect exercise adherence.Objective: To explore perceptions and aspects influencing exercise adherence in people with knee OA in Jordan (a developing country) as they might be different from those reported in the developed world.Methods: Fourteen participants were included in the study (13 females, one male). One focus group and seven in depth semi-structured interviews were conducted. The discussions were audio-taped and transcribed. Framework analysis was used and data were interpreted using the socio-ecological model.Results: At the individual level, knowledge of the role of exercise in knee OA and personal factors influenced exercise performance and adherence. At the sociocultural level, cultural attitudes and beliefs and social interaction affected exercises adherence. At the organizational/political level, suboptimal service delivery process, inappropriate delivery of home exercises, accessibility of services affected exercise adherence. Opportunities for improving service delivery were also reported. At the environmental level, geography and weather affected adherence.Conclusions: Understanding the interaction of health-related behavior with individual, social/cultural, organizational, and environmental aspects would improve exercise adherence and equip physiotherapists with knowledge and resources to facilitate the implementation of patient-centered services.

Correlates and predictors of pain intensity and physical function among individuals with chronic knee osteoarthritis in Nigeria

BACKGROUND

Little is known about the correlates between pain intensity (PI) and physical function (PF) and psychosocial factors {kinesiophobia (K), Pain Catastrophizing (PC) and Self-efficacy (SE)} among patients diagnosed with knee osteoarthritis in developing countries like Nigeria.

OBJECTIVE

To investigate the correlates of PI and PF and psychosocial factors in patients with knee osteoarthritis in Nigeria.

DESIGN

Eighty-nine consecutively sampled patients diagnosed with knee osteoarthritis from three selected public hospitals in Enugu, South-East Nigeria, participated in this cross-sectional survey.

METHOD

Brief Fear of Movement Scale for Osteoarthritis, Pain Catastrophizing Scale and Arthritis Self-Efficacy Scale-8 item were used to assess kinesiophobia, pain catastrophizing and Self-efficacy respectively. Visual Analogue Scale and Ibadan Knee or Hip Osteoarthritis Measure were used to assess PI and PF respectively. Data were analysed using Pearson's correlation coefficient and multiple regression at p = 0.05.

RESULTS/FINDINGS

Participants were aged 59.11 ± 12.46years involving male (17.9%) and female (82.1%) participants. There were no significant gender differences in the scores of kinesiophobia, PI, PF, PC and self-efficacy. Pain intensity was significantly proportional to kinesiophobia (r = 0.38), and PC(r = 0.39). Better physical function was associated with high self-efficacy (r = 0.35), low kinesiophobia (r = -0.43) and low PC(r = -0.28). Significant predictive markers of PI included kinesiophobia (β = 0.24) and PC(β = 0.11) while that of PF, included kinesiophobia (β = -0.41) and SE(β = 2.39).

CONCLUSIONS

Kinesiophobia and pain catastrophizing correlate and predict PI significantly. Kinesiophobia and SE are significant correlates and predictors of PF among patients with knee osteoarthritis in Nigeria.

Joint replacement surgery in Ghana (West Africa)-an observational study

INTRODUCTION

With the continued and effective transfer of orthopaedic knowledge and skills across continents, the incidence of hip and knee replacement surgery has increased in the developing world. More patients are having these procedures done locally rather than having to travel over to the more developed western countries at great financial costs for those who cannot really afford it. We report the data collected by an orthopaedic charity MOTEC LIFE UK which has been offering hip and knee arthroplasty procedures to patients who require them. The time period of the procedures was February 2013-October 2017.

METHODS

The data was collated prospectively and this included age, sex, indication for procedure, and side of procedure (including if bilateral). The information on hip implants used were also collected-implant type (cemented or uncemented), type of bearing surface, size of acetabular cup, liner, femoral head size, and stem size and including if screws were used to augment the fixation of the femoral cup. For the knee implants used, information on the type of implant (semi-constrained, cruciate retaining, or Stanmore hinge knee prosthesis), femoral and tibia stem size, insert type (fixed bearing or mobile bearing), and size; patella button size (whether patella replacement or circumcision) were collected. The surgical approach used in both knee and hip arthroplasty cases was noted.

RESULTS

It is seen from the data collected that a total of 113 hip arthroplasty procedures from 109 patients were carried out and for total knee replacements, 82 knee arthroplasty procedures from 76 patients were carried out. The above procedures were carried out in two separate hospitals. Degenerative osteoarthritis still remains the main indication for hip and knee arthroplasty surgery in our study and this is similar to other joint registries around the world. It was noted that the incidence of avascular necrosis as an indication hip surgery was higher than that seen in registries for developed countries. The mean age for the hip and knee replacement patient in our data was much lower than that what is obtained in the developed world. Furthermore, it was observed that there was increased use of semi-constrained knee prosthesis due to the severe osteoarthritic deformities noted in the patients seen when compared to rate of use of similar implants in the developed world.

CONCLUSION

This observational study could serve as a springboard for establishment of arthroplasty registries for countries in the sub-region as a whole.

Osteoarthritis year in review 2015: clinical

The purpose of this review is to highlight clinical research in osteoarthritis (OA). A literature search was conducted using PubMed (http://www.ncbi.nlm.nih.gov/pubmed/) with the search terms "osteoarthritis [All Fields] AND treatment [All Fields]" and the following limits activated: humans, English language, all adult 19+ years, published between April 1, 2014 and April 1, 2015. A second literature search was then conducted with the search terms "osteoarthritis [All Fields] AND epidemiology [All Fields]", with the same limits. Reports of surgical outcome, case series, surgical technique, tissue sample or culture studies, trial protocols, and pilot studies were excluded. Of 1523, 150 were considered relevant. Among epidemiologic and observational clinical studies, themes included physical activity, early knee OA, and confidence/instability/falls. Symptom outcomes of pharmacologic treatments were reported for methotrexate, adalimumab, anti-nerve growth factor monoclonal antibodies, strontium ranelate, bisphosphonates, glucosamine, and chondroitin sulfate, and structural outcomes of pharmacologic treatments for strontium ranelate, recombinant human fibroblast growth factor 18, and glucosamine and chondroitin sulfate. Symptom outcomes of non-pharmacologic interventions were reported for: neuromuscular exercise, quadriceps strengthening, weight reduction and maintenance, TENS, therapeutic ultrasound, stepped care strategies, cognitive behavior therapy for sleep disturbance, acupuncture, gait modification, booster physical therapy, a web-based therapeutic exercise resource center for knee OA; hip physical therapy for hip OA; and joint protection and hand exercises for hand OA. Structure outcomes of non-pharmacologic interventions were reported for patellofemoral bracing.

Prevalence of Arthritis in Africa: A Systematic Review and Meta-Analysis

OBJECTIVE

In this systematic review, we estimate the prevalence of six types of arthritis in Africa; namely rheumatoid arthritis, osteoarthritis, juvenile arthritis, psoriatic arthritis, gout, and ankylosing spondylitis.

METHODS

We comprehensively searched literature on 31 August 2014 in MEDLINE, EMBASE, Web of Science and the Cochrane Library to identify eligible studies from 1975 up to 31 July 2014. Two review authors independently selected studies, extracted data, and appraised studies. We carried out random effects meta-analysis of prevalence of arthritis and assessed heterogeneity through subgroup analyses. We performed separate analyses for population- and hospital-based studies, as well as rural and urban settings.

MAIN FINDINGS

We included 27 cross-sectional studies (20 population-based and 7 hospital-based) from Africa reporting on the prevalence of arthritis. The majority of the studies were from South Africa (44.4%, 12/27). Rheumatoid arthritis in urban settings ranged from 0.1% in Algeria, 0.6% in the DRC, to a meta-analysis overall prevalence of 2.5% in South Africa, and in rural settings ranged from a meta-analysis overall prevalence of 0.07% in South Africa, 0.3% in Egypt, to 0.4% in Lesotho. Osteoarthritis was the most prevalent form of arthritis and in urban settings it was 55.1% in South Africa and in rural settings, all in South Africa, ranged from 29.5%, 29.7%, up to 82.7% among adults aged over 65 years. Other results include highest prevalence of 33.1% for knee osteoarthritis in rural South Africa, 0.1% for ankylosing spondylitis in rural South Africa, 4.4% for psoriatic arthritis in urban South Africa, 0.7% for gout in urban South Africa, and 0.3% for juvenile idiopathic arthritis in urban Egypt. A third of the included studies had a low risk of bias (33.3%, 9/27), 40.8% (11/27) moderate risk, and 25.9% (7/27) had a high risk of bias.

CONCLUSIONS

In this systematic review, we have identified the paucity of latest prevalence data on arthritis in Africa. More studies are needed to address the prevalence and the true burden of this disease in Africa.

Association between diabetes mellitus and osteoarthritis: systematic literature review and meta-analysis

Objectives

To investigate the prevalence of osteoarthritis (OA) in patients with diabetes mellitus (DM) and prevalence of DM in patients with OA and whether OA and DM are associated.

Design

A systematic literature review and meta-analysis. We included cohort, case–control and cross-sectional studies assessing the number of patients with DM and/or OA. The mean prevalence of OA among patients with DM and DM among patients with OA was calculated. Data from trials assessing an association of diabetes and OA were pooled and results are presented as unadjusted OR and 95% CI.

Results

From the 299 publications, we included 49 studies in the analysis, including 28 cross-sectional studies, 11 cohort studies and 10 case–control studies. In all, 21, 5 and 23 articles involved patients with OA exclusively, patients with DM and the general population, respectively. For 5788 patients with DM, the mean OA prevalence was 29.5±1.2%. For 645 089 patients with OA, the prevalence of DM was 14.4±0.1%. The risk of OA was greater in the DM than non-DM population (OR=1.46 (1.08 to 1.96), p=0.01), as was DM in the OA than non-OA population (OR=1.41 (1.21 to 1.65), p<0.00 001). Among the 12 studies reporting an OR adjusted on at least the body mass index, 5 showed no association of DM and OA and 7 identified DM as an independent risk factor.

Conclusions

This meta-analysis highlights a high frequency of OA in patients with DM and an association between both diseases, representing a further step towards the individualisation of DM-related OA within a metabolic OA phenotype.