1
|
Adelowo O, Omokhowa A, Ochiagha O, Uhunmwangho CU. Comorbidities in Nigerian patients with rheumatoid arthritis. Clin Rheumatol 2024; 43:23-28. [PMID: 37867179 DOI: 10.1007/s10067-023-06797-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/05/2023] [Accepted: 10/16/2023] [Indexed: 10/24/2023]
Abstract
INTRODUCTION Rheumatoid arthritis has been infrequently reported among African black populations. Recent data have shown increasing reportage. Comorbidities are increasingly recognised as important in the overall morbidity, mortality and response to management. There have been few reports from Africa on the frequency and role of comorbidities associated with rheumatoid arthritis (RA) in Africans. METHODS This 20-year retrospective study looked at the frequency of various comorbidities among Nigerian patients with rheumatoid arthritis from a rheumatology facility. Data were obtained from the case record files of 283 RA patients. The chi-square test was used to assess the relationship between patient characteristics and the presence of comorbidity, while logistic regression was used to determine factors that were independently associated with the occurrence of comorbidities in these patients. RESULTS The frequency of comorbidities among RA patients is high at 52.3%, mainly from common conditions such as hypertension (22.3%), dyslipidaemia (11.3%), osteoarthritis (8.1%), diabetes mellitus (7.1%), peptic ulcer disease (6.4%) and interstitial lung disease (3.5%). Increasing age (χ2 47.74, P<0.001) and prolonged duration of symptoms before diagnosis (χ2 9.0, P = 0.02) were significantly associated with the presence of comorbidity on univariate analysis, and only age was found to be independently associated with comorbidities on logistic regression. CONCLUSION The frequencies of these comorbidities are similar in certain aspects to other such reports but differ from others. An important factor may be the delay in presentation to a rheumatologist. It is hoped that other more extensive studies will elucidate some of these findings.
Collapse
Affiliation(s)
- Olufemi Adelowo
- Lagos State University College of Medicine/ Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | | | - Olisa Ochiagha
- Usman Dan Fodio University Teaching Hospital, Sokoto, Nigeria
| | | |
Collapse
|
2
|
Headcraph E, Atukunda I, Kaddumukasa M, Nakiyingi L, Lusobya RC, Ampaire-Musika A, Otike C, Nagawa E, Juma P, Msonge F, Otiti-Sengeri J. Spectrum of and Factors Associated with Eye Disorders among Rheumatoid Arthritis Patients Attending Tertiary Hospital in Uganda. Open Access Rheumatol 2023; 15:103-111. [PMID: 37465162 PMCID: PMC10351586 DOI: 10.2147/oarrr.s413697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 07/06/2023] [Indexed: 07/20/2023] Open
Abstract
Background Ocular morbidities associated with rheumatoid arthritis (RA) have not received much attention in Africa, particularly in sub-Saharan Africa. They are among the commonest (40%) extra-articular organ involvement in RA. If undiagnosed, there is a potential risk of them causing visual impairment or blindness. There is no documented study in Uganda on the magnitude of eye disorders among RA patients. Aim To determine the spectrum of eye disorders and associated factors among patients with RA attending Mulago National Referral Hospital. Methods A hospital based cross-sectional study was conducted among adults with RA attending the rheumatology clinic between July 2021 and September 2021. Clinical and sociodemographic data were collected, and ophthalmologic examinations were performed on all consenting participants. Modified Poisson regression with robust standard error was used to determine factors associated with eye disorders. Results Overall, 105 patients with RA were enrolled, of which, 53 (50.5%) had eye disorders. The commonest disorder (54.7%, n=29) was dry-eye syndrome. Factors that were significantly associated with eye disorders were age 36-55 years (aPR 1.56, p=0.015), duration of RA >5 years (aPR 1.81, p=0.001), use of hydroxychloroquine >5 years (aPR 1.77, p=0.041), dose of oral steroids >10 mg/day (aPR 1.49, p=0.034), and history of both diabetes and hypertension (aPR 1.87, p=0.014). Conclusion The prevalence of eye disorders among patients with RA was high, with the commonest being dry-eye syndrome. We recommend that ocular examinations be performed on every patient at the time of RA diagnosis for early detection of eye disorders.
Collapse
Affiliation(s)
- Eunice Headcraph
- Department of Ophthalmology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Immaculate Atukunda
- Department of Ophthalmology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Mark Kaddumukasa
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Lydia Nakiyingi
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Rebecca Claire Lusobya
- Department of Ophthalmology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Anne Ampaire-Musika
- Department of Ophthalmology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Caroline Otike
- Clinical Epidemiology Unit, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Elizabeth Nagawa
- Department of Ophthalmology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Paul Juma
- Department of Ophthalmology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Fransisco Msonge
- Department of Ophthalmology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Juliet Otiti-Sengeri
- Department of Ophthalmology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| |
Collapse
|
3
|
Kiki GAÀ, Pop RM, Sabin O, Bocsan IC, Chedea VS, Socaci SA, Pârvu AE, Finsia E, Francis T, Mathieu Z, Buzoianu AD. Polyphenols from Dichrostachys cinerea Fruits Anti-Inflammatory, Analgesic, and Antioxidant Capacity in Freund’s Adjuvant-Induced Arthritic Rat Model. Molecules 2022; 27:molecules27175445. [PMID: 36080212 PMCID: PMC9457916 DOI: 10.3390/molecules27175445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/18/2022] [Accepted: 08/22/2022] [Indexed: 11/16/2022] Open
Abstract
Dichrostachys cinerea (L.) Wigth & Arn. (DC) is widely used in traditional medicine against several inflammatory diseases, especially rheumatoid arthritis, because of its antioxidant and anti-inflammatory effects. This study aimed to characterize the polyphenol-rich DC fruit extracts and investigate the analgesic, anti-inflammatory, and antioxidant effects in a rat inflammation model induced by complete Freund’s adjuvant (CFA). Water and ethanolic extracts were characterized using liquid chromatography coupled with mass spectrometry (LC-MS), Fourier-transform infrared (FTIR) spectroscopy, and gas chromatography coupled with mass spectrometry (GC-MS). The polyphenol-rich extracts were administered in three different concentrations for 30 days. Pain threshold, thermal hyperalgesia, edema, and serum biomarkers specific to inflammatory processes or oxidative stress were evaluated. Both extracts were rich in polyphenolic compounds, mainly flavan-3-ols, proanthocyanidins, and flavone glycosides, which had important in vitro antioxidant capacity. DC fruit extracts administration had the maximum antinociceptive and anti-inflammatory effects after one day since the CFA injection and showed promising results for long-term use as well. The measurement of pro-inflammatory cytokines, cortisol, and oxidative stress parameters showed that DC extracts significantly reduced these parameters, being dose and extract-type dependent. These results showed potential anti-inflammatory, analgesic, and antioxidative properties and revealed the necessity of using a standardized polyphenolic DC extract to avoid result variability.
Collapse
Affiliation(s)
- Gisèle Atsang à Kiki
- Department of Biological Sciences, Faculty of Science, University of Maroua, Maroua P.O. Box 814, Cameroon
| | - Raluca Maria Pop
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- Correspondence:
| | - Octavia Sabin
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Ioana Corina Bocsan
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Veronica Sanda Chedea
- Research Station for Viticulture and Enology Blaj (SCDVV Blaj), 515400 Blaj, Romania
| | - Sonia Ancuța Socaci
- Department of Food Science, University of Agricultural Sciences and Veterinary Medicine of Cluj-Napoca, 400372 Cluj-Napoca, Romania
| | - Alina Elena Pârvu
- Department of Pathophysiology, Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Egre Finsia
- Department of Biological Sciences, Faculty of Science, University of Maroua, Maroua P.O. Box 814, Cameroon
| | - Takvou Francis
- Department of Biological Sciences, Faculty of Science, University of Maroua, Maroua P.O. Box 814, Cameroon
| | - Zramah Mathieu
- Department of Biological Sciences, Faculty of Science, University of Maroua, Maroua P.O. Box 814, Cameroon
| | - Anca Dana Buzoianu
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| |
Collapse
|
4
|
Arunsi UO, Chioma OE, Etusim PE, Owumi SE. Indigenous Nigeria medicinal herbal remedies: A potential source for therapeutic against rheumatoid arthritis. Exp Biol Med (Maywood) 2022; 247:1148-1178. [PMID: 35708153 PMCID: PMC9335509 DOI: 10.1177/15353702221102901] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Rheumatoid arthritis (RA) is a debilitating disease associated with locomotion impairment, and conventional therapeutic drugs are not optimal for managing RA. There is an avalanche of medications used for the management of RA. Still, studies have shown that they are associated with severe side effects, including hepatotoxicity, retinopathy, and cardiotoxicity disorders of the central nervous system (CNS), skin, blood, and infections. Complementary and alternative medicine (CAM) is currently gaining attention as a novel panacea for managing debilitating diseases, such as RA. Nigerian folk herbal remedies are replete with a plethora of curative medicine, albeit unvalidated scientifically but with seemingly miraculous provenance. Studies of the identification of bioactive compounds present in these botanicals using advanced spectral analytical techniques have enhanced our understanding of the role of Nigerian herbal remedies in the treatment and management of RA. Interestingly, experimental studies abound that the bioactive compounds present in the extracts of plant botanicals protected animals from the development of RA in different experimental models and reduced the toxicity associated with conventional therapeutics. Validated mechanisms of RA amelioration in human and animal models include suppression of the expression of NF-κB, IL-1β, TNF-α, IL-6, IL-8, IL-17, IL-23, chemokines, TGF-β, RANKL, RANK, iNOS, arginase, COX-2, VEGFA, VEGFR, NFATC1, and TRAP in the synoviocytes. Decreased ROS, NO, MDA, carbonyl groups, and PGE2 in the synovial fluid increased the expression of PPARα/γ; antioxidant and anti-inflammatory molecules also improve RA etiology. In this mini-review, we discuss the global burden of RA, the novel role of plant-based botanicals as potential therapeutics against signaling pathways in RA. Also addressed is the possible repurposing/reprofiling of plant botanicals to increase their therapeutic index among RA patients that patronize traditional healers in Nigeria with a global projection.
Collapse
Affiliation(s)
- Uche O Arunsi
- Cancer Immunology and Biotechnology, School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK,Department of Biochemistry, Faculty of Biological and Physical Sciences, Abia State University, Uturu, 440001, Nigeria
| | - Ogbuka E Chioma
- Department of Social and Environmental Forestry, Faculty of Renewable Natural Resources, University of Ibadan, Ibadan 200005, Nigeria
| | - Paschal E Etusim
- Department of Animal and Environmental Biology, Faculty of Biological and Physical Sciences, Abia State University, Uturu 200, Nigeria
| | - Solomon E Owumi
- Cancer Research and Molecular Biology Laboratories, Department of Biochemistry, Faculty of Basic Medical Sciences, University of Ibadan, Ibadan 200005, Nigeria,Solomon Owumi.
| |
Collapse
|
5
|
Ariyo OO, Ajayi AM, Ben-Azu B, Aderibigbe AO. Morus mesozygia leaf extract ameliorates behavioral deficits, oxidative stress and inflammation in Complete Freund's adjuvant-induced arthritis in rats. JOURNAL OF ETHNOPHARMACOLOGY 2022; 292:115202. [PMID: 35331880 DOI: 10.1016/j.jep.2022.115202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 03/03/2022] [Accepted: 03/11/2022] [Indexed: 06/14/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Morus mesozygia Stapf (Moraceae), otherwise referred to as African mulberry, is utilized domestically as a remedy for a variety of inflammatory disorders including rheumatism. AIM The anti-arthritic effect of the ethylacetate fraction of M. mesozygia leaf extract (EAFMm) was assessed on complete Freund's adjuvant (CFA)-induced arthritis in male Wistar rats. METHOD Groups of male Wistar rats were injected with CFA (0.2 mL; 10 mg/mL) in the plantar surface of their right hind paws and treated orally with EAFMm (50 and 100 mg/kg) or its vehicle daily for 28 days. The effect on joint inflammation and mechanical nociception threshold, behavioral deficits (spontaneous motor activity in the open field test and depressive-like symptoms in the forced swim test) was evaluated. The levels and activities of the biomarkers of oxidative-nitrosative stress (reduced glutathione, superoxide dismutase, nitrite, and malondialdehyde) and inflammatory markers [TNF-α, IL-6, COX-2, NFκB and myeloperoxidase] were also analysed. RESULTS The EAFMm at the doses of 50 and 100 mg/kg produced a dose dependent reduction in joint inflammation and mechanical hyperalgesia, and as well improved behavioral deficits like spontaneous motor activity and depressive-like behavior. The EAFMm also significantly reduced oxido-nitrosative stress response in the joint and brain tissues. It also decreased TNF-α, interleukin-6 levels and myeloperoxidase enzyme activities in joints and brain tissues of rats. Furthermore, EAFMm attenuated the activity of NFκB and reduced the cyclooxygenase -2 protein expression level in joint tissues. CONCLUSION The ethylacetate fraction of Morus mesozygia leaf extract demonstrated anti-arthritic activity and ameliorated co-morbid depressive-like behavior via inhibition of oxidative stress and inflammation in a rat model of arthritis.
Collapse
Affiliation(s)
- Oluwakemi O Ariyo
- Neuropharmacology Unit, Department of Pharmacology & Therapeutics, University of Ibadan, Oyo-State, Nigeria.
| | - Abayomi M Ajayi
- Neuropharmacology Unit, Department of Pharmacology & Therapeutics, University of Ibadan, Oyo-State, Nigeria.
| | - Benneth Ben-Azu
- Neuropharmacology Unit, Department of Pharmacology & Therapeutics, University of Ibadan, Oyo-State, Nigeria; Department of Pharmacology, Faculty of Basic Medical Sciences, College of Health Sciences, Delta State University, Abraka, Delta State, Nigeria.
| | - Adegbuyi O Aderibigbe
- Neuropharmacology Unit, Department of Pharmacology & Therapeutics, University of Ibadan, Oyo-State, Nigeria.
| |
Collapse
|
6
|
Abdallah HY, Ibrahim ME, Abd El-Fadeal NM, Ali DA, Elsehrawy GG, Badr RE, Hassoba HM. Pharmacogenomics of Methotrexate Pathway in Rheumatoid Arthritis Patients: Approach toward Personalized Medicine. Diagnostics (Basel) 2022; 12:diagnostics12071560. [PMID: 35885466 PMCID: PMC9325258 DOI: 10.3390/diagnostics12071560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/10/2022] [Accepted: 06/23/2022] [Indexed: 11/28/2022] Open
Abstract
Background: Methotrexate (MTX) is one of the most common medications used for rheumatoid arthritis (RA) treatment. Single-nucleotide polymorphisms (SNPs) could potentially predict variability in therapeutic outcomes. Aim: This study aims to assess the impact of SNPs in genes encoding for the MTX pathway for predicting clinical and therapeutic responses to MTX in a cohort of Egyptian patients with RA. Subjects and Methods: Data from 107 Egyptian RA patients (aged 44.4 ± 11.4 years) treated with MTX monotherapy, for a duration of 3.7 ± 3.3 years, were collected. Genotypes of 10 SNPs from four different genes were analyzed using the allelic discrimination PCR technique. Results: The ATIC rs3821353 G/T (p = 0.034) and the C/T and C/C of SLC19A1 rs7279445 (p = 0.0018) were associated with a non-response to MTX, while DHFR rs10072026 C/T and C/C were associated with a good response (p < 0.001). Carriers of the ATIC rs382135 3 G (p = 0.001) and ATIC rs4673990 G (p < 0.001) alleles were more likely to develop RA, while the SLC19A1 rs11702425 T (p < 0.001) and GGH rs12681874 T (p = 0.003) allele carriers were more likely to be protected against RA. Carriers of the ATIC rs4673990 A/G genotype (p < 0.001) were at risk of developing RA, while carriers of the following genotypes were mostly protected against RA: ATIC rs3821353 T/T (p < 0.001), ATIC rs3821353 G/G (p = 0.004), SLC19A1 rs11702425 T/T (p = 0.001), SLC19A1 rs11702425 C/T (p = 0.003), GGH rs12681874 C/T (p = 0.004) and GGH rs12681874 T/T (0.002). Conclusion: The genotyping of genes involved in the MTX pathway may be helpful to predict which RA patients will/will not benefit from MTX, and thus, may help to apply a personalized medicine approach in RA.
Collapse
Affiliation(s)
- Hoda Y. Abdallah
- Medical Genetics Unit, Department of Histology and Cell Biology, Faculty of Medicine, Suez Canal University, Ismailia 41522, Egypt;
- Center of Excellence in Molecular & Cellular Medicine, Faculty of Medicine, Suez Canal University, Ismailia 41522, Egypt; (N.M.A.E.-F.); (D.A.A.)
| | - Maha E. Ibrahim
- Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Suez Canal University, Ismailia 41522, Egypt; (M.E.I.); (G.G.E.)
| | - Noha M. Abd El-Fadeal
- Center of Excellence in Molecular & Cellular Medicine, Faculty of Medicine, Suez Canal University, Ismailia 41522, Egypt; (N.M.A.E.-F.); (D.A.A.)
- Department of Medical Biochemistry & Molecular Biology, Faculty of Medicine, Suez Canal University, Ismailia 41522, Egypt
- Oncology Diagnostic Unit, Faculty of Medicine, Suez Canal University, Ismailia 41522, Egypt
| | - Dina A. Ali
- Center of Excellence in Molecular & Cellular Medicine, Faculty of Medicine, Suez Canal University, Ismailia 41522, Egypt; (N.M.A.E.-F.); (D.A.A.)
- Department of Clinical Pharmacology, Faculty of Medicine, Suez Canal University, Ismailia 41522, Egypt
| | - Gehad G. Elsehrawy
- Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Suez Canal University, Ismailia 41522, Egypt; (M.E.I.); (G.G.E.)
| | - Rasha E. Badr
- Department of Clinical and Chemical Pathology, Faculty of Medicine, Port Said University, Port Said 42526, Egypt;
| | - Howayda M. Hassoba
- Department of Clinical and Chemical Pathology, Faculty of Medicine, Suez Canal University, Ismailia 41522, Egypt
- Correspondence: or ; Tel.: +(2)-01-272-430-312; Fax: +(2)-06-432-16496
| |
Collapse
|
7
|
Sakyi SA, Boateng AO, Fondjo LA, Mensah KY, Opoku S, Senu E, Buckman TA, Sampson JE. Polymorphism of protein tyrosine phosphatase non-receptor type 22 and protein arginine deiminase 4 gene among Ghanaian rheumatoid arthritis patients: A case-control study. Int J Rheum Dis 2022; 25:781-786. [PMID: 35607828 DOI: 10.1111/1756-185x.14348] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/10/2022] [Accepted: 05/10/2022] [Indexed: 11/26/2022]
Abstract
AIM Rheumatoid arthritis (RA) is an autoimmune disease which affects millions of lives globally characterized by chronic inflammation in the joints of the body. There is no known cause for RA; however, genetic predisposition has been associated with its occurrence. The association between genetic predisposition and RA has been reported largely among Caucasians and Asians. However, few studies with limited data have reported genome-wide association studies of RA in Africa, especially in Ghana. In addition, there is genetic heterogeneity that exists geographically among different populations. This study therefore investigated the association of protein arginine deiminase type 4 (PAD4) and protein tyrosine phosphatase non-receptor type 22 (PTPN22) single nucleotide polymorphisms with susceptibility of RA among Ghanaians. METHODS This case-control study included 75 RA patients and 75 healthy controls from the Komfo Anokye Teaching Hospital in Ghana. Validated questionnaires were used to obtain demographic data, and blood samples were collected and processed for DNA and polymerase chain reaction analysis. Statistical analysis was done using SPSS version 25.0. RESULTS PTPN22 demonstrated a 100% minor allele frequency (GG) in both cases and healthy controls; however, an association could not be made for PTPN22 polymorphism with susceptibility of RA when comparing cases to controls. The homozygous minor allele (GG) of PAD4 was absent in the population. CONCLUSION PAD4 polymorphism was absent, while PTPN22 was present in the Ghanaian population. The association between PTPN22 (rs2476601) and PAD4 (rs2240340) with RA susceptibility could not be established, thus may not contribute as risk factors for RA in the Ghanaian population.
Collapse
Affiliation(s)
- Samuel Asamoah Sakyi
- Department of Molecular Medicine, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Andy Opoku Boateng
- Department of Molecular Medicine, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Linda Ahenkorah Fondjo
- Department of Molecular Medicine, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Kwame Yeboah Mensah
- Department of Internal Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Stephen Opoku
- Department of Molecular Medicine, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Ebenezer Senu
- Department of Molecular Medicine, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Tonnies Abeku Buckman
- Department of Molecular Medicine, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Joseph Entwi Sampson
- Department of Molecular Medicine, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| |
Collapse
|
8
|
Abstract
Historically, rheumatic diseases have not received much attention in Africa, particularly in sub-Saharan Africa, possibly owing to a focus on the overwhelming incidence of infectious diseases and the decreased life span of the general population in this region. Global attention and support, together with better health policies and planning, have improved outcomes for many infectious diseases; thus, increasing attention is being turned to chronic non-communicable diseases. Rheumatic diseases were previously considered to be rare among Africans but there is now a growing interest in these conditions, particularly as the number of rheumatologists on the continent increases. This interest has resulted in a growing number of publications from Africa on the more commonly encountered rheumatic diseases, as well as case reports of rare diseases. Despite the limited amount of available data, some aspects of the epidemiology, genetics and clinical and laboratory features of rheumatic diseases in African populations are known, as is some detail on the use of therapeutics. Similarities and differences in these conditions can be seen across the multi-ethnic and genetically diverse African continent, and it is hoped that increased awareness of rheumatic diseases in Africa will lead to earlier diagnosis and better outcomes for patients. The prevalence of rheumatic diseases is increasing in African countries, leading to an increased need for specialist rheumatologists and disease-modifying drugs. In this Review, the authors outline what is currently known about the state of rheumatic diseases in Africa. In the past, there has been an emphasis on communicable diseases in Africa, but attention has now shifted towards non-communicable diseases such as rheumatic diseases. Common rheumatic diseases are seen in Africa and are both comparable and different from presentations seen outside of Africa. Diverse genetic and environmental factors affect the presentation of common rheumatic diseases among different African nations. A shortage of appropriately trained staff, laboratory testing capacity and effective medications exists across the whole continent. Advocacy and research are needed to increase awareness of the risk factors, presentations and management of rheumatic diseases in Africa. Specialized treatment guidelines are needed for resource-poor countries in Africa.
Collapse
|
9
|
Ubaka CM, Ibe OG, Amorha KC, Isah A, Okonta MJ. Medication adherence among Nigerian patients with rheumatoid arthritis: a two instruments survey. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2021. [DOI: 10.1093/jphsr/rmaa007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Objectives
Medication adherence is still a significant problem in chronic diseases management and rheumatoid arthritis (RA) is not an exception. There is very little information regarding the level and influencing factors of medication adherence among Nigerian patients with RA. This study evaluated the level and determinants of medication adherence among patients with RA in a Nigerian referral hospital.
Methods
Using a questionnaire based cross sectional survey, 169 patients with RA were evaluated for their medication adherence using two validated instruments namely; five-item Medication Adherence Report Scale and five-item Compliance Questionnaire for Rheumatology. The two instruments were subjected to descriptive (mean and frequencies) and mean difference (chi-square, t-test, Pearson correlation) analysis, and their reliability (Cronbach alpha) in a Nigerian setting was also established.
Key findings
The level of non-adherence reported in this study was high and ranged from 48.5% for the CQR to 63.9% for the Medication Adherence Report Scale questionnaires respectively. Being of a male gender, of an older age, the higher number of pills taken, better education and the duration of the disease all significantly contributed to higher adherence measures among these RA patients (P <0.05 for all). Both questionnaires used were correlated and reliable for use among patients with rheumatoid arthritis in Nigeria.
Conclusion
Findings from this study show that non adherence to medications among RA patients were high and factors such age, gender, education, pill burden could have been responsible.
Collapse
Affiliation(s)
- Chukwuemeka M Ubaka
- Department of Clinical Pharmacy and Pharmacy Management University of Nigeria, Nsukka, Enugu, Nigeria
- Pharmacy Practice and Pharmaceutical Care Research Group, University of Nigeria, Nsukka, Enugu, Nigeria
| | - Ozulonye G Ibe
- Department of Pharmacy, National Orthopedic Hospital, Thinkers Corner, Enugu, Nigeria
| | - Kosisochi C Amorha
- Department of Clinical Pharmacy and Pharmacy Management University of Nigeria, Nsukka, Enugu, Nigeria
- Pharmacy Practice and Pharmaceutical Care Research Group, University of Nigeria, Nsukka, Enugu, Nigeria
| | - Abdulmuminu Isah
- Department of Clinical Pharmacy and Pharmacy Management University of Nigeria, Nsukka, Enugu, Nigeria
- Pharmacy Practice and Pharmaceutical Care Research Group, University of Nigeria, Nsukka, Enugu, Nigeria
| | - Mathew J Okonta
- Department of Clinical Pharmacy and Pharmacy Management University of Nigeria, Nsukka, Enugu, Nigeria
- Pharmacy Practice and Pharmaceutical Care Research Group, University of Nigeria, Nsukka, Enugu, Nigeria
| |
Collapse
|
10
|
Assogba TF, Niama-Natta DD, Kpadonou TG, Lawson T, Mahaudens P, Detrembleur C. Disability and functioning in primary and secondary hip osteoarthritis in Benin. Afr J Disabil 2020; 9:675. [PMID: 33354532 PMCID: PMC7736690 DOI: 10.4102/ajod.v9i0.675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 08/27/2020] [Indexed: 11/23/2022] Open
Abstract
Background In Africa, primary hip osteoarthritis seems to be less frequent than in Europe. Sickle cell disease is responsible for aseptic osteonecrosis of the femoral head associated with secondary hip osteoarthritis. Very little evidence is available on the influence of aetiology (primary and secondary) and radiographic status on pain and disability in a Beninese population with hip osteoarthritis. Objectives The aim of this study was to compare the impacts of aetiology and radiographic status on pain, disability and quality of life in a Beninese population with hip osteoarthritis. Method This was a descriptive cross-sectional study, including participants recruited in the Clinic of Physical Medicine and Rehabilitation at the National Teaching Hospital in Cotonou. Assessment was based on the International Classification of Functioning, Disability and Health model. The main outcomes were severity of osteoarthritis, pain, range of motion, muscle strength, gait speed and quality of life. Statistical comparisons between the aetiologies were performed using a t-test or rank sum test. One-way analysis of variance was used to test the effect of radiographic status. Results Forty-nine participants (26 women and 23 men; mean age [standard deviation] 40.5 [17.9] years) were recruited. According to the aetiology (59.2% and 40.8% of primary and secondary osteoarthritis, respectively), there were no significant differences for any of the outcomes. Grades I, II, III and IV osteoarthritis were observed in 22.4%, 14.3%, 26.5% and 36.7% of the participants, respectively. Participants with grade IV osteoarthritis were more affected than those with grades I, II and III based on the Kellgren and Lawrence classification. Conclusion Aetiology did not influence pain, gait speed or quality of life. Participants with grade IV osteoarthritis had more pain, were more limited in walking and had a more impaired quality of life.
Collapse
Affiliation(s)
- Todègnon F Assogba
- Neuro Musculo Skeletal Lab (NMSK), Faculté des Sciences de la Motricité, Université Catholique de Louvain, Brussels, Belgium.,Clinique Universitaire de Médecine Physique et de Réadaptation, Centre National Hospitalier et Universitaire Hubert K. Maga, Cotonou, Benin
| | - Didier D Niama-Natta
- Clinique Universitaire de Médecine Physique et de Réadaptation, Centre National Hospitalier et Universitaire Hubert K. Maga, Cotonou, Benin
| | - Toussaint G Kpadonou
- Clinique Universitaire de Médecine Physique et de Réadaptation, Centre National Hospitalier et Universitaire Hubert K. Maga, Cotonou, Benin
| | - Teefany Lawson
- Clinique Universitaire de Médecine Physique et de Réadaptation, Centre National Hospitalier et Universitaire Hubert K. Maga, Cotonou, Benin
| | - Philippe Mahaudens
- Neuro Musculo Skeletal Lab (NMSK), Faculté des Sciences de la Motricité, Université Catholique de Louvain, Brussels, Belgium.,Service d'Orthopédie et de Traumatologie de l'Appareil Locomoteur, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Christine Detrembleur
- Neuro Musculo Skeletal Lab (NMSK), Faculté des Sciences de la Motricité, Université Catholique de Louvain, Brussels, Belgium
| |
Collapse
|
11
|
Vento S, Cainelli F. Commentary: Systemic Lupus Erythematosus in Native sub-Saharan Africans: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2020; 7:202. [PMID: 32537453 PMCID: PMC7267008 DOI: 10.3389/fmed.2020.00202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 04/27/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sandro Vento
- Faculty of Medicine, University of Puthisastra, Phnom Penh, Cambodia
- *Correspondence: Sandro Vento ;
| | - Francesca Cainelli
- Faculty of Medicine, University of Puthisastra, Phnom Penh, Cambodia
- Raffles Medical Group Clinic, Phnom Penh, Cambodia
| |
Collapse
|
12
|
Rutter-Locher Z, Galloway J, Lempp H. Rheumatology care of migrants from sub-Saharan Africa: a literature review and qualitative pilot study of patients' perspectives. Clin Rheumatol 2020; 40:3429-3438. [PMID: 32335755 DOI: 10.1007/s10067-020-05099-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/06/2020] [Accepted: 04/08/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Rheumatologists practising in the UK National Health Service (NHS) are likely to treat migrant patients from sub-Saharan Africa. This study aimed to conduct a literature review about rheumatoid arthritis prevalence in Africa and understand the experiences of patients with rheumatological conditions, about their past healthcare in sub-Saharan Africa and their transition of care to the United Kingdom (UK). METHODS A systematic search and a pilot study using semi-structured interviews to gain the views of migrants from sub-Saharan Africa with rheumatological conditions was conducted. RESULTS Thirty-two studies reported on the prevalence of rheumatoid arthritis in Africa. Studies were small and out-of-date, and there was significant heterogeneity in prevalence rates. For the qualitative study, seven participants were recruited. Four themes were highlighted: (i) the physical and emotional impact of rheumatological conditions on participants; (ii) limited rheumatology care in sub-Saharan Africa with high costs, limited access to specialists, lack of investigations and treatments, the use of traditional medicines and poor communication by clinicians; (iii) barriers to rheumatology care in the UK such as migrants' poor understanding of rheumatological conditions and NHS entitlements; (iv) and ways to improve access to care such as patient, public and general practitioner education. CONCLUSION This study has highlighted the paucity of rheumatoid arthritis prevalence data in Africa and described, for the first time, the migrant's perspective of rheumatology care in sub-Saharan Africa and the transition of care to the UK. This description begins to allow healthcare providers in the UK to tailor management for this migrant population. Key Points • Rheumatological conditions are common in Africa, but there is a paucity of epidemiological data regarding the prevalence of specific conditions such as rheumatoid arthritis. • UK clinicians need to be mindful when treating migrants that access to rheumatologists and specialist investigations and treatment is limited in sub-Saharan Africa and that there is often limited public and patient understanding of rheumatological conditions. • Migrants continue to lack understanding of their NHS entitlements and fear data sharing with immigration services which can be a barrier to seeking care. • This study has exposed the lack of understanding about rheumatological conditions by the public and some general practitioners which needs to be addressed with effective education and awareness campaigns.
Collapse
Affiliation(s)
- Zoe Rutter-Locher
- Rheumatology Department, Guy's and St Thomas' NHS Foundation Trust, London, UK.
| | - James Galloway
- The Centre for Rheumatic Diseases, King's College London, Weston Education Centre, Cutcombe Road, London, UK
| | - Heidi Lempp
- The Centre for Rheumatic Diseases, King's College London, Weston Education Centre, Cutcombe Road, London, UK
| |
Collapse
|
13
|
Epidemiology of rheumatoid arthritis in sub-Saharan Africa: a systematic review and meta-analysis protocol. Syst Rev 2020; 9:81. [PMID: 32303250 PMCID: PMC7164226 DOI: 10.1186/s13643-020-01342-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 03/30/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND So far, only one meta-analysis has estimated the prevalence of rheumatoid arthritis (RA) in Africa. Out of 10 studies included in that meta-analysis, nine came from sub-Saharan African countries and had been published between 1968 and 1988. We will conduct a new systematic review and meta-analysis to update their estimates and provide more consistent prevalence data on RA in sub-Saharan Africa. METHODS We will comprehensively search electronic databases to select observational studies addressing RA in sub-Saharan Africa and published as from 1 January 2000: PubMed, EMBASE, African Journals Online, Web of Science, and Global Index Medicus. Summary estimates will be derived through random-effects meta-analysis whenever possible. Alternatively, estimates will be reported through narrative synthesis when the random-effects meta-analysis will be impossible. The risk of bias will be assessed using standard methods. DISCUSSION This systematic review and meta-analysis shall quantify the magnitude of RA morbidity and mortality in sub-Saharan Africa. Results from this review will be disseminated in peer-reviewed journals, conferences and on social media platforms. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020153483.
Collapse
|
14
|
Validity of 7-Joint Versus Simplified 12-Joint Ultrasonography Scoring Systems in Assessment of Rheumatoid Arthritis Activity. J Clin Rheumatol 2020; 25:264-271. [PMID: 29965853 DOI: 10.1097/rhu.0000000000000847] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Musculoskeletal ultrasonography (US) is an objective tool for the evaluation of disease activity in rheumatoid arthritis (RA) patients. There is no consensus on the exact number of joints that should be examined. Examination of reduced joint count is more practical than the comprehensive one. OBJECTIVES This is a cross-sectional study investigated the validity of a 7-joint US score (US7) in assessment of joint inflammation in RA patients compared with a simplified 12-joint US score (US12) and correlated both to composite disease activity indices. METHODS The activity status of 50 RA patients was assessed clinically and ultrasonographically. The disease activity was calculated using 3 composite indices. Ultrasonography was performed by 1 blinded rheumatologist, using power Doppler (PD) and gray-scale (GS) US examination. The US7 and simplified US12 were performed as originally described. However, the GS synovitis and PD synovitis of US12 were computed in 2 separate scores instead of 1. Two sum US7 scores were added, sum (GS) US7 and sum (PD) US7 after summating synovitis and tenosynovitis scores. Ultrasonography interobserver/intraobserver reliability was evaluated on 40 stored images. RESULTS Correlation coefficient between the different ultrasonographic scores showed no difference. The GS scores showed no correlation with disease activity parameters; however, the PD scores did. The sum (PD) US7 was the only score that showed significant correlation with the 3 different composite disease indices. CONCLUSIONS All studied US scores proved valid in assessment of disease activity status in RA. This is in favor of using the less-time-consuming US7 scores. The strongest correlation found with sum (PD) US7 confirmed the importance of incorporating the tendon in the disease activity assessment.
Collapse
|
15
|
Achour Y, Ben Hamad M, Chaabane S, Rebai A, Marzouk S, Mahfoudh N, Bahloul Z, Keskes L, Maalej A. Analysis of two susceptibility SNPs in HLA region and evidence of interaction between rs6457617 in HLA-DQB1 and HLA-DRB1*04 locus on Tunisian rheumatoid arthritis. J Genet 2018; 96:911-918. [PMID: 29321349 DOI: 10.1007/s12041-017-0855-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Previous genomewide association studies (GWAS) and meta-analyses have enumerated several genes/loci in major histocompatibility complex region, which are consistently associated with rheumatoid arthritis (RA) in different ethnic populations. Given the genetic heterogeneity of the disease, it is necessary to replicate these susceptibility loci in other populations. In this case, we investigate the analysis of two SNPs, rs13192471 and rs6457617, from the human leukocyte antigen (HLA) region with the risk of RA in Tunisian population. These SNPs were previously identified to have a strong RA association signal in several GWAS studies. A case-control sample composed of 142 RA patients and 123 healthy controls was analysed. Genotyping of rs13192471 and rs6457617 was carried out using real-time PCR methods by TaqMan allelic discrimination assay. A trend of significant association was found in rs6457617 TT genotype with susceptibility to RA (P = 0.04, pc = 0.08, OR = 1.73). Moreover, using multivariable analysis, the combination of rs6457617*TT-HLA-DRB1*04+ increased risk of RA (OR = 2.38), which suggest a gene-gene interaction event between rs6457617 located within the HLA-DQB1 and HLA-DRB1. Additionally, haplotypic analysis highlighted a significant association of rs6457617*T-HLA-DRB1*04+ haplotype with susceptibility to RA (P = 0.018, pc = 0.036, OR = 1.72). An evidence of association was shown subsequently in antiCCP+ subgroup with rs6457617 both in T allele and TT genotype (P = 0.01, pc = 0.03, OR = 1.66 and P = 0.008, pc = 0.024, OR = 1.28, respectively). However, no association was shown for rs13192471 polymorphism with susceptibility and severity to RA. This study suggests the involvement of rs6457617 locus as risk variant for susceptibility/severity to RA in Tunisian population. Secondly, it highlights the gene-gene interaction between HLA-DQB1 and HLA-DRB1.
Collapse
Affiliation(s)
- Yosser Achour
- Faculty of Medicine, Laboratory of Human Molecular Genetics, Avenue Majida Boulila. 3029, Sfax, Tunisia.
| | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Safety and Efficacy of Biological Disease-Modifying Antirheumatic Drugs in Older Rheumatoid Arthritis Patients: Staying the Distance. Drugs Aging 2017; 33:387-98. [PMID: 27154398 DOI: 10.1007/s40266-016-0374-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The population of older individuals with rheumatoid arthritis (RA) is rapidly expanding, mainly due to increased life expectancy. While targeted biological therapies are well established for the treatment of this disease, their use may be lower in older patients (age > 65 years) and very old patients (age > 75 years) as a result of perceived higher risks for adverse events in this population, taking into account comorbidity, polypharmacy, and frailty. In this review, we discuss the available evidence for the use of biological therapies in this growing patient group with specific attention towards the eventual reasons for biological treatment failure or withdrawal. The majority of data is found in secondary analyses of clinical trials and in retrospective cohorts. The most information available is on tumor necrosis factor (TNF) blockers. Older patients seem to have a less robust response to anti-TNF agents than a younger population, but drug survival as a proxy for efficacy does not seem to be influenced by age. Despite an overall rate of adverse effects comparable to that in younger patients, older RA patients are at higher risk of serious infections. Other biologics appear to have an efficacy similar to anti-TNF agents, also in older RA patients. Again, the drug survival rates for tocilizumab, rituximab, and abatacept resemble those in young RA patients with good general tolerability and safety profiles. The cardiovascular risk and the risk of cancer, increased in RA patients and in the older RA patients, do not appear to be strongly influenced by biologicals.
Collapse
|
17
|
Brunier L, Bleterry M, Merle S, Derancourt C, Polomat K, Dehlinger V, Deligny C, Jean-Baptiste G, Arfi S, Banydeen R, De Bandt M. Prevalence of rheumatoid arthritis in the French West Indies: Results of the EPPPRA study in Martinique. Joint Bone Spine 2017; 84:455-461. [PMID: 27825567 DOI: 10.1016/j.jbspin.2016.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 09/07/2016] [Indexed: 10/20/2022]
|
18
|
Wu J, Li J, Li S, Zhang TP, Li LJ, Lv TT, Pan HF, Ye DQ. Association of HLA-DQB1 polymorphisms with rheumatoid arthritis: a meta-analysis. Postgrad Med J 2017; 93:618-625. [DOI: 10.1136/postgradmedj-2016-134724] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 03/09/2017] [Accepted: 03/19/2017] [Indexed: 01/26/2023]
|
19
|
Effect of Artemisia annua extract on treating active rheumatoid arthritis: A randomized controlled trial. Chin J Integr Med 2016; 23:496-503. [PMID: 28035541 DOI: 10.1007/s11655-016-2650-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To investigate the effect and safety of the complementary use of the extract of Artemisia annua L. (EAA) on treating active rheumatoid arthritis (RA). METHODS A randomized controlled clinical trial was performed. All the 159 participates with active RA were randomly assigned to the control group (80 cases) and EAA group (79 cases) using concealed random allocation method. In the control group, patients were medicated with leflflunomide and methotrexate for 48 weeks; and patients in the EAA group were administrated with leflflunomide, methotrexate plus EAA (30 g/d). At the time points of 0, 12, 24 and 48 weeks, the clinical outcome measures, including objective pain score, tenderness score, number of painful joints, number of swollen joints, health assessment questionnaire (HAQ) score for quality of life, levels of serum rheumatoid factor (RF), anti-cyclic citrullinated protein antibodies (CCP-Ab), erythrocyte sedimentation rate (ESR), C reactive protein (CRP), visual analogue score for pain (VAS), and the overall effificacy were detected and recorded. RESULTS The objective pain score, number of painful joints and ESR at 12 weeks, tenderness score and HAQ at 24 weeks, and the tenderness score, number of painfull joints, number of swollen joints, HAQ, CRP, RF and CCP-Ab at 48 weeks were signifificantly improved in the EAA group compared with the control group (P<0.01 or P<0.05). At 24 and 48 weeks, the overall effificacy of the EAA group was signifificantly higher than the control group (P<0.01). There were signifificantly higher withdrawal rate of corticosteroids within 12 weeks post-treatment and lower incidence rate of adverse effects in the EAA group compared with the control group (P<0.01 or P<0.05). CONCLUSION EAA plus methotrexate and leflflunomide were more effective and safer than the routine use of methotrexate and leflflunomide in the treatment of active RA.
Collapse
|
20
|
Hegab MM, Abdelwahab AF, El-Sayed Yousef AM, Salem MN, El-Baz W, Abdelrhman S, Elshabacy F, Alhefny A, Abouraya W, Ibrahim SM, Ragab G, Rudolph JM. CD28 and PTPN22 are associated with susceptibility to rheumatoid arthritis in Egyptians. Hum Immunol 2016; 77:522-6. [PMID: 27125674 DOI: 10.1016/j.humimm.2016.04.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 02/16/2016] [Accepted: 04/23/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Limited data are available on the genetics of rheumatoid arthritis (RA) in Egyptians. Therefore, we investigated whether the confirmed genetic risk factors for RA in Europeans and/or Asians contribute to RA susceptibility in Egyptians. SUBJECTS AND METHODS A set of seven single-nucleotide polymorphisms (SNPs) in the vicinity of CD28, TNFAIP3, PTPN22, PADI4 and HLA-DRA were tested in a large multi-centric RA cohort in Egypt, consisting of 394 cases and 398 matched controls. Patients were stratified based on the positivity of either anti-citrullinated protein antibodies (ACPAs) or rheumatoid factor (RF). RESULTS Significant association was evident for three SNPs in this cohort: the CD28 (rs1980422) variant showed a strong association in the whole cohort (P=0.000119) and in seropositive subsets of the disease (PACPA+=0.004; PRF+=0.0005). Upon stratification, the PTPN22 (rs2476601) and TNFAIP3(rs5029939) variants showed association only with ACPA positive (PACPA+=0.00573) and negative (PACPA-=0.00999) phenotypes, respectively. CONCLUSION Our results suggest that CD28(rs1980422) and PTPN22(rs2476601) contribute to RA-susceptibility in Egyptians. Failure to replicate the association of PADI4(rs2240340)/(PADI4_94) in Egyptian RA patients provides further support for the notion that genetic architecture of RA is different in multiple populations of European, Asian, African, and Middle Eastern ancestries. Further investigation using large-scale studies is thus needed to maximize the power of genetic association.
Collapse
Affiliation(s)
- Mohsen M Hegab
- Molecular Medicine Research Group, Department of Reproductive Medicine, Division of Medical Research, National Research Centre (NRC), 33 EL Bohouth St., Dokki, Giza P.O.12622, Egypt (Scopus affiliation ID 60014618); Department of Dermatology, University of Lübeck, Germany
| | - Aml Fawzy Abdelwahab
- Molecular Medicine Research Group, Department of Reproductive Medicine, Division of Medical Research, National Research Centre (NRC), 33 EL Bohouth St., Dokki, Giza P.O.12622, Egypt (Scopus affiliation ID 60014618)
| | | | - Mohamed Nabil Salem
- Department of Internal Medicine, Faculty of Medicine, Beni-Suef University, Egypt
| | - Walaa El-Baz
- Department of Internal Medicine, Rheumatology & Immunology Unit, Faculty of Medicine, Al-Azhar University, Egypt
| | - Sherry Abdelrhman
- Department of Rheumatology and Immunology, Benha Teaching Hospital, Egypt
| | - Fatemah Elshabacy
- Department of Rheumatology and Immunology, Benha Teaching Hospital, Egypt
| | - Abdelazim Alhefny
- Department of Internal Medicine, Rheumatology & Immunology Unit, Faculty of Medicine, Ain Shams University, Egypt
| | - Wagida Abouraya
- Department of Internal Medicine, Rheumatology & Immunology Unit, Faculty of Medicine, Al-Azhar University, Egypt
| | | | - Gaafar Ragab
- Department of Internal Medicine, Rheumatology & Immunology Unit, Faculty of Medicine, Cairo University, Egypt.
| | | |
Collapse
|
21
|
Reliable and cost-effective serodiagnosis of rheumatoid arthritis. Rheumatol Int 2016; 36:751-8. [DOI: 10.1007/s00296-016-3433-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 01/26/2016] [Indexed: 10/22/2022]
|
22
|
Rudan I, Campbell H, Marušić A, Sridhar D, Nair H, Adeloye D, Theodoratou E, Chan KY. Assembling GHERG: Could "academic crowd-sourcing" address gaps in global health estimates? J Glob Health 2015; 5:010101. [PMID: 26445671 PMCID: PMC4593291 DOI: 10.7189/jogh.05.010101] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In recent months, the World Health Organization (WHO), independent academic researchers, the Lancet and PLoS Medicine journals worked together to improve reporting of population health estimates. The new guidelines for accurate and transparent health estimates reporting (likely to be named GATHER), which are eagerly awaited, represent a helpful move that should benefit the field of global health metrics. Building on this progress and drawing from a tradition of Child Health Epidemiology Reference Group (CHERG)'s successful work model, we would like to propose a new initiative - "Global Health Epidemiology Reference Group" (GHERG). We see GHERG as an informal and entirely voluntary international collaboration of academic groups who are willing to contribute to improving disease burden estimates and respect the principles of the new guidelines - a form of "academic crowd-sourcing". The main focus of GHERG will be to identify the "gap areas" where not much information is available and/or where there is a lot of uncertainty present about the accuracy of the existing estimates. This approach should serve to complement the existing WHO and IHME estimates and to represent added value to both efforts.
Collapse
Affiliation(s)
- Igor Rudan
- Centre for Global Health Research, The Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Scotland, UK
| | - Harry Campbell
- Centre for Global Health Research, The Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Scotland, UK
| | - Ana Marušić
- Centre for Global Health Research, The Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Scotland, UK ; Croatian Centre for Global Health, University of Split School of Medicine, Split, Croatia ; Department of Research in Biomedicine and Health, University of Split School of Medicine, Split, Croatia
| | - Devi Sridhar
- Centre for Global Health Research, The Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Scotland, UK
| | - Harish Nair
- Centre for Global Health Research, The Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Scotland, UK
| | - Davies Adeloye
- Centre for Global Health Research, The Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Scotland, UK
| | - Evropi Theodoratou
- Centre for Global Health Research, The Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Scotland, UK
| | - Kit Yee Chan
- Centre for Global Health Research, The Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Scotland, UK
| |
Collapse
|
23
|
Usenbo A, Kramer V, Young T, Musekiwa A. Prevalence of Arthritis in Africa: A Systematic Review and Meta-Analysis. PLoS One 2015; 10:e0133858. [PMID: 26241756 PMCID: PMC4524637 DOI: 10.1371/journal.pone.0133858] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 07/02/2015] [Indexed: 12/03/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Anthony Usenbo
- Community Health Division, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Veronika Kramer
- Cochrane Infectious Diseases Group, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Taryn Young
- Centre for Evidence Based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Alfred Musekiwa
- Centre for Evidence Based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| |
Collapse
|
24
|
Rudan I, Sidhu S, Papana A, Meng S, Xin–Wei Y, Wang W, Campbell–Page RM, Demaio AR, Nair H, Sridhar D, Theodoratou E, Dowman B, Adeloye D, Majeed A, Car J, Campbell H, Wang W, Chan KY. Prevalence of rheumatoid arthritis in low- and middle-income countries: A systematic review and analysis. J Glob Health 2015; 5:010409. [PMID: 25969732 PMCID: PMC4416333 DOI: 10.7189/jogh.05.010409] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Rheumatoid arthritis (RA) is an autoimmune disorder that affects the small joints of the body. It is one of the leading causes of chronic morbidity in high-income countries, but little is known about the burden of this disease in low- and middle-income countries (LMIC). METHODS The aim of this study was to estimate the prevalence of RA in six of the World Health Organization's (WHO) regions that harbour LMIC by identifying all relevant studies in those regions. To accomplish this aim various bibliographic databases were searched: PubMed, EMBASE, Global Health, LILACS and the Chinese databases CNKI and WanFang. Studies were selected based on pre-defined inclusion criteria, including a definition of RA based on the 1987 revision of the American College of Rheumatology (ACR) definition. RESULTS Meta-estimates of regional RA prevalence rates for countries of low or middle income were 0.40% (95% CI: 0.23-0.57%) for Southeast Asian, 0.37% (95% CI: 0.23-0.51%) for Eastern Mediterranean, 0.62% (95% CI: 0.47-0.77%) for European, 1.25% (95% CI: 0.64-1.86%) for American and 0.42% (95% CI: 0.30-0.53%) for Western Pacific regions. A formal meta-analysis could not be performed for the sub-Saharan African region due to limited data. Male prevalence of RA in LMIC was 0.16% (95% CI: 0.11-0.20%) while the prevalence in women reached 0.75% (95% CI: 0.60-0.90%). This difference between males and females was statistically significant (P < 0.0001). The prevalence of RA did not differ significantly between urban and rural settings (P = 0.353). These prevalence estimates represent 2.60 (95% CI: 1.85-3.34%) million male sufferers and 12.21 (95% CI: 9.78-14.67%) million female sufferers in LMIC in the year 2000, and 3.16 (95% CI: 2.25-4.05%) million affected males and 14.87 (95% CI: 11.91-17.86%) million affected females in LMIC in the year 2010. CONCLUSION Given that majority of the world's population resides in LMIC, the number of affected people is substantial, with a projection to increase in the coming years. Therefore, policy makers and health-care providers need to plan to address a significant disease burden both socially and economically.
Collapse
Affiliation(s)
- Igor Rudan
- Joint first authorship
- The University of Edinburgh Medical School, Edinburgh, Scotland, UK
| | - Simrita Sidhu
- Joint first authorship
- The University of Edinburgh Medical School, Edinburgh, Scotland, UK
| | | | - Shi–Jiao Meng
- School of Public Health, Capital Medical University, Beijing, China
| | - Yu Xin–Wei
- School of Public Health, Capital Medical University, Beijing, China
| | - Wei Wang
- School of Public Health, Capital Medical University, Beijing, China
- Department of Integrated Early Childhood and Development, Capital Institute of Paediatrics, Beijing, China
| | | | - Alessandro Rhyll Demaio
- Copenhagen School of Global Health, University of Copenhagen, Denmark
- Harvard Global Equity Initiative, Harvard Medical School, Cambridge, USA
| | - Harish Nair
- The University of Edinburgh Medical School, Edinburgh, Scotland, UK
| | - Devi Sridhar
- The University of Edinburgh Medical School, Edinburgh, Scotland, UK
| | | | - Ben Dowman
- The University of Edinburgh Medical School, Edinburgh, Scotland, UK
| | - Davies Adeloye
- The University of Edinburgh Medical School, Edinburgh, Scotland, UK
| | - Azeem Majeed
- School of Public Health, Imperial College London, London, UK
| | - Josip Car
- School of Public Health, Imperial College London, London, UK
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Harry Campbell
- The University of Edinburgh Medical School, Edinburgh, Scotland, UK
| | - Wei Wang
- School of Public Health, Capital Medical University, Beijing, China
- Edith Cowan University, Perth, Australia
| | - Kit Yee Chan
- The University of Edinburgh Medical School, Edinburgh, Scotland, UK
- School of Public Health, Peking University Health Science Centre, Beijing, China
| | - Global Health Epidemiology Reference Group (GHERG)
- Joint first authorship
- The University of Edinburgh Medical School, Edinburgh, Scotland, UK
- University of Macedonia, Thessaloniki, Greece
- School of Public Health, Capital Medical University, Beijing, China
- Department of Integrated Early Childhood and Development, Capital Institute of Paediatrics, Beijing, China
- The University of Toronto, Toronto, Canada
- Copenhagen School of Global Health, University of Copenhagen, Denmark
- Harvard Global Equity Initiative, Harvard Medical School, Cambridge, USA
- School of Public Health, Imperial College London, London, UK
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Edith Cowan University, Perth, Australia
- School of Public Health, Peking University Health Science Centre, Beijing, China
| |
Collapse
|
25
|
Al Saleh J, Ragab G, Nash P, Halabi H, Laatar A, El-Sayed Yousef AM, Ehsouna H, Hammoudeh M. Rheumatoid arthritis in the Middle East and Africa: are we any closer to optimising its management? Clin Rheumatol 2014; 34:1-8. [PMID: 25376467 DOI: 10.1007/s10067-014-2818-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 10/24/2014] [Accepted: 10/26/2014] [Indexed: 12/18/2022]
Affiliation(s)
- Jamal Al Saleh
- Rheumatology Section, Dubai Hospital, Dubai, United Arab Emirates,
| | | | | | | | | | | | | | | |
Collapse
|
26
|
Halabi H, Alarfaj A, Alawneh K, Alballa S, Alsaeid K, Badsha H, Benitha R, Bouajina E, Al Emadi S, El Garf A, El Hadidi K, Laatar A, Makhloufi CD, Masri AF, Menassa J, Al Shaikh A, Swailem RA, Dougados M. Challenges and opportunities in the early diagnosis and optimal management of rheumatoid arthritis in Africa and the Middle East. Int J Rheum Dis 2014; 18:268-75. [PMID: 24620997 DOI: 10.1111/1756-185x.12320] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2014] [Indexed: 02/01/2023]
Abstract
Early diagnosis and early initiation of disease-modifying antirheumatic drug (DMARD) therapy slow the progression of joint damage and decrease the morbidity and mortality associated with rheumatoid arthritis (RA). According to the European League Against Rheumatism (EULAR) guidelines, treatment should be initiated with methotrexate and addition of biological DMARDs such as tumour necrosis factor (TNF) inhibitors should be considered for RA patients who respond insufficiently to methotrexate and/or other synthetic DMARDs and have poor prognostic factors. Africa and the Middle East is a large geographical region with varying treatment practices and standards of care in RA. Existing data show that patients with RA in the region are often diagnosed late, present with active disease and often do not receive DMARDs early in the course of the disease. In this review, we discuss the value of early diagnosis and remission-targeted treatment for limiting joint damage and improving disease outcomes in RA, and the challenges in adopting these strategies in Africa and the Middle East. In addition, we propose an action plan to improve the overall long-term outlook for RA patients in the region.
Collapse
Affiliation(s)
- Hussein Halabi
- King Faisal Specialist Hospital & Research Centre, Jeddah, Saudi Arabia
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Nogueira L, Cornillet M, Singwe-Ngandeu M, Viatte S, Bas S, Gabay C, Serre G. In Black Africans with rheumatoid arthritis, ACPA recognize citrullinated fibrinogen and the derived peptides α36-50Cit38,42 and β60-74Cit60,72,74, like in Caucasians. Clin Immunol 2014; 152:58-64. [PMID: 24589748 DOI: 10.1016/j.clim.2014.02.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 01/27/2014] [Accepted: 02/17/2014] [Indexed: 12/20/2022]
Abstract
Well documented in Caucasians and Asians, the diagnostic value of anti-CCP2 antibodies has been confirmed in Black African populations. However, autoantibodies to other citrullinated peptides/proteins and their fine specificities have not yet been studied. Here, we show that in Cameroonian patients, anti-citrullinated fibrinogen autoantibodies (AhFibA) are sensitive (73%) diagnostic markers for RA. We also determine that autoantibodies directed to α36-50Cit38,42 or β60-74Cit60,72,74 peptides which bear the immunodominant epitopes of citrullinated fibrin, are present in similar proportions in Black Africans and Caucasians with 25/56 (45%) and 41/56 (73%) positive RA-sera in Cameroonians, respectively. They also account for almost all the AhFibA reactivities since 38/41 (93%) AhFibA-positive sera contain anti-α36-50Cit38,42 and/or anti-β60-74Cit60,72,74 autoantibodies. Finally, HLA-DRB1 SE alleles were associated with higher titres of AhFibA and anti-β60-74Cit60,72,74 autoantibodies. In the genetic and environmental backgrounds of Black Africans, AhFibA are a hallmark of RA like in Caucasians, moreover they recognize the same fibrin epitopes.
Collapse
Affiliation(s)
- Leonor Nogueira
- "Epidermis Differentiation and Rheumatoid Autoimmunity" Laboratory, UMR CNRS 5165, INSERM U1056, Toulouse III University, Toulouse, France; Laboratory of Cell Biology and Cytology, Toulouse University Hospital, Toulouse, France.
| | - Martin Cornillet
- "Epidermis Differentiation and Rheumatoid Autoimmunity" Laboratory, UMR CNRS 5165, INSERM U1056, Toulouse III University, Toulouse, France; Laboratory of Cell Biology and Cytology, Toulouse University Hospital, Toulouse, France
| | | | - Sebastien Viatte
- Arthritis Research UK Center for Genetics and Genomics, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, UK
| | - Sylvette Bas
- Division of Rheumatology, University Hospitals of Geneva, Geneva, Switzerland; Department of Genetics and Laboratory Medicine, Geneva, Switzerland
| | - Cem Gabay
- Division of Rheumatology, University Hospitals of Geneva, Geneva, Switzerland; Department of Pathology & Immunology, University of Geneva, School of Medicine, Geneva, Switzerland
| | - Guy Serre
- "Epidermis Differentiation and Rheumatoid Autoimmunity" Laboratory, UMR CNRS 5165, INSERM U1056, Toulouse III University, Toulouse, France; Laboratory of Cell Biology and Cytology, Toulouse University Hospital, Toulouse, France
| |
Collapse
|
28
|
Chan KY, Adeloye D, Grant L, Kolčić I, Marušić A. How big is the 'next big thing'? Estimating the burden of non-communicable diseases in low- and middle-income countries. J Glob Health 2013; 2:020101. [PMID: 23289068 PMCID: PMC3529319 DOI: 10.7189/jogh.02.020101] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Kit Yee Chan
- Nossal Institute for Global Health, University of Melbourne, Melbourne, Australia ; Department of Health Policy and Management, School of Public Health, Peking University Health Science Centre, Beijing, China
| | | | | | | | | |
Collapse
|