A retrospective review of the demographic profile, disease activity, co-existent co-morbid disease and treatment in established rheumatoid arthritis at a tertiary center clinic.

Abstract

Rheumatoid arthritis (RA) is one of the most common forms of chronic inflammatory arthritis and often results in joint damage, physical disability and premature mortality. The incidence of RA is increasing in developing countries, especially in urban areas amongst lower socio-economic groups. There is a dearth of data on non-communicable diseases such as RA in South Africa (SA) as resources and research is concentrated on addressing the high burden of communicable diseases due to human immunodeficiency virus (HIV) and tuberculosis (TB) compounded with addressing high maternal and infant mortality rates. Therefore despite the severity and resultant functional disability, RA remains poorly understood and often mismanaged. This study aims were to understand the natural history of patients with RA treated in a public sector tertiary clinic. The objectives of this retrospective study are to describe the demographic profile, disease activity, drug management and comorbid disease profile in patients with established RA attending a dedicated rheumatic clinic at King Edward VIII Hospital in Durban. A retrospective chart review was conducted of the files of all RA patients attending the arthritis clinic at King Edward VIII Hospital, for a period of at least ten years. The demographic data, serological status, current disease activity, functional class, co-morbid diseases, and treatment were recorded on a structured data collection tool. In this study, Indians comprised the majority (n=81, 58.7%) followed by Blacks (n = 51, 36.9%). All the patients met the clinical criteria for RA on the initial visit, with 73 (63.5%) having a positive rheumatoid factor (RF). Synovitis was still observed in 35.5% of patients at their last visit and in these patients the C-reactive protein remained elevated at ≥ 16 mg/dL (p < 0.0001). Radiographs showed a significant deterioration in terms of erosions between the two time points (p < 0.021). Hypertension was the most frequent co-morbid disease seen in 96 (69.6%) patients. There were several limitations as this was a retrospective study and therefore there were a number of files that had incomplete or missing data. The clinical assessment of disease was performed by several clinicians and inter-observer variability was another shortcoming. Further the study was limited to the public sector only and potentially excluded other ethnicities and therefore may also not be an accurate reflection of natural history of RA in SA. This study highlights the need for better and tighter RA control in the SA public sector and the need for prospective studies with adequate representation of all ethnic groups to evaluate the challenges faced in delivering an effective rheumatology service in SA.