Clinical and socio-demographic profile of patients on treatment for osteoporosis in Nairobi, Kenya

Background: Osteoporosis is a chronic, progressive disease of multifactorial aetiology and one of the most common metabolic bone diseases worldwide. There is a paucity of data on osteoporosis in Africa as it’s generally thought not to affect the non-Caucasian population. We sought to describe the population with osteoporosis in a Nairobi rheumatology clinic.Objective: To evaluate the clinical characteristics of patients with osteoporosis seen at a rheumatology clinic in Nairobi.Methods: Clinical, with emphasis on musculoskeletal manifestations, treatment and selected comorbidities in 56 patients diagnosed with osteoporosis were followed up and evaluated in the Nairobi Arthritis Clinic.Results: The age distribution was 31- 95 years with majority being above the age of 60 years at 71.5%. Majority were female (89.3%). The main musculoskeletal manifestations were polyarthralgia (30.4%) followed by lower back pain (19.6%) and pathological fractures (12.5%). The types of osteoporosis were grouped as primary (9%), secondary (44.6%) and post-menopausal (46.4%). The most common clinical association being rheumatoid arthritis (39.3%) followed by steroids therapy (25%). Other comorbidities included osteoarthritis, fibromyalgia, systemic lupus erythromatosus and diabetes. Seven study participants had history of fracture with lumbar spine fractures leading at 42.8%. None of the study participants were smokers. The number of patients on calcium supplements was at 71.4% and bisphosphonates was low at 32%.Conclusion: The findings of this study from age to comorbidities on osteoporosis are in keeping with literature. The number of patients on bisphosphonates was low which differed from Western literature. Persons at increased risk for osteoporosis in this set-up include post-menopausal women with debilitating chronic illness causing reduced mobilization over time and presenting with bone pains.These patients should be investigated for osteoporosis and effective treatment administered early.Keywords: Osteoporosis, Clinical profile, Nairobi, Keny

Clinical patterns of juvenile idiopathic arthritis: A single tertiary center experience in Kenya

Background: Juvenile Idiopathic Arthritis (JIA) is a heterogeneous group of disorders with different disease manifestations among various populations. There are few reports of JIA among indigenous Africans in sub-Saharan Africa. We present herein the clinical patterns of JIA encountered at a rheumatology clinic, Nairobi, Kenya.Method: Medical records of patients with a diagnosis of chronic arthritis with onset at the age of 16 years or less presenting to the Nairobi Arthritis Clinic were reviewed between January 2009 and January 2016. They were retrospectively reviewed and reclassified as Juvenile Idiopathic Arthritis (JIA) based on the International League of Associations for Rheumatology (ILA R) JIA diagnostic criteria.Results: A total of 68 patients were recruited, the females gender was predominant in all categories of JIA apart from Enthesitis related arthritis. The overall female to male ratio was 2.4:1. The range of age at onset of symptoms was between 2 years and 15 years and the mean age at JIA onset was 8.45 ± 4.37 years. The mean age of presentation at the clinic was 10.22± 3.79 years. Polyarticular rheumatoid factor negative arthritis was most common at 38.2%, followed by oligoarticular 23.5%, polyarticular rheumatoid factor positive 17.6%, systemic JIA at 14.7% and enthesitis associated arthritis at 5.9%. Large joints were affected in 85.2%, small joints 44% and fever was present in 73.5% of patients. One patient had the typical rash of systemic onset JIA (Still’s) and another had uveitis. The ESR was raised in all categories of JIA with a mean of 44.35mm/hr while the haemoglobin was reduced with a mean of 10.82mg/ dl. Positive Rheumatoid Factor (RF) was found only in RF positive polyarticular JIA. NSAIDs were used in all the patients. NSAIDS were combined with corticosteroids in 38/68 (55.9%) patients while NSAIDs, corticosteroids and methotrexate were used in 16/68 (23.5%) patients and biologics were received by 6/68 (8.8%) patients at different and varying length of time.Conclusion: This is the first study of JIA undertaken in Kenya. Our patients had a delayed presentation, were predominantly female and sero negative polyarticular arthritis. Challenges experienced in this setting include late presentation to rheumatologists and inadequate resources (personnel, finances, equipment and drugs).Keywords: Juvenile idiopathic arthritis, ILAR, Kenya, Clinical patterns, Treatmen

Clinical presentation of patients with adult onset still’s disease in Nairobi: case series

Introduction: Adult Still’s Disease (ASD) is a systemic inflammatory disorder of unknown etiology, typically characterized by a clinical triad (daily spiking high fevers, evanescent rash, arthritis), and a biological triad (hyperferritinemia, hyperleukocytosis with neutrophilia and abnormal liver function test). Objective: This case series set out to describe the clinical characteristics of patients with ASD seen at a rheumatology clinic in Nairobi. Results: After a record search, 8 patients were noted to have ASD. Fever and arthritis were noted to be most predominant presenting features with almost all the patients having hyperferritinemia

Experience with rituximab in patients with rheumatoid arthritis in Nairobi, Kenya

Background: Rheumatoid Arthritis (RA) is a disease associated with significant morbidity and mortality. Newer therapies include B-cell targeted therapies such as rituximab. Objectives: To study the outcome in RA patients receiving rituximab following resistance to Disease Modifying Anti- Rheumatic Agents (DMARDS) and to determine the change in disease activity and functional status. Methods: A longitudinal prospective study was carried out on RA patients in Nairobi, Kenya. Patients resistant to DMARDS and on rituximab therapy were identified. Their disease activity was assessed using the Simplified Disease Activity Index (SDAI) and the functional status determined using Health Assessment Questionnaire-Disability Index (HAQ DI). The scores were recorded at the beginning of the study then at 3 and 6 months after the initiation of rituximab therapy. Results: Forty-one patients (36 females and 5 males) receiving rituximab were recruited in this study. At baseline, 18 had moderate and 23 with high disease activity. After 6 months, 7% were in remission, 11% with low, 17 moderate and 6 with high disease activity. There was significant improvement in the SDAI scores witnessed in 13(31.7%) patients in first 3 months and in 22(53.7%) patients after 6 months. There was a significant improvement in the functional and disability score in 95% of the patients after 6 months. There was no significant correlation between the SDAI and the different variables as age, disease duration, type of DMARD and steroids used. Conclusion: Rituximab use resulted in improvement of disease activity, functional status and disability index in patients with RA in Nairobi. Keywords: Rituximab, Rheumatoid arthritis, SDAI, HAQI, Nairobi, Keny

Clinical Characteristics of Patients with Systemic Lupus Erythematosus in Nairobi, Kenya

Background: Systemic lupus erythematosus (SLE), a chronic multisystem autoimmune disease with a wide spectrum of manifestations, shows considerable variation across the globe, although there is data from Africa is limited. Quantifying the burden of SLE across Africa can help raise awareness and knowledge about the disease. It will also clarify the role of genetic, environmental and other causative factors in the natural history of the disease, and to understand its clinical and societal consequences in African set up.Objective: To determine the clinical profile of SLE patients at a tertiary care centre in Nairobi, Kenya.Methods: Case records of patients who were attending the Nairobi Arthritis Clinic seen between January 2002 and January 2013 were reviewed. This was a cross-sectional study done on 100 patients fulfilling the 2012 Systemic Lupus Collaborating Clinics (SLICC) criteria for SLE attending the Nairobi Arthritis Clinic, Kenya. The patients were evaluated for sociodemographic, clinical and immunological manifestations and drugs used to manage SLE.Results: Hundred patients diagnosed with SLE were recruited into the study. Ninety seven per cent of the study participants were female with a mean age of 36.6 years. Thirty three years was the mean age of diagnosis. The mean time duration of disease was 3 years with a range of 0-13 years. There was extensive disease as many had multi-organ involvement. Majority (83%) of the study participants met between 4 and 6 manifestations for the diagnosis criteria for SLE. Non erosive arthritis and cutaneous disease were the commonest initial manifestation. The patients had varied cutaneous, haematological, pulmonary, cardiac, renal and neuropsychiatric manifestations. Antinuclear antibody (ANA) assay and anti-dsDNA was positive in 82% and 52%. Patients on steroids, non-steroidal drugs and synthetic disease modifying anti-rheumatic drugs were 84%, 49% and 43% respectively. None of the patients were on biologic disease modifying antirheumatic drugs.Conclusions: In Nairobi, SLE is a multisystem disorder affecting predominantly young females. Polyarthritis and cutaneous disease were the most common clinical features. This is comparable to other studies done in black African population. We found a higher prevalence of haematological and lower rate of renal disease as compared to other studies done in black Africans. The ANA assay and anti-dsDNA positivity was lower than those in other studies on black Africans. Majority of the patients were on steroids.Keywords: SLE, Nairobi, Keny

The Importance of Communication, Collaboration and Co-production

Building resilient responses to nexus shocks requires effective communication and collaboration across sectors and stakeholders, yet this is not always achieved. The Nexus Shocks project examined how communication and collaboration could be enhanced, adopting a co-production methodology with policy, practitioner and scientific communities. This chapter discusses the barriers and challenges to communication and collaboration on specific nexus shocks, such as heatwaves and flooding, and identifies pathways to strengthen responses. Co-production provides a constructive way to deliver more salient decision-making processes which incorporate the needs of those affected in managing and responding to nexus shocks