Itineraries of the rheumatic patients towards the rheumatologist in DR Congo

Objectives: To describe the itineraries of the rheumatic patients towards the rheumatologist.Methods: A descriptive cross-sectional study was performed in patients attending the rheumatology unit of the University Hospital of Kinshasa from 1st October 2012 to 31st March 2013. Data collected were general demographic parameters, educational level, prior treatment and the delay between the onset of symptoms and the first consultation.Results: Eighty six patients were included with 53 women (61.6%) and 33 men. Mean age was 52.4 ± 8.3 years and the age at onset symptom was 47.3 ± 7.2 years. Disease duration before rheumatologist consultation was 4.7 ± 4.3 years. The lower age was equal to 55 years, low level of education and female gender were the determinants of the long delay in the consultation of the rheumatologist. Prior treatment consisted primarily of NSAIDs and paracetamol.Conclusion: Rheumatic patients followed at the UHK generally consult after a relatively long period, therefore delaying the diagnosis and the treatment.Keywords: Rheumatologist, Itinerarie

Treatment of rheumatoid arthritis with methotrexate in Congolese patients

Methotrexate (MTX) is the anchor drug in the treatment of rheumatoid arthritis (RA) but data concerning the effectiveness of treatment with this compound are lacking in the Congolese population. In the present study, the evolution of RA in Congolese patients on MTX treatment is reported from before disease-modifying antirheumatic drug (DMARD) initiation till 20 months later. All consecutive DMARD-naïve RA patients (ACR 1987 criteria) attending the rheumatology unit of the University Hospital of Kinshasa from January 2008 to September 2010 were included. All were treated with MTX (started at 7.5 mg/week) and bridging steroids (started at 30mg/day). Treatment adaptations of MTX and concomitant drugs are reported as well as evolution of disease activity (DAS28-ESR), functionality (Health Assessment Questionnaire), radiological damage, and safety over 20 months. Of 98 patients recruited, more than one third were lost at follow-up. A follow-up visit at 20 months was available for 51 patients. These 48 women and 3 men had a mean age of 51.2 ± 13 years and a mean delay from symptom onset till their first visit of 3.2 years. At 20 months, the average MTX dose was 9.7 mg weekly. A second DMARD was added in three patients. The average dose of prednisone at 20 months was 7.5 mg daily. A significant improvement of DAS28 and functional disability was observed and 35.3 % of patients entered remission (DAS28 <2.6). A progression of X-ray damage was observed in one third of patients. Two patients had to stop MTX because of severe side effects and two patients developed diabetes. Methotrexate and bridging steroids therapy is effective also in sub-Saharan Africa but the average weekly MTX dose remains low. Implementation of a regular follow-up is a major issue.status: publishe

The phenotype and genotype of rheumatoid arthritis in the Democratic Republic of Congo

INTRODUCTION: Little is known about rheumatoid arthritis in the black, particularly in Congolese, populations. Our objective was to describe the phenotype and genotype of rheumatoid arthritis (RA) in Congolese. METHODS: All consecutive rheumatoid arthritis (RA) patients attending Kinshasa University Hospital in a three-year time period were included. Demographics, clinical features and tobacco consumption were noted. Disease Activity Score (DAS)-28 based on the erythrocyte sedimentation rate (ESR), Health Assessment Questionnaire (HAQ), anti-citrullinated peptide antibodies (CCP) antibodies and rheumatoid factor (RF) were determined. Radiographs were scored according to Sharp-van der Heijde. On a subset of patients and controls HLA-DRB1 typing was performed. RESULTS: A total of 114 females and 14 males aged 51.2 ± 14.9 were included. Mean duration of symptoms was four years. Moderate tobacco consumption was reported in a minority of patients. DAS-28 at first visit was >5.1 and HAQ ≥0.5 in all patients. X-rays showed joint erosions and/or joint space narrowing, mostly of a moderate grade in 55.8% of patients. Anti-CCP and/or RF were present in 48.6% of patients with available data (n = 72) and in 3.0% of controls (n = 67). Radiographic changes and nodules were more frequent in RF or anti-CCP positive patients. One copy of the shared epitope was found in 13 patients (35.1%) and 3 controls (12.5%). Two copies were found in one patient (2.7%) and in one control (4.2%). CONCLUSION: Congolese patients with RA consult long after disease onset. Despite this delay, the majority presents without major damage and is RF, anti-CCP and SE negative. We put forward the hypothesis that besides different environmental factors there is probably also a particular genetic risk profile in Congolese patients, different from the HLA-DRB1 shared epitope.status: publishe

The epidemiology of rheumatic disorders in a rural area of the Democratic Republic of Congo (DRC): A COPCORD study

Objective: To determine the prevalence of rheumatic diseases in a rural area of DR Congo.Methods: A cross-sectional study was performed in six randomly chosen villages of the health division of Gombe- Matadi, in Kongo-Central province (near Kinshasa), from 15th October to 15th November 2012. Investigators questioned all individuals living in these villages, using the COPCORD Core questionnaire (CCQ). Age, sex and rheumatic complaints were noted. X-rays, and laboratory tests (C-reactive protein, erythrocyte sedimentation rate, blood cells count, uric acid and some serological assays) were performed.Results: In total, 1500 individuals were questioned. Rheumatic complaints were reported by 743 individuals (49.5%), of whom 424 women and 319 men (sex ratio H/F 0.8). Their average age was 48.8±15.4 years. The encountered diseases were: osteoarthritis in 552 patients (prevalence of 36.8%), spondylarthropathies in 57 patients (prevalence of 3.8%), soft tissue rheumatism in 78 patients (5.2%), rheumatoid arthritis in 21 patients (1.4%), juvenile arthritis in 19 patients (1.26%), infectious arthritis in 11 patients (0.73%), rheumatic fever in 9 patients (0.6%) and gout in 1 patient (0.06%).Conclusions: All types of rheumatic diseases can be found in rural areas and some of them like SpA, RA were found with very high frequencies. Also, clinical and demographic differences were observed compared to literature data.Key words: Rheumatic diseases, Rural area, DR Cong

Rheumatoid arthritis

Rheumatoid arthritis (RA) is a chronic, inflammatory, autoimmune disease that primarily affects the joints and is associated with autoantibodies that target various molecules including modified self-epitopes. The identification of novel autoantibodies has improved diagnostic accuracy, and newly developed classification criteria facilitate the recognition and study of the disease early in its course. New clinical assessment tools are able to better characterize disease activity states, which are correlated with progression of damage and disability, and permit improved follow-up. In addition, better understanding of the pathogenesis of RA through recognition of key cells and cytokines has led to the development of targeted disease-modifying antirheumatic drugs. Altogether, the improved understanding of the pathogenetic processes involved, rational use of established drugs and development of new drugs and reliable assessment tools have drastically altered the lives of individuals with RA over the past 2 decades. Current strategies strive for early referral, early diagnosis and early start of effective therapy aimed at remission or, at the least, low disease activity, with rapid adaptation of treatment if this target is not reached. This treat-to-target approach prevents progression of joint damage and optimizes physical functioning, work and social participation. In this Primer, we discuss the epidemiology, pathophysiology, diagnosis and management of RA