Socio-demographic and clinical aspects of rheumatoid arthritis

Objective: To determine the socio-demographic profiles and some clinical aspects of patients with rheumatoid arthritis (RA).Design: Prospective, cross-sectional study.Setting: Ambulatory out- patient clinics of Kenyatta National Hospital (KNH), a public national and referral hospital.Subjects: Out of 180 patients interviewed and examined, 60 met American College of Rheumatology (ACR) diagnostic criteria of RA.Results: Of the 60 patients recruited 52 (87%) were females with male: female ratio of 1: 6.5. The mean age of patients was 41.38(± 16.8) years. There were two peaks of age of occurrence, 20-29 and 40-49 years. In 75% of the study patients, one or more of metacarpophalangeal joints of the hand were involved in the disease. Other frequently involved sites were - wrists, elbows, knees, ankles and glenohumeral joints of shoulders in a symmetrical manner. Serum rheumatoid factor was positive in 78.9% while rheumatoid nodules were present in 13.3% of the study patients. A large majority of patients (88%) had active disease with 18% having mild disease, 38% moderate activity and 32% having severe disease. Only 12% of patients had disease in remission. Forty six point seven per cent (46.7%) of the study patients were on at least one Disease Modifying anti Rheumatic Drugs (DMARD) from a selection of methotrexate, sulphasalazine, hydroxychloroquine and leflunamide. The most frequent drug combination was methotrexate plus prednisolone at 30% of the study population; while 66.7% were on oral prednisolone with 25% of the study patients taking only Non-Steroidal anti Inflammatory Drugs (NSAIDS).Conclusion: A large majority of ambulatory patients with RA had active disease. Most of’ them were sub-optimally treated, especially the use of DMARDS. About two thirds were on oral steroids. Sub-optimal therapy in relatively young patients, peak 20-29 and 40-49 years is likely to impact negatively on their disease control and quality of life

The abundance and host-seeking behavior of culicine species (Diptera: Culicidae) and Anopheles sinensis in Yongcheng city, people's Republic of China

<p>Abstract</p> <p>Background</p> <p>The knowledge of mosquito species diversity and the level of anthropophily exhibited by each species in a region are of great importance to the integrated vector control. Culicine species are the primary vectors of Japanese encephalitis (JE) virus and filariasis in China. <it>Anopheles sinensis </it>plays a major role in the maintenance of <it>Plasmodium vivax </it>malaria transmission in China. The goal of this study was to compare the abundance and host-seeking behavior of culicine species and <it>An. sinensis </it>in Yongcheng city, a representative region of <it>P. vivax </it>malaria. Specifically, we wished to determine the relative attractiveness of different animal baits versus human bait to culicine species and <it>An. sinensis</it>.</p> <p>Results</p> <p><it>Culex tritaeniorhynchus </it>was the most prevalent mosquito species and <it>An. sinensis </it>was the sole potential vector of <it>P. vivax </it>malaria in Yongcheng city. There were significant differences (P < 0.01) in the abundance of both <it>An. sinensis </it>and <it>Cx. tritaeniorhynchus </it>collected in distinct baited traps. The relative attractiveness of animal versus human bait was similar towards both <it>An. sinensis </it>and <it>Cx. tritaeniorhynchus</it>. The ranking derived from the mean number of mosquitoes per bait indicated that pigs, goats and calves frequently attracted more mosquitoes than the other hosts tested (dogs, humans, and chickens). These trends were similar across all capture nights at three distinct villages. The human blood index (HBI) of female <it>An. sinensis </it>was 2.94% when computed with mixed meals while 3.70% computed with only the single meal. 19:00~21:00 was the primary peak of host-seeking female <it>An. sinensis </it>while 4:00~5:00 was the smaller peak at night. There was significant correlation between the density of female <it>An. sinensis </it>and the average relative humidity (P < 0.05) in Wangshanzhuang village.</p> <p>Conclusions</p> <p>Pigs, goats and calves were more attractive to <it>An. sinensis </it>and <it>Cx. tritaeniorhynchus </it>than dogs, humans, and chickens. Female <it>An. sinensis </it>host-seeking activity mainly occurred from 19:00 to 21:00. Thus, we propose that future vector control against <it>An. sinensis </it>and <it>Cx. tritaeniorhynchus </it>in the areas along the Huang-Huai River of central China should target the interface of human activity with domestic animals and adopt before human hosts go to bed at night.</p

An evaluation of health related quality of life in patients with rheumatoid arthritis

Objective: To determine Health Related Quality Of Life (HRQOL) profiles of patients with Rheumatoid Arthritis (RA). Design: Prospective, cross-sectional study. Setting: Ambulatory out-patient clinics of Kenyatta National Hospital (KNH), a public national referral hospital. Subjects: Of the 180 patients interviewed and examined, 60 met the American College of Rheumatology (ACR) diagnostic criteria for RA. Results: Of the 60 patients recruited, 58% of study patients had physical component HRQOL scores ranging from poor to fair, compared to 65% who had mental component HRQOL scores ranging from good to very good. Both physical and mental health HRQOL summary scores showed significant negative correlations with disease activity (DAS-28) scores (p&lt; 0.001 for both) among the study patients. The HRQOL physical health summary scores were significantly better in the 28 study patients who were on treatment with at least one DMARD (mean score 67.25 &plusmn; 18.17) than in the other 28 study patients who had not been on DMARD therapy (mean score 53.93 &plusmn; 18.55), p = 0.008. The trend was similar but less prominent with mental health QOL summary scores, with means of 75.11 &plusmn; 19.19 with DMARDs, and 62.29 &plusmn; 21.85 without DMARDs (p = 0.034). There was a significant association between consistency of treatment with any drug and QOL physical health summary scores, with mean score for patients consistently on treatment (65.16 &plusmn; 19.26) being much better than for those on intermittent drug treatment (50.94 &plusmn; 16.27), p = 0.009. These associations were similar for QOL mental health summary scores but did not reach significance. Conclusions: In this population of ambulatory patients with RA, physical component HRQOL ranged from poor to fair, while mental component HRQOL ranged from good to very good in the majority of patients. Severity of disease showed a strong negative association with HRQOL among the study patients, while DMARD therapy and adherence to drug treatment showed a positive association with HRQOL. Improved and better adherence to DMARD therapy with resultant decrease in disease activity is likely to result in improved HRQOL in this population of patients with RA