Prevalence of Arthritis in Africa: A Systematic Review and Meta-Analysis

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

Map of Africa showing the distribution of the number of arthritis prevalence studies from each country published from 1975 to July 2014.

<p>Important characteristics of these studies such as country, year of publication, setting, number of participants, age range, type of arthritis and its case definition/diagnosis are presented in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0133858#pone.0133858.t003" target="_blank">Table 3</a>.</p

Osteoarthritis prevalence (%) and corresponding 95% confidence intervals for urban and rural African settings from population-based studies.

<p>Osteoarthritis prevalence (%) and corresponding 95% confidence intervals for urban and rural African settings from population-based studies.</p

Risk of bias assessment of included studies using the Hoy 2012 tool [14].

<p>Risk of bias assessment of included studies using the Hoy 2012 tool [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0133858#pone.0133858.ref014" target="_blank">14</a>].</p

Forest plot showing the meta-analysis of population-based prevalence (%) of osteoarthritis of the hip in rural settings of South Africa.

<p>Forest plot showing the meta-analysis of population-based prevalence (%) of osteoarthritis of the hip in rural settings of South Africa.</p

Characteristics of arthritis prevalence studies from African countries published from January 1975 to July 2014.

<p>Characteristics of arthritis prevalence studies from African countries published from January 1975 to July 2014.</p

Forest plot showing the meta-analysis of urban population-based prevalence (%) of rheumatoid arthritis in African countries.

<p>Forest plot showing the meta-analysis of urban population-based prevalence (%) of rheumatoid arthritis in African countries.</p

Flow chart showing the search results for cross-sectional studies on the prevalence of arthritis in Africa from 1975 to July 2014.

<p>Flow chart showing the search results for cross-sectional studies on the prevalence of arthritis in Africa from 1975 to July 2014.</p