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Active Rheumatoid Arthritis in Central Africa: A Comparative Study Between Sudan and Sweden
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Clinical Immunology.ORCID iD: 0000-0001-8038-0397
Gavle Cent Hosp, Rheumatol Unit, Gavle, Sweden..
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Clinical Immunology. Khartoum Fertil Ctr, Khartoum, Sudan..
Alribat Univ Hosp, Rheumatol Unit, Khartoum, Sudan..
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2016 (English)In: Journal of Rheumatology, ISSN 0315-162X, E-ISSN 1499-2752, Vol. 43, no 10, p. 1777-1786Article in journal (Refereed) Published
Abstract [en]

Objective. To compare clinical characteristics and treatment between simultaneously investigated Sudanese and Swedish outpatients with rheumatoid arthritis (RA).

Methods. Outpatients with RA from Sudan (n = 281) and Sweden (n = 542) diagnosed according to the 1987 American College of Rheumatology criteria were recruited between December 2008 and September 2010 and compared concerning clinical presentation, treatment, and laboratory findings, including immunoglobulin M with rheumatoid factor (IgM-RF).

Results. Sudanese patients had lower inclusion age (median 49 vs 68 yrs), disease duration (48 vs 107 mos), and disease onset age (43 vs 56 yrs) as compared with Swedish patients (p < 0.0001 for all). When stratified concerning the age of inclusion, Swedish patients between 41-50 years had, however, a significantly lower age of onset, with a similar trend for all age groups above 30 years. The female preponderance was higher among Sudanese patients (89.3% vs 72.5%, p < 0.0001), and smoking was nonexistent among Sudanese female patients (p < 0.0001). Erythrocyte sedimentation rate levels and number of tender joints were significantly higher among Sudanese patients. The proportion of IgM-RF positivity was lower among Sudanese patients with RA (52.4% vs 75.5%, p < 0.0001). Higher proportions of Sudanese patients with RA were treated with methotrexate (MTX) and disease-modifying antirheumatic drug combinations, but none of them used biologics. Sudanese patients used lower doses of MTX and sulfasalazine (p < 0.0001) and higher doses of prednisolone (p < 0.0001) than Swedish patients.

Conclusion. Sudanese patients with RA have significantly higher disease activity and are often IgM-RF-seronegative. Together with reports from Uganda and Cameroon, our data indicate a cluster of highly active and often seronegative RA in central Africa.

Place, publisher, year, edition, pages
2016. Vol. 43, no 10, p. 1777-1786
Keywords [en]
RHEUMATOID ARTHRITIS, SUDAN, DISEASE SEVERITY, RHEUMATOID FACTOR, DISEASE-MODIFYING ANTIRHEUMATIC DRUGS
National Category
Rheumatology and Autoimmunity
Identifiers
URN: urn:nbn:se:uu:diva-313419DOI: 10.3899/jrheum.160303ISI: 000390233000002PubMedID: 27481904OAI: oai:DiVA.org:uu-313419DiVA, id: diva2:1068560
Available from: 2017-01-25 Created: 2017-01-19 Last updated: 2018-02-27Bibliographically approved

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