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

Abstract

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).