Rheumatoid arthritis at Kenyatta National Hospital: a clinical and quality of life evaluation.
Abstract
OBJECTIVES:
To determine the socio-demographic, clinical and QOL profiles of patients with RA at
KNH.
STUDY DESIGN:
This is was a cross-sectional descriptive study.
STUDY SITE:
The study was conducted on patients attending the medical outpatient clinic at KNH.
RESULTS
Sixty of the 180 patients screened satisfied the inclusion criteria and were recruited for
the study. Of the 60 patients, 8 were male and 52 female [M: F = 1: 6.5]. Mean age of
patients was 41.38 ± 16.78. The mean duration, in months, of rheumatoid arthritis was
64.97 ± 85.02 with both mode and median duration of 24 months [range was 1 to 300
months]. The proportion of patients with level of education of primary school and below
was 51.7%, while primary together with secondary level education accounted for the
highest figure of 68.3%. A large majority of the patients [70.2%] were unemployed.
In 75% of the study patients, one or more of the metacarpophalangeal and proximal
interphalangeal joints of the hand were involved by RA. Other frequently involved sites
include wrists, elbows, knees, ankles and gleno-humeral joints of the shoulders. 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
mild disease accounting for 18%, moderate disease 38% and severe disease 32%. The
remaining 12% of the patents had inactive disease [remission].
Fifty-eight percent of study patients had physical component QOL scores ranging from
poor to fair compared to sixty-five percent who had mental component QOL scores
ranging from good to very good.
46.7% of the study patients were on treatment with at least one DMARD from a
selection of MTX, SSZ, HCQ and the biologic leflunomide, while the most frequent drug
combination was MTX plus prednisone in 30% of study patients. 66.7% were on oral
prednisone while 25% took only non-steroidal anti-inflammatory drugs.
CONCLUSIONS:
A large majority of the patients had active disease, most of them with moderate to severe
disease. Less than half of the patients were on DMARDs, a significant number were on
NSAIDs alone, while the majority was on prednisone. Physical component QOL ranged
from poor to fair, while mental component QOL ranged from good to very good in the
majority of patients. Most of the patients were female, young, unemployed, with low
level of education.
RECOMMENDATIONS
There is an urgent need to implement appropriate treatment guidelines in order to get
majority of our patients into early disease remission. There is need to conduct a
comparative QOL study using the same SF-36 version on patients with a different disease
entity. There is a need to conduct a study on the effects of co-morbidity on QOL of
patients with RA.
Citation
Masters of Science in Medicine, University of Nairobi, 2007Publisher
Universty of Nairobi