Rheumatoid arthritis at Kenyatta National Hospital: a clinical and quality of life evaluation.
Ouma, Benard O
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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.