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Shah R, Gathu C, Njenga E, Chakaya J, Ogola E, Oyoo O, Odhiambo A, Wambugu B, Feldman C. A case for implementation of adult pneumococcal vaccine program in Africa: review and expert opinion. Pan Afr Med J 2022; 41:51. [PMID: 35317473 PMCID: PMC8917456 DOI: 10.11604/pamj.2022.41.51.31849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 12/12/2021] [Indexed: 11/11/2022] Open
Abstract
Vaccines are considered as a therapeutic area for children; the scientific community focuses mainly on managing chronic disease when it comes to adults. There currently is an increase in the burden of vaccine preventable illnesses in adults. Adult vaccination has been shown to dramatically increase the health and quality of life of older populations. Therefore, adult vaccinations need to be approached as a public health issue, similar to smoking cessation programs, for example. According to the Kenya Non-Communicable Diseases and injuries poverty commission report, 2018. Kenya has a high percentage of disability adjusted life years (DALYs) from communicable diseases at 63%, while non-communicable diseases (NCDs) contribute 30% of the DALYs. Specific to pneumococcal pneumonia (PP) in adults, the Global burden of disease (GBD) study in 2016 found that 2,377,697 people of all ages died from lower respiratory tract infections (LRTI) in 2016. Of these, more people died from Streptococcus pneumonia(SP) than from all other studied respiratory pathogens combined. While the incidence of LRTIs in children under five years old was reducing, partly as a result of well-established vaccination programs in children, the incidence, morbidity and mortality of PP was increasing in older populations. The expert recommendations included the following; i) all individuals 65 years of age and above, and individuals with a predisposing comorbidity regardless of age, should receive the pneumococcal vaccine; ii) several systemic modules can be emulated from the successful childhood vaccines programs onto an adult vaccine program; iii) formulation of an effective vaccine program will require collaboration from the public, the government, healthcare providers, and the media, to create awareness; iv) stakeholders who need to be involved in vaccine policy development and implementation include medical professional associations, nurses, pharmacists, clinical officers, payers (private and public insurances), government, medical learning institutions and faith-based medical organizations.
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Affiliation(s)
- Reena Shah
- Aga Khan University Hospital, Nairobi, Kenya
| | | | - Eric Njenga
- Aga Khan University Hospital, Nairobi, Kenya
| | - Jeremiah Chakaya
- Department of Internal Medicine, Kenyatta University, Nairobi, Kenya
| | - Elijah Ogola
- Department of Clinical Medicine and Therapeutics, College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Omondi Oyoo
- Department of Clinical Medicine and Therapeutics, College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Andrew Odhiambo
- Department of Clinical Medicine and Therapeutics, College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Benjamin Wambugu
- Department of Medicine, Kenyatta National Hospital, Nairobi, Kenya
| | - Charles Feldman
- Deparment of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Akintayo RO, Akpabio AA, Kalla AA, Dey D, Migowa AN, Olaosebikan H, Bahiri R, El Miedany Y, Hadef D, Hamdi W, Oyoo O, Slimani S, Yerima A, Taha Y, Adebajo AO, Adelowo OO, Tikly M, Ghozlani I, Ben Abdelghani K, Fouad NA, Mosad D, El Mikkawy D, Abu-Zaid MH, Abdel-Magied RA. The impact of COVID-19 on rheumatology practice across Africa. Rheumatology (Oxford) 2021; 60:392-398. [PMID: 33020845 PMCID: PMC7665741 DOI: 10.1093/rheumatology/keaa600] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/18/2020] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES To identify the changes in rheumatology service delivery across the five regions of Africa from the impact of the COVID-19 pandemic. METHODS The COVID-19 African Rheumatology Study Group created an online survey consisting of 40 questions relating to the current practices and experiences of rheumatologists across Africa. The CHERRIES checklist for reporting results of internet e-surveys was adhered to. RESULTS A total of 554 completed responses were received from 20 countries, which include six in Northern Africa, six in West Africa, four in Southern Africa, three in East Africa and one in Central Africa. Consultant grade rheumatologists constituted 436 (78.7%) of respondents with a mean of 14.5 ± 10.3 years of experience. A total of 77 (13.9%) rheumatologists avoided starting a new biologic. Face-to-face clinics with the use of some personal protective equipment continued to be held in only 293 (52.9%) rheumatologists' practices. Teleconsultation modalities found usage as follows: telephone in 335 (60.5%), WhatsApp in 241 (43.5%), emails in 90 (16.3%) and video calls in 53 (9.6%). Physical examinations were mostly reduced in 295 (53.3%) or done with personal protective equipment in 128 (23.1%) practices. Only 316 (57.0%) reported that the national rheumatology society in their country had produced any recommendation around COVID-19 while only 73 (13.2%) confirmed the availability of a national rheumatology COVID-19 registry in their country. CONCLUSION COVID-19 has shifted daily rheumatology practices across Africa to more virtual consultations and regional disparities are more apparent in the availability of local protocols and registries.
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Affiliation(s)
- Richard O Akintayo
- Rheumatology Department, Dumfries and Galloway Royal Infirmary, Dumfries, UK
| | - Akpabio A Akpabio
- Internal Medicine Department, University of Uyo Teaching Hospital, Uyo, Nigeria
| | - Asgar A Kalla
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Dzifa Dey
- Department of Medicine and Therapeutics, Korle Bu Teaching Hospital, Accra, Ghana
| | - Angela N Migowa
- Department of Paediatrics and Child Health, Aga Khan University, East Africa, Kenya
| | - Hakeem Olaosebikan
- Department of Medicine, Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Rachid Bahiri
- Department of rheumatology, El Ayachi Hospital Medical University, Rabat, Morocco
| | | | - Djohra Hadef
- Department of Paediatrics, Batna 2 University, Batna, Algeria
| | - Wafa Hamdi
- Kassab Institute of Orthopedics, Tunis El Manar University, Tunis, Tunisia
| | - Omondi Oyoo
- Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi, Kenya
| | - Samy Slimani
- Rheumatology, Atlas Clinic of Rheumatology, Batna, Algeria
| | - Abubakar Yerima
- Department of Medicine, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
| | - Yassmin Taha
- Paediatrics Department, Ahmed Gasim Children's Hospital, Khartoum, Sudan
| | - Adewale O Adebajo
- Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield, UK
| | - Olufemi O Adelowo
- Department of Medicine, Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Mohammed Tikly
- Department of Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Nermeen A Fouad
- Rheumatology and Rehabilitation, Fayoum University, Fayoum, Egypt
| | - Doaa Mosad
- Paediatrics Department, Mansoura University, Mansoura, Egypt
| | - Dalia El Mikkawy
- Rheumatology and Rehabilitation, Ain Shams University, Cairo, Egypt
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3
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Akintayo RO, Akpabio A, Kalla A, Dey D, Migowa A, Olaosebikan H, Bahiri R, El Miedany Y, Hadef D, Hamdi W, Oyoo O, Slimani S, Yerima A, Taha Y, Adebajo A, Adelowo O, Tikly M, Ghozlani I, Abdelghani KB, Fouad NA, Mosad D, El Mikkawy D, Abu-Zaid MH, Abdel-Magied RA. COVID-19 and the practice of rheumatology in Africa: big changes to services from the shockwave of a pandemic. Ann Rheum Dis 2020; 80:e100. [PMID: 32611599 DOI: 10.1136/annrheumdis-2020-218273] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 06/16/2020] [Indexed: 01/23/2023]
Affiliation(s)
| | - Akpabio Akpabio
- Internal Medicine, University of Uyo Teaching Hospital, Uyo, Nigeria
| | - Asgar Kalla
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Dzifa Dey
- Department of Medicine and Therapeutics, University of Ghana Medical School, Korle bu Teaching Hospital, Accra, Ghana
| | - Angela Migowa
- Paediatrics and Child Health, Aga Khan University Faculty of Health Sciences East Africa, Nairobi, Kenya
| | | | - Rachid Bahiri
- Rheumatology, El Ayachi Hospital, Medical university, Rabat, Morocco
| | | | - Djohra Hadef
- Department of Paediatrics, Faculty of Medicine, Batna 2 University, Batna, Algeria
| | - Wafa Hamdi
- Kassab institute of orthopedics, Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia
| | - Omondi Oyoo
- Department of clinical medicine and therapeutics, University of Nairobi College of Health Sciences, Nairobi, Kenya
| | - Samy Slimani
- Rheumatology, Atlas Clinic of Rheumatology, Batna, Algeria
| | - Abubakar Yerima
- Medicine, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
| | - Yassmin Taha
- Department of Paediatrics, Ahmed Gasim Children's Hospital, Khartoum, Sudan
| | - Adewale Adebajo
- Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield, UK
| | - Olufemi Adelowo
- Medicine, Lagos State University Teaching Hospital, Ikeja, Nigeria
| | - Mohammed Tikly
- Division of Rheumatology, Department of Medicine, University of Witwatersrand, Johannesburg, South Africa
| | | | | | | | - Doaa Mosad
- Pediatrics Department, Mansoura University, Mansoura, Egypt
| | - Dalia El Mikkawy
- Rheumatology and Rehabilitation, Ain Shams University, Cairo, Egypt
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Abstract
PURPOSE OF REVIEW Systemic vasculitides are characterized by inflammation of blood vessel walls leading to a myriad of organ disorders depending on the size, site, and location of the affected blood vessel. The epidemiology of vasculitis in the developing world has been inadequately documented. The description of the vasculitides in Africa, both from hospital series as well as taking into consideration, previous epidemiological studies in the community, indicates that these conditions have been rare until relatively recently. In view of these past observations, this review of publications on the topic looks to shed light on the current state of vasculitis in Africa. RECENT FINDINGS Takayasu and Kawasaki appear to be the most commonly reported vasculitides in Africa. Most of the published reports are from North and South Africa. Furthermore, the contribution of vasculitis associated with infections, and in particular HIV, is significant. There are increasing numbers of publications reflecting a growing recognition of the vasculitides in Africa.
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Affiliation(s)
- Eugene Genga
- Department of Clinical Medicine and Therapeutics, School of Medicine, College of Health sciences, University of Nairobi, P O Box 30197-0100, Nairobi, Kenya
| | - Omondi Oyoo
- Department of Clinical Medicine and Therapeutics, School of Medicine, College of Health Sciences, University of Nairobi, P O Box 19676-00202, Nairobi, Kenya
| | - Adewale Adebajo
- Faculty of Medicine, Dentistry and Health, University of Sheffield, Beech Hill Road, Sheffield, UK.
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Genga EK, Oyoo O, Espinoza LR, Adebajo A. Africa Journal of Rheumatology: enhancing the visibility of rheumatology in Africa. Clin Rheumatol 2017; 36:2167-2168. [PMID: 28748513 DOI: 10.1007/s10067-017-3761-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 07/10/2017] [Indexed: 11/24/2022]
Affiliation(s)
- Eugene K Genga
- Department of Clinical Medicine and Therapeutics, College of Health Sciences, University of Nairobi/Kenyatta National Hospital, Nairobi, Kenya.,Nairobi Arthritis Clinic, Nairobi, Kenya
| | - Omondi Oyoo
- Department of Clinical Medicine and Therapeutics, College of Health Sciences, University of Nairobi/Kenyatta National Hospital, Nairobi, Kenya.,Nairobi Arthritis Clinic, Nairobi, Kenya
| | - Luis R Espinoza
- Louisiana State University School of Medicine, New Orleans, LA, USA
| | - Adewale Adebajo
- Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield, UK.
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Grøn KL, Ornbjerg LM, Hetland ML, Aslam F, Khan NA, Jacobs JWG, Henrohn D, Rasker JJ, Kauppi MJ, Lang HC, Mota LMH, Aggarwal A, Yamanaka H, Badsha H, Gossec L, Cutolo M, Ferraccioli G, Gremese E, Bong Lee E, Inanc N, Direskeneli H, Taylor P, Huisman M, Alten R, Pohl C, Oyoo O, Stropuviene S, Drosos AA, Kerzberg E, Ancuta C, Mofti A, Bergman M, Detert J, Selim ZI, Abda EA, Rexhepi B, Sokka T. The association of fatigue, comorbidity burden, disease activity, disability and gross domestic product in patients with rheumatoid arthritis. Results from 34 countries participating in the Quest-RA program. Clin Exp Rheumatol 2014; 32:869-877. [PMID: 25327997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 04/08/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVES The aim is to assess the prevalence of comorbidities and to further analyse to which degree fatigue can be explained by comorbidity burden, disease activity, disability and gross domestic product (GDP) in patients with rheumatoid arthritis (RA). METHODS Nine thousands eight hundred seventy-four patients from 34 countries, 16 with high GDP (>24.000 US dollars [USD] per capita) and 18 low-GDP countries (<24.000 USD) participated in the Quantitative Standard monitoring of Patients with RA (QUEST-RA) study. The prevalence of 31 comorbid conditions, fatigue (0-10 cm visual analogue scale [VAS] [10=worst]), disease activity in 28 joints (DAS28), and physical disability (Health Assessment Questionnaire score [HAQ]) were assessed. Univariate and multivariate linear regression analyses were performed to assess the association between fatigue and comorbidities, disease activity, disability and GDP. RESULTS Overall, patients reported a median of 2 comorbid conditions of which hypertension (31.5%), osteoporosis (17.6%), osteoarthritis (15.5%) and hyperlipidaemia (14.2%) were the most prevalent. The majority of comorbidities were more common in high-GDP countries. The median fatigue score was 4.4 (4.8 in low-GDP countries and 3.8 in high-GDP countries, p<0.001). In low-GDP countries 25.4% of the patients had a high level of fatigue (>6.6) compared with 23.0% in high-GDP countries (p<0.001). In univariate analysis, fatigue increased with increasing number of comorbidities, disease activity and disability in both high- and low-GDP countries. In multivariate analysis of all countries, these 3 variables explained 29.4% of the variability, whereas GDP was not significant. CONCLUSIONS Fatigue is a widespread problem associated with high comorbidity burden, disease activity and disability regardless of GDP.
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Affiliation(s)
- Kathrine Lederballe Grøn
- Copenhagen University Hospital at Glostrup, Department of Rheumatology RM, Nordre Ringvej 57, DK-2600 Glostrup, Denmark.
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7
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Khan NA, Spencer HJ, Abda EA, Alten R, Pohl C, Ancuta C, Cazzato M, Géher P, Gossec L, Henrohn D, Hetland ML, Inanc N, Jacobs JW, Kerzberg E, Majdan M, Oyoo O, Peredo-Wende RA, Selim ZI, Skopouli FN, Sulli A, Hørslev-Petersen K, Taylor PC, Sokka T. Patient's global assessment of disease activity and patient's assessment of general health for rheumatoid arthritis activity assessment: are they equivalent? Ann Rheum Dis 2012; 71:1942-9. [PMID: 22532638 DOI: 10.1136/annrheumdis-2011-201142] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To assess (A) determinants of patient's global assessment of disease activity (PTGL) and patient's assessment of general health (GH) scores of rheumatoid arthritis (RA) patients; (B) whether they are equivalent as individual variables; and (C) whether they may be used interchangeably in calculating common RA activity assessment composite indices. METHODS Data of 7023 patients from 30 countries in the Quantitative Standard Monitoring of Patients with RA (QUEST-RA) was analysed. PTGL and GH determinants were assessed by mixed-effects analyses of covariance models. PTGL and GH equivalence was determined by Bland-Altman 95% limits of agreement (BALOA) and Lin's coefficient of concordance (LCC). Concordance between PTGL and GH based Disease Activity Score 28 (DAS28), Clinical Disease Activity Index (CDAI) and Routine Assessment of Patient Index Data 3 (RAPID3) indices were calculated using LCC, and the level of agreement in classifying RA activity in four states (remission, low, moderate, high) using κ statistics. RESULTS Significant differences in relative and absolute contribution of RA and non-RA related variables in PTGL and GH ratings were noted. LCC of 0.64 and BALOA of -4.41 to 4.54 showed that PTGL and GH are not equivalent. There was excellent concordance (LCC 0.95-0.99) for PTGL and GH based DAS28, CDAI and RAPID3 indices, and >80% absolute agreement (κ statistics 0.75-0.84) in RA activity state classification for all three indices. CONCLUSIONS PTGL and GH ratings differ in their determinants. Although they are individually not equivalent, they may be used interchangeably for calculating composite indices for RA activity assessment.
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Affiliation(s)
- Nasim Ahmed Khan
- Division of Rheumatology, University of Arkansas for Medical Sciences, 4301 West Markham Street, # 509, Little Rock, AR 72205, USA.
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9
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Naranjo A, Toloza S, Guimaraes da Silveira I, Lazovskis J, Hetland ML, Hamoud H, Peets T, Mäkinen H, Gossec L, Herborn G, Skopouli FN, Rojkovich B, Aggarwal A, Minnock P, Cazzato M, Yamanaka H, Oyoo O, Rexhepi S, Andersone D, Baranauskaite A, Hajjaj-Hassouni N, Jacobs JWG, Haugeberg G, Sierakowski S, Ionescu R, Karateew D, Dimic A, Henrohn D, Gogus F, Badsha H, Choy E, Bergman M, Sokka T. Smokers and non smokers with rheumatoid arthritis have similar clinical status: data from the multinational QUEST-RA database. Clin Exp Rheumatol 2010; 28:820-827. [PMID: 21205460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2010] [Accepted: 05/18/2010] [Indexed: 05/30/2023]
Abstract
OBJECTIVES To analyse clinical severity/activity of rheumatoid arthritis (RA) according to smoking status. METHODS The QUEST-RA multinational database reviews patients for Core Data Set measures including 28 swollen and tender joint count, physician global estimate, erythrocyte sedimentation rate (ESR), HAQ-function, pain, and patient global estimate, as well as DAS28, rheumatoid factor (RF), nodules, erosions and number of DMARDs were recorded. Smoking status was assessed by self-report as 'never smoked', 'currently smoking' and 'former smokers'. Patient groups with different smoking status were compared for demographic and RA measures. RESULTS Among the 7,307 patients with smoking data available, status as 'never smoked,' 'current smoker' and 'former smoker' were reported by 65%, 15% and 20%. Ever smokers were more likely to be RF-positive (OR 1.32;1.17-1.48, p<0.001). Rheumatoid nodules were more frequent in ever smokers (OR 1.41;1.24-1.59, p<0.001). The percentage of patients with erosive arthritis and extra-articular disease was similar in all smoking categories. Mean DAS28 was 4.4 (SD 1.6) in non-smokers vs. 4.0 (SD 1.6) in those who had ever smoked. However, when adjusted by age, sex, disease duration, and country gross domestic product, only ESR remained significantly different among Core Data Set measures (mean 31.7mm in non-smokers vs. 26.8mm in ever smoked category). CONCLUSIONS RA patients who had ever smoked were more likely to have RF and nodules, but values for other clinical status measures were similar in all smoking categories (never smoked, current smokers and former smokers).
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Affiliation(s)
- A Naranjo
- Hospital de Gran Canaria Dr. Negrin, University of Las Palmas de Gran Canaria, Spain.
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10
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Sokka T, Kautiainen H, Pincus T, Verstappen SMM, Aggarwal A, Alten R, Andersone D, Badsha H, Baecklund E, Belmonte M, Craig-Müller J, da Mota LMH, Dimic A, Fathi NA, Ferraccioli G, Fukuda W, Géher P, Gogus F, Hajjaj-Hassouni N, Hamoud H, Haugeberg G, Henrohn D, Horslev-Petersen K, Ionescu R, Karateew D, Kuuse R, Laurindo IMM, Lazovskis J, Luukkainen R, Mofti A, Murphy E, Nakajima A, Oyoo O, Pandya SC, Pohl C, Predeteanu D, Rexhepi M, Rexhepi S, Sharma B, Shono E, Sibilia J, Sierakowski S, Skopouli FN, Stropuviene S, Toloza S, Valter I, Woolf A, Yamanaka H. Work disability remains a major problem in rheumatoid arthritis in the 2000s: data from 32 countries in the QUEST-RA study. Arthritis Res Ther 2010; 12:R42. [PMID: 20226018 PMCID: PMC2888189 DOI: 10.1186/ar2951] [Citation(s) in RCA: 178] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2009] [Revised: 02/12/2010] [Accepted: 03/12/2010] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Work disability is a major consequence of rheumatoid arthritis (RA), associated not only with traditional disease activity variables, but also more significantly with demographic, functional, occupational, and societal variables. Recent reports suggest that the use of biologic agents offers potential for reduced work disability rates, but the conclusions are based on surrogate disease activity measures derived from studies primarily from Western countries. METHODS The Quantitative Standard Monitoring of Patients with RA (QUEST-RA) multinational database of 8,039 patients in 86 sites in 32 countries, 16 with high gross domestic product (GDP) (>24K US dollars (USD) per capita) and 16 low-GDP countries (<11K USD), was analyzed for work and disability status at onset and over the course of RA and clinical status of patients who continued working or had stopped working in high-GDP versus low-GDP countries according to all RA Core Data Set measures. Associations of work disability status with RA Core Data Set variables and indices were analyzed using descriptive statistics and regression analyses. RESULTS At the time of first symptoms, 86% of men (range 57%-100% among countries) and 64% (19%-87%) of women <65 years were working. More than one third (37%) of these patients reported subsequent work disability because of RA. Among 1,756 patients whose symptoms had begun during the 2000s, the probabilities of continuing to work were 80% (95% confidence interval (CI) 78%-82%) at 2 years and 68% (95% CI 65%-71%) at 5 years, with similar patterns in high-GDP and low-GDP countries. Patients who continued working versus stopped working had significantly better clinical status for all clinical status measures and patient self-report scores, with similar patterns in high-GDP and low-GDP countries. However, patients who had stopped working in high-GDP countries had better clinical status than patients who continued working in low-GDP countries. The most significant identifier of work disability in all subgroups was Health Assessment Questionnaire (HAQ) functional disability score. CONCLUSIONS Work disability rates remain high among people with RA during this millennium. In low-GDP countries, people remain working with high levels of disability and disease activity. Cultural and economic differences between societies affect work disability as an outcome measure for RA.
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Affiliation(s)
- Tuulikki Sokka
- Jyväskylä Central Hospital, Keskussairaalantie 19, 40620 Jyväskylä, Finland.
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Abstract
Infection-related vasculitis constitutes the most common cause of secondary vasculitis. A great variety of microorganisms can induce directly or indirectly inflammatory vascular damage resulting in vascular occlusion, tissue ischemia, and necrosis. In the developed world hepatitis B and C-related vasculitis remain the most common clinical syndromes, while HIV-associated vasculitis remains a concern in developing countries.
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Affiliation(s)
- Omondi Oyoo
- Section of Rheumatology, Department of Medicine, LSU Health Sciences Center, New Orleans, LA 70112, USA
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