Background: Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by severe joint pain, swelling, damage, and disability which leads to joint destruction and loss of function. The complication of RA is associated with cardiovascular diseases, particularly due to systemic inflammation and dyslipidemia. The purpose of this study was to assess the development of atherosclerosis, which acts as a major risk factor for cardiovascular complications in RA patients. Methods: A hospital-based cross-sectional study was conducted at the Rheumatology Clinic of Tikur Anbessa Specialized Hospital. The study made a comparison of risk factors (dyslipidemia and inflammatory status) between individuals having RA as a case group and apparently healthy individuals as a control group. Simple descriptive statistics, oneway ANOVA, independent sample t-test and multivariate analysis were utilized for statistical analysis. p-value of <0.05 at the 95% confidence level was considered as statistically significant. Results: The result of this study demonstrated that there was a significant elevation of mean ±SD of TC, TC/HDL, LDL/HDL, and lowered value of HDL-C was seen among RA patients than controls (P-value <0.05). The mean ±SD of inflammatory marker, high-sensitivity C-reactive protein (hsCRP), was significantly higher among RA patients compared to controls (P<0.05). HDL-C had a significant negative correlation with a hsCRP whereas TC/ HDL-C and LDL/HDL-C had a significant positive correlation with hsCRP (P<0.05). Conclusion: In this study, RA patients had lipid abnormalities and elevated systemic inflammation than controls. An increase in hsCRP and dyslipidemia status among RA patients indicates the possible development of an atherosclerotic event. Therefore, assessment of lipid profiles and hsCRP in early RA patients may be helpful to assess the possible development of cardiovascular complications.

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BackgroundTreatment of recent onset Rheumatoid Arthritis (RA) is key to preventing deformities. Initial treatment with methotrexate (MTX) is standard of care. RA treatment in resource-limited countries is complicated by competing health priorities and a lack of rheumatologists. The sole public adult rheumatology clinic in Ethiopia, is at Tikur Anbessa Specialty hospital (TASH) (Addis Ababa). Due to the lack of rheumatologists, care is provided by internists with limited rheumatology training.ObjectivesTo evaluate changes in RA management practice patterns following a series of educational activities provided by visiting rheumatologists.MethodsWith local faculty support, visiting rheumatologists conducted educational activities at TASH between July 2016 and December 2018 (2 continuing medical education workshops; 4 clinical preceptorships lasting 2-4 weeks each). Clinical charts of a convenience sample of RA patients seen in the TASH rheumatology clinic were reviewed in September 2016 (n=48) by a team of rheumatologists and a second set in December 2018 (n=78) by an internist. Socio-demographics, arthritis features, treatment patterns and drug safety monitoring were recorded when documented. Practice patterns were compared between 2016 and 2018 using univariate statistics.ResultsThe patients were mainly female (90%) with a mean (standard deviation) age of 36(13) years, resided in Addis Ababa (61%) and received government funded health care (57%). When documented, (95/117; 81%) had polyarthritis and (42/55; 76%) clinical joint deformity (2016 vs 2018 p=NS). More patients were seropositive in 2016 compared to 2018 (32/43 vs 14/75 p<0.001) and more had radiographic damage (erosions, joint space narrowing, periarticular osteopenia) (21/27 vs 39/71 p<0.05). Between 2016 and 2018, prednisolone use remained common (92% in 2016 vs 99% in 2018 p=0.05) often in high doses (last visit daily dose 7.5mg (0-100) vs 5mg (0-100); p=NS; maximum daily dose 7.5 (0-100) vs 20 (0-100) p=NS) with continued documentation of steroid toxicity (45% vs 20%). The only available DMARDs prescribed were MTX (112/127; 97%) and chloroquine (50/125;40%). Median prescribed weekly MTX dose increased between 2016 and 2018 (starting dose 5 vs 7.5 mg/week p=0.01; maximum dose 7.5 vs 12.5 mg/week p<0.0001) and was co-prescribed with folate by 84% in 2016 vs 93% in 2018 (p=NS). Documentation of drug safety for those prescribed MTX improved with adequate pre-MTX labs (hematology, renal and liver panel and or hepatitis serology) requested by 46% in 2016 to 90% in 2018 (p<0.0001). When documented, MTX use was often interupted (2016 17/24; 2018 14/43 p=0.003) and mainly due to limited drug availability.ConclusionAn educational program conducted with support from the local medical community has potential to improve management of rheumatic disease in resource limited regions without adequate rheumatology capacity. However, interventions must be maintained over time and changes in practice measured to ensure that appropriate diagnosis and safe prescribing practi...