Objectives The prevalence and burden of SLE in Africa are poorly understood. This health-facility-based retrospective study aimed to describe the frequency and the clinical and immunological characteristics of SLE in Uganda. Methods We reviewed clinical notes of patients presenting with rheumatological complaints in two large rheumatology outpatient clinics in Uganda between January 2014 and December 2019. Results Of the 1019 charts reviewed, 5.5% (56) of the patients had confirmed SLE, with a median age of 29 (range: 14–65) years. The male-to-female ratio was ∼1:10, and 19.6% (11/56) of the patients had SLE and RA overlap syndrome. Patients presented with joint pains or swellings (n = 39, 69.6%), typical photosensitive malar rash (n = 34, 60.7%), oral ulceration (n = 23, 41.1%), anaemia (n = 14, 25.0%), hair loss and polyserositis (n = 12, 21.4% each), constitutional symptoms (n = 10, 17.9%), RP (n = 4, 7.1%) or LN (n = 3, 5.4%). ANA and anti-dsDNA autoantibodies were both positive in 25 (75.8%) of the 33 patients with available results. ANA titres were ≥1:160, with a median titre of 1:160 (range: 1:160 to 1:3200). Six patients had titres ≥1:320. The median dsDNA level was 80 (range: 40–283) IU. Ten patients had results of C3 and C4 complement protein levels and, of these, 4 patients had low C3 levels and 3 had low C4 levels. Conclusion SLE is uncommon among patients presenting with rheumatological complains in Uganda. SLE overlaps with RA in our setting, and a majority of patients present to care with complications.

Background There is a scarcity of data on the burden of depression among Ugandans with rheumatoid arthritis (RA) patients. We aimed to screen for symptoms of depression, their severity and associated factors among patients with RA in Uganda. Patients and Methods A descriptive, cross-sectional study was conducted between September and December 2020 at Mulago National Referral Hospital (MNRH) and Nsambya Hospital. Patients with RA were enrolled consecutively. Data on demographics, disease course and comorbidities and depression symptomatology were collected through an interviewer administered questionnaire. Symptoms of depression were screened for using the depression/anxiety dimension of the EuroQoL questionnaire. Results Forty-eight patients with a median age of 52 (IQR: 43.5–60.5) years were recruited in the study. The majority of the patients were female (91.7%, n=44). Twenty-nine patients (60.4%) had comorbidities with a median Charlson comorbidity score of 3 (IQR: 2–4). Overall, 70.8% (n=34) had depressive symptoms. Patients attending MNRH were more likely to have depressive symptoms (p=0.025). Significantly, patients with depressive symptoms were younger (p=0.027), had lower health index value (p<0.001), and lower overall self-reported health status (p=0.013). At binary logistic regression, patients at MNRH (crude odds ratio (COR): 4.32, 95% confidence interval (CI): 1.16–16.15, P=0.030), patients aged <52 years (COR: 5.24, 95% CI: 1.23–22.28, P=0.025) and those with mild RA (COR: 5.71, 95% CI: 1.15–28.35, P=0.033) were significantly more likely to have depressive symptoms. Increase in age (COR: 0.94, 95% CI: 0.89–0.99, P=0.025), and high visual analogue score (COR: 0.94, 95% CI: 0.89–0.99, P=0.013) were protective. Conclusion Depressive symptoms were common among RA patients in Uganda. Routine screening, diagnosis and management of depression is recommended among young patients to improve quality of life and patient outcomes.

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Background Decompensated cirrhosis is a major cause of morbidity and mortality globally affecting close to 10.6 million people of which an estimated 28,877 are in Uganda. Bacterial infections including urinary tract infections (UTIs) are an increasing cause of short-term mortality in this sub-population. Data on UTIs among patients with cirrhosis are scarce in Uganda and other settings in sub-Saharan Africa (SSA) which suffer a high burden of liver diseases. We determined the prevalence, microbiologic spectrum and antibacterial sensitivity patterns of UTIs among patients with decompensated cirrhosis at a large urban health facility in Uganda. Methods Patients with decompensated cirrhosis presenting to a tertiary care centre in Uganda were enrolled in the study. Demographic and clinical features of UTI were captured and urine samples collected. Urinalysis and urine culture studies were conducted to determine presence of UTIs and antibacterial susceptibility patterns. Urinalysis results of ≥ 5 white cells per high power field and or culture findings of ≥ 104CFUs/ml defined UTI. Analysis was done using STATA 16.0 and findings summarized in percentages. Results Irrespective of symptomatology, prevalence of UTI was 37.1% (106/286) on either urinalysis alone 11/286 (3.9%), urine culture alone 77/286 (26.9%) or both 18/286 (6.3%). The most common bacteria isolated were Escherichia coli (40.1%) and Enterococcus spp (22.9%). The majority of isolates were resistant to fluoroquinolones, penicillins and third generation cephalosporins. Multidrug resistant organisms particularly ESBL and MRSA constituted 32.7% of the bacterial isolates. Conclusion Urinary tract infection is common among patients with decompensated cirrhosis, occurring in one third of patients with cirrhosis and are commonly caused by gram negative bacteria resistant to commonly recommended antibacterial agents in Uganda. Regardless of symptomatology, we recommend screening of patients with decompensated cirrhosis for UTI at presentation.

PurposeThis study aimed to assess the patient–reported outcomes (PROs) in rheumatic patients attending two tertiary rheumatology clinics in Uganda.MethodsA cross-sectional, clinical audit of patients aged 16 years or older with a confirmed diagnosis of rheumatic disease and receiving disease modifying anti-rheumatic drugs (DMARDs) was conducted between September and December 2020. Health index and overall self-rated health status were assessed using the ED-5D-5L tool. Comparisons for variables was performed using Student’s t-test or Mann-Whitney U for continuous numerical data while categorical data was compared using either Χ2 tests or Fisher’s exact tests as appropriate.ResultsWe enrolled 74 eligible patients: 48 (64.9%) had rheumatoid arthritis (RA), 14 (18.9%) had systemic lupus erythematosus (SLE), and 12 (16.2%) had other autoimmune rheumatic disorders. Majority (n=69, 93.2%) were female with a mean ±SD age of 45 ± 17 years. Fourteen (18.9%) patients were on concomitant herbal medication while using DMARDs and 26 (35.1%) self-reported at least 1 adverse drug reactions to the DMARDS. Any level of problem was reported by 54 (72.5%) participants for mobility, 47 (63.5%) for self-care, 56 (75.6%) for usual activity, 66 (89.1%) for pain and discomfort, and 56 (75.6%) for anxiety/depression. Patients with SLE had higher median health index compared to those other autoimmune rheumatic disorders (p<0.0001). Overall self-rated health status was comparable across clinical diagnoses (p=0.2), but better for patients who received care from private (Nsambya Hospital) compared to public hospital (Mulago Hospital) (65 vs. 50, p=0.009).ConclusionThere is a substantial negative impact of autoimmune rheumatic diseases on quality of life of patients, especially those receiving care from a public facility in Uganda.Clinical SignificanceAdverse drug reactions to DMARDs was reported by more than one-third of the patientsSLE patients have better quality of life compared to patients with other autoimmune rheumatic disease.Concomitant use of herbal medication is common and associated with lower health index and lower overall self-rated health status.Autoimmune rheumatic diseases impose a heavy financial burden on affected patients, over 70% of the study patients required financial support for management of their disease and a high proportion of these patients were not on their DMARD therapy the week prior to their scheduled clinic appoints.