Rheumatic diseases in Africa

Adelowo, Olufemi; Mody, Girish M.; Tikly, Mohammed; Oyoo, Omondi; Slimani, Samy

doi:10.1038/s41584-021-00603-4

Cited by 42 publications

(28 citation statements)

References 105 publications

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“…Limited drug availability and poverty likely contribute to high rates of corticosteroid and nonsteroidal anti‐inflammatory use even though steroids pose a greater risk of side effects ( 17 , 29 , 30 ). Demand for MTX in Africa will likely increase with greater awareness of chronic rheumatic diseases, optimization of their treatment approaches, and growing number of specialty‐trained rheumatologists ( 31 ). Solutions to address MTX access will vary by region and will likely require multifaceted approaches engaging national and regional governments to stabilize supply pathways and enhance safe drug dispensing capacity.…”

Section: Discussionmentioning

confidence: 99%

Perceptions and Challenges Experienced by African Physicians When Prescribing Methotrexate for Rheumatic Disease: An Exploratory Study

Hitchon

Mody

Feldman

et al. 2021

ACR Open Rheumatology

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Objective Guidelines for methotrexate (MTX) use in rheumatic disease may not be feasible for physicians practicing in the least developed countries. We aimed to understand the experiences of MTX prescribers relating to MTX use for rheumatic disease in African countries to inform the development of culturally and geographically appropriate recommendations. Methods African physicians who self‐identified as MTX prescribers from countries classified as having a low versus a medium or high Human Development Index (L‐HDI versus MH‐HDI) participated in semistructured interviews between August 2016 and September 2017. Interviews were transcribed verbatim, coded thematically, and stratified by HDI. Results Physicians (23 rheumatologists; six internists) from 29 African countries were interviewed (15 L‐HDI; 14 MH‐HDI). Identified barriers to MTX use included inconsistent MTX supply (reported by 87% L‐HDI versus 43% MH‐HDI), compounded by financial restrictions (reported by 93% L‐HDI versus 64% MH‐HDI), patient hesitancy based partly on cultural beliefs and societal roles (reported by 71%), few prescribers (reported by 33%), prevalent infections (especially viral hepatitis, tuberculosis, and human immunodeficiency virus), and both availability and cost of monitoring tests. MTX pretreatment evaluation and starting and maximal doses were similar between L‐HDI countries and MH‐HDI countries. Conclusion The challenges of treating rheumatic disease in African countries include unreliable drug availability and cost, limited subspecialists, and patient beliefs. Adapting recommendations for MTX use in the context of prevalent endemic infections; ensuring safe but feasible MTX monitoring strategies, enhanced access to stable drug supply, and specialized rheumatology care; and improving patient education are key to reducing the burden of rheumatic diseases in L‐HDI countries.

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Section: Discussionmentioning

confidence: 99%

Perceptions and Challenges Experienced by African Physicians When Prescribing Methotrexate for Rheumatic Disease: An Exploratory Study

Hitchon

Mody

Feldman

et al. 2021

ACR Open Rheumatology

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“…5,6,9 There is a lack of data in Africa on the prevalence of RA. [10][11][12] Data extracted from a systematic analysis of 9 (out of 10 included) studies in sub-Saharan Africa and published from 1968 to 1988 estimated a crude prevalence of 0.36% for RA. 11 A systematic review and meta-analysis of populationbased studies from 11 African countries -urban and rural settings -estimated different crude prevalence.…”

Section: Impact Statementmentioning

confidence: 99%

Indigenous Nigeria medicinal herbal remedies: A potential source for therapeutic against rheumatoid arthritis

Arunsi

Chioma

Etusim

et al. 2022

Exp Biol Med (Maywood)

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Rheumatoid arthritis (RA) is a debilitating disease associated with locomotion impairment, and conventional therapeutic drugs are not optimal for managing RA. There is an avalanche of medications used for the management of RA. Still, studies have shown that they are associated with severe side effects, including hepatotoxicity, retinopathy, and cardiotoxicity disorders of the central nervous system (CNS), skin, blood, and infections. Complementary and alternative medicine (CAM) is currently gaining attention as a novel panacea for managing debilitating diseases, such as RA. Nigerian folk herbal remedies are replete with a plethora of curative medicine, albeit unvalidated scientifically but with seemingly miraculous provenance. Studies of the identification of bioactive compounds present in these botanicals using advanced spectral analytical techniques have enhanced our understanding of the role of Nigerian herbal remedies in the treatment and management of RA. Interestingly, experimental studies abound that the bioactive compounds present in the extracts of plant botanicals protected animals from the development of RA in different experimental models and reduced the toxicity associated with conventional therapeutics. Validated mechanisms of RA amelioration in human and animal models include suppression of the expression of NF-κB, IL-1β, TNF-α, IL-6, IL-8, IL-17, IL-23, chemokines, TGF-β, RANKL, RANK, iNOS, arginase, COX-2, VEGFA, VEGFR, NFATC1, and TRAP in the synoviocytes. Decreased ROS, NO, MDA, carbonyl groups, and PGE2 in the synovial fluid increased the expression of PPARα/γ; antioxidant and anti-inflammatory molecules also improve RA etiology. In this mini-review, we discuss the global burden of RA, the novel role of plant-based botanicals as potential therapeutics against signaling pathways in RA. Also addressed is the possible repurposing/reprofiling of plant botanicals to increase their therapeutic index among RA patients that patronize traditional healers in Nigeria with a global projection.

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“…[1] A possible explanation for this is the age limitation for participation in the study, which was 18 to 50 years, and in addition, African samples have reported an average age of onset of 27 years. [11] The large distribution of participants located in the Gauteng province is attributed to Gauteng having the greatest population density, coupled with the highest internet connectivity in South Africa. [12] Global Physical Activity Questionnaire (GPAQ)…”

Section: Demographicsmentioning

confidence: 99%

Pain and physical activity levels among Rheumatoid Arthritis patients between the ages of 18 to 50 years in South Africa

2022

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Background: Little epidemiological research on rheumatoid arthritis (RA) has been done in Africa, suggesting that it is an uncommon illness. In rural South Africa, RA has an overall prevalence of 0.07% and a prevalence of 2.5% in urban areas; therefore, it is not as uncommon as perceived by the lack of research. Patient-centred programmes to improve physical function have been lacking and, as a result, the prior assumption was that physical activity should be avoided. Objectives: To determine pain and physical activity levels among RA patients between the ages of 18 to 50 years in South Africa. Methods: A combination of two questionnaires were used, namely, the Global Physical Activity Questionnaire (2002) and the Pain Outcomes Questionnaire (2003). The collated questionnaires were distributed by rheumatologists and on social media platforms to RA patients between the ages of 18 to 50 years old living in South Africa. This study had a sample size of 105 participants, with participation occurring through the online Google forms platform. Results: One hundred and five participants with RA were recruited with an average age of 38±9 years. Most of the participants were females (93.3%). Seventy-two percent of the sample was classified as physically active, where work, leisure and travel activities were considered. No significant correlation between pain and physical activity was evident (r=0.10; p=0.311). Results showed significant correlations between pain and personal grooming (r=0.30; p=0.002), pain and ambulation (r=0.60; p=0.000), and pain and stair climbing (r=0.60; p=0.000). Conclusion: Physical activity has proven to have multiple benefits for those suffering with RA. In this South African sample of RA patients, the majority were classified as physically active, and pain did not affect the activity levels of the involved participants. This study opens further research questions regarding RA prevalence in South Africa, and the type and intensity of physical activity that would be beneficial for RA.

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Rheumatic diseases in Africa

Cited by 42 publications

References 105 publications

Perceptions and Challenges Experienced by African Physicians When Prescribing Methotrexate for Rheumatic Disease: An Exploratory Study

Perceptions and Challenges Experienced by African Physicians When Prescribing Methotrexate for Rheumatic Disease: An Exploratory Study

Indigenous Nigeria medicinal herbal remedies: A potential source for therapeutic against rheumatoid arthritis

Pain and physical activity levels among Rheumatoid Arthritis patients between the ages of 18 to 50 years in South Africa

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