Comorbidities in Black South Africans with Rheumatoid Arthritis
Date
2018
Authors
Lala, Vikash Goolab
Journal Title
Journal ISSN
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Abstract
Introduction: Comorbidities occur commonly in rheumatoid arthritis(RA) but little is
known about their prevalence and spectrum in South Africans.
Objectives: To determine the prevalence and associated risk factors of
comorbidities in black South Africans with RA.
Methods: A retrospective record review of black RA patients at a tertiary
rheumatology service. The cumulative comorbidity score was assessed using the
Charlson comorbidity score.
Results: Of the 500 patients studied, the mean(SD) age and disease duration was
60.0(11.1) and 10.7(5.0) years, respectively. Most patients (50.5%) had severe
disability (functional class 3-4) at diagnosis with 98% of patients having had ≥1
comorbidities. The median number of comorbidities was 3.0(IQR 2.0-4.0).
Comorbidities were a function of age, follow up duration and disability (p=<0.001).
The table below shows the common comorbidities.
Prevalence
(%)
Prevalence
(%)
Anaemia 391(78.2) Tuberculosis 53(10.6)
Hypertension 350(70.0) HIV (n=204) 44(9.3)
Peptic ulcer disease
(PUD)(n=114)
73(64.0) Congestive heart failure 33(6.6)
Hypercholesterolemia (n=466) 221(47.4) Cerebrovascular disease 14(2.8)
Osteoporosis (n=132) 62(47.0) Malignancy 9(1.8)
Diabetes mellitus 77(15.4) Ischaemic heart disease 3(0.6)
Serious infections 56(11.2)
Serious infections occurred more commonly in those with osteoporosis (OR-4.32),
vasculitis (OR-4.0), anaemia (OR-3.62) and HIV (OR-2.32). Patients with the
following comorbidities were more likely to have deceased during follow up: CCF
(OR-5.44), serious infections (OR-4.58), interstitial lung disease (OR-3.91),
arthroplasty (OR-2.46), TB (OR-2.22) and PUD (OR-1.54).
Conclusion: Despite the high prevalence of cardiac risk factors in this population,
the prevalence of ischaemic heart disease remains low. Osteoporosis is commonly
found in RA patients undergoing DEXA scans.
Description
A research report submitted to the Faculty of Health Sciences, University of the
Witwatersrand, Johannesburg in partial fulfilment of the degree of Master of
Medicine in Internal Medicine. Johannesburg, 2018.