Comorbidities in Black South Africans with Rheumatoid Arthritis

Lala, Vikash Goolab
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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.
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.