THE OFFICIAL NEWS SOURCE OF ACR CONVERGENCE 2022 • NOVEMBER 10-14



Medical community struggles to share information about rheumatolic disease across Africa

Mohammed Tikly, FRCP, PhD
Mohammed Tikly, FRCP, PhD

Although initiatives to increase awareness, improve care, and conduct research are making some inroads in Africa, there remains a dearth of information on rheumatic and musculoskeletal diseases in Africa.

This year’s African League of Associations for Rheumatology (AFLAR) session, Out of Africa: Of Rheumatic Diseases: Pattern, Genetics & Advocacy, will provide attendees current information on conditions such as gout, juvenile arthritis, lupus, HIV, and inflammatory arthritis in Africans, as well as the genetics of rheumatoid arthritis and advocacy efforts. The session will take place from 8:30 – 10:00 am Monday, in Room W471b.

The ACR invited AFLAR to share its perspectives and insights in an effort to help expand the data exchange that is critical to improving patient care worldwide. The ACR expresses its gratitude to AFLAR for helping the ACR provide Annual Meeting attendees additional opportunities to learn from speakers with diverse experiences.

Presenters include Mohammed Tikly, FRCP, PhD, Professor Emeritus at the University of the Witwatersrand and Chris Hani Baragwanath Academic Hospital in Soweto, South Africa, who will discuss the genetics of rheumatoid arthritis in sub-Saharan Africa.

“The first reported cases of rheumatoid arthritis in this region appeared in the late 1950s and 1960s. The few community-based studies that exist suggest that the prevalence of rheumatoid arthritis today varies across the region, with the highest numbers reported in urban black South Africans,” Dr. Tikly said. “Interestingly, there is evidence to suggest that, at least in the 1970s, the disease was rare in rural populations, suggesting that environmental factors such as smoking and viral infections predispose genetically susceptible individuals to RA.”

Genetic studies to date, he said, have focused almost exclusively on HLA Class II gene associations with rheumatoid arthritis. Findings have suggested that the association with HLA DRB1 genes that carry the RA-shared epitope is strongest in seropositive disease in southern African populations and less so in West Africans.

“Additionally, studies have shown that PTPN22 gene polymorphisms that have been associated with RA in Caucasians appear not to be important in sub-Saharan African populations, as the gene is non-polymorphic in these populations,” Dr. Tikly said. “It’s important to understand that black sub-Saharan populations are not genetically homogeneous, so genetic risk factors vary in importance in the Southern, Central, Western, and Eastern Africa subregions.”

G. Omondi Oyoo, MD, FACR, FRCP(Edin)
G. Omondi Oyoo, MD, FACR, FRCP(Edin)

The increasing prevalence of gout in Africa will be the topic of G. Omondi Oyoo, MD, FACR, FRCP(Edin), Associate Professor in the Department of Clinical Medicine and Therapeutics at the University of Nairobi School of Medicine and Head of the Rheumatology Unit at Kenyatta National Hospital in Kenya.

“There are increasing numbers of publications reflecting a growing recognition of gout in Africa,” Dr. Oyoo said. “Drivers of the surge in numbers of gout and hyperuricemia in Africa include adoption of western lifestyle, higher socioeconomic status, male sex, and alcohol. Further contributions are from the rising number of lifestyle diseases, such as obesity, hypertension, and diabetes.”

While there is a paucity of data on epidemiology and its overall impact in an African setting, Dr. Oyoo said most research has noted a delayed time to diagnosis.

“Contributors to this include low numbers of rheumatologists in Africa and low index of suspicion by primary care physicians,” he said. “This has led to a majority presenting with polyarticular tophaceous gout. A lack of available guidelines for local healthcare providers has led to suboptimal treatment of these patients.”

Dr. Oyoo believes that there needs to be a deeper engagement of primary care and affiliated health professionals, particularly in educating people on the dangers associated with western lifestyles.

“Health care programs on diet and weight reduction should be prioritized highly by governments,” he said. “And clinicians in Africa need to recognize gout early, initiate treatment early, and use the treat-to-target approach. Guidelines for Africa will help in this regard.”

Other scheduled presentations include a review of the clinical spectrum and course of inflammatory arthritis in a high HIV-burden environment by Girish M. Mody, MD, Aaron Beare Family Professor of Rheumatology at the University of KwaZulu-Natal in Durban, South Africa.

Current data on juvenile idiopathic arthritis and juvenile SLE among Africans will be the topic of a co-presentation by AFLAR President Olufemi Adelowo, MD, FRCP, MACR, Professor of Medicine and Consultant Rheumatologist at Lagos State University Teaching Hospital and Lagos University Teaching Hospital in Nigeria, and AFLAR President-elect Marie Doualla Bija, MD, Professor of Rheumatology on the Faculty of Medicine and Biomedical Sciences at the University of Yaoundé in Cameroon.

Courage Uhunmwangho, MD, Consultant Rheumatologist at the Jos University Teaching Hospital and a Lecturer in the Department of Internal Medicine at the University of Jos in Nigeria, will present on the prevalence and pattern of rheumatic and musculoskeletal diseases in rural and semi-urban populations in Africa.

Ida Dzifa Dey, MD, Head of Rheumatology in the Department of Medicine and Therapeutics at Korle-bu Teaching Hospital and Lecturer at the University of Ghana School of Medicine and Dentistry, will describe recent efforts at improving advocacy for patients and the role of African rheumatologists in giving patients the voice and right to treatment opportunities they deserve.