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Active Rheumatoid Arthritis in Central Africa: A Comparative Study Between Sudan and Sweden
Amir I Elshafie1, Abdalla D Elkhalifa2, Sahwa Elbagir2
1From the Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala; Rheumatology Unit, Gävle Hospital, Gävle; Section of Rheumatology, Center for Research and Development, Uppsala University, Region of Gävleborg, Sweden; Khartoum Fertility Center; Rheumatology Unit, Alribat University Hospital, Khartoum; Rheumatology Unit, Military Hospital, Omdurman, Sudan.A.I. Elshafie, MD, PhD, Department of Immunology, Genetics and Pathology, Uppsala University; A.D. Elkhalifa, MD, Rheumatology Unit, Gävle Hospital; S. Elbagir, MD, Department of Immunology, Genetics and Pathology, Uppsala University, and Khartoum Fertility Center; M.I. Aledrissy, MD, Rheumatology Unit, Alribat University Hospital; E.M. Elagib, MD, FRCP, Rheumatology Unit, Military Hospital; M.A. Nur, MD, FRCP, Rheumatology Unit, Alribat University Hospital; T. Weitoft, MD, PhD, Rheumatology Unit, Gävle Hospital, and Section of Rheumatology, Center for Research and Development, Uppsala University; J. Rönnelid, MD, PhD, Department of Immunology, Genetics and Pathology, Uppsala University. amir.elshafie@igp.uu.se.
Objective:
To compare clinical characteristics and treatment between simultaneously investigated Sudanese and Swedish outpatients with rheumatoid arthritis (RA).
Methods:
Outpatients with RA from Sudan (n = 281) and Sweden (n = 542) diagnosed according to the 1987 American College of Rheumatology criteria were recruited between December 2008 and September 2010 and compared concerning clinical presentation, treatment, and laboratory findings, including immunoglobulin M with rheumatoid factor (IgM-RF).
Results:
Sudanese patients had lower inclusion age (median 49 vs 68 yrs), disease duration (48 vs 107 mos), and disease onset age (43 vs 56 yrs) as compared with Swedish patients (p < 0.0001 for all). When stratified concerning the age of inclusion, Swedish patients between 41-50 years had, however, a significantly lower age of onset, with a similar trend for all age groups above 30 years. The female preponderance was higher among Sudanese patients (89.3% vs 72.5%, p < 0.0001), and smoking was nonexistent among Sudanese female patients (p < 0.0001). Erythrocyte sedimentation rate levels and number of tender joints were significantly higher among Sudanese patients. The proportion of IgM-RF positivity was lower among Sudanese patients with RA (52.4% vs 75.5%, p < 0.0001). Higher proportions of Sudanese patients with RA were treated with methotrexate (MTX) and disease-modifying antirheumatic drug combinations, but none of them used biologics. Sudanese patients used lower doses of MTX and sulfasalazine (p < 0.0001) and higher doses of prednisolone (p < 0.0001) than Swedish patients.
Conclusion:
Sudanese patients with RA have significantly higher disease activity and are often IgM-RF-seronegative. Together with reports from Uganda and Cameroon, our data indicate a cluster of highly active and often seronegative RA in central Africa.
