Untreated rheumatoid arthritis may cause disability, job loss – Experts

Healthcare professionals have advocated early treatment of Rheumatoid Arthritis, an auto-immune disease that affects the small joints of the body, and which can lead to deformity, disability and job loss if left untreated.

The experts, including two rheumatologists from Lagos State University College of Medicine (LASUCOM), Ikeja, and Lagos University Teaching Hospital (LUTH), Idi-Araba, Olaosebikan Hakeem and Uyiekpan Ima-Edomwonyi, respectively, said if left unaddressed the economy of a country can be negatively affected.

They spoke at a webinar held on Thursday by Pfizer Incorporation, an American multinational pharmaceutical giant.

The company said the webinar was organised as part of its health interventions and aimed at highlighting the prevalence and the social burden of the disease.

Early detection and therapy

According to Mr Ima-Edomwonyi, Rheumatoid Arthritis (RA) affects the small joints of the hand, wrist, and feet before affecting large joints with debilitating symptoms which he said could include pain and stiffness.

“People with Rheumatoid arthritis are seen to have lower functional status. This disability can lead to a loss of career and sources of income, which is a particular problem in low-income settings,” he said.

He added that healthcare professionals need to identify the disease early and commence appropriate therapy, in order to curtail its prevalence in Africa.

He said; “For a certain subset of the population, jobs in Africa involve a level of manual labour and the resource-starved African states can afford only limited or no welfare support for disabled individuals.

“Along with the increase in non–communicable diseases (NCD) in developing countries, an increase in Rheumatoid arthritis occurrence could stress medical services that are already struggling with a high burden of acute infectious illnesses to an extent that they may be unable to cope with the fast-changing patterns of disease distribution seen in Africa today

“However, healthcare professionals, general physicians and rheumatologists need to identify Rheumatoid arthritis early and commence appropriate therapy as soon as possible.”

Prevalence and risk factors

Mr Ima-Edomwonyi said there is limited data on the prevalence of RA in Africa and that very few communities or population-based studies have been conducted. He noted that the development has frustrated efforts to establish the epidemiology of the disease.

According to the rheumatologist, a research study on Rheumatic diseases in Africa, was conducted in 2021, and that it “historically established that rheumatic diseases have not received much attention in Africa, particularly in sub-Saharan Africa.”

He said the research gave a summary of previously published population-based epidemiological studies on RA and describes the setting in which each study was conducted.

He said; “Most of the studies had small numbers of participants, ranging from 543 to 1,070. In 1975, a South African study reported a prevalence of RA of 0.90 per cent in an urban population, which was quite different in rural populations.

“In the same year, another South African study reported a prevalence of RA of only 0.12 per cent in a rural black population, while a 1993 survey of 1,994 people in rural Nigeria failed to detect any patient with RA and, similarly, a 2017 study of a semi-urban Nigerian population identified only three individuals with RA, which represents 0.12 per cent among the 2,454 people studied.”

The medical expert said the research concluded that the findings are similar to observations in other parts of the world, where the prevalence of RA ranges from 0.2 per cent to 0.5 per cent in most rural communities in low-income and middle-income countries.

From symptoms to treatment

On his part, Mr Hakeem recommended that treatment of RA should begin once the patient starts having symptoms before it gets out of hand.

He said: “Treatment of Rheumatoid arthritis is ideally done as soon as possible when the patient starts with disease symptoms, but at any stage, the aim is to get the disease into remission or to have minimal signs and symptoms.

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“This is to decrease the progression of joint disease as the disease process can cause progressive damage to joints with resultant loss of function, which in many patients, will mean that they are unable to fulfil work obligations or cope with activities at home.

“Adequate treatment is also important to try to prevent or lessen the severity of co-morbidities, particularly cardiovascular disease, which is still a major cause of mortality in these patients.”

He added that patients should ideally be treated by a multidisciplinary team to address many other associations of this disease which range from psychological help with anxiety and depression to guidance with physical therapy by physiotherapists or biokinetics and help with daily activities by occupational therapists.”

Disease more prevalent in women

Speaking on why women develop RA more than men, the experts said it has to do with the hormones of females, which they claim tend to ameliorate the immune system.

Mr Hakeem said; “It is not only RA, but all auto-immune diseases are more common in females than males and the reason is just the female hormone called oestrogen, which tends to reduce the immune system. Male also have estrogen, but not as much as women.


“Women also have the double x chromosomes, which have been linked to the reduction of the immune system.”

He said another study, titled: “A Comparison of Risk Factors for Osteo- and Rheumatoid Arthritis Using NHANES Data,” which he noted was published on Science Direct, a journal, listed major risk factors why women are more likely to develop RA compared to men, to include sex, age, and family history.

He said the research further indicated that RA most commonly begins between the ages of 40 and 60.

Therapy costs

Meanwhile, in his contribution, Kodjo Soroh, the country medical director at Pfizer East and West Africa, said the company is coming up with a programme that is aimed at reducing the therapy costs for eligible patients of RA.

“We want to work closely with the healthcare community to ensure early diagnosis, increased patient access and medication adherence. There is Project Afya, a patient assistance programme aimed at improving access to life-saving medications and boosting cancer care and autoimmune disease management.

“In partnership with IQVIA, the platform is helping to reduce therapy costs for eligible patients as Rheumatologists identify patients for enrolment into the program,” he said.

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