Clinical Features of Rheumatoid Arthritis in a Sub-Saharan African Population: A 308 Study Cases in Senegal

Background: Rheumatoid arthritis, formerly rare in sub-Saharan Africa, is becoming increasingly reported. The objective study determines the epidemiological, clinical and biological features of rheumatoid arthritis at diagnosis. Methods: A cross-sectional study conducted at the rheumatology outpatient department of Aristide Le Dantec Teaching Hospital of Dakar in Senegal. Results: Three hundred eight patients with rheumatoid arthritis according, to American College of Rheumatology 1987 criteria, were included: 273 women and 35 men (ratio of 7:8). Median age was 41 years (Q1: 31; Q3: 53 years); predominant age group was 30-40 years. Ninety-three percent resided in urban areas and 7% in rural areas. Family history of chronic inflammatory arthritis was reported by 35.1% of patients. Thirty-nine percent of patients initially consulted a traditional healer. On admission, the median Disease Activity Score 28 was 6.5 (Q1: 5.5; Q3: 7.3). Rheumatoid arthritis was very active in 81.1% and a positive factor in 84% of patients. Cyclic citrullinated peptide antibodies assessed in 116 patients; 95 reported positive (81.9%). Of 169 patients, at least one extra-articular manifestation was presented; the most common, anemia and sicca syndrome. Conclusion: Rheumatoid arthritis was characterized by an important delay in diagnosis, a polyarticular presentation, and a high positivity of immunological markers. Extra-articular manifestations included mainly anemia and sicca syndrome. Early management and a better understanding of rheumatoid arthritis in sub-Saharan Africa are required.