Rheumatoid arthritis in Congo-Brazzaville - A study of thirty-six cases

Objectives. To define the epidemiology, clinical features and outcomes of rheumatoid arthritis in a hospital-based population in Congo-Brazzaville. Patients and methods. We retrospectively reviewed the medical records of the 36 subjects seen on an inpatient or outpatient basis at our rheumatology department who met American College of Rheumatology criteria for rheumatoid arthritis. Results. There were 28 women and eight men (male to female ratio, 0.28), with a mean age of 43.5 years. The total number of patients seen at our department during the study period was 3518, yielding a prevalence of 1% for rheumatoid arthritis. Seven per cent of the patients with inflammatory joint disease had rheumatoid arthritis. Mean disease duration was 9.5 years (range, 1-25 years). The onset was gradual in every case and distal joints were affected first in 33 patients. All the patients but one had bilateral symmetric polyarthritis; affected joints included the proximal interphalangeal joints (n: 33), the metacarpophalangeal joints (n: 27), the wrists (n: 27), the metatarsophalangeal joints (n: 20), the knees (n: 26), the elbows (n: 18), the hips (n: 4), the temporomandibular joints (n: 4), and the cervical spine (n: 5). Boutonniere deformity of the fingers was the most common joint deformity (n: 15), followed by ulnar drift (n: 9). Three patients had tenosynovitis, two had tendon rupture, one had carpal tunnel syndrome and one had rheumatoid nodules. Rheumatoid factors were found in 70% of cases. Evidence of chondrolysis was seen on roentgenograms in every case. Gold and chloroquine were the two most commonly used second-line agents. Seven patients were on prednisone, in a mean daily dose of 6 mg. Mean follow-up was 15 months (range: 3-36 months). Steinbrocker's disease activity stage was IV in 14 patients and III in eight patients; Steinbrocker's functional stage was IV in five patients and III in three. Conclusion. The features and outcomes of rheumatoid arthritis in Congo-Brazzaville match textbook descriptions except for a lower prevalence of extraarticular manifestations. Similar findings have been reported for East Africa, South Africa, and some countries of West Africa.