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1.
Nat Rev Rheumatol ; 17(6): 363-374, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33850309

RESUMO

Historically, rheumatic diseases have not received much attention in Africa, particularly in sub-Saharan Africa, possibly owing to a focus on the overwhelming incidence of infectious diseases and the decreased life span of the general population in this region. Global attention and support, together with better health policies and planning, have improved outcomes for many infectious diseases; thus, increasing attention is being turned to chronic non-communicable diseases. Rheumatic diseases were previously considered to be rare among Africans but there is now a growing interest in these conditions, particularly as the number of rheumatologists on the continent increases. This interest has resulted in a growing number of publications from Africa on the more commonly encountered rheumatic diseases, as well as case reports of rare diseases. Despite the limited amount of available data, some aspects of the epidemiology, genetics and clinical and laboratory features of rheumatic diseases in African populations are known, as is some detail on the use of therapeutics. Similarities and differences in these conditions can be seen across the multi-ethnic and genetically diverse African continent, and it is hoped that increased awareness of rheumatic diseases in Africa will lead to earlier diagnosis and better outcomes for patients.


Assuntos
Predisposição Genética para Doença/epidemiologia , Publicações/estatística & dados numéricos , Doenças Reumáticas/diagnóstico , Doenças Reumáticas/epidemiologia , Reumatologistas/estatística & dados numéricos , Adulto , África ao Sul do Saara/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Antirreumáticos/uso terapêutico , Conscientização , Comorbidade , Gerenciamento Clínico , Meio Ambiente , Feminino , Predisposição Genética para Doença/etnologia , Política de Saúde , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Publicações/provisão & distribuição , Doenças Reumáticas/tratamento farmacológico , Doenças Reumáticas/genética , Fatores de Risco
2.
Rheumatology (Oxford) ; 60(1): 392-398, 2021 01 05.
Artigo em Inglês | MEDLINE | ID: mdl-33020845

RESUMO

OBJECTIVES: To identify the changes in rheumatology service delivery across the five regions of Africa from the impact of the COVID-19 pandemic. METHODS: The COVID-19 African Rheumatology Study Group created an online survey consisting of 40 questions relating to the current practices and experiences of rheumatologists across Africa. The CHERRIES checklist for reporting results of internet e-surveys was adhered to. RESULTS: A total of 554 completed responses were received from 20 countries, which include six in Northern Africa, six in West Africa, four in Southern Africa, three in East Africa and one in Central Africa. Consultant grade rheumatologists constituted 436 (78.7%) of respondents with a mean of 14.5 ± 10.3 years of experience. A total of 77 (13.9%) rheumatologists avoided starting a new biologic. Face-to-face clinics with the use of some personal protective equipment continued to be held in only 293 (52.9%) rheumatologists' practices. Teleconsultation modalities found usage as follows: telephone in 335 (60.5%), WhatsApp in 241 (43.5%), emails in 90 (16.3%) and video calls in 53 (9.6%). Physical examinations were mostly reduced in 295 (53.3%) or done with personal protective equipment in 128 (23.1%) practices. Only 316 (57.0%) reported that the national rheumatology society in their country had produced any recommendation around COVID-19 while only 73 (13.2%) confirmed the availability of a national rheumatology COVID-19 registry in their country. CONCLUSION: COVID-19 has shifted daily rheumatology practices across Africa to more virtual consultations and regional disparities are more apparent in the availability of local protocols and registries.


Assuntos
COVID-19 , Atenção à Saúde/métodos , Padrões de Prática Médica/estatística & dados numéricos , Reumatologistas , Adulto , África , Antirreumáticos/uso terapêutico , Produtos Biológicos/uso terapêutico , Atenção à Saúde/estatística & dados numéricos , Correio Eletrônico/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Aplicativos Móveis/estatística & dados numéricos , Equipamento de Proteção Individual , Exame Físico/métodos , Guias de Prática Clínica como Assunto , Sistema de Registros/estatística & dados numéricos , Doenças Reumáticas/terapia , Reumatologia , SARS-CoV-2 , Sociedades Médicas , Telemedicina/estatística & dados numéricos , Telefone/estatística & dados numéricos , Comunicação por Videoconferência/estatística & dados numéricos
4.
Curr Rheumatol Rep ; 20(2): 4, 2018 02 21.
Artigo em Inglês | MEDLINE | ID: mdl-29464351

RESUMO

PURPOSE OF REVIEW: Systemic vasculitides are characterized by inflammation of blood vessel walls leading to a myriad of organ disorders depending on the size, site, and location of the affected blood vessel. The epidemiology of vasculitis in the developing world has been inadequately documented. The description of the vasculitides in Africa, both from hospital series as well as taking into consideration, previous epidemiological studies in the community, indicates that these conditions have been rare until relatively recently. In view of these past observations, this review of publications on the topic looks to shed light on the current state of vasculitis in Africa. RECENT FINDINGS: Takayasu and Kawasaki appear to be the most commonly reported vasculitides in Africa. Most of the published reports are from North and South Africa. Furthermore, the contribution of vasculitis associated with infections, and in particular HIV, is significant. There are increasing numbers of publications reflecting a growing recognition of the vasculitides in Africa.


Assuntos
Vasculite/epidemiologia , África/epidemiologia , Síndrome de Behçet/epidemiologia , Infecções por HIV/epidemiologia , Humanos , Síndrome de Linfonodos Mucocutâneos/epidemiologia , Arterite de Takayasu/epidemiologia , Vasculite/virologia
7.
Clin Rheumatol ; 35(2): 433-40, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25596014

RESUMO

A major cause of disability and pain, musculoskeletal conditions (MSC) affect all aspects of people's lives and have a significant socioeconomic impact. Access to early diagnosis, effective treatments and rehabilitation enables people with MSCs to maintain their mobility, to work and to have a good quality of life. Despite the significant impact of MSC on health, social and economic well-being in Africa, services for MSC health remain extremely under-resourced. The UWEZO project is a collaboration between Kenyan, UK and Swedish rheumatologists, patients and researchers. It aims to improve access to basic musculoskeletal health care at the local level in communities across Kenya through the development of a sustainable training programme to raise the knowledge and skills of health professionals working in the community in the early detection, diagnosis and management of MSC. A team of physicians and patients have been trained to deliver an MSC education programme to health providers working in 11 locations across Kenya. Over 500 health providers have been trained. The programme has the potential to be adapted for use in other low resource countries where access to care for musculoskeletal conditions is limited.


Assuntos
Países em Desenvolvimento , Doenças Musculoesqueléticas/terapia , Reumatologia/educação , Acesso aos Serviços de Saúde , Humanos , Quênia , Doenças Musculoesqueléticas/diagnóstico
8.
Clin Exp Rheumatol ; 32(6): 869-77, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25327997

RESUMO

OBJECTIVES: The aim is to assess the prevalence of comorbidities and to further analyse to which degree fatigue can be explained by comorbidity burden, disease activity, disability and gross domestic product (GDP) in patients with rheumatoid arthritis (RA). METHODS: Nine thousands eight hundred seventy-four patients from 34 countries, 16 with high GDP (>24.000 US dollars [USD] per capita) and 18 low-GDP countries (<24.000 USD) participated in the Quantitative Standard monitoring of Patients with RA (QUEST-RA) study. The prevalence of 31 comorbid conditions, fatigue (0-10 cm visual analogue scale [VAS] [10=worst]), disease activity in 28 joints (DAS28), and physical disability (Health Assessment Questionnaire score [HAQ]) were assessed. Univariate and multivariate linear regression analyses were performed to assess the association between fatigue and comorbidities, disease activity, disability and GDP. RESULTS: Overall, patients reported a median of 2 comorbid conditions of which hypertension (31.5%), osteoporosis (17.6%), osteoarthritis (15.5%) and hyperlipidaemia (14.2%) were the most prevalent. The majority of comorbidities were more common in high-GDP countries. The median fatigue score was 4.4 (4.8 in low-GDP countries and 3.8 in high-GDP countries, p<0.001). In low-GDP countries 25.4% of the patients had a high level of fatigue (>6.6) compared with 23.0% in high-GDP countries (p<0.001). In univariate analysis, fatigue increased with increasing number of comorbidities, disease activity and disability in both high- and low-GDP countries. In multivariate analysis of all countries, these 3 variables explained 29.4% of the variability, whereas GDP was not significant. CONCLUSIONS: Fatigue is a widespread problem associated with high comorbidity burden, disease activity and disability regardless of GDP.


Assuntos
Artrite Reumatoide/epidemiologia , Avaliação da Deficiência , Fadiga/epidemiologia , Produto Interno Bruto , Inquéritos e Questionários , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/economia , Distribuição de Qui-Quadrado , Comorbidade , Efeitos Psicossociais da Doença , Fadiga/diagnóstico , Fadiga/economia , Feminino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Valor Preditivo dos Testes , Prevalência , Fatores de Risco , Índice de Gravidade de Doença , Fatores Socioeconômicos
9.
Ann Rheum Dis ; 71(12): 1942-9, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22532638

RESUMO

OBJECTIVES: To assess (A) determinants of patient's global assessment of disease activity (PTGL) and patient's assessment of general health (GH) scores of rheumatoid arthritis (RA) patients; (B) whether they are equivalent as individual variables; and (C) whether they may be used interchangeably in calculating common RA activity assessment composite indices. METHODS: Data of 7023 patients from 30 countries in the Quantitative Standard Monitoring of Patients with RA (QUEST-RA) was analysed. PTGL and GH determinants were assessed by mixed-effects analyses of covariance models. PTGL and GH equivalence was determined by Bland-Altman 95% limits of agreement (BALOA) and Lin's coefficient of concordance (LCC). Concordance between PTGL and GH based Disease Activity Score 28 (DAS28), Clinical Disease Activity Index (CDAI) and Routine Assessment of Patient Index Data 3 (RAPID3) indices were calculated using LCC, and the level of agreement in classifying RA activity in four states (remission, low, moderate, high) using κ statistics. RESULTS: Significant differences in relative and absolute contribution of RA and non-RA related variables in PTGL and GH ratings were noted. LCC of 0.64 and BALOA of -4.41 to 4.54 showed that PTGL and GH are not equivalent. There was excellent concordance (LCC 0.95-0.99) for PTGL and GH based DAS28, CDAI and RAPID3 indices, and >80% absolute agreement (κ statistics 0.75-0.84) in RA activity state classification for all three indices. CONCLUSIONS: PTGL and GH ratings differ in their determinants. Although they are individually not equivalent, they may be used interchangeably for calculating composite indices for RA activity assessment.


Assuntos
Artrite Reumatoide/diagnóstico , Artrite Reumatoide/fisiopatologia , Nível de Saúde , Índice de Gravidade de Doença , Adulto , Idoso , Artralgia/diagnóstico , Artralgia/fisiopatologia , Artralgia/terapia , Artrite Reumatoide/terapia , Bases de Dados Factuais , Fadiga/diagnóstico , Fadiga/fisiopatologia , Fadiga/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Autorrelato , Inquéritos e Questionários
11.
Clin Rheumatol ; 30(2): 251-3, 2011 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-20945075

RESUMO

In early 2009, the International League of Associations for Rheumatology (ILAR) funded a program known as the "East Africa Initiative." The long-term goal of this program is to unite the international rheumatology community to aid in enhancing clinical rheumatology services in an area that carries 25% of the world's disease burden but has only 2% of the world's human resources for health. This paper provides an overview of the rationale and progress to date of this collaborative effort toward the globalization of rheumatology.


Assuntos
Necessidades e Demandas de Serviços de Saúde , Cooperação Internacional , Internacionalidade , Reumatologia , Burundi , Humanos , Quênia , Ruanda , Tanzânia , Uganda
12.
Arthritis Res Ther ; 12(2): R42, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20226018

RESUMO

INTRODUCTION: Work disability is a major consequence of rheumatoid arthritis (RA), associated not only with traditional disease activity variables, but also more significantly with demographic, functional, occupational, and societal variables. Recent reports suggest that the use of biologic agents offers potential for reduced work disability rates, but the conclusions are based on surrogate disease activity measures derived from studies primarily from Western countries. METHODS: The Quantitative Standard Monitoring of Patients with RA (QUEST-RA) multinational database of 8,039 patients in 86 sites in 32 countries, 16 with high gross domestic product (GDP) (>24K US dollars (USD) per capita) and 16 low-GDP countries (<11K USD), was analyzed for work and disability status at onset and over the course of RA and clinical status of patients who continued working or had stopped working in high-GDP versus low-GDP countries according to all RA Core Data Set measures. Associations of work disability status with RA Core Data Set variables and indices were analyzed using descriptive statistics and regression analyses. RESULTS: At the time of first symptoms, 86% of men (range 57%-100% among countries) and 64% (19%-87%) of women <65 years were working. More than one third (37%) of these patients reported subsequent work disability because of RA. Among 1,756 patients whose symptoms had begun during the 2000s, the probabilities of continuing to work were 80% (95% confidence interval (CI) 78%-82%) at 2 years and 68% (95% CI 65%-71%) at 5 years, with similar patterns in high-GDP and low-GDP countries. Patients who continued working versus stopped working had significantly better clinical status for all clinical status measures and patient self-report scores, with similar patterns in high-GDP and low-GDP countries. However, patients who had stopped working in high-GDP countries had better clinical status than patients who continued working in low-GDP countries. The most significant identifier of work disability in all subgroups was Health Assessment Questionnaire (HAQ) functional disability score. CONCLUSIONS: Work disability rates remain high among people with RA during this millennium. In low-GDP countries, people remain working with high levels of disability and disease activity. Cultural and economic differences between societies affect work disability as an outcome measure for RA.


Assuntos
Artrite Reumatoide/fisiopatologia , Avaliação da Deficiência , Pessoas com Deficiência , Emprego/estatística & dados numéricos , Bases de Dados Factuais , Fadiga , Feminino , Saúde Global , Nível de Saúde , Humanos , Seguro por Invalidez/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Medicina do Trabalho/estatística & dados numéricos , Dor , Índice de Gravidade de Doença , Inquéritos e Questionários , Avaliação da Capacidade de Trabalho
13.
Curr Rheumatol Rep ; 7(4): 281-7, 2005 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-16045831

RESUMO

Infection-related vasculitis constitutes the most common cause of secondary vasculitis. A great variety of microorganisms can induce directly or indirectly inflammatory vascular damage resulting in vascular occlusion, tissue ischemia, and necrosis. In the developed world hepatitis B and C-related vasculitis remain the most common clinical syndromes, while HIV-associated vasculitis remains a concern in developing countries.


Assuntos
Infecções , Vasculite/microbiologia , Infecções por HIV , Hepatite B/prevenção & controle , Hepatite C Crônica/tratamento farmacológico , Humanos , Poliarterite Nodosa/virologia , Vacinação/efeitos adversos , Vasculite/etiologia , Viroses
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