Non- Taumatic arthritidea: causes and outcome in patients admitted to muhimbili medical cetre,Dar es Salaam,tanzania in !992

Abstract

To determine the causes of non-traumatic arthritides and their outcome In patients admitted tu a national referral hospital. Prospective study of all consecutive admissions with joint symptoms as the primary disorder or in whom the joint disorder was one of the presenting problems. Study period. I May to 31 December. 1992. Muhimhili Medical Centre. Oar es Salaam. Tanzania. 120 patients: 78 male. 42 female. One percent of all medical and orthopaedic admissions during the study period were due to rheumatic diseases. The mean age of the patients was 36 )'c';lr:-; (r~1I1gl' ~-76 years). There were more males (78 (65.0%» than females (42 (3).0%» (p = 0.000). Seventy nine (6).9%) patients were between 11 and 40 years of age. The rheumatic disorders seen in descending order of frequency were: HIV arthropathy 32(26.7%). rheumatoid arthritis 20 (16.7%), septic arthritis 17 ( 14.2 %). Reiter's disease 14 (I I .6 %), gout 7 (5.8 %). osteoarth rit is 7 (5.8 %). acute rheumatic fever 3 (2.7%), palindrornic rheumatism 3 (2.7%). haernarth rns is 2 (I .7 %). h ypertroph ic pulmonary osteoarth ropath y 2 (I .7 %). systemic lupus erythematosus I (0.8%), psoriatic arthropathy I (0.8%). leukaemia I (0.8%) and tuberculous arthritis I (0.8%). In 9 (7.5%) patients no definite diagnosis was made. More males than females suffered from H IV arthropathy and Reiter's disease. the male: female rat io being 2: I and 3: I respectively. More females than males suffered rrorn rheumatoid arthritis. osteuarthritis. palindromic rheumatism and acute rheumatic fever though the differences were not statistically significant.

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The mean age of patients with Reiter's disease was lowest (26 years) while till'. highest was of patients suffering from osreoarthritis (59.5 years). The IllL~,1I1 ages of patients suflering from HIV arthropathy and rheumatoid arthritis were almost similar, 35 and 34 years respectively. The youngest patient (8 years) suffered from septic arthritis while the oldest patient (76 years) suffered from HIV arthropathy. It was not possible to determine statistical associations between various rheumatic diseases and smoking, occupation, level of education and bully m,ISS index because of the small number of patients seen in each diagnostic

category.

Ninety-eight (81 .7 %) patients presented to the hospital after th ree weeks had passed since the onset of symptoms, wh i I e 22 (18.3 %) had an acute presentation. In only 5 (4.2 %) patients was there evidence of familial clustering of rheumatic diseases. The kneejoint was involved in 102 (85%) patients while the ankle joint was involved in 42 (35%) patients. The wrist was the commonest joint involved ill the upper limbs. being involved in 34 (28.3%) patients. The proximal interphalangealjoints were involved in 31 (25.8%) patients. III HIV arthropathy, 17 (53.1 %) patients had ol igoarticular involvement of the joints while 8 (25.0%) presented with polyarthritis and 7 (21.9%) had monuartluitis. Fourteen (82.4%) patients with septic arthritis had a peripheral leucocyte count above 10,000 cells/crnm. In only tour patients was it possible to isolate the causative organisms from the synovial fluid. There were two patients in whom beta-haemolytic streptococci were cultured. one had Streptococcus pyogenes infection and in the fourth Klebsiella species was found The extra-articular features in HIV arthropathy included lymph node enlargement (13/32), pustular skin lesions (2/32) and splenomegaly (2/32). The complications and extra-articular features in patients with rheumatoid arthritis were muscle wasting (3/20). ulnar deviation of fingers at the metacarpophalangeal joints (3/20), vascul itic lesions (2/20), lymph nude enl.ngement (2/20). splenomegaly (2/20) and hepatomegaly (2/20). Only one patient with rheumatoid arthritis had skin nodules.

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Conclusion

Eighty three (69.2%) of the 120 patients were unable to perform normal duties while 12 (10%) were able to carry out normal activities on admission. On discharge. 71 (60.1 %) out of 118 patients were unable to perform normal duties while 37 (31.4%) were able to perform normal activities. One hundred and two (86.4%) patients were followed up after 5.8 months utter discharge. 01 these 64 (62.7%) were able to perform normal duties. 28 (27.4%) were unable to work and 3 (2.9%) were severely incapacitated. There were 7 (6.9%) deaths: two in patients with HIV arthropathy, two in patients with rheumatoid arthritis. and three in patients. one each having acute rheumatic fever. leukaemia and systemic lupus erythematosus. There were 82 patients in whom the Arthritis Impact Measurement Scale was completed at follow up. Ten (12.2%) patients were unable to use public transpon .f (6.0%) needed help in doing household activities, 4 (4.9%) were completely unable to do household activities. Three (3.6%) patients were unable to take care of themselves (needing help in washing and going to the tu iI et). The rheumatic diseases seen in developed countries are also encountered in medical practice in developing countries like Tanzania. affecting people in the productive years of life. While the prevalence of some rheumatic diseases like rheumatoid arthritis may. at present. be low. others like HIV arthropathy are likely to he seen with increasing frequency. The findings of this study suggest a need for increased awareness of rheu matic cl iseases with i n Tanzania, and consideration of how management of these diseases can be i mproved.