…Propose early diagnosis, effective treatment for healthy outcomes

By Chioma Obinna

“I had a successful career while working in Lagos but the debilitating nature of rheumatoid arthritis,(RA) brought me to my knees at age 30, Mrs Edna Okoli, who was forcefully retried said amidst regrets.

Like Edna, many Nigerians have retired untimely from their jobs and active life due to the pains inflicted on them by the disease.

Findings show that for decades, rheumatoid arthritis (RA) has caused many years of pain, and illness, in some cases led to low self-esteem among patients. But experts say early diagnosis and initiation of effective treatment was critical in improving clinical outcomes for patients with the disease.

Rheumatoid arthritis, according to experts, is an autoimmune condition, caused by the immune system attacking healthy body tissue. It affects the small joints of the body.

In the views of Dr. Uyiekpan Ima-Edomwonyi, a Rheumatologist at the Lagos University Teaching Hospital, LUTH, “Rheumatoid arthritis affects the small joints of the hand, wrist, and feet before affecting larger joints and if left untreated can cause deformity and disability.

” With debilitating symptoms that include pain and stiffness, people with Rheumatoid arthritis are seen to have lowered functional status that can lead to a loss of career and sources of income, which is a particular problem in low-income settings like Nigeria.

For a Consultant Orthopaedic/Joint replacement and Trauma Surgeon, at the National Orthopaedic Hospital, Igbobi, Lagos, (NOHIL), Dr  Wakeel Lawal,  rheumatoid arthritis is also a disorder of the immune system in which the body attacks itself, especially where there is synovial tissue causing destruction around the joints and surrounding tissue.

According to Lawal who is also the Head, Direct Patient Care,  although there is no national data on the prevalence in Nigeria, a hospital-based study at the Lagos State University Teaching Hospital, LASUTH by a rheumatologist, Prof Odelewo, showed that 1,215 patients with suspected rheumatoid arthritis and only 128 (10.6 per cent) of these patients met the criteria for RA.

Lawal explained that RA results in progressive destruction of the joints in the body as well as cause damages to some organ structures and small joints of the hand, wrist, and feet are most hit before affecting larger joints. If left untreated, it can cause deformity and disability.

With debilitating symptoms that 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 like Nigeria.

One major factor is the fact that for a certain subset of the population, jobs in Africa involve a level of manual labour and the resource-starved African countries 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 worsen medical services that are already struggling with a high burden of acute infectious illness to an extent that they may be unable to cope with the fast-changing patterns of disease distribution.

Hence, the need for healthcare professionals, general physicians and rheumatologists to identify Rheumatoid arthritis early and commence appropriate therapy as soon as possible.

According to Lawal, there is no total cure for RA but the progression can be slowed or stopped. “Early diagnosis on commence of treatment is a key to a better outcome. It’s important so as to avoid the destruction of the joint that will impart on the activity of daily living. This may require surgical correction in addition to anti-rheumatoid treatments.

“The treatment of RA is a lifelong treatment.  The cost of treatment depends on the type of medication that is deployed. These are the disease modifiers, disease-modifying anti-rheumatoid drugs, the biological agents. The best medications are the biological options which are not readily available in Nigeria and where they exist, they are quite expensive. These are immune modulators which regulate the way the body attacks itself. Irrespective of what medication is used, DMARD, biological agents, they are quite expensive and long life usage is required,” he lamented.

He regretted that patients in Nigeria are faced with enormous challenges; stating from lack of information about the disease condition.

“Hardly can people differentiate between RA and aged-related degenerative arthritis. There are also different forms of inflammatory arthritis that people hardly know. There are a lot of misconceptions and misinformation about it and its treatment.

There is also a dearth of experts to treat patients. We have a limited number of rheumatologists in Nigeria makes it difficult for patients to see specialists early hence contributing to the delay in making the diagnosis. There is a lack of various diagnostic tools to make the diagnosis and where they are available, they are out of reach of the affected patients and the cost of care is too expensive for an average patient.

Other challenges he listed include; lack of insurance coverage and government support for this kind of ailment, and the fact that the treatment is life-long may create apathy in the patient.

“RA is a form of genetic disorder which can hardly be prevented. However, early diagnosis and commencement of treatment before disability sets in is a key to a better outcome.

He said there was a need for continued education, insurance coverage and government support for this group of patients in order to alleviate the difficulties they face.

Also a Consultant Orthopaedic and Trauma Surgeon at the Gbagada General Hospital, Lagos, Dr Saheed Babajide explained that the diagnosis involves clinical presentation and examination, laboratory and diagnostic investigations.

Babajide said the condition affects physical, social and mental conditions with low life activities and also causes pain, disability, and heart disease among others.   He said the study by Adelowo revealed that RA affects more females than males, adding that, early diagnosis and treatment are key for the early resolution of symptoms.

In a report obtained from its website upon approval of Pfizer’s Xeljanz for the treatment of adults with rheumatoid arthritis, the Head of Pfizer Speciality Care Business Unit in Japan, Mark Swindell said RA is a serious and disabling disease, hence, the need for new treatment options as a significant number of patients do not adequately respond to current therapies.

Speaking recently during a virtual media conference on RA, the Country Medical Director at Pfizer East and West Africa, Kodjo Soroh who stressed the need to create awareness on the management of rheumatoid arthritis to prevent disease progression, said Pfizer was committed to creating awareness on the disease even as it is coming up with a programme designed to reduce the therapy costs for eligible patients of RA.

Soroh, said RA remains one of the most common rheumatic and musculoskeletal diseases in the region but there was hope as Pfizer is committed to raising awareness around the treatment options available.  “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 programme”.

How to reduce arthritis pain

Experts say people should manage their weight, and stay at a healthy weight as extra pounds put pressure on weight-bearing joints like hips and knees. Your knees have to support the weight of your body.

Eat your omega-3s: Omega-3 fatty acids are a type of polyunsaturated fat. They have a number of benefits, including reducing inflammation in the body.

Control your blood sugar, exercise, stretch,  avoid injury, quit smoking, eat fish twice a week and get routine preventive care.


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