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Congolese RA patients did not present with major disease damage
Despite first-time consultation well after disease onset, the majority of Congolese patients with rheumatoid arthritis presented without major disease damage, according to recent study results.
Researchers studied 128 patients with rheumatoid arthritis (RA; mean age, 51.2 years; 89% women) who attended a rheumatology clinic in the Democratic Republic of Congo from 2008 to 2010. Disease Activity Score 28 (DAS28) based on erythrocyte sedimentation rate (ESR), anti-citrullinated peptide antibodies (anti-CCP) and rheumatoid factor (RF) were measured. Sharp-van der Heijde scoring was used for radiographs, and a health assessment questionnaire (HAQ) measured functional impairment.
Blood samples were taken from a subset of 72 patients before starting anti-rheumatic drugs and 67 controls (aged 18 to 74 years; 59 women) with other rheumatic diseases. HLA-DRB1 typing was performed on 37 patients with RA and 24 controls.
Mean symptom duration was 4 years among RA patients, with a median delay of 3 years before first visit. Tobacco consumption was reported by nine women and two men. At first consultation, DAS28 was greater than 5.1, and HAQ was more than 0.5 in all patients. Radiographs of hands and feet were obtained for 78 patients, with 43 displaying primarily moderate erosions and/or joint space narrowing.
Anti-CCP positive antibodies and RF positivity were present in 47.2% and 34.7%, respectively, of 72 evaluable RA patients. Controls showed 3% positivity for both factors. The RF- or anti-CCP-positive patients had more frequent radiographic changes and nodules. Thirteen RA patients and three controls had one copy of a shared epitope, while two copies were found in one RA and one control patient.
“The current preliminary data on the phenotype and genotype of RA are the first from this part of the world,” the researchers concluded. “We put forward the hypothesis that besides different environmental factors, there is probably also a particular genetic risk profile in Congolese patients, different from the HLA-DRB1 shared epitope.”
Disclosure: The researchers report no relative financial disclosures.