Background There is a virtual absence of epidemiological data for certain rheumatic diseases in developing countries of the world(1, 2). Data available suggests important differences between developed and developing countries, pointing to a more frequent and severe presentation of rheumatic diseases in the latter (3, 4), presumably due to late medical assistance and lack of effective treatment(4). Aside from Brazil and Puerto Rico(2), little has been published on rheumatic diseases in Latin America.
Objectives To provide an initial description of the population that suffers rheumatic diseases, as well of the relative prevalence of these diseases in a developing country – Dominican Republic.
Methods Since its birth, roughly ten years ago, the Rheumatology service of the José María Cabral y Báez Regional University Hospital has gathered demographic and disease-related data for every patient. This is a descriptive, transversal report of data retrospectively gathered from our patient files. All diagnoses were performed by an experienced Rheumatologist, according to ACR guidelines.
Results 453 Rheumatology patients were included in this report, including 401 women (89%) and 52 men (11%). Mean age was 40.7±13.7 years, ranging between 16 and 86 years. Most patients (31%) had only completed elementary school, only 38 patients had a college degree; the most common occupation (55%) was domestic labors. A large portion of the population suffered from hypertension (59%). By the time medical help was sought, symptoms had been present for more than 36 months in 55% of all cases; however, a significant part of the population (34%) sought medical help within the first year. No significant correlation was found between the educational level and the time elapsed between symptom onset and medical assistance. The most frequently affected system was the musculoskeletal (77%), followed by articulations (69%) and skin (57%). Most patients had two (31%) or three (27%) systems affected. SLE was most prevalent (47%, mean age 35±11 years), followed by RA (23%, mean age 48±13 years) and Scleroderma (6%, mean age 41±15 years). Overall mortality was 12%, though specific mortality for SLE was 18%. Per year mortality for all patients decreased from 11.3% (2003) to 2.7% (2010).
Conclusions The typical Rheumatology patient in Dominican Republic is a female in her forties, with a low educational level, who does domestic labors at home; her main complaint is likely to be musculoskeletal. A high prevalence of both SLE and RA is observed, with a particularly low onset age.
Gabriel SE, Michaud K. Epidemiological studies in incidence, prevalence, mortality, and comorbidity of the rheumatic diseases. Arthritis Research & Therapy. 2009;11(3):229.
Tikly M, Navarra S. Lupus in the developing world – is it any different? Best Practice & Research Clinical Rheumatology. 2008 Aug;22(4):643-55.
Scalzi LV, Hollenbeak CS, Wang L. Racial disparities in age at time of cardiovascular events and cardiovascular-related death in patients with systemic lupus erythematosus. Arthritis & Rheumatism. 2010 Jun 06;62(9):2767-75.
Woolf AD, Brooks P, Åkesson K, Mody GM. Prevention of musculoskeletal conditions in the developing world. Best Practice & Research Clinical Rheumatology. 2008 Aug;22(4):759-72.
Disclosure of Interest None Declared
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.