Background and Objectives Reports from Nigeria claim that rheumatoid arthritis (RA) in Western Africa has relatively low disease activity with a 29 occurrence of hand erosions No data are published on RA in Sudan and our aim was to collect a first Sudanese RA cohort for comparative studies.
Materials and Methods 264 consecutive patients (87% females) with RA according to the 1987 ACR criteria attending two rheumatology centres in Khartoum between December 2008 and September 2010 were included. Samples analysed in Uppsala for anti-CCP and IgM RF.
Results The mean age at inclusion was 48 years (range 14–80). Median disease duration was 3.8 years. ESR data was available for 113 patients, with a mean of 60.3 mm/1 h (range 10–140). Mean blood haemoglobin was 12.1 g/L. On clinical examination, 26% (68/264) had Z deformity, 14% (38/264) had Swan neck deformity and 9% (25/264) had Boutonniere deformity. X-rays of hands were available for 86 patients, with 49/86 (57%) showing erosions. 40% were treated with methotrexate, 7% with sulfasalazine 3% azathioprine, 2% with leflunomide and 2% with hydroxychloroquine in monotherapy. 41 (16%) were treated with steroids + DMARD monotherapy, 48 (18%) with DMARD combinations. Three % were treated with steroids only, and 9% with NSAIDs only.
52% were anti-CCP2 positive and 51% were IgM RF positive, corresponding to 97.6% specificity compared to the Sudanese healthy controls. Compared to Swedish RA patients (Rönnelid et al, ARD 2012) Sudanese patients had 270% higher mean ESR (55 versus 21 mm/h; p < 0001), and significantly lower age of disease onset (median 43 versus 56 years, p < 0.0001).
Conclusions RA as presented in an outpatient clinic in Khartoum is severe and with earlier RA onset than in Sweden. Sudanese patients show significantly higher ESR levels than Swedish patients, more Sudanese than Nigerian RA patients have radiological erosions, and the number of patients with classical hand deformities is substantial. Blood haemoglobin levels are rather well preserved. Immunological and genetic characterisation is now underway.