Worried about the rising cases and burden of rheumatoid arthritis (RA) in Nigeria, healthcare professionals have called for massive awareness and management of the condition to prevent disease progression, stating that early diagnosis and initiation of effective treatment improve clinical outcomes for patients with disease.

They, however, said untreated RA may cause disability, and job loss and people with the condition are seen to have lower functional status, and that the disability can lead to a loss of career and sources of income.

Arthritis is an inflammatory disorder affecting one or more joints of the body with varying causal factors, including trauma, infections, autoimmune disorders, idiopathic causes, and ageing.

Irrespective of the cause, the underlying pathophysiology involves the breakdown of cartilage, which protects the end surfaces of bones at the joints, leading to the loss of smooth glide at the joint during movement; this frictional rubbing results in pain, swelling and stiffness at the joint and eventual muscle strain due to difficulty moving the joint.

According to a study published in the journal PLOS ONE and titled ‘Prevalence of Arthritis in Africa: A Systematic Review and Meta-Analysis’, there are six main types of arthritis. RA is a systemic autoimmune disease that presents as a symmetrical inflammatory polyarthritis, which affects the smaller joints such as the hands and feet first, before affecting larger joints.

Osteoarthritis (OA) is characterised by degeneration of the joints such as the knee and the hip. Juvenile arthritis comprises a range of arthritic disorders affecting children and adolescents below the age of 16 years. Psoriatic arthritis is a form of arthritis affecting people with psoriasis, a skin disorder.

Gouty arthritis, or simply gout, is associated with the deposition of monosodium urate crystals in the tissues and joints. Ankylosing spondylitis is axial arthritis, which affects the vertebra causing inflammatory spinal pain and limited spinal and chest wall movements.

RA is a disabling disease that affects the joints with pain, swelling, and stiffness. RA is a systemic disease, which means it can have an impact on a person’s entire body and may even impact one’s sense of well-being.

More than 350 million people have arthritis globally, more than 22 per cent of adults around the world who are older than 40 have knee osteoarthritis, and up to 14 million people around the world have rheumatoid arthritis, according to recent reports by the World Health Organisation (WHO), Global RA Network, and EClinicalMedicine.

Also, according to the United States Centres for Disease Control (CDC), 60 per cent of people who have arthritis are between the ages of 18 and 64, and 29 per cent of people between the ages of 45 and 64 have arthritis.

Several studies have shown that disability due to musculoskeletal disorders has increased by 45 per cent and RA and OA are listed as the fastest-increasing major health conditions and ranked joint second as a cause of disability by WHO.

As part of efforts to address the menace, Pfizer has intensified efforts at raising awareness about as well as enlightening the public about the management of rheumatoid arthritis. Pfizer has in recent times organised hybrid media roundtables to highlight the disease’s burden in Nigeria.

A rheumatologist and was the Inflammation/Immunology Group Lead for North America Medical Affairs during his time at Pfizer, Incorporation, Dr. Andrew Koenig, said: “RA often results in a gradual limitation of normal activities because the joint damage and symptoms that occur with it usually progress slowly over time. When those who don’t know they have RA feel pain or stiffness, they naturally try to avoid what makes them hurt.

They may first start by changing their schedules (such as stopping early morning exercise or getting to work later), changing what they do (reducing physical activity, switching chores to lower impact ones, or avoiding activities they enjoy because it makes them hurt), or reducing activities because they may not want to ask for help. Eventually, people with RA may start to withdraw, cut back on social activities, and even reduce their work hours. Some patients, with or without appropriate intervention, may even feel the need to quit their job due to limited mobility. This effect can have emotional, social, and economic consequences for patients and their families.”

Country Medical Director, Pfizer East and West Africa, Dr. Kodjo Soroh, said RA remains one of the most common rheumatic and musculoskeletal diseases in the region.

According to him, there is hope as Pfizer is committed to raising awareness around the treatments 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.”

Autoimmune experts who spoke during a recent virtual media roundtable hosted by Pfizer Biopharmaceutical on the ‘Prevalence and Social Burden of Rheumatoid Arthritis in Nigeria’ said the treatment of rheumatoid arthritis, is ideally done as soon as the patient starts with disease symptoms in order to get the disease into remission or have minimal signs and symptoms.

Consultant rheumatologist, at the Lagos State University College of Medicine (LASUCOM), Dr. Hakeem Olaosebikan, explained that early management and treatment would decrease the progression of joint disease as the disease process can cause progressive damage to joints with resultant loss of function, which in many patients, will mean that they are unable to fulfil work obligations or cope with activities at home.

He said adequate treatment is also important to try to prevent or lessen the severity of co-morbidities, particularly cardiovascular disease, a major cause of mortality in rheumatoid arthritis patients. “Apart from treating the rheumatoid disease, the patient should ideally be treated by a multidisciplinary team to address many other associations of this disease which range from psychological help with anxiety and depression to guidance with physical therapy by physiotherapists or biokinetics and help with activities of daily living by occupational therapists.”

Olaosebikan said it had become imperative to raise awareness about rheumatology, as well as, enlighten the public about the management of rheumatoid arthritis as the commonest autoimmune arthritis in Nigeria.

He disclosed that one or two patients are diagnosed weekly with the disease in most tertiary hospitals.

He said the disease poses physical, psychological, and economic burdens for affected patients, their families and the healthcare system. Olaosebikan urged the government to focus on the disease, stressing the need to evolve and pass patient-friendly legislatures.

He advised Nigerians to reduce calorie and salt intake, maintain a healthy weight, avoid smoking and ensure regular exercise to strengthen joint mobility.

A rheumatologist from the Lagos University Teaching Hospital (LUTH), Dr. Uyiekpan Ima-Edomwonyi, said data has shown that the burden of rheumatoid arthritis would increase in most developing countries like Nigeria.

He said along with the increase in non-communicable diseases in developing countries, an increase in Rheumatoid arthritis occurrence could stress medical services to an extent that they may be unable to cope with the fast-changing patterns of disease distribution seen in Africa currently.

Ima-Edomwonyi said that factors that would drive the disease burden include lifestyle, weight, smoking and alcohol consumption, which predisposed to musculoskeletal disorders.

Also, researchers have shown that patients with RA are at approximately 1.5-fold risk of atherosclerotic cardiovascular disease (CVD) compared with the general population, a phenomenon resulting from combined effects of traditional CVD risk factors and systemic inflammation.

Meanwhile, a study suggests competing at elite level in sport is linked with an increased risk of developing osteoarthritis (and joint pain in later life. One in four retired Olympians reported a diagnosis of osteoarthritis, the form of arthritis that causes changes in the joint and can lead to discomfort, pain and disability, the research found.

Elite retired sportspeople who had experienced a sports-related injury had a higher chance of knee and hip osteoarthritis when compared with the general population.

The athletes — who had competed at an Olympic level in 57 sports including athletics, rowing and skiing — also had an increased risk of lower back pain overall, and shoulder osteoarthritis after a shoulder injury.

Researchers hope the findings will help develop new approaches in injury prevention for the benefit of athletes now and in retirement.

The study — led by a University of Edinburgh-based researcher — is the largest international survey of its kind, and the first to observe the consequences of osteoarthritis and pain in different joints from retired elite athletes across different summer and winter Olympic sports.

Researchers quizzed 3,357 retired Olympians aged around 45 on injuries and the health of their bones, joints, muscles and spine. They were also asked if they were currently experiencing joint pain, and if they had an osteoarthritis diagnosis.

For comparison, 1,735 people aged around 41 from the general population completed the same survey.

Researchers used statistical models to compare the prevalence of spine, upper limb and lower limb osteoarthritis and pain in retired Olympians with the general population.

The team considered factors that could influence the risk of pain and osteoarthritis such as injury, recurrent injury, age, sex and obesity.

They found that the knee, lumbar spine and shoulder were the most injury-prone areas for Olympians. These were also among the most common locations for osteoarthritis and pain.

After a joint injury, the Olympians were more likely to develop osteoarthritis than someone sustaining a similar injury in the general population, the research found

The sportspeople also had an increased risk of shoulder, knee, hip and ankle and upper and lower spine pain after injury, although this did not differ with the general population.

Dr. Debbie Palmer, of the University of Edinburgh’s Moray House School of Education and Sport, said: “High-performance sport is associated with an increased risk of sport-related injury and there is emerging evidence suggesting retired elite athletes have high rates of post-traumatic osteoarthritis.

“This study provides new evidence for specific factors associated with pain and osteoarthritis in retired elite athletes across the knee, hip, ankle, lumbar and cervical spine, and shoulder, and identifies differences in their occurrence that are specific to Olympians.”

Researchers say the study may help people make decisions about recovery and rehabilitation from injuries in order to prevent recurrences, and to inform prevention strategies to reduce the risk and progression of pain and OA in retirement.

Meanwhile, Pfizer announced the initial results of its global survey of more than 3,600 adults with RA in 13 countries. The RA NarRAtive patient survey is the first of its kind to simultaneously evaluate the patient and healthcare professional (HCP) relationship and communication, as well as the patient’s experience and satisfaction with treatment and disease management. The data show that a patient’s perception of their RA and its treatment, as well as their relationship with their HCP, can impact the management of their disease.

Executive Vice President and Chief Medical Officer, Pfizer, Dr. Freda Lewis-Hall, said: “More than 23 million people worldwide have RA, many of whom are struggling to manage living with this debilitating illness. The RA NarRAtive survey results indicate that some of the keys to living successfully are having open dialogue and setting treatment goals with healthcare professionals, as well as connecting with patient support groups.

“The RA NarRAtive is an important initiative for Pfizer as we continuously work to better understand what helps people with RA live better.”

The survey, created and sponsored by Pfizer, was fielded online by Harris Poll, as part of the company’s ongoing global collaboration with the RA NarRAtive Advisory Panel comprised of 27 RA experts – including physicians and leaders from patient advocacy groups.