Estimating the burden of rheumatoid arthritis in Africa: A systematic analysis

BACKGROUND: Rheumatoid arthritis (RA) has an estimated worldwide prevalence of 1%. It is one of the leading causes of chronic morbidity in the developed world, but little is known about the disease burden in Africa. RA is often seen as a minor health problem and has been neglected in research and resource allocation throughout Africa despite potentially fatal systemic manifestations. This review aims to identify all relevant epidemiological literature pertaining to the occurrence of RA in Africa and calculate the prevalence and burden of disease. METHODS: A systematic literature review of Medline, Embase and Global Health Library retrieved a total of 335 publications, of which 10 population studies and 11 hospital studies met pre–defined minimum criteria for relevance and quality. Data on prevalence was extracted, analysed and compared between population and hospital studies. Differences between genders were also analysed. FINDINGS: The estimated crude prevalence of RA in Africa based on the available studies was 0.36% in 1990, which translates to a burden of 2.3 million affected individuals in 1990. Projections for the African population in 2010 based on the same prevalence rates would suggest a crude prevalence of 0.42% and the burden increased to 4.3 million. Only 2 population studies have been conducted after 1990, so projections for 2010 are uncertain. Hospital–based studies under–report the prevalence by about 6 times in comparison to population–based studies. CONCLUSION: The availability of epidemiological information on RA in Africa is very limited. More studies need to be conducted to estimate the true burden and patterns of RA before appropriate health policies can be developed.