2015 ACR/ARHP Annual Meeting: Global Challenges in Rheumatic Disease Care

Challenges for rheumatology patients in sub-Saharan Africa and other developing countries include a lack of resources and access to drugs and hospitals.
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SAN FRANCISCO—To convey the plight of rheumatology patients in sub-Saharan Africa, Girish Mody, MD, head of rheumatology at the University of KwaZulu-Natal in South Africa and past president of the African League of Associations for Rheumatology, recounted a story during the 2015 ACR/ARHP Annual Meeting from the World Health Organization about a diabetes patient.

The woman paid out of pocket for her doctor visit and her medications. Taxi fares to get to the doctor ate into her thin income, and because she didn’t get paid for the time she had to skip work to see the doctor, every visit meant lost wages. And, sadly, she was one of the lucky ones: At least she had a job, and at least she had a doctor.

The problems apply to rheumatology patients in many African nations as well, Dr. Mody said.

“Developing countries, especially sub-Saharan Africa, have other challenges, like social, education, cultural, political, financial,” he said. “There are also issues about resources and access to drugs and hospitals.”

Studies on the prevalence of rheumatic disease in Africa are scarce—just 27 were found in a meta-analysis from 1975 to 2014—but they show a much higher prevalence of osteoarthritis than rheumatoid arthritis.¹

In sub-Saharan Africa, communicable diseases might overshadow musculoskeletal diseases, but musculoskeletal diseases still account for 12% of years lived with disability, he said.

Access to Care

And access to rheumatologists, and physicians in general, is very limited: The doctor–nurse–population ratio is just 1.1 to 1,000, compared with 7.4 in the Americas and 9.6 in Europe.

Providing assistance to countries to address specific needs can make big differences, he said. In Nigeria, for example, there was just one rheumatologist 10 years ago, even though, with 173 million people, it’s the most populous country on the continent; now, there are 28 people at some stage of rheumatology training.

In sub-Saharan Africa, communicable diseases might overshadow musculoskeletal diseases, but musculoskeletal diseases still account for 12% of years lived with disability.

Musculoskeletal diseases are also a major burden in the region represented by the Asia Pacific League of Associations for Rheumatology, said Lyn March, MD, professor of rheumatology and musculoskeletal epidemiology at the University of Sydney. The association covers Asia, Oceania and Australia. Low back pain and neck pain ranked as top causes of disability-adjusted life-years in that region in the 2013 Global Burden of Diseases Study, a collaboration across 188 countries.²

Chronic Pain

Dr. March drew particular attention to management of chronic pain as a growing challenge for rheumatologists. An older, but telling, study from 2001 found that 17% of men and 20% of women said they’d been living with pain on most days over the previous six months.³