Spondyloarthritis in the Democratic Republic of the Congo: A prospective hospital-based study

Objectives To determine the spectrum of spondyloarthritis (SpA) in outpatients with symptoms of rheumatism attending two rheumatology practices in the Democratic Republic of the Congo. Design A descriptive prospective multicentre outpatient study. Setting The present study analysed 6 months data (from 1 December 2012 till 31 May 2013). Participants Nine hundred and eighty-four consecutive outpatients were studied. Primary and secondary outcome measures A clinical diagnosis of SpA was made and several classification criteria were applied afterwards. Radiographic lesions in the sacroiliac joint were scored with the modified New York criteria. BASDAI and BASFI were evaluated in axial SpA (axSpA). The primary end point was the prevalence of SpA and the secondary end points were the spectrum of SpA and its subtypes. Results One hundred and five patients (10.7%) were diagnosed among 984 consecutive outpatients with a sex ratio (male to female) of 1.4. The average age at disease onset was 41.3±12.4 years. Non-radiographical axSpA was the most frequent subtype (5.0%) followed by reactive arthritis (4.3%). Other subtypes were: ankylosing spondylitis (1.0%), psoriatic arthritis (0.1%), synovitis, acne, pustulosis, hyperostosis, osteitis syndrome (0.1%) and inflammatory bowel disease-associated arthritis (0.1%). Mean BASDAI and BASFI in axSpA were 42.7/100 and 46.4/100, respectively. Peripheral enthesitis was found in 43% of patients with SpA and uveitis (10.4%) was the most frequent extra-articular manifestation. We did not detect any family history. Median erythrocyte sedimentation rate and C reactive protein were 37 (range: 7-110) mm/hour and 22 (range: 4-48) mg/L, respectively. Conclusions This hospital-based study suggests there is substantial occurrence of some subtypes of SpA in central Africa. A population-based study is needed to evaluate these subtypes.