Juvenile idiopathic arthritis in a Congolese patient with sickle cell haemoglobin C disease: Case report

Background: In order to measuretherapeutic effects or assess diseasecourse, outcome measurementparameters are commonly used inpatients with Rheumatoid Arthritis(RA). Quality of Life (QoL) is importantoutcome measure. There is a paucity ofdata on the impact of chronic rheumaticdiseases on functional disability, as wellas Health-Related Quality of Life (HRQOL)in Africans (1). Unfortunately there is noavailable data about HRQOL in Libya.Objective: Evaluation of RA burden inLibya was the aim of the study; the studygoal was to determine Health RelatedQuality Of Life (HRQOL) in patients withRheumatoid Arthritis (RA), who are ondisease modifying antirheumatic drugs(DMARD).Setting: Rheumatology clinic of TripoliMedical Center, Tripoli, Libya.Methods: The inclusion criteria forthe study were all patients who werediagnosed to have RA by the AmericanCollege of Rheumatology ACR criteria of1987, were on DMARDs (started within6 months of disease duration), had a28-joint disease activity score (DAS28)of 2.6-5.1, attended the rheumatologyclinic of Tripoli Medical Center, Tripoli,Libya, from 1st June 2010 to 30th July2010 and consented to participate in thestudy. The study was done after receivingconsent from the Tripoli Medical Centerethical and research committee.Results: One hundred patients wereincluded in the study. The age atdiagnosis ranged from 15 to 73 years; themedian age was 39 years. The majorityof patients were females 94 (94%)patients and 6 (6%) patients were male.The disease duration (symptoms onsetto evaluation) ranged from 6 months to40 years, the median disease durationwas 7 years. Rheumatoid factor waspositive in 72 (72%) patients. They had a28-joint disease activity score (DAS28) of2.6-5.1. They were on DMARDs startedwithin 6 months of disease duration,85% were on methotrexate, 10% wereon hydroxychloroquine and 5% were onsulfasalazine. Sixty five percent were onprednisolone tablets (5mg) in additionto DMARDs. Sixty three percent ofpatients had score 0-1, 25% of themhad score 1-2 and 12% had score 2-3.The mean of HAQ score for all patientswas 0.86 with standard deviation (SD) of0.76. The median was 0.75 (range 0.000-2.625)Conclusion: After evaluation of the RAburden in Libya, we found that 63% ofour patients had HAQ score of 0-1, whichmeans mild to moderate disability. Inthis study, patients selected were usingDMARDs at early stage of the disease,(disease duration ≤ 6 months), in furtherstudies, we will compare these resultswith results of patients who had usedDMARDs at later stage of the disease.