Rheumatoid Arthritis in Pakistan
Rheumatoid arthritis clinical features and management strategies at an urban tertiary facility in Pakistan.
Rehan Rais, Mohammad Saeed*, Rimsha Haider, Zahra Jassani, Amir Riaz, Tahira Perveen.
Corresponding author: Dr. Mohammad Saeed
Journal Link Full Text Article
Background:
The specialist referral in Pakistan is patient-driven; therefore patients choose to visit multiple physicians before deciding on the course of therapy. Hence, presentation of Rheumatoid Arthritis (RA) to the Rheumatologist is variable.
The salient findings of the study were:
1. RA patients present to Rheumatologists late in the course of their disease, with majority having at least moderate disease activity and a substantial proportion already having developed joint erosions (permanent damage to their bones).
2. High ESR and positive Rheumatoid factor (RF) facilitate earlier referral to a Rheumatologist. However, seronegative RA (RF negative) is likely to be more frequently missed due to lower ESR and absence of RF, thus delaying Rheumatology referral resulting in more damage to joints.
3. Seronegative (RF-) RA was just as aggressive as seropositive (RF+) RA. Therefore early diagnosis and referral of seronegative RA is of greater concern. [Seronegative RA can be diagnosed with Musculoskeletal Ultrasound]
4. Combination therapy of Methotrexate / Hydroxychloroquine / Sulphasalazine known as Triple regimen was infrequently used (8% only) though its response is equal to biologics called TNF inhibitors (highly effective in RA control). This study encourages Rheumatologists to use Triple regimen earlier and more frequently.
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