Document 0139
 DOCN  M9580139
 TI    Rheumatoid arthritis and connective tissue disorders: sub-Saharan
       Africa.
 DT    9506
 AU    Mody GM; Department of Medicine, University of Natal, Durban, South;
       Africa.
 SO    Baillieres Clin Rheumatol. 1995 Feb;9(1):31-44. Unique Identifier :
       AIDSLINE MED/95246160
 AB    Rheumatoid arthritis (RA) once a rarity in Africa, is now reported in
       large numbers from many parts of Africa. Although epidemiological
       surveys have shown that the prevalence in urban populations is similar
       to Western communities, it is less common in rural areas. Further
       epidemiological studies are needed to confirm these findings in other
       parts of Africa and identify factors contributing to this difference to
       provide a better understanding for the emergence of RA in Africa.
       Earlier reports suggested that in African blacks RA was a mild disease,
       severe radiographic changes were uncommon, deformities were rare and
       extra-articular features were unusual and only symptomatic therapy was
       necessary to control symptoms in most patients. Recent experience shows
       that severe disease with deformities and radiographic changes are seen
       and a wide spectrum of extra-articular features are noted although they
       may be less common than in Caucasians. African blacks with RA may have a
       younger age of onset and the genetic association with HLA DR4 has been
       confirmed. Systemic lupus erythematosus (SLE) is also recognized more
       often in African blacks who have a younger age of onset. SLE is also
       recognized less often in males. Features such as photosensitivity and
       serositis are less common while renal disease is more common. A reported
       short-term mortality of about 30% emphasizes the need for urgent efforts
       to improve the prognosis in SLE. The infrequent occurrence of localized
       systemic sclerosis and the absence of anti-centromere antibodies in
       blacks was noted in a recent large series of patients with systemic
       sclerosis. The other connective tissue diseases and systemic
       vasculitides are reported much less frequently and will probably be
       detected more often in future. Anti-cardiolipin antibodies are detected
       frequently in association with infections, including HIV infection. The
       spectrum of diseases associated with ANCA includes a variety of
       connective tissue diseases and infections such as HIV infection and
       invasive amoebiasis must be added.
 DE    Adult  Africa/EPIDEMIOLOGY  Arthritis,
       Rheumatoid/COMPLICATIONS/*EPIDEMIOLOGY/GENETICS/  IMMUNOLOGY
       Autoantibodies/BLOOD  Female  Human  Lupus Erythematosus,
       Systemic/COMPLICATIONS/*EPIDEMIOLOGY/  IMMUNOLOGY  Male  Prevalence
       JOURNAL ARTICLE  REVIEW  REVIEW, TUTORIAL

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