Rheumatoid arthritis in the developing world: stepping up to the challenge

Excerpt

The ‘developing’ world is defined by low gross domestic product, level of education and life expectancy and includes countries in Sub-Saharan Africa, Central and South-East Asia, as well as parts of Central and South America. Financial and human resource constraints impact negatively on health outcomes of chronic diseases like rheumatoid arthritis (RA). A 46-year-old businesswoman in the Netherlands with RA is likely to have early intervention with disease-modifying antirheumatic drugs (DMARDs), resulting in disease remission or low disease activity within 6 months of symptom development [1]. In stark contrast, a 46-year-old domestic worker in peri-urban Soweto, South Africa, will probably experience late diagnosis of her RA and a delay in initiation of DMARD therapy often running into years [2]. Consequently, the South African patient is much more prone than her Dutch counterpart to develop significant functional disability and to be unemployed within 2 years of symptom onset. Moreover, the psychosocial consequences of physical disability from poorly controlled RA are likely to be more severe in this setting. Poor infrastructure leading to lack of electricity and hot water, having to carry water and use of outside toilets, inadequate public transport necessitating walking long distances, poor social support systems and social isolation may be some of her key experiences [3]. Low levels of formal education impact negatively on the risk of depression, possibilities of modifying employment to accommodate disabilities, and may mean that patients take a less active role in problem-solving [4]. …