The community prevalence of early rheumatoid arthritis and health seeking behavior of affected individuals
Early diagnosis of rheumatoid arthritis (RA) and prompt treatment will minimize irreversible joint damage. Detection of early rheumatoid arthritis (ERA) in the community poses challenges. This study aims to establish the prevalence of ERA in a community setting in Sri Lanka and to describe health seeking behavior of the affected.It employed an innovative strategy of data collection and utilizesa validated early inflammatory arthritis screening tool (EIA-3) and 53 joint count of the Ritchie Articular Index (RAI).
METHODS:
This cross-sectional household study conducted in a Health Division in a suburb of Colombo included persons aged 16-60 years (n=1022) without previous rheumatologic disease using multistage cluster sampling. A health sub-division was a cluster and study was conducted in 7/12 randomly selected clusters. Four physiotherapists trained on data collection and in joint examination screened persons and positives by either EIA-3 or RAI were re-examined by a consultant rheumatologist and were investigated to confirm the diagnosis of ERA based on ACR/EULAR 2010 criteria.
RESULTS:
51.8% were females. Mean age was 48.3 (+/- 4.3) years.Self reported joint complaints revealed: 32.5% hand-wrist pain, 10.3% hand-wrist swelling, 9.6% early morning stiffness >one hour and 13.2% functional difficulty. 3.9% persons had at least one tender joint. Of those identified by the EIA-3 and RAI, 7 were diagnosed to have RA based on ACR/EULAR 2010 criteria,establishing a community prevalence of 0.7% for ERA.
Amongst 346 persons with joint symptoms, only 8.3% sought treatment with others delaying treatment mainly due to lack of awareness of disease (6.9%). 32.1% used over-the-counter analgesics, whilst 5.8% used Ayurvedic / traditional treatments.
CONCLUSIONS:
The community prevalence of ERA was low in this suburban setting.Triangulation of epidemiological methods was feasible in assessing community prevalence of this uncommon condition. Though a significant number suffered from joint symptoms, many didn’t seek treatment due to unawareness.