The Need for Tighter Rheumatoid Arthritis Control in a South African Public Health Care Center

Abstract

Medical facilities are restricted in public health care centers in South Africa and patients that enroll in these centers are socioeconomically deprived. We investigated the impact of rheumatoid arthritis (RA) on disability in both a public health care and a private care center. The disability index of the Health Assessment Questionnaire (HAQ-DI) and an extensive range of disease and non-disease-related patient characteristics were recorded in 359 RA subjects, 196 public care and 163 private care patients. We compared the data between both patient groups and identified potential predictors of the HAQ-DI by univariate and multivariable logistic regression analysis. The median (range) HAQ-DI was 1.625 (0 to 3) in the public care patients and 0.500 (0 to 3) in the private care patients (P < 0.0001). As compared with private care patients, public care patients were more often African (P < 0.0001) and of mixed ancestry (P < 0.01) and less often White (P < 0.0001). Public care patients also had higher current disease activity scores (P < 0.0001) (except for tender joint counts and the erythrocyte sedimentation rate), higher cumulative disease activity or disease severity scores (joint deformities) (P < 0.0001), a higher frequency of tuberculosis (P < 0.01), and were more often treated with prednisone (P < 0.0001). In multivariable logistic regression models, a HAQ-DI of >1 was independently predicted by current disease activity (swollen joint count) (P < 0.004), cumulative disease activity (joint deformities) (P < 0.005), being under public care (P < 0.008), and prednisone use (P < 0.04). Racial differences were not independently predictive of disability. Results of disease outcome measurements were poorer in our public care patients than in our private care patients. Facilities that allow for tighter disease activity control of RA are needed in South African public care centers.