Abstract:

Background: Rheumatoid arthritis (RA) is a chronic, symmetrical, inflammatory autoimmune disease that initially affects small joints then progresses to larger joints, and eventually the skin, eyes, heart, kidneys, and lungs. RA is associated with a decreased lifespan and higher mortality rates compared with the general population with cardiovascular complications being implicated in about 50% of all RA-related deaths. Management of RA involves initiating disease-modifying anti-rheumatic drugs and regular assessment of disease activity. Disease activity correlated with complications and mortality with high disease activity being shown to carry the highest risk of increasing morbidity and mortality.

Objectives: The objective was to determine the prevalence of high disease activity and its associated factors among patients with RA attending MOPD at Bugando Medical Centre in Mwanza Tanzania.

Methodology: This was a hospital-based cross-sectional study that was carried out from April 2024 to June 2024 in MOPD at Bugando Medical Centre. A consecutive sampling technique was used to enroll 134 rheumatoid arthritis patients aged 18 years and above. A structured questionnaire was used to collect all demographic information. An observation checklist was used to collect clinical information, the DAS-28 tool was used to document all parameters needed for the calculation of disease activity, and blood samples were drawn for ESR. Data entry and cleaning were done using Microsoft Excel and exported to STATA version 16 for analysis. For the identification of associated factors for high disease activity in rheumatoid arthritisunivariate logistic regression analysis was performed and all variables with p-value < 0.25 were subjected to the multivariate logistic regression analysisand factors with p-value<0.05 were considered statistically significant.


Results: A total of 134 participants were found to have confirmed rheumatoid arthritis (RA), with 74 of them exhibiting high disease activity. This means that the prevalence of high disease activity was 55.2%. Additionally, 29.10% had moderate disease activity, 6.7% had low disease activity, and 9.0% were in remission. After adjusting for the effect of other covariates, participants with HTN, Heart failure, and Overweight all were significantly associated with high disease activity on multivariable logistic regression analysis, (AOR =1.98; 95%CI=1.32-4.13; p-value<0.001), (AOR =.1.76; 95%CI=1.54- 2.66; p-value<0.034) and (AOR=1.54; 95%CI=2.11-4.43; p-value<0.003) respectively.

Conclusion: In our study,55.2% of participants had active disease with few being in remission. Hypertension, overweight, and heart failure which are the main cardiovascular diseases, were associated with high disease activity. Treating to target all patients with RA can be adopted so that we attain disease activity to remission hence improving the cardiovascular complications.