Bio

Prof. OYOO GEORGE OMONDI

Prof. Omondi Oyoo is an Associate Professor  in the department of clinical Medicine and Therapeutics , School of Medicine , University of Nairobi, Head of rheumatology unit at the Kenyatta National Hospital in Nairobi, Kenya and a Honorary Research Fellow in the department of musculoskeletal Biology, University of Liverpool.

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Prof. Omondi Oyoo  FACR; FRCP(Edin); FIPH;  MMed ;MB Ch B; Cert Trop Med; Cert Clin Rheum; Cert Clin Epid.

Prof. Omondi Oyoo is an Associate Professor  in the department of clinical Medicine and Therapeutics , School of Medicine , University of Nairobi and a Honorary Research Fellow in the department of musculoskeletal Biology, University of Liverpool.

Publications


2017

A, O-R, GO O, E K, E G, F O, E O.  2017.  Prevalence of abnormal liver function tests in rheumatoid arthritis. Afr J Rheumatol . 5(1):70-75. Abstractprevalence_of_abnormal_liver2.pdf

Abstract
Objective: To determine the prevalence
of Abnormal Liver Function Tests (LFTs)
in patients with rheumatoid arthritis
at the rheumatology out-patient clinic,
Kenyatta National Hospital (KNH).
Design: Cross-sectional descriptive
study.
Setting: Rheumatology out-patient clinic
at KNH.
Participants: One hundred and seven
RA patients.
Results: The overall prevalence of
abnormal LFTs in the study population
was 57%. The most common abnormal
LFTs were direct bilirubin and alkaline
phosphatase (ALP), which were elevated
in 34.6% and 15% of the study population,
respectively. Abnormal direct bilirubin
was associated with longer duration of
disease; adjusted Odds Ratio (OR) 0.54
(0.34, 0.86) p-value 0.009 and higher
disease activity, adjusted OR 2.79 (1.23,
6.25) p-value 0.014. Abnormal ALP
was significantly associated with BMI,
adjusted OR 0.205 (0.074, 0.57), p-value
0.002 as well as duration of disease,
adjusted OR 1.14 (1.013, 1.29), p-value
0.031.
Conclusion: This study found the
prevalence of liver dysfunction in
patients with rheumatoid arthritis to be
high, at 57%, and recommends regular
monitoring of liver function tests in
patients with rheumatoid arthritis.
Introduction
Rheumatoid Arthritis (RA) is a systemic,
chronic, progressive inflammatory
disease characterized by symmetric joint
polyarthritis that progresses to severe joint
destruction1
. As a systemic illness, RA
has many extra-articular manifestations
and co-morbidities, many of which have
been studied in our local setting, and
have been found to correlate with disease
activity2-5. The liver has however been
overlooked as a target organ in patients
with RA. Rheumatoid arthritis can affect
the liver in many ways6,7; dysfunction
is thought to arise from the disease
itself, independent autoimmune disease,
infections such as viral hepatitis or as a
consequence of anti-inflammatory drugs
such as Non-Steroidal Anti-Inflammatory
Drugs (NSAIDs) or Disease Modifying
Anti-Rheumatic Drugs (DMARDs)6
.
The most common DMARDs used
in treatment of RA in our setting are
methotrexate and leflunomide, which can
be hepatotoxic. The risk of hepatotoxicity
while on treatment with DMARDs may
be increased in the presence of hepatitis
or alcohol intake.
LFTs may be abnormal in up to
50% of patients with RA and this has
been shown to correlate with disease
activity7,8. The ‘rheumatoid liver’ has
long been a topic of interest and previous
studies noted histological changes in
the liver of RA patients who were not
on treatment with DMARDs such as
fatty change, cellular necrosis, chronic
passive congestion and gross atrophy9-12.
Studies have also investigated use of
multiple DMARDs, which were thought
to predispose patients with RA to a higher
risk of developing hepatotoxicity13,14.
With increasing awareness and
knowledge of the RA, more patients
are being diagnosed early and started
on treatment, which may be life-long.
Effective treatment modalities may have
hepatotoxic effects. Abnormal LFTs are
in themselves an independent predictor
of mortality15. Due to high mortality
from both RA as well as abnormal LFTs,
such a subset of patients could therefore
be at a higher risk. This is especially so
because we currently have limited ways
of managing liver injury in our setting.
It is therefore important for us to monitor
liver dysfunction in patients with RA.

JIN, U, GO O, CF O, M M, N N.  2017.  Prevalence of fibromyalgia syndrome in diabetics with chronic pain at the Kenyatta National Hospital. Afr J Rheumatol . Vol. 5(1):54-57. Abstractprevalence_of_fibromyalgia4.pdf

Abstract
Background: Fibromyalgia Syndrome
(FMS), an increasingly recognized
disorder with heightened response to
pressure, characterized by Chronic
Widespread Pain (CWP), for which no
other cause can be identified. Diabetes
Mellitus (DM) is the most common
metabolic endocrinopathy. It is estimated
that more than 50% of diabetic patients
will suffer from chronic disability.
Musculoskeletal complications of
diabetes may be as a consequence of DM
complications or direct associations e.g.
FMS.
Objectives: To determine the prevalence
of FMS in diabetics with chronic pain
and to determine the severity of FMS
related symptoms using the revised FMS
questionnaire (FIQR) tool.
Design: Descriptive cross-sectional study.
Setting: The Diabetic Out-patient Clinic
(DOPC), Kenyatta National Hospital
(KNH).
Subjects: Two hundred and nineteen
patients with chronic musculoskeletal
pain.
Results: The prevalence of fibromyalgia
in this group of patients was 61 (27.9%)
(95% CI 21.9-34.2). Mean age for patients
with FMS was 59.9 years, significantly
older than patients without FMS (55.6%)
(P=0.034). There was a higher female
preponderance at 49 (80%). Majority of
our study population were on followup
for Type 2 DM (94.1%). The mean
tender-point count for patients with FMS
was estimated at 13.7 (SD 2.1). The mean
FIQR score was 51.9 (SD 18.4) (moderate
disease). Patients with FMS had a higher
HBA1c value compared to those without
(9.6% vs. 9.3%) (P=0.565). Other
factors such as marital status, nature of
employment, activities of daily living and
type of medications used were not found
to be statistically significant. (P˃0.05).
Conclusion: FMS is a prevalent disease in
the diabetic population. There is increased
need of awareness by the clinicians of
this disease entity and a multidisciplinary
approach required to manage patients
presenting with CWP in DM.
Introduction
FMS is a common disorder with cardinal
symptoms of diffuse chronic pain associated
with muscle stifness and tenderness of
specific points on examination. This
disease has strong biologic underpinnings
and the aetiopathogenesis is variable.
Trigger factors may be environmental
or psychosocial. This condition affects
mainly women, and its estimated
prevalence in various populations varies
between 0.2% and 4.4%. The American
College of Rheumatology Criteria (ACR)
1990 requires CWP for at least 3 months
and presence of ˃11/18 pre-specified
Tender Points (TP) on examination1
.   
  A newer diagnostic criteria published
in 2010-2011, no longer requires
performing a tender point count to make
the diagnoses and instead entails asking
about the constellation of non-pain
somatic symptoms that are typically
present in addition to the widespread
pain2
. DM affects connective tissue in
multiple ways and this may be as a result
of micro or macrovascular complications,
a consequence of metabolic derangements
inherent to DM, and notable associations,
FMS being a key presentation3
. Over
the past few years, the most important
predictor that predisposed to development
of musculoskeletal complications is
blood glucose control. The HUNT
study4
outlined the association between
DM and chronic musculoskeletal
complaints in 64,785 patients and noted
a high prevalence of FMS and a positive
correlation with HbA1c levels. Attar5
,
revealed that up to 17.9% of diabetics
suffer from chronic musculoskeletal
manifestations, fibromyalgia being one
of them. Yunus6
, in his review article, in
2011, noted that Central Sensitization
Syndromes (CSS) have an increased
prevalence in patients with diabetes
mellitus. Of particular interest, a study

2016

KM, N, GO O, KM B, CS I.  2016.  Disease activity measurement in rheumatoid arthritis. Afr J Rheumatol. :19-24.disease_activity_measurement.pdf

2015

Oyoo, GO, Genga EK, Otieno CF, Ilovi CS, Omondi EA, Otieno FO.  2015.  Clinical and socio-demographic profile of patients on treatment for osteoporosis in Nairobi, Kenya. East African Orthopaedic Journal. 9:62-66.clinical_and_socio-demographic.pdf
B, R, M C, G.O.Oyoo.  2015.  Different techniques to assess microvascular damage in systemic sclerosis. Afr J Rheumatol . 2(3):46-49. Abstractrheumatology_full_flow1.pdf

Blood perfusion
Systemic Sclerosis (SSc) is a connective
tissue disease with multifactorial
aetiology and autoimmune pathogenesis.
SSc is characterized by structural and
functional alterations of microcirculation,
with important clinical implications, such
as Raynaud Phenomenon (RP) and digital
ulcers1,2. For these reason, morphological
and functional assessment of the peripheral
microvasculature is a must for diagnosis,
prognosis and therapy in SSc patients 2.
Nailfold videocapillaroscopy
Nailfold videocapillaroscopy (NVC) is
the best safe and non-invasive method
to detect morphological microvascular
abnormalities. NVC allows to distinguish
secondary RP from both primary RP and
healthy subjects, identify morphological
patterns that are specific to various SSc
stages (‘Early’, ‘Active’ and ‘Late’ patterns
of microvascular damage) and calculate
the Microangiopathy Evolution Score
(MES) to follow disease evolution3,4.
The video-capillaroscope makes
use of a magnification system (from 50x
up to 500x magnification), and it has an
optical/digital probe which can be moved
over the surface of the finger nails from
the 2nd to the 5th finger of both hands2.
The normal NVC image is characterized
by normal skin transparency, morphology
of the capillary to “U” or “hairpin shape”,
morphological/structural homogeneity,
10-12 capillaries / linear millimetre, one
capillary inside dermal papilla, diameters
of capillary branches <20 μm, and lack of
morphological atypia2. Nailfold capillaries
are frequently normal in primary RP,
but it is possible to observe capillaries
with efferent branch enlargement or
tortuous capillaries. Therefore in normal
conditions, or in the presence of primary
RP, the NVC examination is characterized
by a regular array of capillary loops
along the nailfold bed, without abnormal
Different techniques to assess microvascular damage in
systemic sclerosis
Ruaro B1, Sulli A1, Smith V2, Paolino S1, Pizzorni C1, Cutolo M1
enlargements nor capillary loss2.
Conversely, secondary RP is characterized
by the morphological signs that represent
the microvascular damage: these include
giant capillaries, microhaemorrhages,
capillary loss, presence of avascular
areas and angiogenesis. These sequential
capillaroscopic changes are typical of the
microvascular involvement observed in
more than 95% of SSc patients and are
described by the term “SSc pattern”2,3.
NVC technique identifies
morphological patterns specific to
various stages of SSc (‘Early’, ‘Active’
and ‘Late’ patterns)3,4. The ‘Early’
SSc pattern is characterized by few
enlarged/giant capillaries, few capillary
microhaemorrhages, no evident capillary
loss and a relatively well preserved
capillary distribution. The ‘Active’ SSc
pattern, a marker of disease progression, is
characterized by frequent giant capillaries
(more than 66%), frequent capillary
microhaemorrhages, moderate (up to 33%)
capillary loss, absent or mild ramified
capillaries and a mild disorganization of
the capillary architecture. In the ‘Late’
SSc pattern there is irregular enlargement
of the capillaries, severe (>66%) capillary
loss with evident avascular areas,
ramified or bushy capillaries and a severe
disorganization of the normal capillary
array, although giant capillaries and
microhaemorrhages are almost absent3,4
(Figure 1). NVC is also used to make a
quantitative assessment (i.e. quantify
certain characteristics and make semiquantitative
scoring) of the microvascular
damage. The usual capillaroscopic
parameters (diagnostic parameters,
such as irregularly enlarged capillaries,
giant capillaries, microhaemorrhages;
and progression parameters, such as
reduced capillary number, capillary
ramifications and capillary architectural
disorganization) are evaluated by a semiquantitative
scale. Score 0-3 has been
adopted for all these parameters3

EK, G, GO O.  2015.  Catastrophic antiphospholipid syndrome: management challenges and lessons learnt in the third world set-up: Case report. Afr J Rheumatol . 2(3):67-72. Abstractcatastrophic_antiphospholipid.pdf

Background: Antiphospholipid
Syndrome (APS) is a disorder that
manifests clinically as recurrent venous
or arterial thrombosis and/or foetal loss.
Catastrophic Antiphospholipid Syndrome
(CAPS) is a very severe variant of the
classic APS. It is characterized by clinical
evidence of multiple organ involvement
developing over a very short period
of time, histopathological evidence of
multiple small vessel occlusions and
laboratory confirmation of the presence
of antiphospholipid antibodies, usually
in high titre. Although patients with
catastrophic APS represent less than 1%
of all patients with APS, this is usually a
life-threatening condition. The majority
of patients with catastrophic APS end
up in intensive care units with multiorgan
failure. Making the diagnosis is
challenging and can be missed. Unless the
condition is considered in the differential
diagnosis by attending physicians, it
may be completely missed, resulting in
a disastrous outcome. Catastrophic APS
develops rapidly and can result in death of
up to 30-50% of cases.
Case presentation: A nineteen year old
nulliparous lady diagnosed with Systemic
Lupus Erythematosus (SLE) four months
prior to admission with no prior history of
thrombo-embolic events presented at the
accident and emergency department with
one day history of fevers and convulsions.
This was associated with history of
progressively worsening memory loss and
confusion associated with incoordination
of hands. She also reported to have had
a productive cough of 3 months which
was episodic. The patient was admitted
and developed multiple organ failure
from lungs, heart and the kidney during
treatment in hospital attributed to this
disease. She succumbed during treatment

EK, G, G.O.Oyoo, F.O O, E.A O, S J, J O, B.C S.  2015.  Clinical characteristics of patients with systemic lupus erythematosus in Nairobi, Kenya. Afr J Rheumatol . 2(3):62-66. Abstractclinical_characteristics_of_patients.pdf

Abstract
Background: Systemic lupus
erythematosus (SLE), a chronic
multisystem autoimmune disease with a
wide spectrum of manifestations, shows
considerable variation across the globe,
although there is data from Africa is
limited. Quantifying the burden of SLE
across Africa can help raise awareness and
knowledge about the disease. It will also
clarify the role of genetic, environmental
and other causative factors in the natural
history of the disease, and to understand
its clinical and societal consequences in
African set up.
Objective: To determine the clinical
profile of SLE patients at a tertiary care
centre in Nairobi, Kenya.
Methods: Case records of patients who
were attending the Nairobi Arthritis
Clinic seen between January 2002
and January 2013 were reviewed.
This was a cross-sectional study done
on 100 patients fulfilling the 2012
Systemic Lupus Collaborating Clinics
(SLICC) criteria for SLE attending
the Nairobi Arthritis Clinic, Kenya.
The patients were evaluated for sociodemographic,
clinical and immunological
manifestations and drugs used to manage
SLE.
Results: Hundred patients diagnosed with
SLE were recruited into the study. Ninety
seven per cent of the study participants
were female with a mean age of 36.6
years. Thirty three years was the mean
age of diagnosis. The mean time duration
of disease was 3 years with a range of
0-13 years. There was extensive disease
as many had multi-organ involvement.
Majority (83%) of the study participants
met between 4 and 6 manifestations
for the diagnosis criteria for SLE. Non
erosive arthritis and cutaneous disease
were the commonest initial manifestation.
The patients had varied cutaneous,
haematological, pulmonary, cardiac, renal
and neuropsychiatric manifestations.
Antinuclear antibody (ANA) assay and
anti-dsDNA was positive in 82% and
52%. Patients on steroids, non-steroidal
drugs and synthetic disease modifying
anti-rheumatic drugs were 84%, 49% and
43% respectively. None of the patients
were on biologic disease modifying antirheumatic
drugs.

G.O, O, E.K G, R.J M.  2015.  DMARD use in rheumatoid arthritis: can we predict treatment response? Afr J Rheumatol . 2(3):50-58. Abstractdmard_use_in_rheumatoid.pdf

Abstract
Objective: To review the current and emerging predictors of treatment response by DMARD Sin Rheumatoid Arthritis (RA) patients.Data source: Published original research work and reviews were searched in
English related to determinants of treatment response in rheumatoid arthritis on DMARDS Study design: Only articles that emphasis on determinants of rheumatoid arthritis treatment response with DMARDS Data extraction: Online and library searches done.Data synthesis: Data added and summarized Conclusions: Treatment of RA has been based on the use of a group of Disease-Modifying Antirheumatic Drugs
(DMARDs), of which methotrexate is the most widely used. Although
comprehensive clinical experience exists for MTX and synthetic DMARDs, to date it has not been possible to preview correctly whether or not a patient will respond to treatment with these drugs. Predicting response to MTX and other DMARDs would allow the selection of patients based on their likelihood of response,
thus enabling individualized therapy and avoiding unnecessary adverse effects and elevated costs. Distinguishing responders from non-responders at treatment start as studies have failed to consistently
reproduce similar determinants. Variables possibly influencing drug effectiveness may be related to disease, patient, treatment, clinical or biological (genetic and non-genetic) factors. This study
seeks to review the current data regarding biomarkers of treatment response to DMARDS.
Key words: Rheumatoid arthritis, DMARDS, Determinants of treatmentresponse

2014

Gron, KL, Ornbjerg LM, Hetland ML, Aslam F, Khan NA, Jacobs JW, Oyoo O, Stropuviene S, et al.  2014.  The association of fatigue, comorbidity burden, disease activity, disability and gross domestic product in patients with rheumatoid arthritis. Results from 34 countries participating in the Quest-RA program.. Clinical and Experimental Rheumatology. Abstract

Abstract
OBJECTIVES:

The aim is to assess the prevalence of comorbidities and to further analyse to which degree fatigue can be explained by comorbidity burden, disease activity, disability and gross domestic product (GDP) in patients with rheumatoid arthritis (RA).
METHODS:

Nine thousands eight hundred seventy-four patients from 34 countries, 16 with high GDP (>24.000 US dollars [USD] per capita) and 18 low-GDP countries (<24.000 USD) participated in the Quantitative Standard monitoring of Patients with RA (QUEST-RA) study. The prevalence of 31 comorbid conditions, fatigue (0-10 cm visual analogue scale [VAS] [10=worst]), disease activity in 28 joints (DAS28), and physical disability (Health Assessment Questionnaire score [HAQ]) were assessed. Univariate and multivariate linear regression analyses were performed to assess the association between fatigue and comorbidities, disease activity, disability and GDP.
RESULTS:

Overall, patients reported a median of 2 comorbid conditions of which hypertension (31.5%), osteoporosis (17.6%), osteoarthritis (15.5%) and hyperlipidaemia (14.2%) were the most prevalent. The majority of comorbidities were more common in high-GDP countries. The median fatigue score was 4.4 (4.8 in low-GDP countries and 3.8 in high-GDP countries, p<0.001). In low-GDP countries 25.4% of the patients had a high level of fatigue (>6.6) compared with 23.0% in high-GDP countries (p<0.001). In univariate analysis, fatigue increased with increasing number of comorbidities, disease activity and disability in both high- and low-GDP countries. In multivariate analysis of all countries, these 3 variables explained 29.4% of the variability, whereas GDP was not significant.
CONCLUSIONS:

Fatigue is a widespread problem associated with high comorbidity burden, disease activity and disability regardless of GDP.

Oyoo, GO, Muia B, Otino FO, Ganda B, Otieno CF, Moots CF.  2014.   Occurrence of crystal arthropathy in patients presenting with synovitis in Nairobi. African Journal of Rheumatology. 2(2):75-77. Abstract

Background: Crystal arthropathies represent a heterogeneous group of skeletal (musculo-skeletal) diseases associated with the deposition of mineralized material within joints and periarticular soft tissues. Gout is the most common and pathogenetically best understood crystal arthropathy, followed by basic calcium phosphate and calcium pyrophosphate dihydrate deposition diseases, and, in very rare cases, calcium oxalate crystal arthropathy. In Kenya there are no studies to demonstrate the prevalence of these diseases. This study endeavored to describe the different types of crystals seen in patients with synovitis in Nairobi from 1st January 2012 to 31st January 2014.
Objective: To describe different types of crystals seen in patients with synovitis in Nairobi.
Design: Descriptive prospective cross sectional study.
Results: There were 260 samples received from patients with synovitis. Of them, 61 (23.5%) were from males while 199 (76.5%) were from females. The age range of the patients was from 14 – 110 years. The mean, median and mode were 59.6, 60 and 55 years respectively. Majority of the patients were in the 51-60 years age category. Most of the patients recruited had no crystals (n=211; 81.2%)
diagnosed, with 14.2%(n=37) having uric acid crystals and 4.6 % (n=12) having CPPD crystals. For the patients who had uric acid crystals (n=37), when gender was cross tabulated against microscopy, males (n=32; 86.5%) were noted to have more uric acid crystals than females (n=5;
13.5%). Among patients diagnosed with CPPD (n=12), there were more females (n=9; 75%) patients compared to males (n=3; 25%). From the total population recruited (n=260), when age range categories were cross tabulated against microscopy, the age ranges 41-50 (n=9; 3.5%) 51-60 (n=12; 4.6%), and 61-70 (n=6; 2.3%) were noted to have more uric acid crystals than any other age category recruited. Patients in the age category 61-70 (n=6; 50 %) had more CPPD crystal detections than any other age category from the patients recruited.
Conclusion: Crystal arthropathy is a major cause of synovitis in patients seen in Nairobi.

Genga, EK, Oyoo GO, Otieno CF.  2014.  WHEN IS THE LAST TIME YOU LOOKED FOR DIFFUSE INFILTRATIVE LYMPHOCYTOSIS SYNDROME (DILS) IN HIV PATIENT? African Journal of Rheumatology. 2(2):3-6. Abstract

BACKGROUND: Diffuse infiltrative lymphocytosis syndrome (DILS) is characterised by a persistent CD8+ lymphocytosis and lymphocytic infiltration of various organs. The exact prevalence isn’t known but some studies have reported between 0.85 – 3%, and appears to be more common in African population. Patients with DILS tend to have higher CD4cell counts and survive longer than those patients without DILS. Most patients present with bilateral parotid gland enlargement and features of the Sicca syndrome. Common sites of extra glandular involvement are the lungs being the most common site, followed by peripheral neuropathy and liver. With the high incidence of HIV in our population it is likely that DILS is under diagnosed probably due to our ignorance of this disease. Awareness of its various presentations may bring to light undiscovered patients with DILS.
OBJECTIVE: To review pathogenesis, diagnostic approach and current trends in the management of Diffuse interstitial lymphocytic syndrome
DATA SOURCE: Literature review of relevant published literature from both Africa and the rest of the world.
DATA SYNTHESIS:Pathologically, under light microscopy, DILS resembles the focal sialadenitis seen with Sjogren’s syndrome, although it tends to be less destructive of the glandular architecture than in Sjogren’s syndrome. Most of the inflammatory infiltrate is composed of CD8+ lymphocytes unlike Sjogren’s which are CD4+. Lymphoepithelial cysts are frequently observed in the parotid glands of patients with DILS. The variation in CD8 count in the course of HIV disease is less understood. The variation in CD8 lymphocytes is implicated in the pathogenesis of a number of clinical manifestations in HIV diseases including diffuse infiltrative lymphocytic syndrome (DILS) and HIV associated CD8+ lymphocytosis syndrome.Parotid gland enlargement in a patient with HIV infection should prompt clinicians to suspect DILS. In addition, clinicians should be aware that the pulmonary process associated with DILS may mimic clinically and radiographically the pneumonic process caused by Pneumocystis carinii. Other manifestations of DILS to consider include a severe form of peripheral neuropathy; lymphocytic infiltration of the liver, evident as hepatitis; myositis; and lymphocytic interstitial nephritis.Management of DILS is determined by the severity of glandular and extra glandularfeatures.Data on therapeutic trials are lacking although there are isolated reports of good response to antiretroviral and steroid therapy.

CONCLUSION: DILS, a subset of HIV disease manifestation, may present as parotid gland swellings. In general, an HIV patient presenting with DILS has a better prognosis than a patient with HIV alone.With the high incidence of HIV in our population it is likely that DILS is under diagnosed probably due to our ignorance of this disease. Awareness of its various presentations may bring to light undiscovered patients with DILS. Clinicians should watch for the possible transformation into B-cell lymphoma. There is still paucity of data about this disease from pathophysiology to treatment to studies correlating the plasma viral load with CD8 lymphocyte count in patients with HIV disease.

G.O.Oyoo, A.A.Amayo, A.O.Oyunga.  2014.  Performance characteristics of anti-cyclic citrullinated peptide and rheumatoid factor tests in rheumatoid arthritis and undifferentiated arthritis at Kenyatta National Hospital. EAJP. 1(1):23-27. Abstractperformance_characteristics.pdf

Background: The rheumatoid factor (RF) test has been the main serological test for
diagnosis of rheumatoid arthritis. Reports of it’s low sensitivity and specificity led to the
introduction of anti cyclic citrullinated peptide (anti CCP) test, which was added to the
diagnostic criteria. The analytical method and cost of the anti CCP test limits its availability
in resource constrained environments.
Objective: To determine the analytical performance characteristics of anti CCP in patients
with rheumatoid arthritis (RA) and undiffentiated arthritis (UA), and compare with those of RF.
Design: Cross-sectional study.
Methodology: The study subjects comprised 64 RA and 31 UA patients. Serum anti CCP
was measured using an automated immunoassay and 3rd generation anti-CCP test. RF was
determined using a qualitative particle agglutination method. Manufacturer cut-offs were
used for interpretation of results. Sensitivity, specificity, negative and positive predictive
values were calculated and compared, for anti-CCP and RF tests.
Results: Anti CCP showed a higher sensitivity than RF (62.5% versus 50%). Specificity
was however higher with RF (90.3%) than anti-CCP (83.9%). RF also had a slightly higher
positive predictive value (91.4%) than anti-CCP (88.9%). Combining RF and anti-CCP tests
led to a slightly higher sensitivity and negative predictive values than those obtained with
RF alone but not specificity or positive predictive values.
Conclusion: Although the anti CCP test has shown better sensitivity than RF in RA, there
was slightly higher specificity and positive predictive value with RF compared with anti-
CCP. The findings show that the latex RF test is an effective test for initial evaluation of
patients with arthritis.

G.O.Oyoo, E. N. Ogola, E.N.Amayo.  2014.  Cardiovascular risk factors and carotid atherosclerosis in patients with systemic lupus erythematosus at Kenyatta National Hospital. Afr J Rheumatol. 2(2)(1):1-17. Abstractcardiovascular_risk_factors-1.pdf

Background: Cardiovascular disease is
now acknowledged as a primary cause of
morbidity and mortality in patients with
Systemic Lupus Erythematosus (SLE).
The risk of developing coronary artery
disease in these patients is four to eight
times higher than that in the normal
population. Prior to this study there was
no data regarding cardiovascular risk in
SLE patients in our setting.
Objective: To determine the prevalence
of selected cardiovascular risk factors
and carotid atherosclerosis in patients
with systemic lupus erythematosus at
Kenyatta National Hospital.
Methods: This was a cross-sectional
survey carried out in patients with SLE
and age- and sex-matched controls at
the Kenyatta National Hospital. The SLE
patients underwent clinical assessment
of their blood pressure, weight, height,
waist and hip circumferences as well as
laboratory testing to determine their
fasting blood sugar and fasting lipid
pro le. In addition, measurement of
carotid Intima-Media Thickness (IMT)
and assessment for presence of carotid
plaque was done for the lupus patients.
The controls had similar clinical and
laboratory assessment done as for
patients. Carotid ultrasonography was
however not done for controls.
Results: Sixty six SLE patients and 66
healthy controls participated in this
study. Mean age of the patients was
35.9 years, with a female to male ratio
of 21:1 and median duration of illness
of two years. Hypertension prevalence
was 42.4% in the patients and 24.2%
in the controls (p=0.027), dyslipidemia
occurred in 74.2% of the patients and
62.1% of the controls (p=0.135) while
diabetes prevalence was 4.5% in patients
and 1.5% in controls (p=0.619). Obesity
by Body Mass Index (BMI) assessment
was found in 12.1% of patients and
21.2% of the controls (p=0.330) whereas
abdominal obesity (by waist: hip ratio)
occurred in 33.3% of patients and 24.2%
of controls (p=0.249). Mean carotid IMT in
SLE patients was 0.63mm (SD=0.15) with
9 (13.6%) patients having IMT readings
of 0.8mm and above. Carotid plaque was
detected in 15 (22.7%) patients. Carotid
IMT and BMI signi cantly correlated with
disease duration (p values= 0.006 and
0.021 respectively).
Conclusion: There was a high preva-
lence of atherosclerosis and selected
cardiovascular risk factors in this popu-
lation of SLE patients. Hypertension was
signi cantly more common in the lupus
patients than controls. Cardiovascular
risk assessment and appropriate treat-
ment of risk factors identi ed should be
enhanced in patients with SLE.
Key words: Systemic lupus erythemato-
sus, Cardiovascular risk factors, Carotid
intima-media thickness, Carotid

G.O.Oyoo, E. K. Genga.  2014.  When is the last time you looked for diff use infi ltrative lymphocytosis syndrome in HIV patients? Afr J Rheumatol. 2(2)(1):2-6. Abstractdiff_use_infi_ltrative.pdf

Background: Di use In ltrative
Lymphocytosis Syndrome (DILS) is
characterised by a persistent CD8+
lymphocytosis and lymphocytic
in ltration of various organs. The exact
prevalence isn’t known but some studies
have reported between 0.85 – 3%, and
appears to be more common in African
population. Patients with DILS tend to have higher CD4 cell counts and survive
longer than those patients without DILS.
Most patients present with bilateral
parotid gland enlargement and features
of the Sicca syndrome. Common sites
of extra glandular involvement are the
lungs being the most common site,
followed by peripheral neuropathy and
liver. With the high incidence of HIV in
our population it is likely that DILS is
under diagnosed probably due to our
ignorance of this disease. Awareness of
its various presentations may bring to
light undiscovered patients with DILS.
Objective: To review pathogenesis,
diagnostic approach and current trends
in the management of di use interstitial
lymphocytic syndrome.
Data source:  Literature review of
relevant published literature from both
Africa and the rest of the world.
Data synthesis: Pathologically, under
light microscopy, DILS resembles the
focal sialadenitis seen with Sjogren’s
syndrome, although it tends to be less
destructive of the glandular architecture
than in Sjogren’s syndrome. Most of the
in ammatory in ltrate is composed
of CD8+ lymphocytes unlike Sjogren’s
which are CD4+. Lymphoepithelial
cysts are frequently observed in the
parotid glands of patients with DILS.
The variation in CD8+ count in the
course of HIV disease is less understood.
The variation in CD8+ lymphocytes is
implicated in the pathogenesis of a
number of clinical manifestations in HIV
diseases including Di use In ltrative
Lymphocytic Syndrome (DILS) and
HIV associated CD8+ lymphocytosis
syndrome. Parotid gland enlargement
in a patient with HIV infection should prompt clinicians to suspect DILS. In addition, clinicians should be aware
that the pulmonary process associated
with DILS may mimic clinically and
radiographically the pneumonic process
caused by pneumocystis carinii. Other
manifestations of DILS to consider
include a severe form of peripheral
neuropathy; lymphocytic in ltration of
the liver, evident as hepatitis; myositis;
and lymphocytic interstitial nephritis.
Management of DILS is determined
by the severity of glandular and extra
glandular features. Data on therapeutic
trials are lacking although there are
isolated reports of good response to
antiretroviral and steroid therapy.
Conclusion: DILS, a subset of HIV
disease manifestation, may present as
parotid gland swellings. In general, an
HIV patient presenting with DILS has a
better prognosis than a patient with HIV
alone. With the high incidence of HIV
in our population it is likely that DILS is
under diagnosed probably due to our
ignorance of this disease. Awareness of
its various presentations may bring to
light undiscovered patients with DILS.
Clinicians should watch for the possible
transformation into B-cell lymphoma.
There is still paucity of data about
this disease from pathophysiology to
treatment to studies correlating the
plasma viral load with CD8+ lymphocyte
count in patients with HIV disease.

G.O.Oyoo, D.K.Katukui, J.Rajab.  2014.  Serum erythropoietin in patients with anaemia on HAART attending the Kenyatta National Hospital, Comprehensive Care Centre. EAJP. Vol. 1(1):2-6. Abstractserum_erythropoietin.pdf

Background: Anaemia is the leading haematological abnormality in HIV/AIDS and an
independent contributor to morbidity and mortality. HAART has been shown to be effective
in reversing anaemia in HIV/AIDS, however a significant proportion of patients remain
anaemic despite being on antiretroviral therapy. Deficiency of erythropoietin has been
demonstrated as a cause of anaemia in HIV infected HAART naïve patients. The levels of
erythropoietin have not been studied in anaemic patients who are on HAART.
Objectives: To describe serum EPO levels of HIV infected anaemic patients who have been
on HAART for more than six months.
Design: Cross sectional descriptive study.
Setting: The study was carried out at a national hospital HIV treatment and follow-up
outpatient facility: Comprehensive Care Centre, Kenyatta National Hospital.
Methods: A total of 196 HIV elisa positive HAART experienced patients with anaemia
visiting the Comprehensive Care Centre were consecutively recruited. They were evaluated
by total blood counts, CD4 count, documented WHO clinical stage and serum erythropoietin
levels. Serum erythropoietin levels were measured by IMMULITE 2000 Elisa method.
Accrued data was entered in SPSS version 17 and analyzed therein.
Results: A total of 196 HIV positive adult patients with anaemia and who had been on
HAART for more than six months were evaluated. A total of 181 (92.3%) were found to
have a deficient erythropoietin response to anaemia in HIV, (EPO < 500IU/L). In this study
Hb was the main predictor of erythropoietin response.
Conclusion: Erythropoietin deficiency is nearly universal in anaemic patients on HAART
for more than six months.

Oyoo.G.O, Odhiambo.J, Amayo.E..  2014.  An evaluation of quality of life in ambulatory patients with systemic lupus erythematosus attending rheumatology clinic in Kenyatta National Hospital. ISSN. Abstractan_evaluation_of_quality.pdf

Background: Systemic Lupus
Erythematosus (SLE) is a chronic
autoimmune disease that affects all
organs of the body. It is becoming
increasingly clear that SLE is not as rare
in Kenya as was previously thought. Due
to its chronicity SLE has been known to
affect the quality of life of those affected
by it. There is minimal data on SLE in
East Africa and especially in Kenya. The
quality of life of SLE patients in this
country has never been assessed.
Objectives: To document the quality
of life of patients with SLE in Kenyatta
National Hospital using LUPUS QOL
questionnaire. We also sought to correlate
HRQOL with duration of illness, drugs
used and age of the patient.
Design: This was a cross sectional study
done on patients attending Rheumatology
Clinic in Kenyatta National Hospital.
Methods: Patients who satisfy the ACR
criteria were consecutively recruited.
All patients with SLE attending the
clinic were included in the study.
Consent was obtained from the patients
after which their demographic data was
obtained. Patients were examined for
the presence of malar rash, discoid rash,
arthritis/athralgia, photosensitivity, CNS
symptoms, serositis and oral ulcers. The
patients then filled the LUPUS QOL
questionnaire. The information acquired
was then analysed using SPSS version
17.0 using student t test and regression
analysis. The quality of life was
calculated and then correlated with age,
duration of illness and drug management.
Results: Sixty two patients were analysed
(60 females 2 males). Mean age of the
population was 37.3 years (range 14-71
years). All patients had some level of
education with 61.3% of the population
having some form of secondary education.
Most patients 54.8% were married.
Mean age of diagnosis was 34.5 years
with mean duration of illness 1.5 years.
Majority (88.7%) had arthritis/ athralgia,
oral ulcers (62.9%), malar rash (59.7%),
photosensitivity (58.1%), serositis
(32.3%), CNS symptoms (27.4%) and
discoid rash (17.7%). Patients scored
globally low in all domains of LUPUS
QOL. Highest domain was planning
63.7 (29.3), emotional health 61.3 (26.5),
burden to others 58.9 (31.2), fatigue 57.5
(30.0), pain 56.6 (29.6), physical health
54.0 (23.3), body image 47.1 (24.2)
intimate relations 41.1 (38.4).The most
common drug in use in our population
was prednisone at 74.2%. This was
followed by HCQ at 69.4%, NSAIDS
54.8%, azathioprine 37.1%, methotrexate
22.6%, mycofenolate mofetil 8.1%, CCB
11.3%, cyclosporine 3.2%. HRQOL
correlated positively with advance in age
for the domains. Physical health, burden
to others, emotional health and fatigue.
There was no correlation between
HRQOL and duration of illness or drugs
used by the population.
Conclusion: The HRQOL of our SLE
patients was found to be low in all
domains and to correlate with advance
in age in the domains of physical health,
burden to others, emotional health and
fatigue. However there was no correlation
with duration of illness or the drugs used
by the patients

Oyoo.G.O, Wanjohi.W, H.M K, Ogutu.E, Radia.K, Mutei.T.M.  2014.  Prevalence of gastroduodenal lesions in chronic nonsteroidal anti-inflammatory drug users presenting with dyspepsia at the Kenyatta National Hospital. ISSN. Abstractprevalence_of_gastroduodenal2.pdf

Non-Steroidal Anti-
Inflammatory Drugs (NSAIDs) are
among the most widely prescribed and
used classes of drugs worldwide. They
are known to cause gastroduodenal
mucosal damage and can result in
ulcerations, upper gastrointestinal
bleeding, perforation and even death.
However, no local data exist to show the
prevalence.
Objectives: The main objective
was to determine the prevalence
of gastroduodenal lesions seen at
endoscopy and histopathology in
chronic NSAID users presenting with
dyspepsia at the Kenyatta National
Hospital.
Design: This was a hospital-based crosssectional
study.
Methods: Seventy patients aged
13 years and above, on NSAIDs for 4
weeks or more, and presenting with
dyspepsia were recruited and done
for endoscopies. Six biopsy specimens
were taken from each patient (2 from
each of the following sites: - corpus,
antrum and duodenum). One specimen
from each site was subjected to the
rapid urease test for H. pylori detection.
The remaining three were subjected to
histopathological evaluation.
Results: Forty male and 25 female
patients aged between 16-77 years, with
a mean age of 43.4 years were studied.
At endoscopy, only 10 (13.9%) patients
had normal gastroduodenal mucosa.
Gastritis was the most prevalent lesion
occurring in 50% of the patients. Peptic
ulcer disease had a point prevalence
of 30.5% (duodenal ulcers 22.2%, and
gastric ulcers 8.3%). Other lesions at
endoscopy were duodenitis 16.7%,
gastric erosions 5.6%, duodenal erosions
1.4% and hemorrhagic gastritis 1.4%.
At histopathology, only 5 (6.9%)
patients had normal gastroduodenal
mucosa. Chronic active gastritis was the
most prevalent lesion at 77.8%. Other
lesions were chronic gastritis 12.5%,
chemical gastritis 6.9%, duodenitis
41.7% and intestinal metaplasia 4.2%.
Prevalence of H. pylori in our study
population was 50%. There was no
association between the gastroduodenal
lesions and H. pylori infection.
Conclusions: There was a high
prevalence of gastroduodenal mucosal
lesions both at histopathology (93.1%)
and endoscopy (86.1%) in the chronic
NSAID users.

Oyoo.G.O, Genga.E.  2014.  Pulmonary manifestations in scleroderma: a review. ISSN. Abstractpulmonary_manifestations1.pdf

Background: Scleroderma is a chronic
multisystem autoimmune disease of
unknown aetiology. Scleroderma is
characterized by widespread obliterative
vasculopathy of small arteries and is
associated with varying degrees of tissue
fibrosis and multiple organ involvement.
Pulmonary disease is an important
component of SSc. It is estimated that
80% of patients with SSc have some
evidence of pulmonary disease. Systemic
sclerosis has the poorest prognosis
amongst rheumatology diseases with
the highest case-specific mortality of any
of the autoimmune rheumatic diseases
as well as causing major morbidity.
Objective: This article will review
pathogenesis, diagnosis and
management of pulmonary disease in
scleroderma.
Data source: Literature review of
relevant published literature from both
Africa and the rest of the world.
Data synthesis: The pathogenesis of
lung disease in scleroderma involves
a variety of pathways, including
immunological/inflammatory activation
and vascular injury. The primary
cytokines responsible for the disease
are unknown but it is postulated that it
involves a complex interplay between
inflammatory, B lymphocyte antibody
production, oxidative stress and fibrotic
pathways. This leads to the activation
of lung fibroblasts by inflammatory and
fibrotic mediators. Lung fibroblasts play
a central role in the deposition of excess
intracellular matrix. This inflammatory
response leads to fibrosis and occurs in
the setting of vascular derangements.
The most common symptoms are dry
cough and dyspnea on exertion. The
high morbidity and mortality seen in
SSc is generally attributed to the two
major pulmonary manifestations of the
disease: interstitial pulmonary fibrosis, or
interstitial lung disease, and pulmonary
arterial hypertension. Exertional dyspnea
and dry cough are the most common
presenting symptoms in patients
with SSc who develop pulmonary
involvement Algorithm of diagnostic
procedures in these patients does not
Department of Clinical
Medicine and Therapeutics,
College of Health Sciences,
University of Nairobi, Kenya
Corresponding author:
Dr GO Oyoo. Email:
geomondi@hotmail.com
Review Article
differ considerably from the procedures
of any other interstitial lung disease. At
the current time, cyclophosphamide
remains the best studied therapeutic
agent although alternatives are actively
being evaluated. The pathogenesis of
pulmonary disease in scleroderma is
still an enigma and is being actively
researched. This will advance our
understanding of the disease and ability
to care for these patients.
Conclusion: Pulmonary complications
are common in SSc and are the leading
causes of death. Careful evaluation
by the clinician is warranted to detect
the presence of an ILD and to select
patients appropriately for consideration
of therapy. It is a major clinical challenge
largely due to the enigma of the disease
pathology as well as limited therapeutic
options available. This is compounded
by the perceived lack of evidence for
clinical effectiveness of those treatments
that are currently in use. Clinical trials
are underway and offer hope for novel
approaches to this mysterious and
often devastating manifestation of
scleroderma.

2013

Nour, HA, Oyoo GO, JOSHI MD, Otsyeno FMT.  2013.  PATTERNS OF KNEE, HIP AND HAND OSTEOARTHRITIS IN KENYATTA NATIONAL HOSPITAL. East African Orthopaedic Journal. 7:53-57. Abstract

Background: Osteoarthritis (OA) is one of the most common chronic rheumatic disorders and is associated with significant morbidity and disability. Few studies examined the spectrum of rheumatic diseases in Sub-Saharan Africa. Obesity is not only a risk factor for incidence of OA but also for the progression of the disease.
Objective: The aim of the study was to determine the patterns of knee, hip and hand osteoarthritis as well as obesity prevalence in the patients with established disease.
Design: A cross-sectional descriptive study.
Methods: Patients with knee, hip and hand OA were studied. Of these participants, 77% had knee OA, 15% hip OA, 3% hand OA and 5% had combined knee and hip OA. Obese participants were 41% and 32% were overweight. There were 89(44.3%) participants with bilateral knee or hip disease while 112(55.7%) had unilateral disease. Obesity was more common in participants with knee than in hip OA(45.3% vs 10.3% respectively) P<0.001. The bilateral disease was higher in obese (55.2%) and overweight (44.6%) participants compared to participants with normal body mass indices (26.5%) P value <0.007.
Conclusion: Knee OA was very common and the majority of the patients were overweight and obese. Bilateral OA was was more prevalent in obese and overweight participants compared to normal weight participants. Obesity is an easily modifiable risk factor for knee OA so it can be made a valid target for preventing as well halting the progression of OA

G.O.Oyoo, H.A.Nour, M. D. JOSHI.  2013.  PATTERNS OF KNEE, HIP AND HAND OSTEOARTHRITIS IN KENYATTA NATIONAL HOSPITAL. EOAJ. 7(7):1-56. Abstractpatterns_of_knee_hip_and_hand-1.pdf

Background: Osteoarthritis (OA) is one of the most common chronic rheumatic disorders and is associated
with significant morbidity and disability. Few studies examined the spectrum of rheumatic diseases in sub-
Saharan Africa. Obesity is not only a risk factor for incidence of OA but also for the progression of the
disease.
Objective: The aim of the study was to determine the patterns of knee, hip and hand osteoarthritis as well
as obesity prevalence in the patients with established disease.
Design: A cross-sectional descriptive study.
Methods: Patients with knee, hip and hand osteoarthritis were examined to describe the patterns of
osteoarthritis in 201 patients who fulfilled the ACR diagnostic criteria. Their body mass indices were also
studied to determine the prevalence of obesity in this cohort of patients.
Results: A total of 201 patients with knee, hip or hand osteoarthritis were studied. Of these participants,
77% had knee OA, 15% hip OA, 3% hand OA and 5% had combined knee and hip OA. Obese participants
were 41% and 32% were overweight. There were 89 (44.3%) participants with bilateral knee or hip disease
while 112(55.7%) had unilateral disease. Obesity was more common in participants with knee than in hip OA
(45.3% vs 10.3% respectively) P < 0.001. The bilateral disease was higher in obese (55.2%) and overweight
(44.6%) participants compared to participants with normal body mass indices (26.5%) P value < 0.007.
Conclusion: Knee OA was very common and the majority of the patients were overweight and obese.
Bilateral OA was more prevalent in obese and overweight participants compared to normal weight
participants. Obesity is an easily modifiable risk factor for knee OA so it can be made a valid target for
preventing as well as halting the progression of OA.
INTRODUCTION
Osteoarthritis (OA) is the most prevalent of chronic
rheumatic disorders in the world (1). The prevalence
is increasing as populations are aging and epidemic
obesity is in the rise. OA is estimated to be the fourth
leading cause of disability in most countries worldwide
(2). Worldwide, around 10% of the population who
are 60 years or older have symptomatic problems
attributable to OA (3). Knee, hip, hand and spine
are typically the affected joints. Knee OA is the most
common form and it is associated with profound
clinical and public health burden (4). Risk factors
include obesity, joint injury, previous joint surgery and
occupational bending and lifting. Of these, obesity is
the most powerful and modifiable risk factor for the
development of OA (5). It has been shown that 24%
of surgical cases due to knee OA can be prevented if
overweight and obese reduce their weights by 5Kg or
until they keep their BMIs in the recommended range
(6). On the other hand, maintaining an ideal weight not
only reduces the onset of the disease but also alleviates
the pain, reduces the disability and improves the quality
of life (7,8). The access to modalities of treatments of
the established disease, particularly the surgical aspect
of it, is beyond the reach of the most of the people living
in the developing countries like Kenya. We do not have
local data on the magnitude of the disease in our set up
as well as the prevalence of obesity in this population
with the disease. For these reasons and because obesity
is modifiable risk factor, we examined patients with
specific joint osteoarthritis and determined the obesity
prevalence in a simple descriptive cross-sectional
hospital based study.
MATERIALS AND METHODS
Subjects: Participants of this study were patients with
primary knee, hip and hand OA who were attending
the outpatient rheumatology and orthopaedic clinics in
Kenyatta National Hospital during the periods between
August and December 2012. A total of 2100 patients
with rheumatic diseases, (88%) from the orthopaedic
and rheumatology clinics (12%) were screened for
diagnostic label of knee, hip or hand OA confirmed
by ACR criteria. Of them, 210 (10%) patients were
eligible so 1890 (90%) patients were excluded. Nine
patients declined to give consent. In the final analysis,
201 patients were studied. Their consent was sought.
All procedures were in accordance with the institutional

G.O.Oyoo, F.Adelowo.  2013.  AfricanJournal ofRheumatology Systemic. ISSN. 1(2483):88. Abstractafrica_journal_rheumatology.pdf

Background: Hepatitis C Virus (HCV)
infection is a worldwide burden whose
seroprevalence is higher in developing countries with Cameroon being the
third most aff ected country in Africa.
HCV both a hepatotropic and lympho-
tropic infection is responsible for a great
number of hepatic and extra hepatic
disorders some of which are rheumatic
in nature. These rheumatologic mani-
festations though extensively studied
in western countries; there is little or no
data in sub-Saharan Africa.
Objective: The study was conducted
with the aim to describe the musculo-
skeletal manifestations associated to
HCV infection in a hospital setting in
Cameroon.
Design: A cross-sectional study.
Setting: Three hospitals in Cameroon:
the Douala General Hospital, a tertiary
referral hospital with a capacity of 320
beds in Douala, the largest city and
economic capital of Cameroon; the
University Teaching Hospital of the
Faculty of Medicine and Biomedical
Sciences of the university of Yaoundé
1, a 240 beds hospital in Yaoundé the
political capital of Cameroon and the
“Centre Médical de la Cathédrale”,
a private acceptable standard
Gastroenterology clinic also found in
Yaoundé.
Patients and methods: From February
to June 2009, we did a multicentric
cross-sectional study of patients from
the Gastroenterology, Rheumatology
and Internal medicine outpatient clinics
of three hospitals in Cameroon. Patients
with HIV or HBV infection and those on
antiviral treatment were excluded.
Results: Among 148 patients with HCV
infection identifi ed during the study
period, only 62 fulfi lled eligibility, 15
(24.2%) of whom had musculoskeletal
manifestations related to HCV, the
commonest of which were myalgia
9/62 (14.5%) , arthritis 6/62 (9.7%), bone
pain 6.4% (4/62), sicca syndrome 3/62
(4.8%), and Raynaud’s phenomenon
6/62 (9.7%). Among patients with
rheumatologic manifestations, 9/15
(60%), had rheumatologic symptoms at
HCV diagnosis and in 6/15 (40%). HCV
infection was discovered during routine
medical check-up. Musculoskeletal
manifestations were neither associat ed
with the genotype (p=0.17) nor with the
viral load (p>0.98).
Conclusion: Arthralgia is the most
common presenting feature of the
symptomatic disease. Musculoskeletal
manifestations may be confused with symptoms of common tropical infections, leading to delayed diagnosis
and treatment of HCV infection.
Key words: Hepatitis C Virus, Arthralgia,
Extra hepatic manifestations; Africa
Introduction
Hepatitis C Virus (HCV) infection
which occurs worldwide has a higher
seroprevalence in Africa, estimated
at 5.3% compared to about 1.03%
in Europe1,2. Cameroon, the third
most affected country in Africa, has a
seroprevalence which varies from as low
as 0.6% to 4.8% in Pygmy groups and
blood donors, to as high as 13% in hospital
based studies4,5. Hepatitis C virus (HCV)
which is a single-stranded, spherical RNA enveloped fl avivirus, measuring 38 to 50
nm in diameter has multiple genotypes
and quasispecies classifi ed in six major
clades. This genetic diversity confers to
this virus a difference in pathogenicity,
disease severity, and response to treatment
with interferon3. Though considered a
hepatotropic virus, HCV’s lymphotropic
nature is responsible for a great number of
extra hepatic immune system disorders1.
About 40 to 70% of affected patients will
develop an extra hepatic manifestation
that can have a rheumatic nature

Oyoo, GO, Joshi D, Nour HA.  2013.  PATTERNS OF KNEE, HIP AND HAND OSTEOARTHRITIS IN KENYATTA NATIONAL HOSPITAL. EAOJ. 7(1):24. Abstractpatterns_of_knee_hip_and_hand.pdf

Background: Osteoarthritis (OA) is one of the most common chronic rheumatic disorders and is associated
with significant morbidity and disability. Few studies examined the spectrum of rheumatic diseases in sub-
Saharan Africa. Obesity is not only a risk factor for incidence of OA but also for the progression of the
disease.
Objective: The aim of the study was to determine the patterns of knee, hip and hand osteoarthritis as well
as obesity prevalence in the patients with established disease.
Methods: A cross-sectional descriptive study, we examined patients with knee, hip and hand osteoarthritis
to describe the patterns of osteoarthritis in 201 patients who fulfilled the ACR diagnostic criteria. Their
body mass indices were also studied to determine the prevalence of obesity in this cohort of patients
Results: A total of 201 patients with knee, hip or hand osteoarthritis were studied. Of these participants,
77% had knee OA, 15% hip OA, 3% hand OA and 5% had combined knee and hip OA. Obese participants
were 41% and 32% were overweight. There were 89 (44.3%) participants with bilateral knee or hip disease
while 112(55.7%) had unilateral disease. Obesity was more common in participants with knee than in hip OA
(45.3% vs 10.3% respectively) P < 0.001. The bilateral disease was higher in obese (55.2%) and overweight
(44.6%) participants compared to participants with normal body mass indices (26.5%) P value < 0.007.
Conclusion: Knee OA was very common and the majority of the patients were overweight and obese.
Bilateral OA was more prevalent in obese and overweight participants compared to normal weight
participants. Obesity is an easily modifiable risk factor for knee OA so it can be made a valid target for
preventing as well as halting the progression of OA.

2012

Omondi, O;G, Bartlett SJ;, Colmegna I.  2012.  The ILAR-East Africa initiative: current needs and progress in the globalization of rheumatology. Abstract

n early 2009, the International League of Associations for Rheumatology (ILAR) funded a program known as the “East Africa Initiative.” The long-term goal of this program is to unite the international rheumatology community to aid in enhancing clinical rheumatology services in an area that carries 25% of the world’s disease burden but has only 2% of the world’s human resources for health. This paper provides an overview of the rationale and progress to date of this collaborative effort toward the globalization of rheumatology.

2011

B Ganda, GO Oyoo, KMJM.  2011.  Peripheral arterial disease in rheumatoid arthritis patients at the Kenyatta National Hospital, Kenya. East African Medical Journa. 88(12) AbstractWebsite

Objective: To determine the magnitude of the rosclerotic arterial disease in Rheumatoid Arthritis(RA) patients at Kenyatta National Hospital.
Design: hospital based cross-sectional study.
Setting: Kenyatta National Hospital Rheumatology outpatient clinic.
Subjects: Rheumatoid Arthritis patients.
Results: We obtained ABI measurements in 90 RA patients, among them 23(25.5% 95% CI 17.2-36.1) had obstructed lower limb arteries. Among the 23, 21(91.3%) had mild PAD, two (8.7%) had moderate PAD; none had severe PAD nor incompressible vessels. The obstruction of vessels was independent of diabetes, hypertension, dyslipidemia and cigarette smoking though these factors increased the likelihood of having PAD. Risk age( ≥45 males, ≥55 females), Established RA(> 5 year duration) and severe RA were found to be significantly associated with the likelihood of having PAD. These trends remained significant after multivariable adjustment for potential confounders. twenty five (27.7%) of the study subjects exhibited symptoms of intermittent claudication, 13(52%) of them had PAD on ABI measurements, The Edinburgh claudication questionnaire was found to have 56.5% sensitivity and 82% specificity in detection
of PAD in RA patients. Conclusion: There seems to be an association between PAD in RA with chronicity and severity of the RA. This association may support the pathogenic role of accumulated systemic inflammation in atherosclerosis. Clinicians should be alert to the possibility of impared arterial function and thus subsequent cardiovascular morbidity and mortality in this group of patients.

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