Bio

Prof. OYOO GEORGE OMONDI

Biographical Sketch

Prof. Omondi Oyoo FCP(ECSA) FACR; FRCP(Edin); FIPH;  MMed ;MB Ch B; Cert Trop Med;  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, 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 FCP(ECSA) FACR; FRCP(Edin); FIPH; MMed ;MB Ch B; Cert Trop Med; 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, Head of rheumatology unit at the Kenyatta National Hospital in Nairobi, Kenya.
Prof.Oyoo received his medical degree from the University of Nairobi and completed his residency in internal medicine at the University of Nairobi.

Publications


2021

Adelowo, O, Mody GM, Tikly M, Oyoo O, Slimani S.  2021.  Rheumatic diseases in Africa. Af r ic a n J o u r n a l o f R h e u mat o l o g y. 7(1):1-6. Abstracts41584-021-00603-4_1_2.pdf

Abstract
|
Historically, rheumatic diseases have not received much attention in Africa, particularly
in sub- Saharan Africa, possibly owing to a focus on the overwhelming incidence of infectious
diseases and the decreased life span of the general population in this region. Global attention
and support, together with better health policies and planning, have improved outcomes for
many infectious diseases; thus, increasing attention is being turned to chronic non- communicable
diseases. Rheumatic diseases were previously considered to be rare among Africans but there is
now a growing interest in these conditions, particularly as the number of rheumatologists on the
continent increases. This interest has resulted in a growing number of publications from Africa
on the more commonly encountered rheumatic diseases, as well as case reports of rare diseases.
Despite the limited amount of available data, some aspects of the epidemiology, genetics and
clinical and laboratory features of rheumatic diseases in African populations are known, as is some
detail on the use of therapeutics. Similarities and differences in these conditions can be seen
across the multi- ethnic and genetically diverse African continent, and it is hoped that increased
awareness of rheumatic diseases in Africa will lead to earlier diagnosis and better outcomes
for patients.

NM, M, GO O.  2021.  Fibromyalgia: Reviewing the epidemiology and gender-based differences in Africa. African Journal of Rheumatology. 7(1):3-7. Abstractfibromyalgia.pdf

Objectives: Fibromyalgia is a
complex disorder which presents with
chronic widespread musculoskeletal
pain, together with other symptoms
like fatigue, sleep disturbances and
cognitive disturbance. The cause remains
unclear but it is postulated that there
are abnormalities in neurohormonal
profile and central sensitization to pain
as the main mechanism. It is known to
occur more commonly in females than
males. This study set out to look at these
differences in terms of epidemiology and
gender differences.
Data source: We conducted online and
public library searches using the English
language.
Data extraction: We reviewed several
papers and research work focusing on
epidemiology and differences in gender
presentation. The period of the search was
between the years 1990 up to 2020.
Conclusion: Fibromyalgia is a commonly
occurring rheumatologic condition.
Gender differences exist with regard to
epidemiology, clinical presentation and
health seeking behaviors. Population
based studies would be of use to establish
the prevalence in Africa. More studies
would be necessary to explain the gender
differences noted in the many aspects
of the disease including response to
treatment.
Key words: Fibromyalgia, Fibromyalgia
in women, Gender differences and impact
of fibromyalgia

S1, A, GO O, E3 A, J4 K.  2021.  Profiles of vitamin D among patients with rheumatoid arthritis at the Kenyatta National Hospital. Department of Clinical Medicine and Therapeutics, College of Health Sciences, University of Nairobi,. 1(1):23-27.
Olufemi Adelowo, Girish M. Mody, Mohammed Tikly, Omondi Oyoo, Samy Slimani.  2021.  Rheumatic diseases in Africa. Nature reviews. s41584(021):00603-4. Abstract

Abstract | Historically, rheumatic diseases have not received much attention in Africa, particularly
in sub- Saharan Africa, possibly owing to a focus on the overwhelming incidence of infectious
diseases and the decreased life span of the general population in this region. Global attention
and support, together with better health policies and planning, have improved outcomes for
many infectious diseases; thus, increasing attention is being turned to chronic non- communicable
diseases. Rheumatic diseases were previously considered to be rare among Africans but there is
now a growing interest in these conditions, particularly as the number of rheumatologists on the
continent increases. This interest has resulted in a growing number of publications from Africa
on the more commonly encountered rheumatic diseases, as well as case reports of rare diseases.
Despite the limited amount of available data, some aspects of the epidemiology, genetics and
clinical and laboratory features of rheumatic diseases in African populations are known, as is some
detail on the use of therapeutics. Similarities and differences in these conditions can be seen
across the multi- ethnic and genetically diverse African continent, and it is hoped that increased
awareness of rheumatic diseases in Africa will lead to earlier diagnosis and better outcomes
for patients.

W, G, M O, GO O.  2021.  Treatment Approaches for Multiple Myeloma: A Review. Journal of Kenya Association of Physicians. 3(1):29-34. Abstract

Background: Multiple Myeloma (MM) is a
haematological cancer characterized by complications
of end-organ damage and subsequently high mortality.
Previously, there were few therapies available with
minimal survival benefit for most patients. Survival
was less than a year in many countries. The survival of
MM patients can range from 6 months to over 10 years,
with a median of 6 years, depending on stage of the
disease at diagnosis and prognostic factors. However,
with the advent of newer immune modulating agents
and novel therapies, there exists an opportunity to
improve the management of MM.
Objective: The purpose of this review is to discuss
the current chemotherapy and novel agents available
for treatment of Multiple Myeloma and highlight
emerging therapies in treatment of Multiple Myeloma,
some of which are now locally available in Kenya.
Data Sources: International Guidelines on Treatment
of Multiple Myeloma; Published articles from peerreviewed
journals; ESMO, NCCN guidelines on
Multiple Myeloma
Conclusion: New MM therapies have been shown to
improve progression-free survival and overall survival
of to upto 82% at four years. Some of these therapies
are now accessible locally through government
funding. In combination with a wholesome approach
which includes appropriate supportive care, there
exists an opportunity to improve the quality and
standard of care of MM patients in Kenya to replicate
the success of that in developed countries.
Key words: Multiple myeloma, Cancer

Muyodi, MM, Oyoo GO, KAYIMA JK, Bhatt KM.  2021.  PREVALENCE OF AND FACTORS ASSOCIATED WITH CHRONIC KIDNEY DISEASE IN OSTEOARTHRITIS PATIENTS AT KENYATTA NATIONAL HOSPITAL. EAOJ. 14(2):72-80. Abstract

Background: Chronic Kidney Disease (CKD) is a global health problem with an increase in prevalence especially
in Sub-Saharan Africa (SSA). It has a high morbidity and mortality. CKD and osteoarthritis (OA) are related as
they both increase with age and are associated with comorbidities e.g. hypertension, obesity etc. However,
there is limited evidence on the prevalence and associated risk factors of CKD among OA patients.
Objective: To assess the prevalence and factors associated with CKD in OA patients attending Rheumatology
and Orthopaedic clinics at Kenyatta National Hospital.
Design: A hospital-based descriptive cross-sectional study.
Methods: The study was conducted between November 2019 and January 2020 involving patients aged 18
years and above; being followed up in the rheumatology and orthopaedic clinics at Kenyatta National Hospital
with a diagnosis of knee, hip, spine and hand osteoarthritis based on the American College of Rheumatology
criteria. Chronic kidney disease was defined as an eGFR of less than or equal to 60 ml/min/1.73m2 and/or
proteinuria of 30 mg/dl detected on urinary dipstick for three months or more. Descriptive statistics were
used to describe the participants. Association between participants’ characteristics and CKD prevalence were
assessed using chi-square and factors associated with CKD among OA patients using bivariate and multivariable
logistic regressions.
Results: The overall prevalence of CKD among patients with osteoarthritis was 61.9% (56.4–66.3) as per eGFR
using Cockrauft Gault (CG). Most were in CKD stage 3 at 59.2% with 45.5% in G3a and 13.7% in G3b. One point
one percent were in stage 1, 38.3% in stage 2 and 1.4% were in CKD stage 4 and 5. Only 12.1% of the respondents
had persistent proteinuria and thus most of the patients had low and moderate risk for CKD progression at
38% and 38.2% respectively. Only 12.1% and 11.6% had high and very high risk for CKD progression. The CKD
prevalence increased with age, being highest among older adults (65+ years). The prevalence was higher
among men than women (65.9%, 95% CI: 54.7–75.5 vs. 60.2%, 95% CI: 54.4–65.7). The factors associated with
CKD in OA were old age, hypertension and poor and fair self-rated health which increased the odds of CKD
while moderate physical activity

Akintayo, RO, Akpabio AA, Kalla AA, Dey D, Migowa AN, Olaosebikan H, Bahiri R, Miedany YE, Hadef D, Oyoo O.  2021.  TheimpactofCOVID-19onrheumatologypractice acrossAfrica. Af r ic a n J o u r n a l o f R h e u mat o l o g y. 9(1):1-6. Abstractthe_impact_of_covid-19_on_rheumatology_practice.pdf

Objectives. To identify the changes in rheumatology service delivery across the five regions of Africa from the
impact of the COVID-19 pandemic.
Methods. The COVID-19 African Rheumatology Study Group created an online survey consisting of 40 questions
relating to the current practices and experiences of rheumatologists across Africa. The CHERRIES checklist for
reporting results of internet e-surveys was adhered to.
Results. A total of 554 completed responses were received from 20 countries, which include six in Northern
Africa, six in West Africa, four in Southern Africa, three in East Africa and one in Central Africa. Consultant grade
rheumatologists constituted 436 (78.7%) of respondents with a mean of 14.56 10.3 years of experience. A total of
77 (13.9%) rheumatologists avoided starting a new biologic. Face-to-face clinics with the use of some personal
protective equipment continued to be held in only 293 (52.9%) rheumatologists’ practices. Teleconsultation modalities
found usage as follows: telephone in 335 (60.5%), WhatsApp in 241 (43.5%), emails in 90 (16.3%) and video
calls in 53 (9.6%). Physical examinations were mostly reduced in 295 (53.3%) or done with personal protective
equipment in 128 (23.1%) practices. Only 316 (57.0%) reported that the national rheumatology society in their
country had produced any recommendation around COVID-19 while only 73 (13.2%) confirmed the availability of a
national rheumatology COVID-19 registry in their country.
Conclusion. COVID-19 has shifted daily rheumatology practices across Africa to more virtual consultations and
regional disparities are more apparent in the availability of local protocols and registries.
Key words: COVID-19, Africa, rheumatology, DMARD, rheumatic and musculoskeletal diseases, telem

S, A, GO O, E A, J K.  2021.  Profiles of vitamin D among patients with rheumatoid arthritis at the Kenyatta National Hospital. Af r ic a n J o u r n a l o f R h e u mat o l o g y. 9(1):23-27. Abstractprofiles_of_vitamin_d_among_patients_with_ra_at_knh.pdf

Background: Rheumatoid Arthritis (RA)
is an autoimmune, chronic debilitating
condition of undetermined cause. It
affects numerous extra- articular organ
systems. Vitamin D is a steroid hormone
synthesized in the skin by the action of
ultraviolet B (UVB) irradiation. Active
vitamin D is important in the inhibition
of T cell proliferation and downregulation
of key inflammatory cytokines
responsible for the pathogenesis of RA.
There is growing evidence demonstrating
the association between vitamin D
insufficiency and higher incidence of RA
as well as increased severity of disease
and increased functional disability in RA
patients.
Objective: The purpose of this study
was to determine serum vitamin D levels
among patients with rheumatoid arthritis
at the Kenyatta National Hospital (KNH)
and its association with disease activity
and functional disability.
Design: This was a descriptive crosssectional
survey.
Methods: The study involved subjects
with RA at the Kenyatta National Hospital.
Consecutive sampling technique to
recruit patients with rheumatoid arthritis,
having met the 2010 American College
of Rheumatology/ European League
Against Rheumatism (ACR/EULAR)
classification criteria was selected. Ten
mls of peripheral blood was collected
from the recruited subjects to determine
serum vitamin D levels. Every participant
had their demographics, clinical history
and disease duration documented. Clinical
Disease Activity Index (CDAI) was used
to assess disease activity and severity. It
comprised of number of tender joint out
of 28 joints (T-28), number of swollen
joints out of 28 (S-28) global health
assessment score by both the physician
and the patient. level of disability was
determined by the standard Modified
Health Assessment Questionnaire
(MHAQ). Data analyzed was correlated
to determine their association with serum
vitamin D levels. SPSS version 21 was
used to analyze the data collected and this
entailed descriptive statistics, chi-square,
ANOVA and students’-test to compare
and correlate vitamin D levels with age,
duration of disease, CDAI score and
modified HAQ score in RA.
Results: Eighty one patients with a mean
age of 48.7 (SD 13.9), median of 48.0
(IQR 40.0-59.0) were evaluated. The
female to male ratio was 4:1. The mean
serum 25-VD concentration was 34.9ng/
ml (SD11.6). Thirty five participants
(43.2%) had insufficient vitamin D levels
(<30ng/ml), whereas 46 study participants
(56.8%) had sufficiency of vitamin D.
Majority of the patients 54 (67.5%) had
low disease activity. Fourteen subjects
17.5% had high disease activity and while
2.5% were on remission. Functional
disability was assessed using the modified
health assessment questionnaire. Thirty
eight participants (46.5%) demonstrated
no disability, 33.8% had mild disability
while 9% had severe disability.
Correlation between vitamin levels with
age, duration of disease, CDAI and HAQ
did not attain statistical significance.
Conclusion: Vitamin D insufficiency is
high among patients with rheumatoid
arthritis with no correlation with age,
duration of disease, functional disability
and disease activity.
Key words: Rheumatoid arthritis,
Vitamin D, Disease activity, Functional
disability, Cytokines
Introduction

NM, M, GO O.  2021.  Fibromyalgia: Reviewing the epidemiology and gender-based differences in Africa. African Journal of Rheumatology. 7(1):3-7. Abstractfibromyalgia.pdf

Abstract
Objectives: Fibromyalgia is a
complex disorder which presents with
chronic widespread musculoskeletal
pain, together with other symptoms
like fatigue, sleep disturbances and
cognitive disturbance. The cause remains
unclear but it is postulated that there
are abnormalities in neurohormonal
profile and central sensitization to pain
as the main mechanism. It is known to
occur more commonly in females than
males. This study set out to look at these
differences in terms of epidemiology and
gender differences.
Data source: We conducted online and
public library searches using the English
language.
Data extraction: We reviewed several
papers and research work focusing on
epidemiology and differences in gender
presentation. The period of the search was
between the years 1990 up to 2020.
Conclusion: Fibromyalgia is a commonly
occurring rheumatologic condition.
Gender differences exist with regard to
epidemiology, clinical presentation and
health seeking behaviors. Population
based studies would be of use to establish
the prevalence in Africa. More studies
would be necessary to explain the gender
differences noted in the many aspects
of the disease including response to
treatment.
Key words: Fibromyalgia, Fibromyalgia
in women, Gender differences and impact

2020

Muyodi, MM, Bhatt KM, KAYIMA JK.  2020.  PREVALENCE OF AND FACTORS ASSOCIATED WITH CHRONIC KIDNEY DISEASE IN OSTEOARTHRITIS PATIENTS AT KENYATTA NATIONAL HOSPITAL. EAOJ. 14(2):72-80. Abstractprevalence_of_and_factors_associated_with_ckd_in_osteoarthritis.pdf

Background: Chronic Kidney Disease (CKD) is a global health problem with an increase in prevalence especially
in Sub-Saharan Africa (SSA). It has a high morbidity and mortality. CKD and osteoarthritis (OA) are related as
they both increase with age and are associated with comorbidities e.g. hypertension, obesity etc. However,
there is limited evidence on the prevalence and associated risk factors of CKD among OA patients.
Objective: To assess the prevalence and factors associated with CKD in OA patients attending Rheumatology
and Orthopaedic clinics at Kenyatta National Hospital.
Design: A hospital-based descriptive cross-sectional study.
Methods: The study was conducted between November 2019 and January 2020 involving patients aged 18
years and above; being followed up in the rheumatology and orthopaedic clinics at Kenyatta National Hospital
with a diagnosis of knee, hip, spine and hand osteoarthritis based on the American College of Rheumatology
criteria. Chronic kidney disease was defined as an eGFR of less than or equal to 60 ml/min/1.73m2
and/or
proteinuria of 30 mg/dl detected on urinary dipstick for three months or more. Descriptive statistics were
used to describe the participants. Association between participants’ characteristics and CKD prevalence were
assessed using chi-square and factors associated with CKD among OA patients using bivariate and multivariable
logistic regressions.
Results: The overall prevalence of CKD among patients with osteoarthritis was 61.9% (56.4–66.3) as per eGFR
using Cockrauft Gault (CG). Most were in CKD stage 3 at 59.2% with 45.5% in G3a and 13.7% in G3b. One point
one percent were in stage 1, 38.3% in stage 2 and 1.4% were in CKD stage 4 and 5. Only 12.1% of the respondents
had persistent proteinuria and thus most of the patients had low and moderate risk for CKD progression at
38% and 38.2% respectively. Only 12.1% and 11.6% had high and very high risk for CKD progression. The CKD
prevalence increased with age, being highest among older adults (65+ years). The prevalence was higher
among men than women (65.9%, 95% CI: 54.7–75.5 vs. 60.2%, 95% CI: 54.4–65.7). The factors associated with
CKD in OA were old age, hypertension and poor and fair self-rated health which increased the odds of CKD
while moderate physical activity, overweight/obesity and use of more than one medication (NSAID/ACEI/ARB)
reduced the odds of CKD.
Conclusion: This study provides evidence that osteoarthritis is associated with a high prevalence of CKD.
However, most of the patients are asymptomatic and in low and moderate risk category based on Kidney
Disease Improving Global Outcomes (KDIGO) nomenclature. Osteoarthritis patients should be considered a
high-risk group for chronic kidney disease given their older age, chronic use of NSAIDs and high prevalence of
comorbidities e.g. hypertension, overweight/obesity which are known risk factors for CKD. Screening for CKD
in OA patients should therefore be done routinely as is the case in other high risk groups e.g. diabetes.

W1, G, Ongondi M2, GO1 O.  2020.  Treatment Approaches for Multiple Myeloma: A Review. Journal of Kenya Association of Physicians. 3(1):29-34.
A, N, GO O, C O.  2020.  The use of musculoskeletal ultrasound of the wrist and hand in the assessment of treatment response in rheumatoid arthritis patients. Afr J Rheumatol. 8(1):3-7. Abstract

Objective: Rheumatoid arthritis is a
debilitating disease with accrual of joint damage during each flare of the disease that progresses to considerable functional disability. Early treatment is
thus aimed to achieve remission status so as to reduce the progression of joint
damage. Currently the disease activity parameter DAS28 (amongst others)
is used to define a remission status and thus demonstrate the efficacy
of a treatment regimen, however musculoskeletal ultrasound (MSUS) is
proving to be superior at determining the amount of inflammation within joints by grading synovial hypertrophy and neo-vascularization of the
inflamed synovium. This article is thus intended to shed light on the usefulness of musculoskeletal ultrasound
both greyscale and Doppler in the determination of treatment response
in rheumatoid arthritis patients. Design: This article will elaborate
the importance and effectiveness of musculoskeletal ultrasound. Thus it will involve a discussion on the need for an effective tool to detect inflammatory activity, the ability of ultrasound to detect and grade the disease activity i.e.
being sensitive to change, the various scoring systems currently used, and
lastly a comparison of musculoskeletal ultrasound to other modalities and
clinical and serological evaluation. Data source and extraction:
Published studies, reviews and guidelines regarding the use of
musculoskeletal ultrasound of the wrist/hand in assessing treatment
response in rheumatoid arthritis patients were sourced through the
internet and library searches and the relevant data extracted. Conclusion:
status of the patient or a high initial ESR with significant serological and clinical
improvement, which will again not be portrayed in the DAS28 results. There may also be variability when assessing joints that are swollen or tender in between different examiners4. Moreover, there is a subset of
patients who still have disease progression despite achieving clinical remission status5.
  Magnetic Resonance Imaging (MRI) and radiographic evaluation have also been used as adjuncts to clinical exam but both have their drawb

S, D, GO O, V O-H.  2020.  Depression and its association with disease activity and quality of life in patients with rheumatoid arthritis at the Kenyatta National Ho. Afr J Rheumatol. 8(1):15-21. Abstractdepression_and_its_association_with_disease_activity.pdf

Background: Rheumatoid arthritis
is a systemic inflammatory disease that affects the synovial membrane,
resulting in the structural damage of cartilage, bone and ligaments. The
course of RA differs between patients, and its severity can range from selflimiting
disease to severe destruction and systemic complications. RA affects
patients physically, psychologically and socially. Patients experience pain,
joint swelling, stiffness, functional limitations and fatigue and overall poor
quality of life. In addition, they report anxiety and depressive symptoms
and concerns about increased physical limitations. Experiencing
psychological distress may inflate the subjective severity of patient-reported
symptoms such as pain and tenderness. Furthermore, patients experience a
loss of independence and restrictions in participation, i.e. a decrease in
socializing which may in turn propagate symptoms of depression. An accurate
description of the relationship between depression, disease severity and quality
of life is necessary for our setting. If an interaction exists, then there is a
group of vulnerable patients who could benefit from earlier identification
of depression and the impact their disease has on HRQoL and appropriate
management provided. Objective: To determine the prevalence
of depression and the relationship between depression, disease activity
and quality of life in ambulatory patients with rheumatoid arthritis at
the Kenyatta National Hospital.Design: A descriptive-cross sectional

GO, O, EK G, S N.  2020.  Audit on the management of early rheumatoid arthritis in Nairobi. Afr J Rheumatol. 8(1):22-25. Abstractaudit_on_the_management_of_early_rheumatoid_arthitis_in_nairobi.pdf

Background
: Clinical audit for rheumatoid arthritis on patients over
the age of 18 years in Nairobi, Kenya within the first three months of referral to a specialist. Objective: The audit gives detailed
information on the following; access to care, quality of treatment and
care received by patients from their rheumatology team in these first 3 months and the early impact of arthritis on the patient’s life.
Design: This was a cross-sectional
survey. Results
: The audit included 100 patients referred to the Nairobi Arthritis
Clinic between January and April 2018. A majority (54%) had symptoms for
more than 6 months before being referred to a rheumatologist. Most of
the patients (83%) were seen within 3 weeks of referral. Disease Modifiying
Antirheumatic Drugs (DMARDs) were commenced in 90% within 6 weeks of
being seen at the clinic. Treatment to target was done in 98% of the patients
with a further 60% able to access the clinic within a day of flare of symptoms. Conclusion: The audit revealed the
need to improve on referral time to the rheumatologist. It was encouraging
to note that once they saw the rheumatologists the patients were
commenced on the proper treatment with the treat to target strategy. An area
that needs improvement is the time to access the rheumatologist in case of
side effect from the treatment or flare of the disease

2018

LT, E, J O, GO O.  2018.  Fever of unknown origin: A rheumatologic perspective. Afr J Rheumatol . 6(1):26-28.fever_of_unknown_origin.pdf
EK, G, GO O, A G, KM B, B M, FO O, RG C.  2018.  Sarcocystosis: a rare polymyositis mimic. Afr J Rheumatol . 6(1):18-19.sarcocystosis.pdf

2017

Genga, EK, Oyoo O, Espinoza LR, Adebajo A.  2017.  Africa Journal of Rheumatology: enhancing the visibility of rheumatology in Africa. Abstractajr_enhancing_the_visibility_of_rheumatology_in_africa_2017-clinical_rheumatology.pdf

Africa Journal of Rheumatology: enhancing the visibility
of rheumatology in Africa
Eugene K. Genga1,2 & Omondi Oyoo1,2 & Luis R. Espinoza3 & Adewale Adebajo4
Received: 5 July 2017 /Accepted: 10 July 2017
# International League of Associations for Rheumatology (ILAR) 2017
Clinical Rheumatology welcomes the African Journal of
Rheumatology as an important development for the furtherance
of rheumatological scholarship and education on the
African continent and for rheumatology research in
Africans. It is hoped that this development will in turn raise
the profile of rheumatological conditions in Africa and among
Africans. In particular, it is hoped that this will lead to the
much needed collection of African musculoskeletal epidemiological
and health services data, assist in the training of
African rheumatologists, help to open up African rheumatology
to the global rheumatology community, and ultimately
improve the quality of care for myriads of Africans with rheumatic
disorders.
The current population of Africa is 1,241,858,354
which is equivalent to 16.36% of the total world population
based on the latest United Nations estimates [1].
There are many challenges facing Africa including limited
financial resources, misuse of finances, malnutrition, poor
water, and sanitation among others. Despite these many
challenges faced in Africa, in recent times, the continent
has undergone rapid economic growth and development.
The available healthcare resources are overburdened by
the high burden of communicable diseases and the rising
prevalence of non-communicable diseases. Rheumatic
diseases are therefore not considered a high priority by
the various African governments. Part of the reason for
this is due to the limited epidemiological data on rheumatic
diseases and their burden in Africa. Scientific
journals play a central role in the dissemination of research
results which will ultimately impact on policy
change. Horton et al. [2] noted that researchers and policy
makers in developing countries believe that the main way
to solve problems of developing countries is by using
information from Western research rather than using local
data to solve regional problems. He, however, noted that
in Africa “there is already a well-developed local information
culture that needs support, not swamping,” noting,
moreover, the lack of African journals in MEDLINE [2].
Researchers in Africa and the developing world require
access not only as readers but also as authors: for them
to feel part of the global science community, they need
not only to obtain information but also to be able to contribute
to it and take part in the global discourse. The
continent’s resources are prioritized towards infectious
diseases like HIV and malaria over the now increasing
non-communicable diseases. Data on rheumatic diseases
in Africa has been limited partly due to lack of infrastructure
thus under diagnosis but also due to low scholarly
output. Thus, the Africa Journal of Rheumatology was
born. Since its inception 5 years ago, it has provided an
uninterrupted forum through which medical practitioners
and scientists from Africa and beyond can publish their
rheumatology research. It has become a rich source of
information about rheumatic disorders in the continent
and a timely addition to our worldwide rheumatology
community [3]. The journal has published various research
articles on diseases once thought to be rare in Africa. They
* Adewale Adebajo
a.o.adebajo@sheffield.ac.uk
1 Department of Clinical Medicine and Therapeutics, College of
Health Sciences, University of Nairobi/Kenyatta National Hospital,
Nairobi, Kenya
2 Nairobi Arthritis Clinic, Nairobi, Kenya
3 Louisiana State University School of Medicine, New Orleans, LA,
USA
4 Faculty of Medicine, Dentistry and Health, University of Sheffield,
Sheffield, UK
Clin Rheumatol
DOI 10.1007/s10067-017-3761-z
range from rheumatoid arthritis, lupus, gout, myositis to rheumatology
in HIV. Research articles published in the journal
shows rheumatoid arthritis, juvenile idiopathic arthritis, systemic
lupus erythematosus, and antiphospholipid syndrome to
be increasing in frequency in the indigenous populations of
East, West, Central, and Southern Africa [4–7]. The HIV pandemic
has changed the epidemiological spectrum of diseases
in Africa. It has led to an increase in a variety of previously
rarely seen conditions like spondyloarthropathies, fibromyalgia,
pyomyositis, and scleroderma. Various scholars have
shared their experiences in the journal [8–12]. The journal
has also provided a forum through which scholars have been
able to share their experiences in management of the rheumatic
diseases with biologic therapy. The results have been similar
to data from around the world [13, 14]. Case reports of rare
diseases and review articles have not been left out and have
enriched the content of the journal bringing diversity in the
articles published.
The visibility of the journal is hampered by the low scholarly
output. This is in part due to severe limitations in the
overall economic development and especially in research infrastructure.
Researchers have limited access to funding for
research as most African countries have no national agencies
that are responsible for research. This is compounded by limitations
in scientific writing, designing, and conducting research
and in reporting the results. Partnership with international
journals like the African Journal Partnership Project is
welcome to bridge that gap by training African health researchers
to improve the quality and visibility of their research
and make the Africa journal of rheumatology a better resource
for local researchers and policy makers [15].
This journal has become a site for exchange of knowledge
of local rheumatic diseases, research, and debate and providing
a forum through which international research can be made
applicable to the African set-up. The Africa Journal of
Rheumatology encourages international agencies, which conduct
research in the region to support the journal through
submission of research and subscription to the publication. It
is our hope that this journal will provide a big step to bridge
the big gaps in rheumatology in Africa.
Compliance with ethical standards
Disclosures None.
References
1. Worldometers (2017) (www.Worldometers.info)
2. Horton R (2000a) Development aid: manna or myth? Lancet 356:
1044–1045
3. Espinoza LR (2014) Welcoming an African asset: African Journal
of Rheumatology. Afr J Rheumatol 2(2):47–48
4. Otieno FO, Moots RJ, Oyoo GO (2017) Rheumatoid arthritis in
Kenya. Afr J Rheumatol 5(1):1–2
5. Akintayo RO, Aworinde OO, Olawumi HO, Yusuf IA (2016)
Antiphospholipid syndrome in Africa: a review. Afr J Rheumatol
3(1):3–8
6. Genga EK, Otieno FO, Oyoo GO (2015) Clinical profiles of patients
SLE in Nairobi. Afr J Rheumatol 3(2):62–66
7. Adelowo F (2013) Systemic lupus erythematosus: not a rare disease
among black Africans. Afr J Rheumatol 1(2):46–47
8. Oyoo GO, Genga EK, Otieno FO, Omondi EA (2016) Clinical
patterns of juvenile idiopathic arthritis: a single tertiary centre experience
in Kenya Nairobi. Afr J Rheumatol 4(2):66–71
9. Venkat R, Jawad ASM, Chikanza IC (2014) Spontaneous resolution
of a case of anti-retroviral treatment-naïve HIV-associated
polymyositis. Afr J Rheumatol 2(2):78–84
10. Ilovi S, Oyoo G (2013) Characteristics of systemic sclerosis patients
in Nairobi, Kenya: a retrospective study. Afr J Rheumatol 1(1):8–12
11. Malombe NM, Oyoo GO, Maritim MC, Kwasa J (2013) Prevalence
of fibromyalgia in ambulatory HIV positive patients with musculoskeletal
pain at Comprehensive Care Clinic, Kenyatta National
Hospital. Afr J Rheumatol 1(2):70–75
12. Ouédraogo DD, Ouédraogo T, Kaboré F et al (2013) Prevalence of
HIV infection among the patients with an avascular necrosis of the
femoral head in Ouagadougou, Burkina Faso Ouédraogo. Afr J
Rheumatol 1(2):57–60
13. Oyoo GO, Otieno FO, Mbuthia B, Omondi EA, Genga EK (2015)
Experience with rituximab in patients with rheumatoid arthritis in
Nairobi, Kenya. Afr J Rheumatol 3(1):17–21
14. Elhabbash B, Tarsin R (2017) Certolizumab effect in a cohort of 60
Libyan patients with rheumatic diseases. Afr J Rheumatol 5(1):19–
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15. Muula AS (2008) Medical journals and authorship in low-income
countries. Croat Med J 49:681–683

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.

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