Think You've Got it Bad?

Do you think you have it bad? Try getting RA if you live in Sudan. Until recently, there was only 1 Sudanese case report describing the evidence of lytic RA-like lesions in a Nubian female mummy 3000 years ago. The population of Sudan is about 25 million with only 5 rheumatologists in the country. That's 1 rheumatologist to every 5 million people.

Traditionally, a challenge with studying the RA population in Sudan has been having adequate follow-up data since many individuals don't have home phones or even addresses. However, the advent of cellular phones has changed all of this.

One research group has compared the characteristics of an RA population in Sweden to an RA population in Sudan. The striking highlights include:

The Sudanese population was significantly younger. This in part due to the lower life expectancy in Sudan vs. Sweden.
The ESR was considerably higher in Sudan with a mean ESR of 60 vs. 20 in Sweden.
The Sudanese population was well treated with higher or comparable rates of methotrexate and DMARD combination use. However, NSAIDs were much more commonly used in Sudan and there was no use of biologics.
The proportion of IgM RF positivity was significantly lower (50%) among Sudanese RA patients.

As I was looking at this poster, Dr. Alf Cividino (McMaster University, Hamilton) told me that the situation is even worse in Zambia where there are no rheumatologists and if you want to order an ANA you have to actually send the blood to South Africa! So, do you think you've really got it that bad?

More reports from ACR 2014