Polyarthritis in Kenya

Abstract

An attempt is made to describe the general physician's view of rheumatology in the African in Kenya with a review of findings elsewhere in tropical Africa. Osteoarthritis is excluded and monoarticular disease is only touched on. The author draws on three original sources of information. One is his general observations whilst practicing internal medicine in Kenya from 1957-1964, the second is a retrospective analysis of the case notes of 78 patients with polyarthritis admitted to King George VI Hospital in Nairobi, and the third a personal study of 131 patients with rheumatic diseases admitted to the Rift Valley Hospital, Nakuru, during a period of twenty months. The last group included 108 cases of polyarthritis. The overall figures from Nakuru are shown in the table below. Numbers of Nakuru patients with rheumatic diseases Rheumatoid arthritis 8 Systemic lupus erythematosus 3 Ankylosing spondylitis 1 Reiter's disease 3 Rheumatic fever 66 Joint infection 10 Gout 4 Miscellaneous 9 Undiagnosed 27 Total 131

The apparent incidence of these conditions is discussed and four factors affecting it are listed. They are: 1. The way in which patients are selected for admission. 2. The age and sex structure of the population. 3. Local difficulties in diagnosis. 4. Real differences in individual susceptibility.

Attention is drawn to unusual manifestations of these diseases as they are seen in the African, such as the way in which rheumatic fever affects adults, the relative sparing of the hands in rheumatoid arthritis, the frequent spinal involvement in brucellosis and a tendency to unusual radiological changes which are probably due to endemic fluorosis. The rheumatic diseases affecting the African in Africa appear to be much the same as those affecting the Englishman in England, although the relative incidence of them is different. Acute rheumatic fever, joint infections and perhaps Reiters disease are more common in the African but rheumatoid arthritis