The management of gout in Africa: challenges and opportunities
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REVIEW ARTICLE
The management of gout in Africa: challenges and opportunities Eugene Kalman Genga 1
&
G. O. Oyoo 1 & Asgar Ali Kalla 2
Received: 8 May 2020 / Revised: 1 September 2020 / Accepted: 12 September 2020 # International League of Associations for Rheumatology (ILAR) 2020
Abstract The rise in non-communicable diseases in Africa presents challenges for health systems that are burdened by infectious diseases. Gout is one of those diseases that has seen an increase in numbers worldwide, including Africa. Gout is commonly associated with comorbidities and mortality. It directly impacts the quality of life, increases health costs, decreases physical function, and significantly increases the time from work, much of which is potentially avoided if treatment is instituted early. Despite advances in understanding the pathophysiology and outcomes of gout, the quality of care delivered to patients in Africa is still suboptimal. Existing data on gout in Africa reveals a general low index of suspicion due to limited knowledge of the disease by healthcare workers resulting in late diagnosis, with severe polyarticular tophaceous gout being a common presenting feature. These late presentations are associated with avoidable disability and increase the direct and indirect costs of managing gout. The challenges are related to lack of government budgetary support for staff training, infrastructure for diagnosis, and availing medicines. The picture of gout in Africa largely mirrors the west concerning risk factors, comorbidities, and burden of disease, but with some unique presentations seen in HIV, sickle cell disease, and vertigo. We discuss the challenges of gout diagnosis and management in Africa and propose a roadmap to improve gout outcomes across Africa. Keywords AFLAR . Africa . Challenges . Gout . Opportunities
Background Gout is the most common inflammatory arthritic condition characterized by urate crystal deposition into the joints [1]. It causes recurrent acute arthritis, subcutaneous tophi, and chronic painful arthritis and impacts morbidity and premature mortality [2]. It is commonly associated with cardiovascular and renal diseases and is an independent predictor of early death. Gout has a worldwide distribution. The different prevalence rates reflect the influences of environmental, dietary, and genetic factors [3]. For years gout was thought to be a preserve of the developed world. We are now seeing a surge in the numbers in the developing world. The emergence of gout in Africa
* Eugene Kalman Genga [email protected] 1
Department of Clinical Medicine and Therapeutics, College of Health Sciences, University of Nairobi/Kenyatta National Hospital, Nairobi, Kenya
2
Department of Medicine, University of Cape Town, Cape Town, South Africa
can be attributed to an increased awareness among healthcare givers of the disease and the adoption of more western lifestyles and diets by the developing world [4].
Epidemiology The paucity of data on incidence and prevalence rates has led to underestimating the
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