Background/Purpose: Data regarding the prevalence of rheumatic diseases in sub-Saharan Africa is scarce and only a small number of rheumatologists practice in this region. Uganda with its 48 million people has two practicing rheumatologists, both working in the capital city of Kampala. The goal of this project was to describe the local spectrum of rheumatic diseases, available testing, medications, costs, and unique challenges.

Methods: From January-February 2024, de-identified clinic-level data regarding types of referrals and diagnoses encountered at the weekly Rheumatology Clinic at Mulago National Referral Hospital in Kampala, Uganda was aggregated over a six-week period. Pricing for laboratory tests and medications was obtained from a local laboratory and three local pharmacies.

Results: The most common conditions presenting at the Rheumatology Clinic included rheumatoid arthritis, osteoarthritis, connective tissue diseases, including systemic lupus erythematosus and systemic sclerosis, fibromyalgia, and unclear diagnoses. Knowledge gaps among primary care doctors lead to a high number of referrals for osteoarthritis. The available diagnostic testing includes anti-nuclear antibodies, disease-specific autoantibodies such as rheumatoid factor, anti-cyclic citrullinated peptide antibodies, anti-double stranded DNA antibodies, anti-neutrophil cytoplasmic antibodies, CRP, and complement levels. Laboratory testing is mainly provided by private laboratories and is usually paid out-of-pocket. Test prices range from USD 3.35 to USD 33.25, thereby exceeding multiple times the median daily income of USD 2.50. Prednisolone and oral disease-modifying anti-rheumatic drugs (DMARDs) such as azathioprine, methotrexate, hydroxychloroquine, and tofacitinib are frequently prescribed. Average monthly drug prices range from USD 3.12 to USD 65.52. Some biologics including rituximab and adalimumab are available, however, are usually not affordable for patients. The easy availability of glucocorticoids over-the-counter complicates the management of steroid tapers. Cost and the reportedly high rate of latent tuberculosis in the population limit the use of TNF-alpha inhibitors.

Conclusion: Access to rheumatology care in Uganda is constrained by a paucity of rheumatologists. The spectrum of available laboratory testing is extensive. Oral DMARDs are the mainstay of therapy, whereas biologics are not regularly used. Costs are a strong limiting factor for both diagnostics and medications. Research is needed to determine the prevalence of rheumatic diseases in Uganda. Additionally, the education of more providers in the diagnosis and management of rheumatic and musculoskeletal conditions is paramount to meet the needs of a growing population. This emphasizes the necessity for enhanced training opportunities for local physicians.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/insights-into-rheumatology-practice-in-uganda/