Experience with rituximab in patients with rheumatoid arthritis in Nairobi, Kenya

Background: Rheumatoid Arthritis (RA) is a disease associated with significant morbidity and mortality. Newer therapies include B-cell targeted therapies such as rituximab. Objectives: To study the outcome in RA patients receiving rituximab following resistance to Disease Modifying Anti- Rheumatic Agents (DMARDS) and to determine the change in disease activity and functional status. Methods: A longitudinal prospective study was carried out on RA patients in Nairobi, Kenya. Patients resistant to DMARDS and on rituximab therapy were identified. Their disease activity was assessed using the Simplified Disease Activity Index (SDAI) and the functional status determined using Health Assessment Questionnaire-Disability Index (HAQ DI). The scores were recorded at the beginning of the study then at 3 and 6 months after the initiation of rituximab therapy. Results: Forty-one patients (36 females and 5 males) receiving rituximab were recruited in this study. At baseline, 18 had moderate and 23 with high disease activity. After 6 months, 7% were in remission, 11% with low, 17 moderate and 6 with high disease activity. There was significant improvement in the SDAI scores witnessed in 13(31.7%) patients in first 3 months and in 22(53.7%) patients after 6 months. There was a significant improvement in the functional and disability score in 95% of the patients after 6 months. There was no significant correlation between the SDAI and the different variables as age, disease duration, type of DMARD and steroids used. Conclusion: Rituximab use resulted in improvement of disease activity, functional status and disability index in patients with RA in Nairobi. Keywords: Rituximab, Rheumatoid arthritis, SDAI, HAQI, Nairobi, Keny