Prevalence and spectrum of rheumatic and musculoskeletal diseases in a Lagos hospital community: An under-reported non-communicable disease in Africa

Background: Rheumatic and Musculo-skeletal Diseases (RMDs) previously known as the musculoskeletal (MSK) diseases are a major cause of chronic pain and functional disability. While there are few hospital based reports of RMDs and its individual conditions in Nigeria, community data of these conditions are even rarer. Objectives: To determine the prevalence and spectrum of RMDs as well as the factors associated with MSK pain in Nigeria. Design: This was a cross-sectional survey of staff and patients’ relatives at a Lagos tertiary hospital. Methods: We prospectively collected data on 350 respondents using a pre-tested interviewer-based study questionnaire and the Health Assessment Questionnaire-Disability Index (HAQ-D1) questionnaire. Clinical information was recorded and laboratory tests done for all participants. Data was analysed with descriptive statistics using Statistical Package for Social Sciences (SPSS) version 21. Ethical approval was obtained for the study. Results: A total of 268 (76.6%) respondents completed the study comprising 176 (65.7%) females and 92 (34.3%) males with a mean age of 57.3±12.4 years (range 20-70 years). RMDs and MSK pain (current/past) were diagnosed in 59 (22%) and 162 (60.4%) respondents respectively most of whom were female (n=38, 64%) and middle aged (n=31, 52.5%). Osteoarthritis (25.5%), limited joint mobility (18.6%), lumbosacral spondylosis (10.1%) and DeQuervain’s tenosynovitis (10.1%) were the most frequent RMDs. The median HAQ-DI was 0.8 (IQR 0.1-1.8) with significant disability (HAQ-DI≥1) in 57.5% of the subjects with RMDs. Respondents with MSK pain had higher proportions of truncal obesity (BMI>30) (n=89, 54.9%, p=0.016), family history of arthritis (n=93, 57.4%, p=0.001), abdominal obesity (n=97, 60%, p=0.002), hypertension (n=102, 63%, p=0.001), elevated acute phase reactants (n=57, 35.2%, p=0.003) and hyperuricemia (n=61, 37.6%, p=0.001) than respondents without MSK pain with no significant predictors of MSK pain documented after multivariate regression analysis. Conclusions: RMDs and MSK pain are common among Nigerians occurring in 22% and 60.4% respectively resulting in significant functional disability. Osteoarthritis was the most frequent presentation of MSK pain while obesity, hypertension, hyperuricaemia, positive family history of arthritis and elevated acute phase reactants were all associated with MSK pain