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Clinical patterns in patients with osteoarthritis seen at the orthopedic clinic of MTRH.


Josiah Nyakwara


Background: Osteoarthritis is a major public health issue related to age, which is characterized by progressive loss of articular cartilage that results in pain, functional impairment, disability and diminished quality of life. The disability associated with osteoarthritis (OA) and the difficulty associated with accessing treatment including the associated health care costs makes osteoarthritis an important condition in our set up. The clinical patterns of OA may be different in different cultures due to differences in lifestyle and daily activities. At Moi Teaching and Referral Hospital the clinical patterns of osteoarthritis continue to be dominated by opinions rather than evidence.

Objective: To describe the clinical patterns in patients with OA seen at the orthopedic clinic of MTRH.

Methods: This was a cross-sectional descriptive hospital based study that characterized osteoarthritis (OA) seen in purposely selected 177 patients consulting for osteoarthritis at MTRH, Eldoret, using an interviewer administered questionnaire. Data analysis focused on descriptive statistics among clinical and demographic characteristics. The clinical characteristics of OA were analyzed on Kellgren and Lawrence scale and The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). The relationship of OA pattern with socio-demographic factors was also determined. Statistical tables, bar graphs and pie charts were used to present data.

Results: The sample of 177 participants selected during a single clinic visit comprised 80 men and 97 women aged 20 to 81 years. Most patients (75.14%) with OA were 41 years and above. A considerable number (65.54%) of the patients had involved themselves in heavy level activities such as peasant farming. The most common joints affected were the hip (35.02%), the knee (24.29%), spine (15.81%) and the ankle (10.16%), an anatomical distribution that varied with socio-demographic factors of the patients. Most patients presented with worse pain (93.84%), extensive joint destruction (89.26%), and functional limitation (92.66%). More than a quarter (28.25%) of the patients with osteoarthritis had higher BMI. About 25% of patients with OA reported a prior joint destroying disease. Almost half (48.0%) of patients with OA had life threatening co-morbid conditions of which they were on follow up.

Conclusion: Advancing age, female gender, cigarette smoking, alcohol consumption, positive family history of osteoarthritis, and involvement in heavy level of activity are significant socio-demographic features seen in patients with osteoarthritis in our setup. The salient clinical characteristics seen in patients with osteoarthritis were severe pain, high grade joint destruction, functional limitation, and higher BMI index. Patients with OA present with other medical conditions that deserve attention. However, infective arthritis and mechanical loading during high level activities may explain the high occurrence of coxarthrosis in the present study.

Recommendation: There is need for prevention programs to reduce the burden of osteoarthritis in our set up.






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Document Type:Dissertion
Health Topic:Health Services & Policy, Surgery, Surgical Services
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KeywordsJoint pain, Orthopedics, Josiah, MTRH, Osteoarthritis, Kenya, Clinical patterns
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