Prevalence and profiles of rheumatoid arthritis biomarkers among type II diabetes mellitus patients at Moi Teaching and Referral Hospital, Eldoret.

Abstract

Background: Rheumatoid arthritis (RA) is a chronic, progressive autoimmune disease of unknown cause. It is characterized by persistent inflammation that primarily affects the peripheral joints. It usually starts as an insidious symmetrical arthritis and has an unpredictable and variable course, although pain and disability can be minimized if the condition is recognized early and treated promptly and appropriately. In Kenya, there are minimum data regarding the prevalence of RA biomarkers in type II diabetic patients as a focus to reduce Non–communicable disease related morbidity and mortality. Objective: To determine the prevalence and profiles of early RA biomarkers among type II diabetes mellitus patients attending Clinic at Moi Teaching and Referral Hospital (MTRH). Methods: This was a quantitative cross sectional study conducted in Diabetic Clinic Chandaria MTRH for four months from May to August 2018. One hundred and eighty (180) parsons aged 18 years and above were recruited at the phlebotomy section to participate in the study using convenient sampling technique. A structured questionnaire was used to collect socio-demographic data. Venous blood samples were obtained for the measurement of Rheumatoid Factor, Anti- Cyclic Citrullinated proteins and Tenascin-C in the Laboratory using agglutination tests and Enzyme Linked Immunosorbent Assays (ELISA). Data was analyzed using EPI INFO for measures of central tendencies mean, median, standard deviation. Measures of associations Odds ratio, cross tabulation and logistic regression outcome were calculated at 95% confidence interval to correlate relationship of type II diabetes and Rheumatoid Arthritis. Results: The mean age of the participants’ was 55.2 years (SD 15.4) and the modal age was 58 years with the age range between 22 and 89 years. Females comprised of 67% of the participants. The mean years the participants have lived with T2DM was 8.4 (SD 6.2). Prevalence of biomarkers (RF, Anti-CCP and TNC) among T2DM was 10%, 17.8% and 96.7% respectively. Among the participants 7 (3.9%) had elevated early biomarker hence a prevalence of 3.9% of RA among people living with T2DM. The mean elevated serum level of Anti–CCP was 21.9 U/ml with females (11.7%) males (6.1%). Comparing positivity for RA, Anti-CCP/RF-ve 76.1 % (137), Anti- CCP/ RF +ve 3.9 %( 7), Anti-CCP +ve/ RF-ve 13.9% (25) and Anti-CCP-ve/ RF +ve 6.1 %( 11). Likely hood of RF negative to be Anti-CCP positive OR=3.5(P=0.0184).Majority had elevated TNC (96/7%) with mean of 577pg/ml. Conclusion: The proportion of participants living with T2DM and RF antibodies was 10%. Prevalence of RA among type II diabetes patients was 3.9% with higher occurrence at the age of 71-.80 years. Females were more likely to have RA antibodies than males. The proportions with elevated Anti- CCP biomarker were 17.8% hence more specific to RA. Majority had elevated levels of antibodies to Tenascin C a pro-inflammatory marker hence not associated to Rheumatoid Arthritis. Recommendation: Routine screening for early biomarkers of RA in People living with type II diabetes