Browsing by Author "Hodkinson, Bridget"

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    Open Access
    A retrospective study of patients with biologics treatment at Groote Schuur and Red Cross Children's War Memorial Hospitals
    (2020) Ahmed, Mohammed Awad Eltoum; Hodkinson, Bridget; Gcelu, Ayanda
    Introduction. The high cost and concern of adverse events, particularly infections, limit the use of biologic disease-modifying anti-rheumatic (bDMARD) therapies. We undertook this retrospective study to document their use for immune-mediated diseases (IMDs) and explore the efficacy, safety, adherence and screening practices prior to initiating bDMARDs in a tertiary referral hospital. Methods. A folder review of all adult and paediatric patients treated for IMDs with bDMARDs at Groote Schuur and Red Cross Hospitals between January 2013 and December 2019. Clinico-demographic particulars, details of bDMARD therapy, and adverse events were collated. Changes in disease activity were measured by diseasespecific tools at 6, 12, 24-months and at the last available visit, and patient adherence to bDMARDs was explored by folder and pharmacy record review. Results. We studied 151 folders, with 182 bDMARDs uses (29 patients used more than 1 bDMARD). Patients were from rheumatology (n= 38: 13 rheumatoid arthritis; 10 spondyloarthritis, 5 Systemic Lupus Erythematosus (SLE) , 5 inflammatory myositis and 5 other conditions); gastroenterology (n=31; 26 Crohn`s and 5 Ulcerative Colitis), dermatology (n=9; psoriasis), neurology (n=4, ophthalmology (n= 25; 6 scleritis, 18 uveitis, 1 optic neuritis), and paediatrics (n= 45, 26 juvenile idiopathic arthritis , 12 SLE, 7 other conditions). The bDMARDs used were TNF inhibitors (112), rituximab (55), tocilizumab (10), anakinra (3), abatacept (1), and tofacitinib (1). The vast majority of patients had an excellent response and were in low disease activity or remission at their last available visit. Adverse events included severe infection (4), tuberculosis (TB) (2), mild infection (4), severe allergic reaction (3), mild skin reaction (14), elevated liver enzymes (2), and worsening interstitial lung disease ILD (1). bDMARD Therapy was discontinued in 18 patients, most commonly due to adverse reaction (9), lack of response (3), poor adherence (2), or remission (1). bDMARD Therapy was changed to alternative therapy in 29 patients, most commonly because of poor response (14), or adverse effects (9) or poor adherence (3). Poor adherence or patients lost to follow-up was noted in 18/182 (9.9%). Complete latent TB infection screening with chest x-ray and TB skin test was performed in only 55 (36.4 %) but INH prophylaxis was given to 51/88 (57.9%) of patients prescribed TNFi therapy. Hepatitis B screening performed in 93 (61.6 %) patients, but most patients (72.2 %) were not tested for Hepatitis B core ab. Hepatitis C screening was performed in 81 (53.6 %) patients. Only 88 (58.3%) patients had a recent HIV test. The majority (17.2%) received the influenza vaccine, but only 24 (15.8 %) received pneumococcal vaccination. Discussion and Conclusion. bDMARD therapy was an effective treatment, and the most common adverse effect was infection (7.2%), with 2 TB infections. Vaccination and screening for TB, viral hepatitis and HIV was suboptimal. Of concern, poor adherence to bDMARDs was frequently encountered.
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    Anti-neutrophil cytoplasmic antibody (ANCA) testing at Groote Schuur Hospital: Adherence to indications for testing
    (2021) Govender, Ramona; Hodkinson, Bridget
    Appropriate use of laboratory investigations is increasingly important in resource-constrained environments. We receive the anti-neutrophil cytoplasmic antibody (ANCA) testing practices in a tertiary hospital in South Africa.
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    Axial Spondyloarthropathies in the Western Cape
    (2019) Smith, Robert; Hodkinson, Bridget; Gould Trevor
    Impaired Health-Related Quality of Life and Work Productivity amongst South African patients with Axial Spondyloarthritis. Background: No studies have investigated health-related quality of life (HRQoL) or work productivity in patients with axial spondyloarthritides (axSpA) living in sub-Saharan Africa. Methods: This cross-sectional study of adults with axSpA collated demographic particulars and patient questionnaires: Bath Ankylosing Spondylitis Disease Activity Index (BASDAI); Bath Ankylosing Spondylitis Functional Index (BASFI); Bath Ankylosing Spondylitis Global Score (BASG); Medical Short Form (SF)-36; and Work Productivity and Activity Impairment Questionnaire: Specific Health Problem (WPAI:SHP). Results: Of 36 patients, the mean (SD) age was 40.3 (13.3) years and mean (SD) diagnostic delay was 8.7 (8.4) years. Most patients were male (80.6%) and of mixed racial ancestry (69.4%). Most (66.7%) patients were smokers and only 5 (13.9%) patients received tumor necrosis factor inhibitor (TNFi) therapy. The mean (SD) BASDAI was 5.3 (2.1), and 72.2% had a BASDAI ≥ 4. Patients with a high BASDAI (i.e. BASDAI ≥ 4) had higher BASG scores (p=0.003), higher WPAI:SHP activity impairment scores (p=0.003), and poorer SF-36 scores, particularly in the role-physical, bodily pain, and social functioning domains (p=0.0001, 0.001 and 0.02 respectively). Activity impairment according to the WPAI:SPH was 57.4%, with the BASDAI and activity impairment correlating closely (p=0.006). The SF-36 scores were low in physical (particularly role-physical, bodily pain, and general health) and mental (notably vitality and role emotional) domains. 6 Conclusion: This study describes a cohort of South African patients with axSpA who have poor prognostic features including diagnostic delay and cigarette smoking. Active disease, impaired function, poor physical- and mental HRQoL, and work disability are unmet needs.
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    Cigarette smoking amongst Rheumatoid Arthritis patients in a tertiary centre in South Africa
    (2023) le Roux, Simon; Hodkinson, Bridget
    Background: Cigarette smoking is associated with worse outcomes amongst rheumatoid arthritis (RA) sufferers, with poorer disease control, increased extra-articular complications and comorbidities. There are currently no data from sub-Saharan Africa. Objective: To describe the prevalence of cigarette smoking, and explore disease control, comorbidities, extra-articular disease, and attitudes of smokers to their habit amongst RA patients in an outpatient clinic at tertiary level public hospital in South Africa. Further, we asked patients about the impact of prohibition during the COVID pandemic. Methods: A cross-sectional study of consenting adult outpatients with RA meeting the EULAR/ACR 2010 Classification Criteria. Demographic, clinical and patient-reported outcome measures (PROMs) together with a questionnaire about smoking and Fagerström test for nicotine dependence were collated. (1) Results: Of 632 patients (536 females), the mean (SD) age and disease duration were 55.4 (13.0) and 10.1 (9.3) years. The mean (SD) Clinical Disease Activity Index (CDAI) and HAQ-DI were 14.3 (11.8) and 1.5 (0.7). The cohort included 218 (34,5%) smokers, and 89 (14.1%) exsmokers, and more males smoked (p=0,0002). Compared to non- or ex-smokers, smokers had lower BMI (29.7 vs 32.9 p= 0.01), higher anxiety scores (p=0,048) and incidence of COPD (8,26 % vs 2,66%, p< 0.005). Smokers were more likely than non-smokers to have a positive Rheumatoid Factor (80,3% vs 69,8%, p=0.006). There were no significant differences in age of RA onset, disease duration, SES, number of comorbidities, CDAI nor its individual components, extra-articular diseases nor in HAQ-DI, FACIT, depression nor pain scores. Of 160 patients who completed the smoking questionnaire, only 83 (49,5%) believed smoking worsened their arthritis, yet 119 (71,6%) reported receiving smoking cessation advice at the RA clinic. Participants' most common reasons for smoking were emotional support (45.8%), nicotine craving (30.5%) and pain control (25,2%). The Fagerström score revealed mild, moderate and severe nicotine dependence in 67.5%, 24.4%, and 7.5% respectively. Although 50.1% felt that living with RA made quitting difficult, 86.9% had considered quitting, and almost half (45.6%) had previously quit for more than 3 months. Conclusion: In this cohort of RA patients, a third actively smoke. Smoking is a modifiable risk factor, although half of the smokers reported that their RA made quitting difficult despite only 7.5% having severe nicotine addiction. Adequate disease control along with behavioural support should be the basis of engaging around tobacco cessation.
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    Determinants of patient and physician global assessment of disease activity and their discrepancies amongst South Africans with Rheumatoid Arthritis
    (2025) Didi, Sariu Ali; Hodkinson, Bridget
    Background: Patient and physician global assessments (PGA and PhGA) play a crucial role in treatment decisions, yet discordance in these assessments is common. Factors influencing PGA and PhGA and discordance in South African (SA) RA patients remain poorly understood. Methods: This cross-sectional study included consenting adults with RA attending a tertiary hospital. Demographic, disease-specific, and patient-reported outcome data were collected. A discordance score was calculated by subtracting the PhGA score from the PGA score, and discordance was defined as PGA-PhGA ≥ 2.5. Determinants of PGA, PhGA, and determinants were explored using correlation analyses, linear regression, and logistic regression. Results: Of 550 patients, most were female (84.9%), with a mean (SD) age and disease duration of 55.8 (12.9) and 11.5 (9.7) years. Discordance was seen in 27.5%. Pain severity significantly influenced PGA, while tender and swollen joint counts predominantly influenced PhGA. A large portion of the variance in PGA and PhGA (62.0 % and 50.3% respectively) was unexplained. Patients with discordance reported higher pain scores, and problems with usual activities but had lower swollen joint counts and were more likely to be in remission or low disease activity than concordant patients. Conclusion: Discordance in patient-physician assessments exists in a considerable proportion of SA RA patients. Pain severity and functional limitations greatly influence patient perceptions. Addressing pain and activity limitations could help reduce discordance, optimize disease management, and foster shared decision-making. Further longitudinal and qualitative research is essential for a more comprehensive understanding of our RA patients' perspectives.
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    Health related quality of life, perceptions and experiences of female patients with Systemic Lupus Erythematosus in South Africa: exploring unmet needs using a mixed methods approach
    (2020) Phuti, Angel; Hodkinson, Bridget; Schneider, Marguerite
    Objective: Systemic Lupus Erythematosus (SLE) is a multi‐system disease that predominately affects women. Considering the lack of data on health related quality of life (HRQoL) especially in sub‐ Saharan Africa, we undertook a literature review on HRQoL of SLE patients in developing countries to collate the existing evidence and identify information gaps. A mixed methods qualitative and quantitative study of lived experiences of South African women with SLE was performed. Methods: A literature search was conducted on medical databases using MeSH terms pertaining to HRQoL amongst SLE patients in the developing or low income countries to identify articles published between January 1975 and February 2018. The main study included 25 consenting SLE patients attending two tertiary hospitals in Johannesburg and Cape Town. Individual in‐depth interviews, using a topic guide, were conducted and analysed using NVivo software. In addition, participants completed the Short Form‐36 (SF‐36), Functional Assessment Instrument (FAI) and functional assessment of chronic illness therapy (FACIT) for fatigue questionnaires. The questionnaires were analysed per each tool's scoring method and SPSS software was used to calculate mean, standard deviations and correlations. Results The review of 31 articles, from 11 countries indicated that SLE women have a poor general HRQoL. In addition, we found relationships between disease factors including disease activity, organ damage, functioning, and mental health. Poor socioeconomic status worsened SLE outcomes by limiting patients' access to health care and psychosocial services. In the main study, the majority (72.0%) were black Africans, unemployed (76.0%), with low formal educational level and singlehood status (72.0%). The mean (SD) mental and physical composite SF‐36 scores were poor (50.9 (22.1) and 49.1 (20.5) respectively), and 68.0% of women had FACIT scores of severe fatigue. The mean (SD) FAI was 1.33 (0.8), showing that activities of daily living (ADL) were performed with difficulty. Major themes expressed were fatigue, pain, impaired functioning, depression, pregnancy, aesthetic concerns and sexuality issues. Disease chronicity, fatigue and pain were described by many participants as ‘taking over life' and impacting on performing ADL and career opportunities contributing to indigence. Negative pregnancy outcomes were frequently exacerbated by poor sexual relationships and miscommunication between patient and health care workers. Lack of understanding of SLE by patients, community and family as well as suicidal ideations and depressive symptoms were expressed. Although the quantitative tools measured these aspects, they were unable to explore complexities such as limitations in job acquisition, suicidal ideations, disease understanding and support systems. Conclusion This study underscores the complex, chronic and challenging life experiences, often exacerbated by poverty, of SA women with SLE. Quantitative tools may be inadequate in capturing important aspects of HRQoL that emerged from the qualitive interviews. Awareness of these limitations, together with psycho‐social support and education, might improve HRQoL. This thesis recommends multi‐centred, interventional longitudinal studies that incorporate mixed methods and focus on strategies to improve the negative outcomes in SLE.
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    High prevalence of metabolic syndrome in patients with SLE in the Western Cape
    (2021) Nkabane, Avela Ntombenkosi; Hodkinson, Bridget
    INTRODUCTION: Patients with systemic lupus erythematosus (SLE) are at increased risk of the metabolic syndrome (MetS) and its complications. In the absence of published studies from sub-Saharan Africa, we investigated the prevalence and associations of the MetS amongst recent-onset SLE patients. METHODS: A cross-sectional study of recent onset (<5 years disease duration) patients with SLE meeting the SLICC SLE classification criteria. The MetS was defined by Joint Interim Statement criteria. Clinical and demographic data and a Functional Assessment of Chronic Illness Therapy score and the 36-Item Short-Form Healthy Survey were completed. RESULTS: Of 75 patients, the mean age was 37.1 (11.7) years, disease duration was 30.8 (23.6) months, 65 (86.7%) were female, 68.0% were of mixed ethnic ancestry and 29.3% were Black Africans. The mean SLEDAI score was 0.9 (1.6). The prevalence of MetS was 40.0%, and age and body mass index were the only significant features associated with MetS (p = 0.003 and 0.001 respectively). Increased waist circumference (WC) was the most frequently observed feature, present in 92.9% of MetS patients. Patients with an elevated WC were 32.5 times more likely to have MetS. CONCLUSION: This study shows a high prevalence of MetS amongst South Africans with recently diagnosed SLE. This calls for aggressive strategies to reduce the prevalence of Mets and atherosclerotic cardiovascular disease. Waist circumference is a useful and costeffective screening tool to identify SLE patients at risk of MetS.
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    Interstitial lung disease (ILD) in adult patients with autoimmune connective tissue disease (CTD) at Groote Schuur Hospital
    (2020) Palalane, Elisa Assis; Hodkinson, Bridget; Alpizar-Rodriguez, Deshire; Botha, Stella; Calligaro, Greg; Said-Hartley, Qonita
    Introduction. Interstitial lung disease (ILD) is prevalent in patients with autoimmune rheumatic diseases (ARD), leads to significant morbidity and mortality and is poorly characterized in South Africa (SA). We undertook this study to describe the clinical, serological and radiological features of ILD associated with ARD in a tertiary referral hospital. Methods. A cross-sectional study of patients with ILD attending the rheumatology and respiratory outpatient clinics of Groote Schuur Hospital between October 2018 and September 2019. Clinical, serological and radiological features were documented. We compared features of 3 groups of patients: rheumatoid arthritis (RA), systemic sclerosis (SSc) and other autoimmune connective tissue diseases (OCTD) which included idiopathic inflammatory myopathies, mixed connective tissue disease, systemic lupus erythematosus, primary Sjogren's syndrome and overlap syndromes. Factors associated with usual interstitial pneumonia (UIP) subtype were assessed. Results. Of 124 patients, 37 (29.8%) had RA, 32 (25,8%) SSc and 55 (44.4%) OCTD. Most patients were female (86.3%), of mixed racial ancestry (75.0%), and the median (IQR) age was 55 (46-66). Over one-third were smokers, emphysema was diagnosed in 22.6%, and one-third had previous pulmonary tuberculosis (PTB) infection. Smoking, emphysema, and previous PTB were higher in RA group but the difference was not statistically significant. All SSc patients and more than two-thirds of RA and OCTD patients had gastroesophageal reflux disease (GORD). Nonspecific interstitial pneumonia (NSIP) was the commonest pattern of ILD (63.7%), followed by usual interstitial pneumonia (UIP) (26.6%) and other patterns (9.7%). RA patients had similar frequencies of NSIP and UIP. Patients with RA were significantly older (median (IQR)) at ILD onset (62 (55-68) years), compared to SSc (49 (38-56)) and OCTD (42 (33-56)) (p < 0.001). Pulmonary function tests (PFTs) were significantly worse in SSc and OCTD groups. Regarding MTX exposure, 37.1% patients has MTX prescribed before ILD diagnosis, 33.9% continued, started or restarted after ILD diagnosis. No case of acute pneumonitis was documented. Pulmonary function tests and high-resolution computer tomography severity correlated poorly, with PFTs underestimating the severity. In the analysis comparing patients with and without UIP, RA diagnosis (OR 3.8, 95% CI 1.5-9.5), older age (0R 1.1, 95% CI 1.0-1.1), COPD (OR 3.2, 95% CI 1.4-8.0), longer ARD-ILD interval, and higher FVC (OR 1.0, 95% CI 1.0-1.1) were significantly associated with UIP. Conclusions: ILD was most commonly diagnosed in RA and SSc patients, with NSIP seen most frequently overall. Smoking, GORD, and PTB were frequent comorbidities. Amongst RA patients, we observed older age of onset and, interestingly, similar frequencies of NSIP and UIP patterns. The use of MTX was not associated with the development of acute pneumonitis in patients with ILD.
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    Points to consider in cardiovascular disease risk management among patients with rheumatoid arthritis living in South Africa, an unequal middle income country
    (2020-06-16) Solomon, Ahmed; Stanwix, Anne E; Castañeda, Santos; Llorca, Javier; Gonzalez-Juanatey, Carlos; Hodkinson, Bridget; Romela, Benitha; Ally, Mahmood M T M; Maharaj, Ajesh B; Van Duuren, Elsa M; Ziki, Joyce J; Seboka, Mpoti; Mohapi, Makgotso; Jansen Van Rensburg, Barend J; Tarr, Gareth S; Makan, Kavita; Balton, Charlene; Gogakis, Aphrodite; González-Gay, Miguel A; Dessein, Patrick H
    Background It is plausible that optimal cardiovascular disease (CVD) risk management differs in patients with rheumatoid arthritis (RA) from low or middle income compared to high income populations. This study aimed at producing evidence-based points to consider for CVD prevention in South African RA patients. Methods Five rheumatologists, one cardiologist and one epidemiologist with experience in CVD risk management in RA patients, as well as two patient representatives, two health professionals and one radiologist, one rheumatology fellow and 11 rheumatologists that treat RA patients regularly contributed. Systematic literature searches were performed and the level of evidence was determined according to standard guidelines. Results Eighteen points to consider were formulated. These were grouped into 6 categories that comprised overall CVD risk assessment and management (n = 4), and specific interventions aimed at reducing CVD risk including RA control with disease modifying anti-rheumatic drugs, glucocorticoids and non-steroidal anti-inflammatory drugs (n = 3), lipid lowering agents (n = 8), antihypertensive drugs (n = 1), low dose aspirin (n = 1) and lifestyle modification (n = 1). Each point to consider differs partially or completely from recommendations previously reported for CVD risk management in RA patients from high income populations. Currently recommended CVD risk calculators do not reliably identify South African black RA patients with very high-risk atherosclerosis as represented by carotid artery plaque presence on ultrasound. Conclusions Our findings indicate that optimal cardiovascular risk management likely differs substantially in RA patients from low or middle income compared to high income populations. There is an urgent need for future multicentre longitudinal studies on CVD risk in black African patients with RA.
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    Rheumatoid arthritis
    (MedPharm, 2014) Ally, Mahmood M T M; Hodkinson, Bridget
    Immune-mediated inflammatory disorders include a clinically diverse group of conditions sharing similar pathogenic mechanisms. Conditions such as rheumatoid arthritis, psoriasis, spondyloarthropathy, inflammatory bowel disease and connective tissue diseases are characterised by immune dysregulation and chronic inflammation. This review will focus immuno-pathogenic mechanisms, aspects of early disease, co-morbidity and therapy in rheumatoid arthritis.