Rheumatoid Arthritis in Chad: Epidemiological, Clinical and Therapeutic Profile

Objective: Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disease. Data from sub-Saharan Africa, particularly Central Africa, remain scarce and diagnosis is often delayed. This study aimed to describe the epidemiological, clinical, biological, radiological, therapeutic, and functional profile of RA in Chad and to situate these findings within the sub-Saharan and international literature. Methods: We conducted a retrospective descriptive study from January 2018 to December 2024 in the Rheumatology Department of the Hospital of the Refoundation of Chad. Patients fulfilling the 2010 ACR/EULAR classification criteria for RA and with complete medical records were included. Demographic, clinical, laboratory, radiographic, disease activity (DAS28), and quality-of-life data (SF-36, NHP) were collected, as well as treatments used and disease course. Results: Among 5000 rheumatology consultations, 211 patients had RA, representing 4.22% of visits. The mean age at diagnosis was 44.5 years (range 12 - 90), and women accounted for 86.3% of cases. The mean diagnostic delay was 72.4 months (≈6.5 years). At presentation, polyarthritis (93.8%), symmetrical involvement (90.3%), deformities (61%) and ankylosis (52.2%) were frequent. Inflammatory markers were elevated in most patients, rheumatoid factor and anti-CCP antibodies were positive in 69% and 67.5% of tested cases, respectively. Radiographically, 55.2% of patients were classified as Steinbrocker stage 3 - 4, with joint space narrowing in 97.7% and erosions in 43.1%. Methotrexate was the cornerstone of therapy (81.5%), often combined with hydroxychloroquine or sulfasalazine. No biologic DMARDs were used because of cost and availability constraints, and treatment adherence was frequently irregular. Functional status and quality of life (SF-36, NHP) were markedly impaired, with only partial improvement under conventional DMARDs. Conclusion: This large Chadian series confirms that RA in sub-Saharan Africa is often diagnosed at an advanced, structurally destructive, and functionally disabling stage, with prolonged diagnostic delays and limited access to biologic therapies. Strengthening early detection in primary care, improving continuous access to conventional DMARDs, and progressively implementing national strategies for affordable biologic therapy are priorities to improve the prognosis of RA in Chad and similar African settings.