Rheumatoid Arthritis: Mody GM

Woolf AD, Brooks P, Akesson K, Mody GM. · Institute of Health Research, Peninsula Medical School, Universities of Exeter and Plymouth, UK. · Best Pract Res Clin Rheumatol. · Pubmed #18783749 No free full text.

Abstract: Musculoskeletal conditions are an increasingly common problem across the globe due to increased longevity and increased exposure to risk factors such as obesity and lack of physical activity. The increase is predicted to be greatest in developing countries, and there is thus an urgent need for the implementation of strategies and policies that will prevent and control these conditions. The ideal is modification of the risk factors in the whole community, and this will have wide-ranging health benefits as these risk factors are common to other major conditions. Changing people's behaviour is a challenge; targeting those at highest risk is potentially more effective, providing that there are both affordable ways of identifying those at risk and affordable interventions. Early intervention in those with a condition such as rheumatoid arthritis is probably the most cost-effective approach, but requires diagnostic capacity--in clinical skills and/or technology--as well as access to care. There is now much evidence for what can be achieved, but the challenge is how to implement these different strategies in developing countries where there are competing priorities for limited resources. The key strategy is to raise awareness among the public, health professionals, and policy makers of the importance of musculoskeletal health, of what can be achieved by prevention and treatment, and to ensure that policies reflect this. It is also necessary to educate the public to know when to seek care, and health-care workers to recognize the early signs of musculoskeletal conditions.

Mody GM, Cardiel MH. · Department of Rheumatology, Nelson R Mandela School of Medicine, University of Kwa Zulu-Natal, Congella, Durban 4013, South Africa. · Best Pract Res Clin Rheumatol. · Pubmed #18783741 No free full text.

Abstract: Rheumatoid arthritis (RA) is a systemic autoimmune disease which is characterized by chronic inflammation of the joints. Patients experience chronic pain and suffering, and increasing disability; without treatment, life expectancy is reduced. It is imperative to identify patients early so that control of inflammation can prevent joint destruction and disability. Although great advances have been made in the developed nations, early diagnosis remains a great challenge for developing countries during the Bone and Joint Decade (2000-2010) and beyond. Developing countries face important and competitive social, economic, health- and poverty-related issues, and this frequently results in chronic diseases such as RA being forgotten in health priorities when urgent health needs are considered in an environment with poor education and scarce resources. Epidemiological studies in developing countries show a lower but still important prevalence in different regions when compared to that in Caucasians. It seems that the severity of RA varies among different ethnic groups, and probably starts at a younger age in developing countries. Practising rheumatologists in these regions need to take into account several important problems that include suboptimal undergraduate education, inadequate diagnosis, late referrals, lack of human and technical resources, poor access to rheumatologists, and some deficiencies in drug availability. Infections are very important in RA, and special care is needed in developing countries as some endemic infections include tuberculosis, human immunodeficiency virus (HIV), hepatitis B, and hepatitis C. These infections should be carefully taken into account when medications are prescribed and monitored. This chapter presents published information covering the main challenges faced in these environments, and suggests strategies to overcome these important problems in RA management.

Kalla AA, Stanwix A, Gotlieb D, Asherson RA, Mody GM. · No affiliation provided · S Afr Med J. · Pubmed #14763411 No free full text.

This publication has no abstract.

Chinniah K, Mody GM, Bhimma R, Adhikari M. · Department of Paediatrics and Child Health, Nelson R. Mandela School of Medicine, University of KwaZulu Natal, Private Bag X7, Congella, 4013, South Africa. · Rheumatology (Oxford). · Pubmed #15827039 links to  free full text

Abstract: OBJECTIVES: To compare human immunodeficiency virus (HIV)-infected and HIV-uninfected children with arthritis of unknown origin to determine whether the association between HIV infection and arthritis is causal or coincidental. METHOD: Retrospective review of 132 children with arthritis who were tested for HIV infection. RESULTS: Thirty-five (27%) of the children were HIV infected and the male to female ratio was 2.5:1 (P = 0.02). Arthritis was the presenting feature of HIV infection in 78% of these children. The remaining 97 (73%) were diagnosed as having juvenile idiopathic arthritis. 'Spondyloarthropathy-like' features were found in 34% of HIV-infected children compared with 5% of uninfected children. CONCLUSION: The high prevalence of HIV infection in 27% of children, the predominance of males and the increased prevalence of 'spondyloarthropathy-like' features, supports a causal relationship between HIV infection and arthritis.

Sebastian D, Nayiager S, York DY, Mody GM. · Rheumatology Unit, Nelson R Mandela School of Medicine, Private Bag 7, Congela 4013, Durban, South Africa. · Clin Rheumatol. · Pubmed #12605314 No free full text.

Abstract: In South Africa the association of HTLV-1 infection with myelopathy is well described in Kwa Zulu Natal, which is an endemic area for HTLV-1 infection. Japan also has a high background prevalence of HTLV-1 infection, and a significant association of HTLV-1 infection with rheumatoid arthritis has been reported. This study was undertaken to determine whether there was an association with HTLV-1 infection among black Africans with rheumatoid arthritis (RA) in Kwa Zulu Natal, South Africa. A randomly selected group of 110 black people with RA were studied. The age, sex and duration of disease were recorded and a rheumatoid factor test was performed. The presence of antibodies to HTLV-1 was assessed using an enzyme-linked immunosorbent assay. The integration of proviral DNA in peripheral blood monocytes was also studied using the polymerase chain reaction (PCR). Control data were available from a previously reported community-based study of 1018 subjects from the same geographical area. None of the 110 patients studied were positive for HTLV-1 infection by serology or by PCR. Although HTLV-1 infection is reported as a possible triggering agent for RA in Japan, we failed to detect any excess of HTLV-1 infection in black Africans with RA. Our findings are in agreement with observations in the USA and Europe.