Juvenile Idiopathic Arthritis in Chad: Delayed Diagnosis, Clinical Patterns and Limited Access to Biologics

  • Garba Harine Abdel Aziz Rheumatology Units, National Reference University Hospital (CHU-RN), University of N’Djamena, Chad
  • Adama Bah Rheumatology Department, Ignace Deen University Hospital, Gamal Abdel Nasser University of Conakry, Guinea
  • Ramadhane Bouchrane Rheumatology Unit, National Gold Mining and Orthopedics Center of Dakar (CNAO), Cheikh Anta Diop University of Dakar, Senegal
  • Hamid Harine Abdel Aziz Rheumatology Unit, Chad Refoundation Hospital (HRT), University of N’Djamena, Chad
  • Awa Cheikh Ndao Internal Medicine Department, Hospital Center Dallal Djam University, Cheikh Anta Diop University of Dakar, Senegal
  • Sadou Yamoga Lam Department of Pediatrics, Albert Royer Hospital, Cheikh Anta Diop University of Dakar, Senegal
  • Moustapha Niasse Department of Rheumatology, Coud Hospital, Cheikh Anta Diop University of Dakar, Senegal
  • Saidou Diallo Department of Rheumatology, Coud Hospital, Cheikh Anta Diop University of Dakar, Senegal
Keywords: Juvenile idiopathic arthritis; Chad; ERA; Uveitis; Biologics; Delayed diagnosis;Treat-to-target; Low-resource settings

Abstract

Background: Juvenile idiopathic arthritis (JIA) is the leading cause of chronic inflammatory rheumatism in children, yet data from Central Africa remain scarce. This study aimed to describe the clinical patterns, diagnostic delay and access to biologic therapies in children with JIA in Chad.

Methods: Retrospective study (2020–2024) including 85 ILAR-confirmed JIA cases among 111 pediatric systemic diseases. Data included clinical, biological, radiologic, CHAQ, JADAS and treatment patterns.

Results: Mean age at onset was 11.26 years; diagnostic delay averaged 4.2 years. RF-negative polyarthritis and ERA each accounted for 30.6% of cases. Uveitis was noted in 15.3% of patients. CRP was elevated in 63.3% and HLA-B27 positive in 60% of those tested. CHAQ mean was 0.78 ± 0.34, and JADAS median was 8.4 (IQR 4.3–14.6), indicating significant functional impairment and persistent disease activity in many children. Methotrexate was used in 72.9% of children, biologics in 4.7%. CHAQ and JADAS indicated substantial functional impairment and persistent activity.

Conclusion: JIA in Chad is characterized by long diagnostic delays, significant disability and minimal access to biologics. Improving referral pathways and access to advanced therapies is urgently needed.

Downloads

Download data is not yet available.

PlumX Statistics

References

Abdwani, R., Abdalla, E., & Al-Zakwani, I. (2012). Juvenile idiopathic arthritis in Oman: Demographics and disease expression. Pediatric Rheumatology, 10(1), 1–6. https://doi.org/10.1186/1546-0096-10-1

Behrens, E. M., & Koretzky, G. A. (2007). Cytokine storms in inflammatory diseases. Journal of Clinical Investigation, 117(5), 1334–1340. https://doi.org/10.1172/JCI31776

Chipeta, J., Njobvu, P., Wa-Shaula, G., & Chintu, C. (2013). Juvenile idiopathic arthritis in Zambian children: A hospital-based study. Clinical Rheumatology, 32(5), 659–663. https://doi.org/10.1007/s10067-012-2156-7

Diomandé, M. A., et al. (2016). Profil épidémiologique et évolutif des arthrites juvéniles idiopathiques en Côte d’Ivoire. Revue Africaine de Rhumatologie, 4(2), 12–18.

Doualla, S., et al. (2014). Les arthrites juvéniles idiopathiques au Cameroun : Étude préliminaire. Pan African Medical Journal, 19, 57–64. https://doi.org/10.11604/pamj.2014.19.57.4355

El Maghraoui, A. (2014). Epidemiology and characteristics of juvenile idiopathic arthritis in North Africa. Clinical Rheumatology, 33(4), 543–547. https://doi.org/10.1007/s10067-014-2526-1

Ravelli, A., & Martini, A. (2007). Juvenile idiopathic arthritis. The Lancet, 369(9563), 767–778. https://doi.org/10.1016/S0140-6736(07)60363-8

Ravelli, A., et al. (2018). Treating juvenile idiopathic arthritis to target: Recommendations of an international task force. Annals of the Rheumatic Diseases, 77(6), 819–828. https://doi.org/10.1136/annrheumdis-2018-213030

Solau-Gervais, E., et al. (2010). Juvenile idiopathic arthritis in Europe: Epidemiological evolution and therapeutic challenges. Joint Bone Spine, 77(5), 425–430. https://doi.org/10.1016/j.jbspin.2010.07.002

Wallace, C. A., et al. (2008). The clinical presentation and treatment of juvenile idiopathic arthritis in North America. Arthritis & Rheumatism, 58(4), 987–994. https://doi.org/10.1002/art.23375

Wulffraat, N. M., & Kuis, W. (2000). Methotrexate therapy in juvenile idiopathic arthritis. Clinical and Experimental Rheumatology, 18(5), 561–564.

El Miedany, Y. M., et al. (2016). Juvenile idiopathic arthritis in Egypt: Disease expression and clinical phenotype. Clinical Rheumatology, 35(4), 1027–1036. https://doi.org/10.1007/s10067-015-3133-6

Hussein, Z., et al. (2018). Patterns of juvenile idiopathic arthritis in Egyptian children. Egyptian Journal of Pediatric Allergy and Immunology, 16(1), 7–14.

Huang, J., et al. (2013). Clinical characteristics and disease activity of juvenile idiopathic arthritis in Taiwan. Pediatric Rheumatology, 11(1), 12–19. https://doi.org/10.1186/1546-0096-11-12

Li, S., et al. (2016). Epidemiology of juvenile idiopathic arthritis in China: A multicenter study. Modern Rheumatology, 26(6), 920–925. https://doi.org/10.3109/14397595.2016.1155678

Yokota, S., et al. (2012). Therapeutic outcomes in Japanese children with juvenile idiopathic arthritis treated with biologics: A multicenter study. Modern Rheumatology, 22(6), 882–888. https://doi.org/10.3109/14397595.2012.691217

Ringold, S., et al. (2019). Updated ACR guidelines for the treatment of juvenile idiopathic arthritis. Arthritis Care & Research, 71(6), 817–834. https://doi.org/10.1002/acr.23870

Ravelli, A., et al. (2020). Advances in JIA treatment and outcomes worldwide. Nature Reviews Rheumatology, 16(4), 205–216. https://doi.org/10.1038/s41584-020-0379-8

Bouayed, K., et al. (2022). Biothérapies dans l’arthrite idiopathique juvénile : Une expérience marocaine. Journal Médical Panafricain, 41, 135. https://doi.org/10.11604/pamj.2022.41.135.27377

Aït El Hadj, F., et al. (2021). Management of juvenile idiopathic arthritis in Algerian children: Challenges and outcomes. Mediterranean Journal of Rheumatology, 32(4), 291–298. https://doi.org/10.31138/mjr.32.4.291

Liang, J., et al. (2018). Epidemiological characteristics of juvenile idiopathic arthritis in China: A multicenter cohort study. Pediatric Rheumatology, 16(1), 62–70. https://doi.org/10.1186/s12969-018-0258-4

Wei, Z., et al. (2020). Biologic treatment patterns and outcomes in Chinese children with juvenile idiopathic arthritis. Modern Rheumatology, 30(2), 335–343. https://doi.org/10.1080/14397595.2019.1638098

Shimizu, T., et al. (2015). National registry analysis of juvenile idiopathic arthritis in Japan. Modern Rheumatology, 25(4), 651–659. https://doi.org/10.3109/14397595.2014.996641

Petty, R. E., et al. (2021). Updated clinical practice guidelines for juvenile idiopathic arthritis. Arthritis Care & Research, 73(7), 957–969. https://doi.org/10.1002/acr.24589

Lovell, D. J., et al. (2013). Long-term safety and efficacy of etanercept in children with polyarticular JIA. Arthritis & Rheumatism, 65(9), 2486–2494. https://doi.org/10.1002/art.38023

Consolaro, A., et al. (2012). Towards a treat-to-target approach in juvenile idiopathic arthritis: The Juvenile Arthritis Disease Activity Score. Annals of the Rheumatic Diseases, 71(7), 1118–1123. https://doi.org/10.1136/annrheumdis-2011-200349

Huemer, C., et al. (2021). Registry-based outcomes in European JIA cohorts under treat-to-target strategies. Pediatric Rheumatology, 19(1), 15. https://doi.org/10.1186/s12969-021-00492-8

Bader-Meunier, B., et al. (2020). Paediatric rheumatology in France: Current management of JIA. Joint Bone Spine, 87(6), 559–566. https://doi.org/10.1016/j.jbspin.2020.06.014

Pipitone, N., et al. (2023). Juvenile idiopathic arthritis in Italy: Changing clinical spectrum and prognosis. Clinical Rheumatology, 42(2), 511–520. https://doi.org/10.1007/s10067-022-06396-4

Nigrovic, P. A., et al. (2022). Juvenile idiopathic arthritis: New insights from the CARRA registry. Arthritis Care & Research, 74(1), 75–84. https://doi.org/10.1002/acr.24677

Lovell, D. J., et al. (2021). Long-term biologic safety and remission rates in polyarticular JIA. Arthritis & Rheumatology, 73(3), 468–479. https://doi.org/10.1002/art.41571

Singh, S., et al. (2022). Juvenile idiopathic arthritis in India: National registry data and treatment gaps. International Journal of Rheumatic Diseases, 25(9), 1002–1012. https://doi.org/10.1111/1756-185X.14444

Zribi, S., et al. (2023). Clinical spectrum and management of juvenile idiopathic arthritis in Tunisian children. African Journal of Rheumatology, 11(2), 87–95.

Garba, H. A. A., et al. (2025). Epidemiological, diagnostic, therapeutic, and outcome profile of pediatric systemic diseases in Chad. Open Access Library Journal, 12(3), e14386. https://doi.org/10.4236/oalib.1114386

Published
2026-09-30
How to Cite
Abdel Aziz, G. H., Bah, A., Bouchrane, R., Abdel Aziz, H. H., Ndao, A. C., Lam, S. Y., Niasse, M., & Diallo, S. (2026). Juvenile Idiopathic Arthritis in Chad: Delayed Diagnosis, Clinical Patterns and Limited Access to Biologics. European Scientific Journal, ESJ, 22(27), 71. https://doi.org/10.19044/esj.2026.v22n27p71
Section
ESJ Natural/Life/Medical Sciences

Most read articles by the same author(s)