THERAPEUTIC PRACTICES IN OSTEOARTHRITIS IN SUB-SAHARAN AFRICA: EXPERIENCE OF THE CHU-RN OF N'DJAMENA AND CHALLENGES OF CARE IN CHAD

Introduction: Osteoarthritis is a chronic and disabling rheumatic condition whose management relies on a multimodal approach. In sub-Saharan Africa, data on therapeutic practices remain limited. In Chad, such data are particularly scarce. The objective of this study was to describe therapeutic practices for osteoarthritis at the CHU-RN of N’Djamena and to analyze the main challenges of its management.
Methods: This was a retrospective cross-sectional study conducted in the Department of Internal Medicine of the CHU-RN of N’Djamena. Patients managed for osteoarthritis in the initial study were included. Sociodemographic, clinical, and radiographic data, comorbidities, and prescribed or received treatments were collected. Therapeutic modalities were classified into non-pharmacological measures, pharmacological treatments, local treatments, physical modalities, and surgery.
Results: A total of 894 patients were included in the therapeutic analysis. Pharmacological treatment was the main therapeutic modality. Paracetamol was prescribed in 782 patients (87.5%), non-steroidal anti-inflammatory drugs in 591 (66.1%), step-II analgesics in 321 (35.9%), and symptomatic slow-acting drugs for osteoarthritis in 475 (53.1%). Corticosteroid injections were performed in 253 patients (28.3%). Physiotherapy was provided to 244 patients (27.3%), while surgical management was performed in 62 patients (6.9%). Disease-modifying treatments identified in some patients corresponded to associated rheumatoid arthritis and were not considered specific treatments for osteoarthritis.
Conclusion: Osteoarthritis management at the CHU-RN of N’Djamena relies mainly on pharmacological treatments, with substantial use of paracetamol and non-steroidal anti-inflammatory drugs. The relatively limited use of physiotherapy highlights the need to strengthen non-pharmacological approaches. A multimodal strategy combining rational symptomatic treatment, patient education, adapted physical activity, weight management, rehabilitation, and targeted use of interventional and surgical treatments appears necessary in the Chadian context.